Alopecia Areata

£195  I Consultation

Sinclair Grades - Female Pattern Hair Loss (FPHL)

Female Pattern Hair Loss can develop at any age and causes great distress. It often starts in the early 40s with thinning of the hair at the front of the scalp. As it progresses, the parting becomes wider and the hair is thin and sparse on the vertex (top) of the scalp. 

The first step in treating any form of hair loss is an accurate diagnosis by a Dermatologist or a Trichologist. Often a diagnosis can be made on clinical examination alone. Sometimes a biopsy of the scalp is necessary to determine the cause of the hair loss. Blood tests may be recommended to look for underlying reasons for hair loss.

Treatments are aimed at preventing further hair loss and, if treatment is started early enough, to reverse some of the hair loss.


Currently, the only Licensed treatment in the UK for Female Pattern Hair Loss is Topical Minoxidil (Regaine). This comes in a lotion or a foam preparation which is applied to the scalp once a day. There may be an initial hair shedding phase for about 4 weeks, before things settle down. People usually start to notice an improvement in their hair after about 6 months of use. Sometimes Topical Minoxidil can cause scalp irritation with redness, soreness and itching, or the hair becomes dry and frizzy.


To begin with, most people are asked to try Topical Minoxidil to see if it prevents progression of the hair loss. If it doesn't help, or if the side-effects are too severe, they may need to consider alternative treatments for the hair loss.

Dermatologists are able to recommend unlicensed treatments such as oral Spironolactone, oral Finasteride or low dose oral Minoxidil for hair loss. Each of these treatments have been shown to be helpful for the treatment of Female Pattern Hair Loss, and the choice of drug depends on the individual's circumstances and health status. Each drug has potential side-effects and people need to be closely monitored whilst taking the medication with regular clinic visits and blood tests. Pregnancy should be avoided whilst taking any of these medications.

Spironolactone is an old-fashioned anti-hypertensive treatment which has been used off-label for Acne, Hirsuitism and Female Pattern Hair Loss for many years. Doses often start at 25mg daily, slowly increasing up to 200mg daily, depending on the condition being treated and the response to treatment. Spironolactone is often combined with the Oral Contraceptive Pill, or may be combined with Topical or low dose oral Minoxidil.  

Finasteride 1mg daily is licensed for the treatment of Male Type Baldness in men, but is not licensed for treatment in women.  It has been used off-label for Female Pattern Hair Loss at a dose of 2.5-5mg daily. Finasteride may be taken in combination with the Oral Contraceptive Pill, or with topical Minoxidil. 

In recent years, attention has turned to low dose oral Minoxidil for the treatment of Female Pattern Hair Loss, and for other hair loss conditions. Minoxidil is an old-fashioned treatment for raised Blood Pressure (hypertension), for which a dose of 10-40mg daily is typical. In Female Pattern Hair Loss, very low doses of oral Minoxidil are taken, usually starting at a dose of 0.625mg, and increasing over several months to 2.5mg for females. Recent scientific publications confirm the efficacy of this treatment and highlight the safety profile of taking low dose oral Minoxidil. A worldwide, multi-centre study of 1404 patients found that the most common side-effect was hypertrichosis or excessive hair growth on the body (15%) which led to 14 people stopping the treatment (0.5%). Other side-effects included lightheadedness, fluid retention, tachycardia, headache, periorbital oedema and insomnia, leading to a further 29 people stopping the treatment (1.2%). Low dose oral Minoxidil may be combined with Spironolactone in women (and Finasteride in men).

The Hair Loss Consultation includes an examination of the scalp to help make a diagnosis, and advice on any necessary tests or investigations. In addition, the Consultation covers the use of cosmeceuticals and nutraceuticals in the management of hair loss, including advice on products that help to volumise hair, and those that camouflage bald or thin areas. Prescriptions are only issued where it is safe to do so, and depends on clinical need. The fee for blood tests and biopsies are in addition to the consultation fee.