Hair Thinning in a 64-Year-Old Female: Oral Minoxidil and Alma TED for Androgenetic Alopecia
Case Overview
A 64-year-old female presented to our dermatology clinic in Houston, Texas, with a one-year history of gradual, generalized hair thinning. The patient denied itching, tenderness, or scaling of the scalp. She previously underwent pharmacogenomic “genetic testing” through an outside clinic and had been placed on spironolactone and finasteride, though she reported minimal benefit.
She discontinued both medications several months prior and sought an evidence-based treatment plan for her hair loss. Notably, she reported a 30-pound weight loss over the past year while using semaglutide, which correlated with a period of increased hair shedding.
Clinical Findings
On physical and dermatoscopic examination, the patient exhibited diffuse hair thinning throughout the crown and vertex regions with visible follicular miniaturization.
There was no evidence of scarring, inflammation, or perifollicular erythema. Findings were consistent with female pattern hair loss (androgenetic alopecia, L64.8) with an element of telogen effluvium likely related to recent weight loss.
Diagnosis
Androgenetic Alopecia (Female Pattern Hair Loss)
Discussion and Counseling
An extensive 70-minute consultation was conducted to review treatment options, address the limitations of prior “genetic testing,” and establish a comprehensive, stepwise plan based on current dermatologic evidence.
Key discussion points included:
The chronic and progressive nature of androgenetic alopecia (AGA)
The importance of consistent, long-term therapy for visible improvement
The limited predictive value of genetic testing for hair growth response
Treatment personalization based on tolerance, preference, and comorbidities
Treatment Plan
1. Oral Minoxidil (Low-Dose)
The patient elected to initiate oral minoxidil, a well-tolerated off-label treatment shown to improve female AGA by enhancing blood flow to the follicles and prolonging the anagen phase.
Start with a low dose to minimize side effects
Possible initial shedding during the first 6–8 weeks
Side effects reviewed: unwanted hair growth, fluid retention, pericardial effusion (rare), and shortness of breath
Oral minoxidil is increasingly recognized as a powerful alternative for women who cannot tolerate topical formulations or have not responded to topical minoxidil alone.
2. Continue Spironolactone
The patient was advised to continue spironolactone, which offers mild anti-androgenic benefit and is often synergistic with minoxidil in postmenopausal women.
She tolerated the medication well with no prior adverse effects.
3. Procedural Options
Two procedural hair restoration options were reviewed:
Platelet-Rich Plasma (PRP) Therapy
Uses the patient’s own blood, processed to extract growth factor–rich plasma
Injected into the scalp in a series of 3–4 treatments spaced 4–6 weeks apart
Maintenance every 4–6 months recommended
Risks: mild discomfort, swelling, bruising, or rare infection
Results: gradual improvement in hair density over 3–6 months
Alma TED (TransEpidermal Delivery)
Non-invasive ultrasound-based treatment that delivers growth factors and nutrients into the scalp
No needles or downtime
Series of 3–4 monthly sessions recommended
Results visible in 8–12 weeks
Ideal for patients preferring needle-free or cosmetic hair restoration
Key Difference:
PRP involves injections and has robust data supporting efficacy in AGA, while Alma TED provides a comfortable, non-invasive alternative with promising results for those seeking a gentler approach.
4. Nutritional and Supportive Therapy
Recommended Nutrafol or Viviscal to support scalp health and hair growth
Advised maintaining stable weight, avoiding rapid loss
Suggested checking iron, vitamin D, and thyroid function to rule out metabolic contributors
Follow-Up Plan
The patient will follow up in 6 months to assess treatment response and adjust therapy as needed. If results are suboptimal, adjunctive PRP or Alma TED treatments will be initiated.
Discussion
This case highlights the modern management of female pattern hair loss using a combination of systemic therapy (oral minoxidil, spironolactone) and non-invasive procedures (Alma TED).
For postmenopausal women, oral minoxidil offers a powerful alternative to topical treatments, often achieving better scalp penetration and adherence.
Non-invasive procedures such as Alma TED provide needle-free, comfortable options that can be paired with medications for optimal results.
At Reena Jogi MD Dermatology, every hair loss treatment plan is customized to balance safety, effectiveness, and patient comfort, using only evidence-based therapies.
Key Takeaways
Oral minoxidil is an effective treatment for female pattern hair loss when topical options fail.
PRP and Alma TED can enhance follicular stimulation and regrowth.
Consistent therapy and follow-up are essential for long-term success.
Evidence-based, individualized plans outperform commercial “genetic” testing recommendations.
About Our Clinic
At Reena Jogi MD Dermatology, we specialize in comprehensive hair loss evaluation and treatment for both men and women across Houston and Katy, Texas.
Our clinic offers the latest medical and procedural therapies, including oral minoxidil, PRP, Alma TED, and hair health supplements, guided by board-certified expertise in medical dermatology.
