Review finds no clear hormonal cause for frontal fibrosing alopecia
Frontal fibrosing alopecia, or FFA, is a scarring form of hair loss. It mostly affects women around and after menopause. Researchers have long asked whether hormones play a role. Many patients also ask whether they should stop hormone therapy or birth control pills.
Our lab searched three large research databases through August 2025. We found 11 studies that met our criteria. Ten of them covered 1,948 FFA cases. The eleventh, a large health record study, included 45,955 cases that grouped FFA with lichen planopilaris.
Studies of the body's own hormones found no consistent pattern. Most hormone levels stayed within normal ranges. Two studies linked FFA to hormone replacement therapy, with odds ratios of 1.76 and 3.87. One of them also linked it to birth control pills, with an odds ratio of 2.92. But when we pooled 3 studies, the results differed sharply between them. That makes the pooled numbers hard to interpret.
The studies defined FFA in different ways. Some relied on patients' own reports of hormone use. Others mixed FFA with lichen planopilaris. These links do not prove cause. Routine hormone blood tests are not advised unless another hormone problem is suspected. Stopping hormones as a reflex is not supported, and decisions should be made case by case. We proposed a standard reporting framework for future studies.
Ezzat RZ, Chen LC, Paz M, Kreytak C, Senna MM. Hormonal associations in frontal fibrosing alopecia: a systematic review. JAAD Int. 2026;27:38-39.
