Combination Therapy for Female Androgenetic Alopecia: A Case Report from Katy & Houston, Texas
Female pattern hair loss often requires a multi-modal treatment approach, particularly when patients have tried individual therapies without sufficient improvement. At Reena Jogi, MD, we tailor hair loss treatment plans using evidence-based medications and regenerative procedures. This case highlights a 45-year-old woman with long-standing androgenetic alopecia who elected to pursue combination therapy with oral minoxidil, spironolactone, and platelet-rich plasma (PRP).
Patient Presentation
A 45-year-old female presented as a new patient with a history of generalized, gradual hair thinning involving the scalp. The hair loss was described as moderate in severity and had been ongoing for several years.
She reported previous treatment attempts, including:
Spironolactone
The patient noted minimal improvement with medications and only mild improvement with prior PRP treatments, prompting her to seek further evaluation and additional options.
Clinical Examination
A comprehensive dermatologic examination was performed, including inspection of the scalp, hair, face, eyelids, lips, neck, and chest. The patient was well developed, well nourished, alert, oriented, and in no acute distress.
Scalp examination revealed diffuse, non-scarring hair thinning, consistent with female androgenetic alopecia, including widening of the midline part with preservation of the frontal hairline.
Diagnosis: Female Androgenetic Alopecia
Based on the clinical history and examination findings, the patient was diagnosed with androgenetic alopecia. The genetically predetermined and slowly progressive nature of female pattern hair loss was reviewed in detail.
Treatment Discussion & Shared Decision-Making
A thorough discussion was held regarding additional and alternative treatment options, including:
Oral minoxidil
Finasteride or dutasteride
Spironolactone
Hair growth supplements (Viviscal, Nutrafol)
Restarting PRP
Risks, benefits, expectations, and potential side effects of each option were reviewed extensively.
After shared decision-making, the patient elected to proceed with a combination treatment plan, including:
Oral minoxidil
Restarting spironolactone
Restarting PRP injections
Medication & Treatment Plan
Oral Minoxidil
Minoxidil 2.5 mg tablets
Take ½ tablet once daily
Counseling provided regarding possible side effects, including dizziness, ankle swelling, fluid retention, unwanted hair growth, and initial shedding during the first 8–10 weeks
Spironolactone
Spironolactone 50 mg twice daily
Counseling included risks of menstrual irregularities, breast tenderness, fatigue, hyperkalemia, and the importance of avoiding pregnancy
Laboratory monitoring for kidney function and potassium levels discussed
The patient verbalized understanding of medication use and potential adverse effects.
PRP Hair Restoration Procedure
The patient also underwent Platelet-Rich Plasma (PRP) Injection – Treatment #1 during the visit.
Procedure highlights:
Written consent obtained with review of risks including pain, infection, scarring, and incomplete improvement
Venipuncture performed using sterile technique
Blood centrifuged to isolate platelet-rich plasma
7 cc of PRP injected into the scalp at the subdermal level
Pain control achieved with Zimmer device
Pro-Nox (nitrous oxide) used for comfort during the procedure
No complications; patient tolerated the procedure well
Post-procedure instructions included avoiding hair dye for 2–3 days, using sulfate-free shampoos, and continuing prescribed hair loss treatments.
Follow-Up & Expectations
The patient was counseled that combination therapy often provides the best outcomes in androgenetic alopecia, particularly in patients who have not responded to single-modality treatments. Visible improvement typically occurs over 3–6 months.
A follow-up visit in one month was scheduled to assess tolerability and early response, with plans to continue PRP treatments as indicated.
