Last reviewed: 22 May 2021
Last updated: 01 Sep 2020



History and exam

Key diagnostic factors

  • presence of risk 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

Risk factors

  • advancing age
  • polycystic ovary syndrome in women
  • insulin resistance disorders
  • prostate cancer

Diagnostic investigations

1st investigations to order

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

Investigations to consider

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

Treatment algorithm


Associate Clinical Professor

Department of Medicine

Division of Dermatology

UCLA Medical Center

Los Angeles



CG has spoken for the International Society of Hair Restoration Surgeons, the American Academy of Dermatology, the Pacific Dermatologic Association, and has had manuscripts published in a variety of journals.

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 reviewersVIEW ALL

Director of Dermatopathology

The Dermatology Group




MGH declares that he has no competing interests.

Professor of Dermatology

Emory University School of Medicine




ARS declares that he has no competing interests.

Medical Director

The Baylor Hair and Skin Research and Treatment Center




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.

Use of this content is subject to our disclaimer