What are the best treatment options for a 29 year old female suffering from Androgenetic Alopecia?

Thank you for your question. You are asking about the best ways to treat female pattern hair loss. You have been using minoxidil for the past 15 months, PCOS has been ruled out, your doctor is hesitant to prescribe spironolactone due to side effects, you are considering a hair transplant, and ask if finasteride can work for you.
I can certainly give you some guidance about this, with just your one photo, and without a physical exam. I’m a Board Certified Cosmetic Surgeon and Fellowship-trained Oculoplastic Surgeon. I’ve been in practice in Manhattan and Long Island for over 20 years. I’ve been performing hair transplants since I started my practice, and have been prescribing finasteride to male pattern hair loss patients since 1997. I’m also the founder of TrichoStem Hair Regeneration Centers, based on a system we developed for non-surgical treatment of pattern hair loss for men and women. We have patients from around the world who come to see us for this treatment.
From your picture alone, your hair thinning does not seem to be severe, but it is a little noticeable in the crown, and does appear to be female pattern hair loss. Female pattern hair loss is diffuse thinning throughout the head, and is most noticeable as widening of the hair part, also called a Christmas tree pattern. Since hair loss is diffuse, most female patients are not hair transplant candidates because the trauma of transplantation can permanently damage native hair follicles close to the transplant area, also known as collateral loss, which actually causes more hair loss. Finasteride is a DHT-blocker, and women do not have a significant amount of DHT in their system, so finasteride is also ruled out as a treatment.
Unfortunately, there are limited treatments for female pattern hair loss. Minoxidil is a treatment for women, but it doesn’t thicken thinning hair. Minoxidil appears to extend the hair growth cycle, and delays the hair shedding cycle, so it appears you have more hair on your head at a given time. If you stop minoxidil, you can have a sudden hair shed. The effects of minoxidil can also wane with time. I generally don’t prescribe spironolactone, which is used to treat excess testosterone.
We do have a treatment in our practice that has been very effective for female pattern hair loss called Hair Regeneration, or TrichoStem Hair Regeneration. This is a treatment comprised of platelet-rich plasma, or PRP, which is a concentration of wound healing and growth factors present in your own blood, which are used for healing cuts. PRP is the activator of the main ingredient extracellular matrix by ACell, which is a wound healing material. This is an injection treatment, that when applied to male and female pattern hair loss patients, thickens thinning hair, and stimulates hair growth from dormant hair follicles. Most patients only need one treatment session, which can last 3-5 years, or even more. This treatment uses a wound healing mechanism to stimulate production of your body’s own adult stem cells, and appears to renew the hair growth cycle. It has proven to be successful in more than 99% of pattern hair loss patients who show visible improvement in scalp coverage and thicker hair growth. I am a pioneer of this type of treatment, and have been administering to patients from around the world since 2011.
Proper diagnosis is important because there are many causes of hair loss in women, but you do likely have female pattern hair loss. You can look into the video attached about proper diagnosis of female pattern hair loss, and how this and similar treatments can help in managing hair loss, and getting more scalp coverage with thicker hair and additional growth from follicles that are still viable, but currently not growing. I hope you found this information helpful. Thank you for your question.

This needs an in-person evaluation. I suggest seeing a hair loss expert now to evaluate and go over your condition and provide you information about your best treatment options. There are great non-invasive options like prp/progesterone and/or hair transplantation. See an expert. Best, Dr. Emer

I assume that you have been visiting a hair loss expert and they have determined that you have miniaturization due to female pattern hair loss and other etiologies have been ruled out. You might consider switching to oral minoxidil. We have found that it is more effective than the topical. Finasteride and spironolactone can be helpful, however you must be on some form of contraception as pregnancy is contraindicated. We have found good results with using PRP in female pattern hair loss. I recommend the subdermal Depo injection technique. Purchase of a low level laser can be of some value. Your hair loss expert should be monitoring your hair density to determine which of the treatments is effective.