Poor Therapeutic Response in Female Pattern Hair Loss: Mechanisms and a Practical Framework for Clinical Management

This review addresses the issue of poor therapeutic response in female pattern hair loss (FPHL), highlighting that responses to standard treatments are often inconsistent. It identifies key factors contributing to this variability, such as pharmacogenetic influences, metabolic and endocrine disorders, treatment barriers, and advanced follicular miniaturization. Notably, androgen receptor polymorphisms and sulfotransferase activity may affect treatment efficacy. Conditions like obesity-related insulin resistance and polycystic ovary syndrome can worsen hair loss through hyperandrogenism and inflammation. The authors propose a three-step framework for managing poor responders, emphasizing the importance of identifying the primary contributing factor to tailor treatments effectively, rather than merely increasing treatment intensity.