Saving the Scalp: A Primary Care Guide to Female Pattern Hair Loss

Lots of prep getting ready for our Summer events - updating course manuals and slide decks - hope to see you there!

-Simon and Paul

May the "forest" be with you.

Patients will soon be asking you about their thinning hair. This is covered in an article from CMAJ, published in 2026. Female Pattern Hair Loss is a common, nonscarring condition.

• Prevalence increases significantly with age.

• One in four patients has symptoms by age 50.

• Up to half are affected by age 70.

  
  

Pop quiz: A patient presents with thinning at the temples but a full central scalp. Is this Female Pattern Hair Loss?

The answer is likely no. Female Pattern Hair Loss typically presents as central or diffuse thinning. This differs from the male version, which starts at the temples or crown. The process involves the progressive miniaturization of hair follicles. Risk factors often include genetics or endocrinological diseases. Look for Polycystic Ovarian Syndrome, adrenal hyperplasia, or tumours.

Diagnosis: The diagnosis is primarily clinical. A hair-pull test helps rule out Telogen Effluvium. In Female Pattern Hair Loss, this test is usually negative. It may be positive only in the central scalp. Reserve investigations like ferritin or Thyroid-Stimulating Hormone for alternative suspected diagnoses. Androgen levels are usually normal and rarely provide help.

Treatment: Treatment aims to slow the progression of loss. Combined therapies often improve efficacy.

• First-line: Topical minoxidil or oral spironolactone.

• Second-line: Oral minoxidil, finasteride, or low-level laser therapy.

• Platelet-rich plasma and oral contraceptives are also options.

  
  

Expect results to take 6 to 12 months. Patients may notice transient shedding when starting. Most pharmacological treatments are contraindicated during pregnancy. Refer to dermatology if the diagnosis is unclear. Seek help if the patient experiences pain, burning, or scarring. Female Pattern Hair Loss causes significant psychological stress. Screen your patients for anxiety and depression.

EXAM TIP: On a SAMP, don't confuse Female Pattern Hair Loss with Telogen Effluvium. Telogen Effluvium causes diffuse shedding and usually has a positive hair-pull test. Female Pattern Hair Loss is about miniaturization and a negative hair-pull test. Missing this distinction could cost marks on a diagnosis question.

BONUS EXAM TIP: Old SOO scripts on the CFPC's website have asked for 2nd and even 3rd line treatments for medical conditions... can you remember the ones listed above?

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