Managing Androgenetic Alopecia in a 72-Year-Old Female in Katy & Houston, Texas
At Reena Jogi MD Hair Loss Dermatology, we frequently evaluate hair loss in women of all ages, including post-menopausal women with long-standing thinning. This case features a 72-year-old female presenting with a multi-year history of diffuse thinning and a strong family history of hair loss.
Patient Background
The patient reported:
Diffuse hair thinning present for 3 years
Moderate progression without acute shedding events
Family history of hair loss (mother and sister)
Prior use of OTC supplements, shampoos, and serums
Previous trial of oral minoxidil 2.5 mg (½ tablet), discontinued due to unwanted facial hair growth
She denied scalp pain, burning, or itching.
Clinical Examination
A full scalp evaluation using dermatoscopy revealed:
Diffuse, non-scarring thinning
Follicular miniaturization consistent with female-pattern hair loss (AGA)
Positive hair pull test, suggesting active shedding
No signs of inflammation, flaking, or scarring alopecia
Her overall exam was normal—alert, oriented, and in no distress.
Diagnosis
Androgenetic Alopecia (Female Pattern Hair Loss)
ICD-10: L64.8
Findings were consistent with AGA, with potential overlap of chronic telogen effluvium given long-term stressors and age-related hormonal shifts.
A scalp biopsy was offered but not required to proceed with treatment.
Treatment Discussion
A wide range of treatment options was reviewed, including:
Medical Therapies
Oral minoxidil (declined due to facial hair growth)
Finasteride (not ideal for pre-menopausal women)
Dutasteride (considered in post-menopausal women)
Spironolactone (to be discussed with PCP/Dr. Williams for dual use: BP + hair loss)
Topical Therapies
Topical minoxidil 5% (recommended continuation)
Compounded topicals with minoxidil/finasteride (optional)
Procedural Options
Low-level laser therapy (LLLT) such as helmet devices
Nutraceuticals
Nutrafol
Viviscal
Votesse
She had already started Nutrafol, and will continue it.
Treatment Plan
The patient elected the following treatment strategy:
1. Start Oral Dutasteride
Dutasteride 0.5 mg once daily
Risks reviewed:
Breast tenderness
Low libido
Mood changes
Rare depression
Teratogenicity reviewed (not a concern at her age, but documented)
2. Continue Topical Minoxidil
Recommended daily application
Reviewed normal initial shedding period
Discussed long-term maintenance requirement
3. Consider Adding Spironolactone
She will consult her PCP regarding adding spironolactone, which may assist with both blood pressure and hair loss.
4. AlmaTED Treatment Scheduled
This non-invasive ultrasound therapy helps enhance follicular growth without needles or downtime.
5. Future PRP as Needed
She may consider PRP as an additional regenerative therapy.
Follow-Up
She will return as needed to monitor response, medication tolerance, and procedure outcomes.
