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J Clin Endocrinol Metab. 2019 Jul 1;104(7):2875-2891. doi: 10.1210/jc.2018-02548.

Female Pattern Hair Loss and Androgen Excess: A Report From the Multidisciplinary Androgen Excess and PCOS Committee.

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Department of Health Sciences and Mother and Child Care, University of Palermo, Palermo, Italy.
Department of Health Policy, Management, and Behavior, School of Public Health, University at Albany, State University of New York, Albany, New York.
Department of Dermatology, Cleveland Clinic, Cleveland, Ohio.
Department of Pathology, Cleveland Clinic, Cleveland, Ohio.
Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain.
Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas, Madrid Spain.
Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain.
Mount Sinai School of Medicine, New York, New York.
Department of Obstetrics and Gynecology, University of California at San Francisco, San Francisco, California.
Department of Obstetrics and Gynecology, Columbia University, New York, New York.
Department of Dermatology, Duke University Medical Center, Durham, North Carolina.
Department of Medicine, Duke University Medical Center, Durham, North Carolina.



To determine the current state of knowledge and provide evidence-based recommendations that could be valid for all specialists taking care of female pattern hair loss (FPHL), a common form of hair loss in women that is characterized by the reduction of hair density in the central area of the scalp, whereas the frontal hairline is generally well conserved.


An expert task force appointed by the Androgen Excess and PCOS Society, which included specialists from dermatology, endocrinology, and reproductive endocrinology.


Levels of evidence were assessed and graded from A to D. Peer-reviewed studies evaluating FPHL published through December 2017 were reviewed. Criteria for inclusion/exclusion of the published papers were agreed on by at least two reviewers in each area and arbitrated by a third when necessary.


(i) The term "female pattern hair loss" should be used, avoiding the previous terms of alopecia or androgenetic alopecia. (ii) The two typical patterns of hair loss in FPHL are centrifugal expansion in the mid scalp, and a frontal accentuation or Christmas tree pattern. (iii) Isolated FPHL should not be considered a sign of hyperandrogenism when androgen levels are normal. (iv) The assessment of patients with FPHL is primarily clinical. (v) In all patients with FPHL, assessment of a possible androgen excess is mandatory. Measurement of vitamin D, iron, zinc, thyroid hormones, and prolactin are optional but recommended. (vi) Treatment of FPHL should start with minoxidil (5%), adding 5α-reductase inhibitors or antiandrogens when there is severe hair loss or hyperandrogenism.


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