A Guide to Androgenetic Alopecia: Male and Female Pattern Hair Loss

Medically Reviewed By Joan Paul, MD, MPH, DTMH
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Androgenetic alopecia is a type of hair loss. Hormones called androgens cause it, and genes can play a role. It is more common and severe in males, and it has different symptoms in females. Androgenetic alopecia is also called male pattern hair loss (MPHL) or female pattern hair loss (FPHL).

This article explains what androgenetic alopecia is, what it looks like, its causes, risks, and treatments.

Sex and gender exist on a spectrum. This article uses the terms “male” and “female” to refer to sex that was assigned at birth. 

Learn more about the difference between sex and gender here.

What is androgenetic alopecia?

An older man combing his hair
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Androgenetic alopecia is a common type of thinning of hair and balding. Experts believe that a combination of androgen hormones and genetic predisposition cause androgenetic alopecia.

MPHL typically presents as hair loss from the front and top of the head, as well as the classic receding hairline. This type of hair loss is very common. It affects up to half of white males by the age of 50 and up to 80% by the age of 70.

With FPHL, thinning hair occurs in the mid-frontal area of the scalp and is typically less severe than in MPHL. About 40% of females show signs of hair loss by age 50. Less than 45% have a full head of hair by age 80.

What does androgenetic alopecia look like?

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In males, androgenetic alopecia usually looks like a receding hairline or bald spot on the top of the head.

Yashkin Ilya/Shutterstock

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In females, hair loss usually presents on the top of the scalp along the part line. Hair gradually thins.

Stevens, J., & Khetarpal, S. (2018). Platelet-rich plasma for androgenetic alopecia: A review of the literature and proposed treatment protocol. International journal of women's dermatology, 5(1), 46–51. https://doi.org/10.1016/j.ijwd.2018.08.004

In males, androgenetic alopecia usually looks like a receding hairline or bald spot on the top of the head. The hair will start by thinning and becoming sparse on the scalp. Eventually, the scalp within the thinning area will be bald.

In females, balding is uncommon. Hair loss usually presents on the top of the scalp along the part line. Gradually the hair becomes thinner. Typically, the hairline does not recede.

What are the symptoms of androgenetic alopecia?

Symptoms of androgenetic alopecia appear differently.

In MPHL, common symptoms are:

  • receding hairline
  • hair thinning on the top or front of the head
  • bald area of the scalp
  • increased hair shedding

In FPHL, common symptoms are:

  • a widening part in the hair
  • thinning hair on top of the scalp
  • non-receding hairline
  • increased hair shedding

What causes androgenetic alopecia?

The two causes of androgenetic alopecia are genetics and androgens. Androgens regulate hair growth and sex drive. One androgen, in particular, dihydrotestosterone, has been linked to androgenetic alopecia.

The gene, AR, plays a role in developing androgenetic alopecia. The AR gene makes androgen receptor proteins which help the body properly regulate dihydrotestosterone and other androgens. Variations in the AR gene lead to increased activity of androgen receptors in the hair follicles. Increased androgen levels in hair follicles cause shorter hair growth cycles.

What are the risk factors for androgenetic alopecia?

People with certain medical conditions may be at more risk for developing androgenetic alopecia. These risk factors include:

How do you prevent androgenetic alopecia?

There may be no way to prevent androgenetic alopecia. If you have a medical condition that places you more at risk, you should consider seeking treatment.

In general, it is a good idea to be gentle with your hair to prevent additional hair shedding.

How do doctors diagnose androgenetic alopecia?

Your doctor will visually examine your hair and scalp, checking the density and distribution of the hair. They will also evaluate your medical history, current medical conditions, and any medications you are taking.

Your doctor may order blood work to check your hormone levels and confirm a diagnosis. Rarely, your doctor may order a skin biopsy to help diagnose the condition.

Your doctor may do a hair pull test by gently pulling on a cluster of 40–60 hairs and seeing how many come out. A positive test, in which more than 10% of hairs easily come out, indicates active hair shedding.

What treatments are available for androgenetic alopecia?

Two medications have FDA approval for treating androgenetic alopecia. Both medications take 4–6 months to show noticeable results. These two medications work better when used together:

  • Minoxidil: This topical medication is available over the counter. The highest strength, 5%, is most effective. Minoxidil helps dilate blood vessels, which is thought to bring more blood, oxygen, and nutrients to hair follicles. Minoxidil can cause scalp irritation and flaking.
  • Finasteride: This 5 alpha-reductase type 2 inhibitor medication helps increase hair regrowth on the top of the scalp, or the scalp vertex. Its effectiveness for FPHL is uncertain, and it is not recommended before or during pregnancy

To treat FPHL, doctors may prescribe spironolactone, an oral antiandrogen. For hair loss, this hormonal medication blocks androgen effects and helps convert testosterone to estradiol.

Other hair loss treatments include:

  • Hair transplants: A person needs enough donor plugs, more than 40 follicular units per centimeters squared, to treat the bald area. Hair transplants may not be covered by insurance, and can be expensive as a result.
  • Red light or laser therapy: Over-the-counter devices that deliver a red light at 660 nm have been effective in treating hair loss.
  • Platelet rich plasma injections: These injections involve taking a small amount of your blood and using a machine to separate out the plasma. This plasma is then injected into the area affected by hair loss.

What are the potential complications of androgenetic alopecia?

Most people with androgenetic alopecia are otherwise healthy. They do not experience any systemic effects from the condition. However, there can be a psychological impact from the condition.

People with androgenetic alopecia may be embarrassed by their hair loss and not want to interact with others. This can lead to low self-esteem, depression, and loneliness.

You can seek out mental health counseling if you experience negative psychological effects from this condition.

Other frequently asked questions

Here are questions people also ask about androgenetic alopecia. Joan Paul, MD, MPH, DTMH, reviewed the answers.

Can female androgenetic alopecia be reversed?

The general goal of treatment for female androgenetic alopecia is to slow or stop any further hair loss. Some people may experience hair regrowth while others may not. Without medication, the severity of the condition tends to get worse. Minoxidil and hormonal medications that block the effects of androgens have been shown to be effective in treating female pattern hair loss.

What is the difference between telogen effluvium and androgenetic alopecia?

Telogen effluvium, another condition that causes increased hair shedding, is commonly confused with androgenetic alopecia. Telogen effluvium is temporary, non-scarring hair shedding that is caused by emotional or physiological stress. In contrast, androgenetic alopecia is a more permanent form of hair shedding caused by hormones, genetics, and environmental factors.

Can hair grow back from androgenetic alopecia?

Hair may grow back spontaneously in some people with androgenetic alopecia but not in others. However, with the proper use of prescribed medications, some hair can grow back. The goal of treatment is generally to prevent further hair loss. Without treatment, hair shedding tends to get worse over time.

Is androgenetic alopecia caused by stress?

Stress is more likely a trigger for telogen effluvium than for androgenetic alopecia. Because androgenetic alopecia is caused by hormones, it is hard to know when hair shedding will occur. Hair shedding in androgenetic alopecia is usually spontaneous and not necessarily linked to emotional or physical stress.

Summary

Androgenetic alopecia is also known as male or female pattern hair loss. Balding and a receding hairline is more common in MPHL. FPHL typically presents as thinning hair at the part line. Androgen hormones and certain genes cause androgenetic alopecia.

While it is possible for some hair to grow back spontaneously, prescription medication is the usual treatment for hair shedding. Unlike telogen effluvium, androgenetic alopecia is not linked to stress.

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Medical Reviewer: Joan Paul, MD, MPH, DTMH
Last Review Date: 2022 Dec 12
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