{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T16:39:28Z","timestamp":1787330368168,"version":"build-2736575974"},"reference-count":72,"publisher":"S. Karger AG","license":[{"start":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T00:00:00Z","timestamp":1784505600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/karger.com\/pages\/terms-and-conditions"},{"start":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T00:00:00Z","timestamp":1784505600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/karger.com\/pages\/terms-and-conditions"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Skin Appendage Disord"],"abstract":"<jats:p>Background: Female pattern hair loss (FPHL) is the most common cause of hair loss in women, yet therapeutic responses remain highly variable. A substantial proportion of patients experience persistent hair thinning or limited hair density improvement despite standard therapies, and current guidelines provide limited guidance for managing patients with poor therapeutic response. Summary: This review summarizes the major determinants of poor therapeutic response in FPHL, including pharmacogenetic factors, metabolic and endocrine comorbidities, treatment-related barriers, and advanced follicular miniaturization. Emerging evidence suggests that androgen receptor (AR) polymorphisms may influence antiandrogen responsiveness, whereas sulfotransferase (SULT1A1) activity may affect topical minoxidil efficacy. Obesity-related insulin resistance and polycystic ovary syndrome may further impair the follicular microenvironment through hyperandrogenism and chronic inflammation. Based on current evidence, we propose a practical three-step framework for evaluating poor responders: exclusion of pseudo-nonresponse, identification of metabolic-endocrine comorbidities, and incorporation of emerging biomarkers to support individualized treatment selection. Key Messages: Poor therapeutic response in FPHL is multifactorial. Identifying the dominant contributing factor rather than simply escalating treatment intensity may facilitate precision management and improve outcomes in refractory patients.<\/jats:p>","DOI":"10.1159\/000553568","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T16:00:57Z","timestamp":1784563257000},"page":"1-10","source":"Crossref","is-referenced-by-count":0,"title":["Poor Therapeutic Response in Female Pattern Hair Loss: Mechanisms and a Practical Framework for Clinical 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