What should I actually do about my hair thinning?

Ferritin (iron stores)

Low iron stores are linked to hair shedding and are common in menstruating women even without anemia. Correcting it can stop shedding on its own.

Normal vs optimal. A ferritin that is technically "normal" on the lab report can still be low for hair. Many dermatologists aim higher than the bottom of the reference range, so ask what your actual number is rather than accepting "normal."

Thyroid panel (TSH, and often free T4)

Both under- and over-active thyroid cause diffuse shedding, and thyroid hormone acts directly on the hair follicle. Easy to test and treat.

Full blood count

Checks for anemia and general health issues that can drive shedding.

Androgens (testosterone, DHEAS) if there are signs of hormone excess

Only needed if you also have acne, unwanted facial or body hair, or irregular periods. Most women with pattern loss have normal levels, so this is not routine.

Vitamin D (and zinc if alopecia areata is suspected)

Low vitamin D and low zinc are both consistently associated with alopecia areata across large meta-analyses, and deficiency is common and easy to correct. Correcting a deficiency is sensible general care, though it has not been proven to regrow hair on its own.

Fix the reversible cause first

If work-up finds low iron, a thyroid problem, a triggering medication, or a recent stressor behind telogen effluvium, addressing that is the treatment. Shedding from telogen effluvium usually stops within a few months once the trigger is gone.

Topical minoxidil (2% or 5%)

The first-line treatment for female pattern hair loss and the one with the strongest trial evidence. It extends the growth phase of the follicle. The 5% foam once daily and 2% solution twice daily give broadly similar results in women.

Low-dose oral minoxidil

A low-dose tablet (well below blood-pressure doses) that is now widely used off-label for hair loss when topical minoxidil is irritating, inconvenient, or not enough. A large safety review found it well tolerated at these doses.

Anti-androgens (spironolactone)

For female pattern loss, especially with signs of androgen excess, spironolactone blocks androgen effects on the follicle. Often combined with minoxidil. Bicalutamide is an alternative a specialist may use.

Oral JAK inhibitors (alopecia areata only)

For the autoimmune type, alopecia areata, oral JAK inhibitors (baricitinib and ritlecitinib) are the first drugs approved specifically for the condition. In large phase 3 trials, a meaningful share of people with severe, extensive disease regrew most of their scalp hair. They do nothing for ordinary pattern thinning, so this only applies once alopecia areata is diagnosed.

Microneedling with minoxidil

Rolling fine needles over the scalp appears to boost the response to minoxidil in pattern loss. Usually done in courses.

Low-level laser therapy

Home laser caps and combs, and in-clinic devices, have modest evidence for pattern loss in sham-controlled trials. A reasonable, low-risk add-on for people who want a non-drug option.

Platelet-rich plasma (PRP)

Injections of a concentrate from your own blood into the scalp. Trials suggest benefit for pattern loss, though protocols vary and it is not cheap.

Biotin supplements

Widely sold "hair, skin and nails" supplements are built around biotin, but there is no good evidence it helps hair loss unless you have a genuine (rare) biotin deficiency. It can also distort common lab tests including thyroid and troponin.

Finasteride (in postmenopausal women)

A 5-alpha-reductase inhibitor that works in men. A randomized trial in postmenopausal women with pattern loss found it no better than placebo, so it is not a default choice in women.

Questions to ask

• Does my pattern look like female pattern loss, shedding, or something that needs a biopsy?
• Can we check ferritin, thyroid, and vitamin D, and can you tell me the actual numbers?
• Given my situation, is minoxidil the right place to start, and should we add anything?
• Do I need a referral to a dermatologist, and is there any sign of scarring?

What to bring

• Photos of your part and crown taken over the past few months
• A list of medications and supplements, including any biotin
• Family history of hair thinning, and any changes in periods, weight, or energy

JAK inhibitors for alopecia areata

For the autoimmune type (alopecia areata, not pattern loss), oral JAK inhibitors have become the first drugs approved specifically for the condition after large trials showed meaningful regrowth. They are prescription, specialist-managed, and carry class safety warnings, but they changed the outlook for extensive alopecia areata.

Dutasteride for pattern loss

A stronger 5-alpha-reductase inhibitor sometimes used off-label for female pattern loss by specialists, including as a scalp injection. Evidence in women is still limited and it carries the same pregnancy precautions as related drugs.

Exosomes and growth-factor treatments

Marketed aggressively by clinics, but the evidence base is early and standards vary widely. Treat bold before-and-after claims with caution until better trials arrive.