Androgenic alopecia (AGA), also known as androgenetic alopecia, is the most common type of hair loss, driven by a combination of genetic factors and androgen hormones. This condition affects approximately 80% of men and 40% of women at some point in their lives.
When it comes to prevalence across races, Caucasian men top the list, with 50% experiencing androgenic alopecia by age 50. In comparison, Japanese and Chinese men follow with a 21% rate, while Koreans and Africans show a lower prevalence at 14%. Native Americans, however, experience androgenic alopecia the least.
What Is Androgenic Alopecia?
Androgenic alopecia, often referred to as male or female pattern hair loss, is a hereditary condition where hair follicles undergo miniaturization, leading to increased hair loss in both men and women. This miniaturization disrupts the hair growth cycle, causing follicles to shrink and reducing their ability to produce hair. Typically, these follicles, which once grew thick hair, begin producing thin vellus hair—or, in some cases, stop growing hair entirely. Understanding what is androgenic alopecia is the first step to recognizing its impact and exploring treatment options.
Is Androgenic Alopecia Genetic?
Yes, this form of hair loss is genetically influenced, making it a polygenic condition. A recent study by Dr. Molly Quinn and Dr. Kanade Shinkai identified 287 genes linked to androgenic alopecia. The most significant of these is the Androgen Receptor (AR) gene, located on the X chromosome. Since we inherit our genes from our parents, your risk of developing androgenic alopecia increases if your parents have it. This genetic connection explains why it’s often referred to as hereditary hair loss.
Is Androgenic Alopecia Influenced by Environmental Factors?
Beyond genetics, environmental factors also play a role in this hair loss condition. Research has shown that habits like smoking and alcohol consumption can contribute to androgenic alopecia. A 2020 study on the effects of cigarette smoking revealed that genetically predisposed individuals who smoke experience hair loss more frequently than non-smokers. Another study, published in Clinical and Experimental Dermatology, involving Korean patients, found that smoking and alcohol use can worsen the severity of AGA as people age.
Is Androgenic Alopecia an Autoimmune Disease?
No, androgenic alopecia is not an autoimmune disease. In autoimmune conditions, the immune system attacks healthy cells, but this doesn’t happen with AGA. Instead, androgenic alopecia is tied to genetics and hormonal changes, not immune system activity.
Symptoms of Androgenic Alopecia
The symptoms of androgenic alopecia differ between men and women, presenting distinct patterns of hair loss.
Early Symptoms
Recognizing the early signs of androgenic alopecia is key to addressing it effectively. Catching these symptoms early can improve your chances of restoring hair thickness and density.
Early Symptoms in Men:
- Thinning hair
- Decreased hair density
- Receding hairline
- Visible hair whorl
Early Symptoms in Women:
- Diffuse hair thinning
- Widening of the middle part
Late-Stage Symptoms
In the later stages of androgenic alopecia, treatments can help maintain your current hair condition rather than reverse the loss entirely.
Late-Stage Male Hair Loss:
- Balding in the frontal area
- Thinning across the mid-scalp
- Crown (vertex) baldness
Late-Stage Female Hair Loss:
- Diffuse hair loss across the upper scalp
- Reduced hair density
- Visible scalp
⚠️ Note: Unlike men, women typically retain their hairline even in the late stages of androgenic alopecia in women.
Which Areas Are Most Commonly Affected by Androgenic Alopecia?
Androgenic alopecia primarily affects the upper part of the scalp, while the lower areas typically remain untouched by hair loss. The upper scalp includes:
- Hairline
- Mid-scalp
- Vertex (crown)
This pattern explains why androgenic alopecia in women and men often presents as thinning or baldness concentrated in these specific regions, making it a hallmark of this condition.
Does Androgenic Alopecia Affect the Eyebrows?
No, androgenic alopecia does not impact the eyebrows—it’s limited to the scalp. There’s no research linking AGA to eyebrow hair loss. Other types of hair loss, such as alopecia areata, telogen effluvium, and trichotillomania, are known to affect the eyebrows, but androgenic alopecia remains scalp-specific.
Can You Lose All Your Hair with Androgenic Alopecia?
With androgenic alopecia, it’s possible to lose all the hair on the upper part of the scalp. The hormone dihydrotestosterone (DHT), a key player in AGA, is more active on the top of the head. This is why complete baldness typically occurs only in the upper scalp area, leaving the sides and back less affected. For those wondering, “Do people with androgenic alopecia still have their hair follicles?”—yes, the follicles remain, but they shrink and may stop producing visible hair.
What Causes Androgenic Alopecia?
As the term “andro-genetic” suggests, androgenic alopecia is triggered by a mix of androgen hormones and genetics. However, the causes of this hair loss condition vary slightly between men, women, and children.
Men:
Two primary factors drive androgenic alopecia in men:
- Genetics
- Dihydrotestosterone (DHT)
In men, testosterone is converted into DHT by an enzyme called 5α-reductase (5AR). If this enzyme is highly active, more testosterone transforms into DHT. For those genetically predisposed to AGA, elevated DHT levels disrupt the natural hair growth cycle, shortening it and leading to male pattern hair loss.
Women:
The causes of androgenic alopecia in women differ from men and are less straightforward. They’re believed to involve:
- Genetics
Genetics play a major role in androgenic alopecia in women. A study published inDermatologic Therapy found that over 50% of women with AGA have a family member with the condition. However, unlike in men, genetics may not be the sole contributor. - Hormones
Research suggests that high androgen levels can contribute to female pattern hair loss (FPHL), while other studies point to an imbalance between androgens and estrogen. Aging naturally shifts hormone levels in women, increasing the likelihood of AGA over time. - Environmental Factors
Environmental influences, like vitamin D deficiency, also factor into androgenic alopecia in women. Reports indicate that low vitamin D levels are a common issue in female hair loss cases.
Children:
The causes of androgenic alopecia in children are not fully understood, but genetics is considered the leading factor. A study in the Journal of the American Academy of Dermatology revealed that 3 out of 4 children with AGA had a family member with the condition, highlighting the strong hereditary link.
Can Stress Cause Androgenic Alopecia?
No, stress does not cause androgenic alopecia. While stress can heighten susceptibility to other hair loss conditions like telogen effluvium, alopecia areata, or trichotillomania, it’s not a factor in AGA. If you suspect stress-related hair loss, consult your doctor for an accurate diagnosis to rule out other causes.
Does PCOS Cause Androgenic Alopecia?
Yes, polycystic ovary syndrome (PCOS) can trigger androgenic alopecia. PCOS increases androgen levels, which may lead to hair loss in women. A study by Dr. Molly Quinn and Dr. Kanade Shinkai found that 22% of women diagnosed with PCOS also had androgenic alopecia, highlighting a significant link between the two conditions.
Can Medications Cause Androgenic Alopecia?
No, androgenic alopecia is not caused by medications. Drug-induced hair loss typically falls under categories like anagen effluvium or telogen effluvium. For a precise diagnosis of medication-related hair loss, it’s best to see a healthcare professional.
At What Age Does Androgenic Alopecia Start?
Androgenic alopecia typically begins in the early 20s, post-puberty, though noticeable symptoms often emerge in the 30s. The reason it starts after puberty is the rise in testosterone production, which converts to dihydrotestosterone (DHT) on the scalp. For AGA to occur, sufficient testosterone must be present to transform into DHT, miniaturizing follicles and causing hair loss.
Does Androgenic Alopecia Stop?
No, androgenic alopecia doesn’t stop on its own. Without proper intervention, AGA progresses over time. Androgenic alopecia treatments can slow or halt hair loss, but their effects last only as long as the treatment continues. Medications can’t alter your genetic predisposition, though they can manage contributing factors effectively during use.
Is Androgenic Alopecia Reversible?
Androgenic alopecia is reversible to some extent. If treatment begins in the early stages, much of the original hair thickness can be restored. However, in the late stages of androgenic alopecia, treatments can’t fully reverse the condition—they can only maintain the current state and prevent further loss.
Is Androgenic Alopecia in Women Reversible?
Androgenic alopecia in women can be reversed if treatment starts early. Early intervention can restore hair thickness and promote healthy growth. However, if treatment begins in the late stages, reversing the hair loss becomes unlikely. At that point, follicles lose their ability to produce healthy hair, though treatment can still help preserve what remains.
How Is Androgenic Alopecia Diagnosed?
Diagnosing androgenic alopecia involves a physical exam, hair root analysis, and specific tests to pinpoint the cause of hair loss.
Trichoscopy
Trichoscopy uses a dermatoscope—a handheld device—to examine the scalp and hair roots up close. It reveals the condition of follicles and strands. Common signs of AGA in trichoscopy include:
- A hair diameter variation of over 20%
- More than 10% thin hairs
- An increase in follicles producing single strands
Hamilton-Norwood Scale (for Men)
The Hamilton-Norwood Scale classifies androgenic alopecia in men across 7 stages, indicating the severity of male pattern hair loss. These stages track progression from a receding hairline to advanced baldness.
Ludwig Scale (for Women)
The Ludwig Scale measures the severity of androgenic alopecia in women across 3 stages:
- Mild thinning or loss on the crown
- Progressive thinning with a wider part and more visible scalp
- Severe hair loss or complete baldness on the crown, with the scalp fully exposed
Blood Tests
Blood tests for AGA focus on hormone levels. High androgen or low estrogen levels can signal androgenic alopecia, and these tests provide clarity on hormonal influences.
Hair Pull Test
The hair pull test checks for active hair loss. About 50 strands are gently grasped near the scalp with the thumb, index, and middle fingers, then tugged upward. Losing more than 10% of the pulled hairs indicates ongoing hair loss.
A Sample Diet for Androgenic Alopecia
Ernährung bei androgenetischer Alopezie
Below is a sample diet tailored for androgenic alopecia, inspired by the Mediterranean approach, which may support hair health. A diet rich in plant-based foods, particularly those high in antioxidants, can complement androgenic alopecia treatment efforts.
Breakfast | Snack | Lunch | Snack | Dinner |
Scrambled eggs | Veggie smoothie | Lentil soup | Dried fruits | Broccoli soup |
Whole-grain bread | Tuna salad | Lemon-dill salmon | ||
Orange juice | Whole-grain bread | Couscous |
Focusing on antioxidant-rich, plant-based foods may help reduce the activity of enzymes like 5α-reductase, which converts testosterone into DHT—the hormone driving androgenic alopecia. This dietary approach can’t cure AGA but may support overall hair health.
Can I Dye My Hair If I Have Androgenic Alopecia?
Yes, you can dye your hair if you have androgenic alopecia—it won’t affect hair growth. Hair dye works on the hair strands, not the follicles, so it doesn’t interfere with the condition. While it might weaken the hair shaft, it has no impact on follicle function or the progression of hair loss androgenic alopecia.
What’s the Difference Between Telogen Effluvium and Androgenic Alopecia?
Androgenic alopecia and telogen effluvium differ in their causes, duration, progression, and treatment needs. Here’s a clear comparison to help distinguish between the two:
Telogen Effluvium:
- Cause:Triggered by physical or emotional stress
- Duration:Temporary, typically lasts about 6 months
- Onset:Sudden, occurring 1-3 months after a stressful event
- Progression:Resolves on its own without intervention
- Pattern:Diffuse hair shedding across the scalp
Androgenic Alopecia:
- Cause:Driven by genetics and hormones
- Duration:Permanent unless treated
- Onset:Slow and progressive, potentially spanning 25 years
- Progression:Patterned hair loss—receding hairline and crown thinning in men; diffuse upper scalp thinning in women
- Treatment:Requires androgenic alopecia treatment to slow or stop hair loss
Understanding these differences can clarify whether you’re dealing with a temporary shedding phase or the chronic condition of androgenic alopecia. For those asking, “What is androgenic alopecia?”—it’s a genetically influenced, hormone-driven form of hair loss, distinct from stress-induced conditions like telogen effluvium.
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