Background <p>Female pattern hair loss (FPHL) has a severe impact on physical and mental well-being. The aim of this study is to assess factors associated with the severity of FPHL.</p> Methods <p>This retrospective study included 289 patients with FPHL (150 classified as F1 and 139 as F2/3). Thirteen elements were determined using an Inductively Coupled Plasma Mass Spectrometry method. Univariate and multivariate analyses, propensity score-matched (PSM) models, and restricted cubic spline (RCS) analyses were applied to investigate associations and dose-response relationships between elements, vitamins, hormones and FPHL severity</p> Results <p>Patients in the F2/3 group were significantly older than those in the F1 group (<i>P</i> = 0.002) and had a longer duration of FPHL (<i>P</i> &lt; 0.001). Serum levels of selenium (Se), zinc (Zn), vitamin B9, and testosterone were significantly lower in the F2/3 group compared with the F1 group (all <i>P</i> &lt; 0.05). However, multivariate analysis demonstrated that only disease duration remained an independent risk factor for increased FPHL severity (OR 1.123 [95% CI 1.047–1.211]; <i>P</i> = 0.02), which was further validated by RCS analysis. After PSM adjustment of demographic characteristics, no significant differences in elements, vitamins, or hormone levels were observed between the F1 and F2/3 groups.</p> Conclusions <p>Elements, vitamins, and hormones were not predictors of FPHL after adjustment for demographic characteristics. Larger prospective cohort studies are warranted to validate these findings.</p> Level of Evidence III <p>This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors <a href="http://www.springer.com/00266">www.springer.com/00266</a>.</p>