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.
• It has a strong genetic basis with a hormonal (androgen) contribution.
• It becomes more common around and after the menopause, with an earlier peak during the reproductive years.
Rely on pattern recognition:
• Confirm the FPHL pattern.
• Exclude reversible mimics (iron deficiency, thyroid disease, telogen effluvium) and dangerous look-alikes (scarring alopecia, a virilising tumour).
• 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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