Chronic Female Hair Thinning in a 52-Year-Old with PCOS: Combination Therapy for Androgenetic Alopecia
Case Overview
A 52-year-old female presented to our dermatology clinic in Houston, Texas, with a 20-year history of progressive diffuse hair loss. The patient reported recent worsening over the past three months and described ongoing shedding and thinning primarily along the mid-frontal and crown regions of the scalp.
She noted a strong family history of hair loss involving her mother, father, and brother. The patient has a known history of polycystic ovary syndrome (PCOS) and has previously used oral minoxidil for two to three months but discontinued due to side effects. She remains on spironolactone, which she tolerates well.
Clinical Findings
On examination, the scalp revealed diffuse, non-scarring thinning consistent with androgenetic alopecia (AGA), complicated by a component of telogen effluvium (TE).
A positive hair pull test indicated active shedding. Dermatoscopic evaluation demonstrated miniaturized follicles and variation in hair shaft diameter, supporting the diagnosis of AGA.
The patient appeared well-developed, alert, and in no acute distress. No erythema, scaling, or scarring was noted on the scalp.
Diagnosis
Androgenetic Alopecia (L64.8) – diffuse pattern hair thinning with genetic and hormonal factors.
Telogen Effluvium (L65.0) – increased shedding secondary to chronic stress or hormonal imbalance.
Given the chronic course and worsening shedding, a scalp punch biopsy was recommended for confirmation and to exclude scarring alopecia.
Treatment Plan
1. Topical Compounded Minoxidil + Finasteride + Tretinoin
The patient began a topical compound formulation containing:
Minoxidil 7% – to stimulate follicular growth and extend the anagen (growth) phase.
Finasteride 0.1% – to inhibit local DHT conversion and reduce androgen-related miniaturization.
Tretinoin 0.0125% – to enhance scalp absorption and follicle penetration.
She was instructed to apply the medication daily to the affected areas of the scalp.
2. Oral Dutasteride 0.5 mg Daily
The patient was prescribed oral dutasteride as a systemic anti-androgen to help block both type I and type II 5-alpha-reductase enzymes.
Potential side effects—breast tenderness, mood changes, and decreased libido—were discussed in detail. She was counseled on the teratogenic risks and the importance of avoiding pregnancy during therapy.
3. Supportive and Adjunctive Treatments
Nutritional Support: Recommended Xtress supplements, which promote hair growth and stress resilience.
Scalp Care: Advised gentle hair care and use of mild shampoos to support scalp health.
Low-Level Laser Therapy (LLLT): Discussed options such as the Theradome or REVIAN Red System for photobiomodulation therapy to enhance follicular activity.
PRP and Alma TED Procedures: Both were reviewed as advanced, cosmetic options for stimulating regrowth.
PRP (Platelet-Rich Plasma) delivers natural growth factors through injections.
Alma TED uses ultrasound-based transdermal delivery of growth serums without needles or downtime.
4. Stress and Hormonal Management
Because telogen effluvium can be triggered by stress, hormonal changes, and PCOS, lifestyle support and hormonal optimization were emphasized as essential parts of her care plan.
Follow-Up
The patient will return in 3–6 months for re-evaluation and to monitor response. If improvement is limited, procedural therapies such as PRP or Alma TED will be considered to enhance outcomes.
Discussion
This case illustrates a multifactorial approach to chronic female hair loss associated with PCOS and androgenetic alopecia.
By combining topical and oral anti-androgen therapy, nutritional support, and scalp optimization, patients can experience measurable improvement in density and shedding control.
Androgenetic alopecia in women is often underrecognized but highly treatable, especially when therapy is individualized. Combining treatments that address both hormonal imbalance and follicular health offers the best long-term outcomes.
Key Takeaways
Female pattern hair loss can coexist with telogen effluvium and PCOS.
Combination therapy (dutasteride + topical minoxidil/finasteride) offers effective non-surgical improvement.
Procedural options like PRP and Alma TED can boost results for resistant cases.
Ongoing follow-up ensures safe and sustained regrowth.
About Our Practice
At Reena Jogi MD Dermatology, we specialize in diagnosing and treating female pattern hair loss, PCOS-related alopecia, and chronic shedding. Our clinic serves patients throughout Houston and Katy, Texas, providing evidence-based medical and cosmetic therapies including PRP, Alma TED, topical compounds, and oral treatments tailored to each patient’s needs.
