Female Androgenetic Alopecia in a 45-Year-Old Woman: A Case Report from Katy & Houston, Texas
Female hair loss is often multifactorial and may be influenced by genetics, hormonal changes, medical conditions, and metabolic factors. At Reena Jogi, MD, we take a comprehensive, individualized approach to evaluating and treating female pattern hair loss (androgenetic alopecia). This case highlights a 45-year-old woman with long-standing diffuse hair thinning who elected to restart topical minoxidil with consideration of additional therapies.
Patient Presentation
A 45-year-old female presented as a new patient with a several-year history of gradual, generalized hair thinning involving the scalp. The hair loss was described as moderate in severity and slowly progressive. She denied scalp itching, burning, pain, or scaling.
The patient reported prior use of over-the-counter topical minoxidil in the past, as well as Nutrafol supplements, which she had recently restarted approximately one month prior to this visit. She was not using any prescription hair loss medications at the time of evaluation.
Her medical history included Hashimoto’s thyroiditis, managed with low-dose naltrexone, and hormone replacement therapy with estrogen and progesterone (without testosterone). She also reported use of a GLP-1 medication over the past year, with a total weight loss of approximately 35 pounds.
Clinical Examination
A focused dermatologic examination of the scalp and hair was performed. The patient was well developed, well nourished, alert, oriented, and in no acute distress.
Scalp examination demonstrated diffuse, non-scarring hair thinning with a patterned distribution and preservation of the frontal hairline, consistent with female androgenetic alopecia.
Diagnosis: Female Androgenetic Alopecia
Based on the patient’s history and clinical findings, her hair loss was felt to be most consistent with androgenetic alopecia. The chronic, genetically predetermined, and slowly progressive nature of female pattern hair loss was reviewed in detail.
Contributing factors such as hormonal changes, thyroid disease, and metabolic stressors were discussed as potential exacerbating influences.
Treatment Discussion & Plan
A comprehensive discussion was held regarding available treatment options, including:
Oral minoxidil
Spironolactone
Hair growth supplements (Nutrafol, Viviscal, Votesse, Xtresse)
After shared decision-making, the patient elected to:
Reinitiate topical minoxidil 5% solution (twice daily)
Continue Nutrafol, with consideration of Xtresse in the future
Use ketoconazole shampoo and fluocinonide solution if seborrheic dermatitis flares
Have oral minoxidil prescribed as an option should she decide to initiate it
Patient education materials were provided.
Medication Counseling & Expectations
The patient was counseled that initial shedding can occur during the first several weeks of minoxidil use and is a normal part of treatment. Consistent daily use is required to maintain results.
Oral minoxidil counseling included discussion of potential side effects such as dizziness, palpitations, ankle swelling, shortness of breath, and unwanted hair growth. Spironolactone counseling was reviewed for future consideration, including risks of menstrual irregularities, fatigue, breast tenderness, and the need for potassium monitoring.
She was advised that treatment goals include slowing progression and improving hair density, with visible changes typically taking 3–6 months.
Follow-Up & Ongoing Care
The patient will continue topical therapy and supplements and will consider oral minoxidil if desired. A follow-up visit in six months was scheduled to reassess response and adjust the treatment plan as needed.
Expert Female Hair Loss Care in Katy & Houston, Texas
At Reena Jogi, MD, we specialize in diagnosing and treating complex female hair loss, including hormonally and metabolically influenced androgenetic alopecia. Personalized treatment plans are key to achieving long-term success.
📍 Serving Katy, TX and Houston, TX
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