Hair Breakage vs. Androgenetic Alopecia in a 71-Year-Old Woman
Hair thinning and breakage are common concerns among older women and can be caused by a variety of underlying factors. At Reena Jogi, MD, we take a comprehensive approach to evaluating hair loss to distinguish between hair shaft damage, nutritional deficiencies, and androgenetic alopecia (female pattern hair loss). This case highlights a 71-year-old female presenting with new-onset hair thinning and perceived hair breakage.
Patient Presentation
A 71-year-old female presented as a new patient with a one-year history of gradual, generalized hair loss involving the scalp. The hair loss was described as moderate in severity and slowly progressive. She denied scalp itching, pain, scaling, or inflammation.
Importantly, the patient denied common causes of hair breakage, including:
Chemical hair treatments
Excessive heat styling
Overuse of hair products
She also denied a history of anemia or thyroid disease and was not actively treating her hair loss. Her medical history was notable for long-term estradiol use, which had remained stable for many years and was managed by her primary care physician.
Clinical Examination
A focused dermatologic examination of the scalp and hair was performed. The patient was well developed, well nourished, alert, and oriented, with no acute distress.
On exam, there was diffuse, non-scarring hair thinning with a patterned distribution, without signs of shaft fragility, inflammation, or scarring. The overall clinical appearance was most consistent with female androgenetic alopecia rather than true hair shaft breakage.
Hair Breakage vs. Female Pattern Hair Loss
During the visit, the distinction between hair breakage and androgenetic alopecia (AGA) was reviewed in detail. Hair breakage is most commonly associated with over-processing, chemical damage, or excessive heat, which the patient denied. Given her history and exam findings, over-processed hair was considered unlikely.
The clinical picture instead favored androgenetic alopecia, a genetically influenced, hormonally mediated condition that commonly presents as diffuse thinning with a widened midline part and preservation of the frontal hairline in women.
Diagnostic Evaluation
To assess for potential contributing factors, a comprehensive laboratory evaluation was ordered, including:
Ferritin and iron studies
Vitamin D, vitamin B12, and folate
Zinc
Thyroid function tests (TSH + Free T4)
Testosterone (free and total)
DHEA-Sulfate
Prolactin and morning cortisol
CBC, comprehensive metabolic panel, and lipid panel
These labs help identify nutritional deficiencies or hormonal imbalances that may worsen hair thinning.
Treatment Discussion & Plan
All available treatment options for androgenetic alopecia were reviewed, including:
Oral minoxidil
Spironolactone
Hair growth supplements (Nutrafol, Viviscal, Xtresse, Votesse)
Low-level laser therapy (LLLT)
After an in-depth discussion, the patient elected to:
Initiate topical minoxidil 5% solution, applied twice daily
Proceed with laboratory testing
Review additional treatment options over time
She was counseled that initial shedding can occur when starting minoxidil, which is normal and temporary, and that consistent daily use is essential to maintain results.
Counseling & Expectations
The patient was educated that female pattern hair loss is chronic and slowly progressive, and that treatment aims to slow progression and improve density, rather than cure the condition. She was advised to contact the office if hair loss worsened or if treatment side effects occurred.
A follow-up visit in six months was scheduled to review lab results and reassess treatment response, with consideration of oral minoxidil or PRP therapy if additional improvement is desired.
Expert Female Hair Loss Care in Katy & Houston, Texas
At Reena Jogi, MD, we specialize in diagnosing and treating complex hair loss in women of all ages. Differentiating hair breakage from androgenetic alopecia is essential to creating an effective treatment plan.
📍 Serving patients in Katy, TX and Houston, TX
📞 Schedule a hair loss consultation today
