Perimenopausal Androgenetic Alopecia in a 49-Year-Old Woman: A Case Report from Katy & Houston, Texas
Hair loss in women often accelerates during the perimenopausal years due to hormonal shifts combined with genetic predisposition. At Reena Jogi, MD, we frequently evaluate women who have tried multiple therapies without improvement and require a more targeted, individualized treatment approach. This case highlights a 49-year-old female with long-standing hair thinning diagnosed with androgenetic alopecia (female pattern hair loss).
Patient Presentation
A 49-year-old female presented as a new patient with a several-year history of gradual, generalized scalp hair loss. The hair thinning was described as moderate in severity and progressive. She denied scalp pain, itching, or inflammation.
The patient reported a positive family history of hair loss in her mother, suggesting a strong genetic component. She had previously used multiple treatments, including:
Oral minoxidil 5 mg daily for approximately 2.5 years
Pantogar supplements
Despite consistent use, she reported no meaningful regrowth with minoxidil therapies. She did note that Pantogar supplements subjectively improved hair quality, and these were considered safe to continue.
The patient is perimenopausal, reporting longer intervals between menstrual cycles, and declined hormone replacement therapy at this time.
Clinical Examination
A comprehensive dermatologic examination was performed, including evaluation of the scalp, hair, face, eyelids, lips, nose, and neck. The patient was well developed, well nourished, alert, oriented, and in no acute distress.
Scalp examination revealed diffuse, non-scarring hair thinning with a patterned distribution, consistent with female androgenetic alopecia.
Diagnosis: Female Androgenetic Alopecia
Based on the clinical presentation, family history, treatment response, and examination findings, the patient was diagnosed with androgenetic alopecia.
The diagnosis and natural course of female pattern hair loss were reviewed in detail, emphasizing that it is:
Genetically influenced
Hormone-sensitive
Slowly progressive over time
Perimenopausal hormonal changes were discussed as a potential contributing factor to disease progression.
Treatment Discussion & Decision-Making
A comprehensive discussion was held regarding available treatment options, including:
Spironolactone
Low-level laser therapy
Hair growth supplements (Viviscal, Nutrafol, Votesse)
After reviewing risks, benefits, alternatives, and expectations, the patient elected to initiate spironolactone therapy.
Baseline clinical photographs were obtained to objectively monitor treatment response.
Treatment Plan & Counseling
The patient was started on:
Spironolactone 50 mg twice daily
Extensive medication counseling was provided, including discussion of possible side effects such as:
Breast tenderness
Menstrual irregularities
Dizziness and fatigue
Elevated potassium levels
Importance of avoiding pregnancy while on therapy
The need for laboratory monitoring of kidney function and potassium levels was reviewed. The patient verbalized understanding of proper use and potential adverse effects.
She was advised to continue Pantogar supplements and informed that combination therapy often provides the best outcomes in female hair loss.
Follow-Up & Expectations
The patient was counseled that visible improvement may take 3–6 months and that treatment goals include slowing progression and improving density, rather than complete reversal.
A follow-up visit in three months was scheduled to assess tolerability, review response, and consider adjunctive therapies such as PRP or AlmaTED if needed.
Expert Female Hair Loss Care in Katy & Houston, Texas
At Reena Jogi, MD, we specialize in diagnosing and treating complex hair loss in women, including perimenopausal and hormonally influenced androgenetic alopecia. Individualized treatment plans are essential for achieving optimal outcomes.
📍 Serving patients in Katy, TX and Houston, TX
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