Androgenetic alopecia

Last reviewed: 22 Aug 2023
Last updated: 19 May 2023



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
More key diagnostic factors

Risk factors

  • family history of baldness
  • advancing age
  • polycystic ovary syndrome in women
  • white ethnicity
  • insulin resistance
  • prostate cancer
More risk factors

Diagnostic investigations

1st investigations to order

  • hair-pull test
  • thyroid function test
  • serum ferritin
More 1st investigations to order

Investigations 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
More investigations to consider

Treatment algorithm


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



Carolyn Goh, MD

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, 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.


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




MGH declares that he has no competing interests.

Alvin R. Solomon, MD

Professor of Dermatology

Emory University School of Medicine




ARS declares that he has no competing interests.

David Whiting, MD, FACP

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.

  • 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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