Highlights & Basics
- Androgenetic alopecia, also known as pattern hair loss, is a genetically determined, patterned, progressive loss of hair from the scalp.
- Men present with hair thinning in the temporal areas (producing a characteristic M shape) that advances to the crown (vertex) area as the alopecia progresses. Women usually have more diffuse thinning on the crown area, and less commonly present with a male-type pattern.
- Diagnosis is clinical and is based on recognizing the pattern of hair loss.
- Possible treatments are oral finasteride and/or topical minoxidil solution or foam for men, and topical minoxidil solution or foam for women.
- For women with female-pattern hair loss and concomitant hyperandrogenism (<40% of cases), additional androgen-suppressive therapy may be considered.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
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Citations
Starace M, Orlando G, Alessandrini A, et al. Female androgenetic alopecia: an update on diagnosis and management. Am J Clin Dermatol. 2020 Feb;21(1):69-84.[Abstract]
European Dermatology Forum. S3 - European Dermatology Forum guideline for the treatment of androgenetic alopecia in women and in men. 2017 [internet publication].[Full Text]
Olsen EA, Messenger AG, Shapiro J, et al. Evaluation and treatment of male and female pattern hair loss. J Am Acad Dermatol. 2005 Feb;52(2):301-11.[Abstract]
Olsen EA, Whiting D, Bergfeld W, et al. A multicenter, randomized, placebo-controlled, double-blind clinical trial of a novel formulation of 5% minoxidil topical foam versus placebo in the treatment of androgenetic alopecia in men. J Am Acad Dermatol. 2007 Nov;57(5):767-74.[Abstract]
Kaufman KD, Olsen EA, Whiting D, et al. Finasteride in the treatment of men with androgenetic alopecia. Finasteride Male Pattern Hair Loss Study Group. J Am Acad Dermatol. 1998 Oct;39(4 Pt 1):578-89.[Abstract]
Lucky AW, Piacquadio DJ, Ditre CM, et al. A randomized, placebo-controlled trial of 5% and 2% topical minoxidil solutions in the treatment of female pattern hair loss. J Am Acad Dermatol. 2004 Apr;50(4):541-53.[Abstract]
Olsen EA, Hordinsky MK, Price VH, et al. Alopecia areata investigational assessment guidelines: part II. National Alopecia Areata Foundation. J Am Acad Dermatol. 2004;51:440-7.[Abstract]
1. Norwood OT. Male pattern baldness: classification and incidence. South Med J. 1975 Nov;68(11):1359-65.[Abstract]
2. Ludwig E. Classification of the types of androgenetic alopecia (common baldness) occurring in the female sex. Br J Dermatol. 1977 Sep;97(3):247-54.[Abstract]
3. Stough D, Stenn K, Haber R, et al. Psychological effects, pathophysiology, and management of androgenic alopecia in men. Mayo Clin Proc. 2005 Oct;80(10):1316-22.[Abstract]
4. Gan DC, Sinclair RD. Prevalence of male and female pattern hair loss in Maryborough. J Investig Dermatol Symp Proc. 2005 Dec;10(3):184-9.[Abstract][Full Text]
5. Rhodes T, Girman CJ, Savin RC, et al. Prevalence of male pattern hair loss in 18-49 year old men. Dermatol Surg. 1998 Dec;24(12):1330-2.[Abstract]
6. Otberg N, Finner AM, Shapiro J. Androgenetic alopecia. Endocrinol Metabol Clin N Am. 2007 Jun;36(2):379-98.[Abstract]
7. Starace M, Orlando G, Alessandrini A, et al. Female androgenetic alopecia: an update on diagnosis and management. Am J Clin Dermatol. 2020 Feb;21(1):69-84.[Abstract]
8. Venning VA, Dawber RP. Patterned androgenic alopecia in women. J Am Acad Dermatol. 1988 May;18(5 Pt 1):1073-7.[Abstract]
9. Birch MP, Lalla SC, Messenger AG. Female pattern hair loss. Clin Exp. Dermatol. 2002 Jul;27(5):383-88.[Abstract]
10. Küster W, Happle R. The inheritance of common baldness: two B or not two B? J Am Acad Dermatol. 1984 Nov;11(5 Pt 1):921-6.[Abstract]
11. European Dermatology Forum. S3 - European Dermatology Forum guideline for the treatment of androgenetic alopecia in women and in men. 2017 [internet publication].[Full Text]
12. Bergfeld W. Androgenetic alopecia: an autosomal dominant disorder. Am J Med. 1995 Jan 16;98(1A):95S-98S.[Abstract]
13. Fabbrocini G, Cantelli M, Masarà A, et al. Female pattern hair loss: A clinical, pathophysiologic, and therapeutic review. Int J Womens Dermatol. 2018 Dec;4(4):203-11.[Abstract][Full Text]
14. Trüeb RM. Molecular mechanism of androgenetic alopecia. Exp Gerontol. 2002 Aug-Sep;37(8-9):981-90.[Abstract]
15. Olsen EA, Messenger AG, Shapiro J, et al. Evaluation and treatment of male and female pattern hair loss. J Am Acad Dermatol. 2005 Feb;52(2):301-11.[Abstract]
16. Itami S, Kurata S, Takayasu S. Androgen induction of follicular epithelial cell growth is mediated via insulin-like growth factor I from dermal papilla cells. Biochem Biophys Res Commun. 1995 Jul 26;212(3):988-94.[Abstract]
17. Harris G, Azzolina B, Baginsky W, et al. Identification and selective inhibition of an isoenzyme of steroid 5 alpha -reductase in human scalp. Proc Natl Acad Sci. 1992 Nov 15;89(22):10787-91.[Abstract][Full Text]
18. Chen W, Thiboutot D, Zouboulis CC. Cutaneous androgen metabolism: basic research and clinical perspectives. J Invest Dermatol. 2002 Nov;119(5):992-1007.[Abstract][Full Text]
19. Jeong KH, Jung JH, Kim JE, et al. Prostaglandin D2-Mediated DP2 and AKT Signal Regulate the Activation of Androgen Receptors in Human Dermal Papilla Cells. Int J Mol Sci. 2018 Feb 12;19(2):556.[Abstract][Full Text]
20. González-González JG, Mancillas-Adame LG, Fernández-Reyes M, et al. Androgenetic alopecia and insulin resistance in young men. Clin Endocrinol (Oxf). 2009 Oct;71(4):494-9.[Abstract]
21. Mumcuoglu C, Ekmekci TR, Ucak S. The investigation of insulin resistance and metabolic syndrome in male patients with early-onset androgenetic alopecia. Eur J Dermatol. 2011 Jan-Feb;21(1):79-82.[Abstract]
22. Nabaie L, Kavand S, Robati RM, et al. Androgenic alopecia and insulin resistance: are they really related? Clin Exp Dermatol. 2009 Aug;34(6):694-7.[Abstract]
23. Matilainen V, Laakso M, Hirsso P, et al. Hair loss, insulin resistance, and heredity in middle-aged women. A population-based study. J Cardiovasc Risk. 2003 Jun;10(3):227-31.[Abstract]
24. Kartal D, Borlu M, Çınar SL, et al. The association of androgenetic alopecia and insulin resistance is independent of hyperandrogenemia: a case-control study. Australas J Dermatol. 2016 Aug;57(3):e88-92.[Abstract]
25. Giles GG, Severi G, Sinclair R, et al. Androgenetic alopecia and prostate cancer: findings from an Australian case-control study. Cancer Epidemiol Biomarkers Prev. 2002 Jun;11(6):549-53.[Abstract][Full Text]
26. Arias-Santiago S, Gutiérrez-Salmerón MT, Castellote-Caballero L, et al. Androgenetic alopecia and cardiovascular risk factors in men and women: a comparative study. J Am Acad Dermatol. 2010 Sep;63(3):420-9.[Abstract]
27. Whiting DA, Olsen EA, Savin R, et al. Efficacy and tolerability of finasteride 1 mg in men aged 41 to 60 years with male pattern hair loss. Eur J Dermatol. 2003 Mar-Apr;13(2):150-60.[Abstract]
28. Springer K, Brown M, Stulberg DL. Common hair loss disorders. Am Fam Physician. 2003 Jul 1;68(1):93-102.[Abstract]
29. Drake LA, Dinehart SM, Farmer ER, et al. Guidelines of care for androgenetic alopecia. J Am Acad Dermatol. 1996 Sep;35(3 Pt 1):465-9.[Abstract]
30. Goodman NF, Bledsoe MB, Cobin RH, et al. American Association of Clinical Endocrinologists medical guidelines for the clinical practice for the diagnosis and treatment of hyperandrogenic disorders. Endocr Pract. 2001 Mar-Apr;7(2):120-34.[Abstract]
31. Shapiro J. Clinical practice. Hair loss in women. N Engl J Med. 2007 Oct 18;357(16):1620-30.[Abstract]
32. Gupta AK, Venkataraman M, Talukder M, et al. Relative efficacy of minoxidil and the 5-alpha reductase inhibitors in androgenetic alopecia treatment of male patients: a network meta-analysis. JAMA Dermatol. 2022 Mar 1;158(3):266-74.[Abstract][Full Text]
33. Olsen EA, Whiting D, Bergfeld W, et al. A multicenter, randomized, placebo-controlled, double-blind clinical trial of a novel formulation of 5% minoxidil topical foam versus placebo in the treatment of androgenetic alopecia in men. J Am Acad Dermatol. 2007 Nov;57(5):767-74.[Abstract]
34. Adil A, Godwin M. The effectiveness of treatments for androgenetic alopecia: a systematic review and meta-analysis. J Am Acad Dermatol. 2017 Jul;77(1):136-41.e5.[Abstract]
35. Buhl AE, Waldon, DJ, Conrad SJ, et al. Potassium channel conductance: a mechanism affecting hair growth both in vitro and in vivo. J Invest Dermatol. 1992 Mar;98(3):315-9.[Abstract]
36. Price VH, Menefee E, Strauss PC. Changes in hair weight and hair count in men with androgenetic alopecia after application of 5% and 2% topical minoxidil, placebo, or no treatment. J Am Acad Dermatol. 1999 Nov;41(5 Pt 1):717-21.[Abstract]
37. Olsen EA, Dunlap FE, Funicella T, et al. A randomized clinical trial of 5% topical minoxidil versus 2% topical minoxidil and placebo in the treatment of androgenetic alopecia in men. J Am Acad Dermatol. 2002 Sep;47(3):377-85.[Abstract]
38. Tsuboi R, Arano O, Nishikawa T, et al. Randomized clinical trial comparing 5% and 1% topical minoxidil for the treatment of androgenetic alopecia in Japanese men. J Dermatol. 2009 Aug;36(8):437-46.[Abstract]
39. Kanti V, Hillmann K, Kottner J, et al. Effect of minoxidil topical foam on frontotemporal and vertex androgenetic alopecia in men: a 104-week open-label clinical trial. J Eur Acad Dermatol Venereol. 2016 Jul;30(7):1183-9.[Abstract]
40. Kaufman KD, Olsen EA, Whiting D, et al. Finasteride in the treatment of men with androgenetic alopecia. Finasteride Male Pattern Hair Loss Study Group. J Am Acad Dermatol. 1998 Oct;39(4 Pt 1):578-89.[Abstract]
41. Lee S, Lee YB, Choe SJ, et al. Adverse Sexual Effects of Treatment with Finasteride or Dutasteride for Male Androgenetic Alopecia: A Systematic Review and Meta-analysis. Acta Derm Venereol. 2019 Jan 1;99(1):12-17.[Abstract][Full Text]
42. Nguyen DD, Marchese M, Cone EB, et al. Investigation of suicidality and psychological adverse events in patients treated with finasteride. JAMA Dermatol. 2021 Jan 1;157(1):35-42.[Abstract][Full Text]
43. Blume-Peytavi U, Hillmann K, Dietz E, et al. A randomized, single-blind trial of 5% minoxidil foam once daily versus 2% minoxidil solution twice daily in the treatment of androgenetic alopecia in women. J Am Acad Dermatol. 2011 Dec;65(6):1126-1134.e2.[Abstract]
44. Lucky AW, Piacquadio DJ, Ditre CM, et al. A randomized, placebo-controlled trial of 5% and 2% topical minoxidil solutions in the treatment of female pattern hair loss. J Am Acad Dermatol. 2004 Apr;50(4):541-53.[Abstract]
45. Yeon JH, Jung JY, Choi JW, et al. 5 mg/day finasteride treatment for normoandrogenic Asian women with female pattern hair loss. J Eur Acad Dermatol Venereol. 2011 Feb;25(2):211-4.[Abstract]
46. Oliveira-Soares R, E Silva JM, Correia MP, et al. Finasteride 5 mg/day Treatment of Patterned Hair Loss in Normo-androgenetic Postmenopausal Women. Int J Trichology. 2013 Jan;5(1):22-5.[Abstract][Full Text]
47. Price VH, Roberts JL, Hordinsky M, et al. Lack of efficacy of finasteride in postmenopausal women with androgenetic alopecia. J Am Acad Dermatol. 2000 Nov;43(5 pt 1):768-76.[Abstract]
48. Sinclair R, Wewerinke M, Jolley D. Treatment of female pattern hair loss with oral antiandrogens. Br J Dermatol. 2005 Mar;152(3):466-73.[Abstract]
49. Ismail FF, Meah N, Trindade de Carvalho L, et al. Safety of oral bicalutamide in female pattern hair loss: a retrospective review of 316 patients. J Am Acad Dermatol. 2020 Nov;83(5):1478-9.[Abstract]
50. Fernandez-Nieto D, Saceda-Corralo D, Jimenez-Cauhe J, et al. Bicalutamide: a potential new oral antiandrogenic drug for female pattern hair loss. J Am Acad Dermatol. 2020 Nov;83(5):e355-6.[Abstract]
51. Raudrant D, Rabe T. Progestogens with antiandrogenic properties. Drugs. 2003;63(5):463-92.[Abstract]
52. Sadick NS, White MP. Basic hair transplantation: 2007. Dermatol Ther. 2007 Nov-Dec;20(6):436-47.[Abstract]
53. Lueangarun S, Panchaprateep R, et al. J Am Acad Dermatol. May 2015; Volume 72, Issue 5, Supplement 1, Page AB113
54. Chan L, Cook DK. Female pattern hair loss. Aust J Gen Pract. 2018 Jul;47(7):459-464.[Abstract][Full Text]
55. Olsen EA, Hordinsky MK, Price VH, et al. Alopecia areata investigational assessment guidelines: part II. National Alopecia Areata Foundation. J Am Acad Dermatol. 2004;51:440-7.[Abstract]
56. Gubelin Harcha W, Barboza Martínez J, Tsai TF, et al. A randomized, active- and placebo-controlled study of the efficacy and safety of different doses of dutasteride versus placebo and finasteride in the treatment of male subjects with androgenetic alopecia. J Am Acad Dermatol. 2014 Mar;70(3):489-98.e3.[Abstract]
57. Kim H, Choi JW, Kim JY, et al. Low-level light therapy for androgenetic alopecia: a 24-week, randomized, double-blind, sham device-controlled multicenter trial. Dermatol Surg. 2013 Aug;39(8):1177-83.[Abstract]
58. Lanzafame RJ, Blanche RR, Bodian AB, et al. The growth of human scalp hair mediated by visible red light laser and LED sources in males. Lasers Surg Med. 2013 Oct;45(8):487-95.[Abstract]
59. Chen JX, Justicz N, Lee LN. Platelet-Rich Plasma for the Treatment of Androgenic Alopecia: A Systematic Review. Facial Plast Surg. 2018 Dec;34(6):631-640.[Abstract][Full Text]
60. Drake L, Hordinsky M, Fiedler V, et al. The effects of finasteride on scalp skin and serum androgen levels in men with androgenetic alopecia. J Am Acad Dermatol. 1999 Oct;41(4):550-4.[Abstract]
61. Plante J, Robinson I, Elston D. The need for potassium monitoring in women on spironolactone for dermatologic conditions. J Am Acad Dermatol. 2022 Nov;87(5):1097-9.[Abstract]
62. Plovanich M, Weng QY, Mostaghimi A. Low usefulness of potassium monitoring among healthy young women taking spironolactone for acne. JAMA Dermatol. 2015 Sep;151(9):941-4.[Abstract][Full Text]
63. Lee KS, Zhang JJY, Kirollos R, et al. A systematic review and meta-analysis of the association between cyproterone acetate and intracranial meningiomas. Sci Rep. 2022 Feb 4;12(1):1942.[Abstract][Full Text]
