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Androgenetic alopecia

Last reviewed: 21 Oct 2024
Last updated: 19 May 2023

Summary

Definition

History and exam

Key diagnostic factors

  • family history of baldness
  • gradual receding of frontal hairline, central, and crown (vertex)
  • diffuse thinning of the central scalp with preservation of frontotemporal hairline
Full details

Risk factors

  • family history of baldness
  • advancing age
  • polycystic ovary syndrome in women
  • white ethnicity
  • insulin resistance
  • prostate cancer
Full details

Diagnostic tests

1st tests to order

  • hair-pull test
  • thyroid function test
  • serum ferritin
Full details

Tests to consider

  • CBC with differential
  • comprehensive metabolic panel
  • antinuclear antibodies
  • rapid plasma reagin
  • free testosterone
  • serum dehydroepiandrosterone (DHEA)-sulfate
  • sex hormone-binding globulin
  • dermatoscopy/trichoscopy
  • scalp biopsy
Full details

Treatment algorithm

ONGOING

men who opt for conservative management

men who opt for medical management

women who opt for conservative management

women who opt for medical management

failed medical treatment

Contributors

Authors

Carolyn Goh, MD

Associate Clinical Professor

Department of Medicine

Division of Dermatology

UCLA Medical Center

Los Angeles

CA

Disclosures

CG has spoken for the International Society of Hair Restoration Surgeons, the American Academy of Dermatology, the Pacific Dermatologic Association, the California Society of Dermatology and Dermatologic Surgery, and has had manuscripts published in a variety of journals. CG has also participated in advisory boards for Pelage Pharmaceuticals and Pfizer, Inc.

Acknowledgements

Dr Carolyn Goh would like to gratefully acknowledge Dr Robert Haber, Dr Christiane Querfeld, and Dr Christopher R. Shea, previous contributors to this topic. RH has an ownership interest in a company that manufactures light-based hair growth devices and receives royalties for the sales of a surgical device used in hair restoration surgery. CQ and CRS declare that they have no competing interests.

Peer reviewers

Marcelo G. Horenstein, MD

Director of Dermatopathology

The Dermatology Group

Verona

NJ

Disclosures

MGH declares that he has no competing interests.

Alvin R. Solomon, MD

Professor of Dermatology

Emory University School of Medicine

Atlanta

GA

Disclosures

ARS declares that he has no competing interests.

David Whiting, MD, FACP

Medical Director

The Baylor Hair and Skin Research and Treatment Center

Dallas

TX

Disclosures

DW is an author of a number of references cited in this topic. We have since been made aware that Dr David Whiting is deceased.

  • Androgenetic alopecia images
  • Differentials

    • Diffuse alopecia areata
    • Acute telogen effluvium
    • Chronic telogen effluvium
    More Differentials
  • Guidelines

    • S3 - European dermatology forum guideline for the treatment of androgenetic alopecia in women and in men
    • Medical guidelines for clinical practice for diagnosis and treatment of hyperandrogenic disorders
    More Guidelines
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