GPAtlas🧭 When to suspect
Suspect female pattern hair loss (FPHL) – also called female androgenetic alopecia – in a woman with gradual, diffuse thinning over the crown and central parting and a characteristically preserved frontal hairline. It is the commonest cause of hair loss in women, has a strong genetic basis with a hormonal (androgen) contribution, and becomes more common around and after the menopause, with an earlier peak during the reproductive years.
The key skill in primary care is pattern recognition: confirm the FPHL pattern, exclude reversible mimics (iron deficiency, thyroid disease, telogen effluvium) and dangerous look-alikes (scarring alopecia, a virilising tumour), and support the patient – for whom the impact on confidence and identity is often far greater than the visible loss suggests.
| Condition | Typical pattern | Key discriminator |
|---|---|---|
| FPHL (androgenetic) | Gradual diffuse thinning of the crown and central parting; frontal accentuation | Preserved frontal hairline; miniaturised (finer) hairs; slow course |
| Chronic telogen effluvium | Diffuse increased shedding, sometimes mild bitemporal recession | Preserved density; positive hair-pull test; trigger ~2–3 months earlier |
| Alopecia areata | Well-defined round or oval bald patches | Exclamation-mark hairs; smooth patches; often regrows |
| Scarring (cicatricial) alopecia | Patchy loss with inflammation, scaling or pustules | Loss of follicular openings; shiny scalp; irreversible |
Source: British Association of Dermatologists · DermNet
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