Treatment Of Female Pattern Hair Loss Research Articles

Efficacy and safety of spironolactone versus bicalutamide in female pattern hair loss: A retrospective comparative study.

Female-pattern hair loss (FPHL) is characterized by decreased scalp hair density, thinning of hair shafts, and progressive miniaturization of hair follicles. To compare the safety and efficacy of spironolactone versus bicalutamide in female pattern hair loss [FPHL]. The study design was retrospective, and all eligible females aged between 18 years and 50 years with FPHL were included. We identified 120 patients from our database who fulfilled the inclusion and exclusion criteria, and patients were then categorized into two groups, Group A comprising patients who were taking 100 mg of spironolactone once daily and Group B comprising patients who were taking 50 mg of bicalutamide once daily along with topical minoxidil 2% in both groups. Patient were analysed at approximately at 24 weeks from the commencement of the treatment. Mean reduction in hair loss severity score on Sinclair scale was 19.51% in spironolactone group compared to 28.20% in bicalutamide group at 24 weeks, which was statistically significant. On global photographic assessment, marked improvement was seen in bicalutamide group compared to spironolactone group (p = 0.139). Our study, though limited by its retrospective design and small sample size, showed that bicalutamide has greater efficacy and better safety profile in comparison to spironolactone in the treatment of FPHL.

Clinical, Trichoscopic And Immunohistochemical Evaluation of Autologous Adipose Derived Adult Stem Cell Injection in the Treatment of Female Pattern Hair Loss

Abstract Background Cellular and cell-derived components of adipose-derived tissue for the purposes of dermatologic and aesthetic rejuvenation applications have become increasingly studied and integrated into clinical practice. The hair follicle goes through phases of growth, regression, and quiescence, and it is suspected that adipocytes secrete factors to promote activation of hair follicles dermal papilla cells, increasing migration, and proliferation in vitro; as well as increasing conversion of hair follicles from the telogen to anagen phase in vivo. Objectives Evaluation of efficacy and safety of adipose-derived adult stem cells (ADSCs) injection in hair follicle regeneration in female pattern hair loss (FPHL). Methods 33 patients were included and divided into 3 groups according to Sinclair’s classification according to severity. ADSCs were extracted from lipoaspirate and injected into the frontoparietal scalp. Patients were assessed clinically, trichoscopically and immunohistochemically. Results At week 24, there was improvement of hair thickness and count, both in frontal and occipital areas. Histopathological and immunohistochemical assessment at week 12 showed decrease of perifollicular inflammation and decrease of DKK-1 immunostaining. Conclusion The use of ADSCs in treatment of FPHL in subjects included in this study showed improvement of perifollicular inflammation, in addition to density and thickness of hair.

Combination oral minoxidil and spironolactone for the treatment of androgenetic alopecia in adolescent girls

Combination oral minoxidil and spironolactone for the treatment of androgenetic alopecia in adolescent girls

Efficacy of Topical Finasteride 0.5% vs 17α-Estradiol 0.05% in the Treatment of Postmenopausal Female Pattern Hair Loss: A Retrospective, Single-Blind Study of 119 Patients

Female pattern hair loss (FPHL) is a common form of scalp hair loss that occurs in 38% of females. Currently, minoxidil solution is the only therapy approved by the US Food and Drug Administration, but many other treatments are used, including cyproterone acetate, spironolactone, topical 17α-estradiol, and prostaglandin analogs. Systemic finasteride has been considered a treatment option in women even though its teratogenic effects tend to limit its prescription. Recently, topical finasteride has been evaluated to limit the side effect profile of the drug. The objective of the present study is to compare retrospectively the efficacy of topical 0.05% 17α-estradiol solution and a 0.5% finasteride lotion in the treatment of FPHL. We enrolled 119 postmenopausal female patients. The first group comprised 69 women treated with finasteride 0.5% and minoxidil 2%. The second group included 50 women treated with 17α-estradiol 0.05% and minoxidil 2%. At baseline and at 6- and 12- to 18-month follow-up, global photographs were systematically taken. Three operators blind to the prescribed treatment evaluated photographs using a 7-point scale. One-way analysis of variance and unpaired Student t tests were performed to analyze 7-point scale scores. The improvement was statistically significant from 6 months to 12-18 months, both for finasteride (P < 0.005) and 17α-estradiol (P < 0.05). The efficacy of topical finasteride was significantly greater than that of 17α-estradiol solution, both at the 6-month (P < 0.05) and at the 12- to 18-month follow-up (P < 0.005). In general, the highest improvement was observed after 12-18 months of treatment with topical finasteride therapy. Topical finasteride 0.5% in combination with minoxidil 2% could represent a valid therapeutic option for the treatment of postmenopausal FPHL, showing higher efficacy than topical 17α-estradiol with minoxidil 2% both at 6-month and 12- to 18-month follow-up.

How safe is prescribing oral minoxidil in patients allergic to topical minoxidil?

To the Editor: We present 9 female patients (Table I) who became allergic to topical minoxidil and were able to tolerate low-dose oral minoxidil without adverse effects.Table IList of patientsPatientAge, y∗Mean age of 47.2 years (range, 22-72 years).SexTopical minoxidil use, yAdverse effects from topical minoxidilOral minoxidil use, 0.25 mg twice daily, mo†All patients currently on treatment.Adverse effects from oral minoxidil148Female8Scalp pruritus15None247Female12Scalp pruritus, scaling20None372Female14Scalp pruritus, scaling33Mild hypertrichosis on temples449Female3Scalp pruritus, eczematous rash on ears10None554Female1.5Scalp pruritus7None655Female0Scalp pruritus18None731Female0Scalp pruritus, eczematous rash on ears8None847Female4Scalp pruritus, scaling24Mild hypertrichosis on cheeks922Female1Scalp pruritus, eczematous rash on ears18None∗ Mean age of 47.2 years (range, 22-72 years).† All patients currently on treatment. Open table in a new tab Topical minoxidil is the only approved treatment for female pattern hair loss.1Friedman E.S. Friedman P.M. Cohen D.E. Washenik K. Allergic contact dermatitis to topical minoxidil solution: etiology and treatment.J Am Acad Dermatol. 2002; 46: 309-312Abstract Full Text Full Text PDF PubMed Scopus (113) Google Scholar It has a safe profile, and the most common adverse effects include irritant and allergic contact dermatitis and hypertrichosis. Contact dermatitis to commercial minoxidil is often caused by propylene glycol that is present in the 2% and 5% solutions. Patients with contact allergy or irritation to propylene glycol can use the 5% minoxidil foam, which is free of this ingredient. Contact allergy to minoxidil itself is uncommon and requires discontinuation. Our patients had been using topical minoxidil for an average of 4.8 years (range, 1-14 years) (Table I) when an acute contact dermatitis developed. All were patch tested with propylene glycol 30% in water (Chemotechnique Diagnostics, Vellinge, Sweden), 5% commercial minoxidil solution, and 5% commercial minoxidil foam. Patches were removed after 48 hours and the reading was performed at 72 and 96 hours. All 9 patients had a positive patch test result to the 5% minoxidil solution and the foam and a negative patch test result to propylene glycol, indicating that the cause of contact dermatitis was minoxidil itself (Fig 1). Oral minoxidil has been used in the last few years as an off-label treatment both in male and in female pattern hair loss with good clinical efficacy.2Jimenez-Cauhe J. Saceda-Corralo D. Rodrigues-Barata R. et al.Effectiveness and safety of low-dose oral minoxidil in male androgenetic alopecia.J Am Acad Dermatol. 2019; 81: 648-649Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar,3Sinclair R.D. Female pattern hair loss: a pilot study investigating combination therapy with low-dose oral minoxidil and spironolactone.Int J Dermatol. 2018; 57: 104-109Crossref PubMed Scopus (58) Google Scholar Proposed doses are different in men than in women, with a range from 0.25 to 1 mg daily.4Ramos P.M. Sinclair R.D. Kasprzak M. Miot H.A. Minoxidil 1 mg oral versus minoxidil 5% topical solution for the treatment of female-pattern hair loss: a randomized clinical trial.J Am Acad Dermatol. 2020; 82: 252-253Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar Lower doses are used in women because hypertrichosis is a common adverse effect.3Sinclair R.D. Female pattern hair loss: a pilot study investigating combination therapy with low-dose oral minoxidil and spironolactone.Int J Dermatol. 2018; 57: 104-109Crossref PubMed Scopus (58) Google Scholar Our experience with more than 200 patients on oral minoxidil indicates that 0.5 mg daily is effective and very well tolerated. The possibility that patients with contact allergy to topical minoxidil could safely tolerate oral minoxidil was suggested by the fact that systemic skin reactions to topical or oral minoxidil have never been described. Systemic contact dermatitis refers to a rare diffuse reaction that individuals sensitized to a contact allergen might develop after exposure to the same allergen via a different route. The exact pathophysiology is unknown; however, it appears to be mediated by a type 4 and possibly type 3 hypersensitivity reaction. Cases of systemic contact dermatitis have been reported for propylene glycol5McGowan M.A. Scheman A. Jacob S.E. Propylene glycol in contact dermatitis: a systematic review.Dermatitis. 2018; 29: 6-12Crossref PubMed Scopus (32) Google Scholar but not for minoxidil, so treatment with oral minoxidil was started at the dose of 0.25 mg twice daily. The 0.25-mg capsules were compounded by pharmacies. All of our patients have been using the same dose to date, for an average of 17 months (range, 7-33 months) without any adverse effects. All of them were satisfied with results of treatment. Cardiac adverse effects of oral minoxidil, such as edema, pericarditis, or pericardial effusion, are dose-dependent and have never been reported with low doses. Our experience therefore suggests that oral minoxidil is reasonably safe in patients allergic to topical minoxidil, even if it is advisable to warn patients to stop the medications in case of cutaneous adverse effects.

Literature ReviewOral Minoxidil for Female Pattern Hair LossTopical Finasteride for Treatment of AGASulfotransferase Activity Predicts Response to Minoxidil

![][1] # Oral Minoxidil for Female Pattern Hair Loss {#article-title-2} P.M. Ramos, . Minoxidil 1mg oral versus minoxidil 5% topical solution for the treatment of female-pattern hair loss: a randomized clinical trial. JAAD . 2019; 82(1):252-253. There are limited options for women

A randomised trial of 5% minoxidil versus combination of 5% minoxidil and oral spironolactone in treatment of female pattern hair loss

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Female pattern hair loss (FPHL) is a common form of nonscarring hair loss. We compared the usefulness and safety of topical minoxidil alone with combination of oral spironolactone and topical minoxidil in the treatment of FPHL.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This prospective, single-centre, randomised open label study over 100 patients attending tertiary care hospital in Mumbai during period December 2011 to June 2012. The data were entered into SPSS version 21 for analysis. Data collected were coded and described as frequency and percentage for qualitative data and means and standard deviation for quantitative data. Statistical analysis was done using chi-square and student t test. Statistical significance was considered if p value was less than 0.05.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; There were 48 patients in Group I and 46 patients in Group II. At 6 months, significantly higher mean Sinclair grade was observed among Group I patients as compared to Group II patients (2.85±0.68 vs 2.56±0.50, p=0.02). We observed a significant improvement in women’s androgenetic alopecia quality of life questionnaire in Group I patients at 12 months after treatment (26.93±2.25 vs 23.47±2.95, p&amp;lt;0.001). Minoxidil and spironolactone were tolerated well by the patients.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Combination therapy of topical minoxidil and oral spironolactone has an additive effect. However, plateau of effectiveness of the combination therapy in normoandrogenic patients at 6 months of therapy was observed. We recommend the combination for 6 months and continuation of therapy with minoxidil only.&lt;/p&gt;

Minoxidil 1 mg oral versus minoxidil 5% topical solution for the treatment of female-pattern hair loss: A randomized clinical trial

Minoxidil 1 mg oral versus minoxidil 5% topical solution for the treatment of female-pattern hair loss: A randomized clinical trial

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

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.

Female pattern hair loss: A clinical, pathophysiologic, and therapeutic review.

Female pattern hair loss (FPHL) is the most common form of alopecia in women. Affected women may experience psychological distress and impaired social functioning. Early diagnosis and initiation of treatment are desirable because treatments are more effective to avoid the progression of hair loss than stimulating regrowth. Typically, a diagnosis of FPHL can be confirmed by review of a patient's medical history and a physical examination alone. Testing a scalp biopsy is diagnostic but usually not required. In women with signs of hyperandrogenism, an investigation for ovarian or adrenal disorders should be performed. Treatment for FPHL is obscured by myths. The aim of FPHL treatment could be two-fold: Reverse or stabilize the process of hair follicle miniaturization. Mild-to-moderate FPHL in women can be treated with oral antiandrogen therapies (cyproterone acetate and spironolactone) and/or topical minoxidil with good results in many cases. If used correctly, available medical treatments arrest the progression of the disease and reverse miniaturization in most patients with mild-to-moderate FPHL. Hair systems and surgery may be considered for selected cases of severe FPHL.

Treatment of chronic telogen effluvium with oral minoxidil: A retrospective study

Background: Chronic telogen effluvium (CTE) may be primary or secondary to various causes, including drug reaction, nutritional deficiency and female pattern hair loss (FPHL). Oral minoxidil stimulates hair growth, and topical minoxidil is used in the treatment of FPHL and male androgenetic alopecia. minoxidil has not been used to treat CTE. This study aimed to assess the treatment of CTE with once daily oral minoxidil. Methods: Women with a diagnosis of CTE based on >6 month history of increased telogen hair shedding, no visible mid frontal scalp hair loss (Sinclair stage 1) and no hair follicle miniaturization on scalp biopsy were treated with once daily oral minoxidil. Hair shedding scores (HSS) at baseline, 6 and 12 months were analysed using the Wilcoxon rank sum test for pair-wise comparisons. Results: Thirty-six women were treated with oral minoxidil (range, 0.25-2.5 mg) daily for 6 months. Mean age was 46.9 years (range 20-83), HSS at baseline was 5.64, and duration of diagnosis was 6.55 years (range 1-27). There was a reduction in mean HSS scores from baseline to 6 months of 1.7 (p<0.001) and baseline to 12 months of 2.58 (p<0.001). Five women who described trichodynia at baseline, noted improvement or resolution within 3 months. Mean change in blood pressure was minus 0.5 mmHg systolic and plus 2.1 mmHg diastolic. Two patients developed transient postural dizziness that resolved with continued treatment. One patient developed ankle oedema. Thirteen women developed facial hypertrichosis. For 6 patients this was mild and did not require treatment; 4 had waxing of their upper lip or forehead; 3 had laser hair removal. No patients developed any haematological abnormality. All 36 women completed 12 months of treatment. Conclusions: Once daily oral minoxidil appears to reduce hair shedding in CTE. Placebo controlled studies are recommended to further assess this response.

Treatment of chronic telogen effluvium with oral minoxidil: A retrospective study.

Background: Chronic telogen effluvium (CTE) may be primary or secondary to various causes, including drug reaction, nutritional deficiency and female pattern hair loss (FPHL). Oral minoxidil stimulates hair growth, and topical minoxidil is used in the treatment of FPHL and male androgenetic alopecia. minoxidil has not been used to treat CTE. This study aimed to assess the treatment of CTE with once daily oral minoxidil. Methods: Women with a diagnosis of CTE based on >6 month history of increased telogen hair shedding, no visible mid frontal scalp hair loss (Sinclair stage 1) and no hair follicle miniaturization on scalp biopsy were treated with once daily oral minoxidil. Hair shedding scores (HSS) at baseline, 6 and 12 months were analysed using the Wilcoxon rank sum test for pair-wise comparisons. Results: Thirty-six women were treated with oral minoxidil (range, 0.25-2.5 mg) daily for 6 months. Mean age was 46.9 years (range 20-83), HSS at baseline was 5.64, and duration of diagnosis was 6.55 years (range 1-27). There was a reduction in mean HSS scores from baseline to 6 months of 1.7 (p<0.001) and baseline to 12 months of 2.58 (p<0.001). Five women who described trichodynia at baseline, noted improvement or resolution within 3 months. Mean change in blood pressure was minus 0.5 mmHg systolic and plus 2.1 mmHg diastolic. Two patients developed transient postural dizziness that resolved with continued treatment. One patient developed ankle oedema. Thirteen women developed facial hypertrichosis. For 6 patients this was mild and did not require treatment; 4 had waxing of their upper lip or forehead; 3 had laser hair removal. No patients developed any haematological abnormality. All 36 women completed 12 months of treatment. Conclusions: Once daily oral minoxidil appears to reduce hair shedding in CTE. Placebo controlled studies are recommended to further assess this response.

Low level light-minoxidil 5% combination versus either therapeutic modality alone in management of female patterned hair loss: A randomized controlled study.

Female pattern hair loss (FPHL) is the most common form of hair loss in women. Nevertheless, its management represents a real challenge. Among the FDA approved therapeutic modalities for FPHL are topical minoxidil and more recently low-level light therapy (LLLT). Assess the efficacy and safety of LLLT in comparison to topical minoxidil 5% and to a combination of both therapies in the treatment of FPHL. This study included 45 female patients with proven FPHL. They were randomly divided into three equal groups, where group (i) patients were instructed to apply topical minoxidil 5% twice daily, group (ii) patients received LLLT using the helmet iGrow® device for 25 minutes 3 days weekly, and group (iii) patients received a combination of both topical minoxidil 5% twice daily and LLLT for 25 minutes 3 days weekly for 4 months (study duration). Evaluation was done according to clinical, dermoscopic (folliscopic), and ultrasound bio-microscopic (UBM) parameters. Patient satisfaction and side effects were reported. The efficacy and safety of both topical minoxidil and LLLT were highlighted with comparable results in all parameters. The combination group (iii) occupied the top position regarding Ludwig classification and patient satisfaction. UBM and dermoscopic findings showed significant increase in the number of regrowing hair follicles at 4 months in all groups, whereas only UBM showed such significant increase at 2 months in the combination group (iii). A non-significant increase in the hair diameter was also documented in the three groups. LLLT is an effective and safe tool with comparable results to minoxidil 5% in the treatment of FPHL. Owing to the significantly better results of combination therapy, its usage is recommended to hasten hair regrowth. Lasers Surg. Med. 49:835-843, 2017. © 2017 Wiley Periodicals, Inc.

Interventions for female pattern hair loss.

Interventions for female pattern hair loss.

Mesotherapy using dutasteride‐containing preparation in treatment of female pattern hair loss: photographic, morphometric and ultrustructural evaluation

Treatment of female pattern hair loss (FPHL) is frustrating for both patients and doctors. Mesotherapy is a novel treatment for hair fall and its efficacy in FPHL has not been evaluated. Evaluation of the efficacy and safety of mesotherapy using dutasteride-containing preparation in treatment of FPHL. This study included 126 female patients with FPHL. They were classified into two groups; group I (86 patients) injected with dutasteride-containing preparation and group II (40 control patients) injected with saline. Patients received 12 sessions and were evaluated at the 18th week by: photographic assessment, hair pull test, hair diameter and patient self-assessment. Ultrastructural evaluation was done for three patients. After mesotherapy with dutasteride-containing preparation, photographic improvement occurred in 62.8% of patients compared with 17.5% in control group (P < 0.05), mean number of epilated hairs was significantly decreased (P < 0.05), mean hair diameter was significantly increased (P < 0.05). Patient self-assessment showed statistically significant improvement compared with the controls (P < 0.05). There was a negative correlation between degree of improvement and duration of FPHL (P < 0.05). Side effects were minimal with no statistically significant difference between the two groups (P > 0.05). Ultrastructural examination of pretreated hairs revealed absent cuticle in one patient and focal destruction of the cuticle in the second patient, which reappeared in both after therapy. We concluded that mesotherapy with dutasteride-containing preparation was effective, tolerable and minimally invasive treatment modality in FPHL with better response for shorter duration of the disease.

Efficacy of Finasteride 1.25 mg on Female Pattern Hair Loss; Pilot Study

Dear Editor: Although finasteride was approved only for male pattern baldness1, it has been in off-label use on female pattern hair loss (FPHL). A pilot study done on postmenopausal women showed that 1mg of finasteride had no effect on FPHL2. Following that report, 2.5 mg or 5 mg of finasteride in FPHL was shown to be effective in several case reports and a few studies3,4. This suggests that finasteride may be effective in FPHL, but its optimal dosage on FPHL needs to be clarified. Researchers have not described any dose-dependent side effect (1 mg; 11.9% vs. 5 mg; 4.6%)2-4, in women, administering the medication beyond what is efficacious is unreasonable. To determine whether 1.25 mg finasteride can be the minimal effective dosage on FPHL, we conducted a 28 week, open-labeled, prospective study for 18 normoandrogenic FPHL patients with finasteride 1.25 mg daily. All the patients had normal androgen, iron, ferritin level and normal thyroid function test at initial screening. The treatment efficacy was evaluated with the changes of hair density and thickness4 assessed by phototrichogram (Aramo-SG, Aram HUVIS Co., Seoul, Korea) and patients' and physician's global assessment a using 7-point scale score5. All premenopausal women (n=9) were informed of the potential risk of the finasteride on a male fetus. Fourteen patients completed the study, and their demographics and results were noted in Table 1. Three patients withdrew after treatment of 2~4 months because of no remarkable clinical improvement and another patient has been lost to follow-up. Baseline mean hair density was 101.7±27.14/cm2 and hair thickness was 53.4±10.3 µm. After 28 weeks of treatment, phototrichogram assessment demonstrated 5.87% mean increment (from 101.7±27.14 to 107.8±18.34/cm2, p=0.29) of hair density and 11.8% mean increment (from 53.4±10.3 to 60.1±10.4 µm, p=0.06) of hair thickness without statistical significance (paired t-test, SPSS 13.0; SPSS Inc., Chicago, IL, USA) (Fig. 1). Ten (71.4%) of the 14 patients rated their states as 'no change' and the physicians also recorded 'no change' in 9 (64.3%) patients, at the end of the study. Fig. 1 The patients with improved physician's global assessment score (+1) after 7 months of daily finasteride 1.25 mg medication. Table 1 Baseline characteristics, folliscope assessment of hair density/thickness, and global assessment of enrolled patients before and 28 weeks after finasteride 1.25 mg/day treatment Though the clinical pattern of hair loss is different from men and women and the role of androgen in the pathogenesis of FPHL is unclear until now, it is believed that the pathogenesis of FPHL is similar with an inherited tendency of hair follicles to miniaturize progressively when exposed to dihydrotestosterone6,7. Price et al.2 reported that finasteride at 1 mg/day in a patient with FPHL failed to show slowing hair thinning, increasing growth, or improved appearance. Iorizzo et al.3 showed some improvement in 62% of patients with finasteride 2.5 mg daily and Yeon et al.4 also reported daily finasteride 5 mg was effective in FPHL, but Carmina and Lobo.8 reported the opposite result with the same dosage (5 mg/day). A previous report of finasteride 1.25 mg daily was limited to just four hyperandrogenic FPHL people9. This is the first study of daily finasteride 1.25 mg in normoandrogenic FPHL patients. In addition, most previous studies evaluate the efficacy through photographic assessment by patients and investigators8,9, but we used phototrichogram for objective evaluation of efficacy. In this study, patients with FPHL did not show a significant increase in hair growth, but hair density and thickness was minimally increased or constant without further hair loss even though the sample size was small and the duration of treatment was short. Most women with FPHL tend to experience more negative body-image, more social anxiety, and poor self-esteem than control subjects10. Therefore, we thought that subjects reporting 'no change' or 'slight increased' about their condition is meaningful in the treatment of FPHL. Previous studies reported drug-related adverse effect such as headache, depression, nausea, hot flushing, menstrual irregularity, or increased body hair in some patients2,4,6. However, no one reported drug-related symptoms during this study. From this study, we found out that daily finasteride 1.25 mg medication for 28 weeks in FPHL patients show some measurable efficacy but it doesn't show objective clinical efficacy. Therefore, we suggest that a dose higher than 1.25 mg/day, more number of patients and longer duration of treatment are needed to confirm the effects of this clinical trial in normoandrogenic FPHL.