Androgenetic Alopecia
Hair loss is first observed in women in their late twenties to early forties, somewhat later in age than first onset in men. Unlike men the frequency of women affected does not continue to increase with increasing age. After the fifth decade of life the numbers of women with androgenetic alopecia does not increase. Androgenetic alopecia has been suggested to be present in the general female population at a rate anywhere between 20 to 40%. It is perhaps one of the best kept secrets that female androgenetic alopecia is so common.
Can women who develop androgenetic alopecia have very rapid hair loss?
Yes possibly. Some women on the keratin.com web forum have reported initially developing telogen effluvium as diagnosed by their dermatologists. This was observed after chronic stress and/or child birth. In some cases, telogen effluvium can be a trigger for the onset of androgenetic alopecia. Some women have reported that diffuse hair loss due to telogen effluvium, developing over a time span of six months to a year, later became a permanent androgenetic alopecia type hair loss. These are anecdotal observations by just a few individuals, but they claim these diagnoses were made by their dermatologists.
Rapid onset androgenetic alopecia can occur in both men and women when abnormally high levels of testosterone are produced. Thius may occur in certain diseases including Polycystic ovary syndrome (PCOS) and ovary or adrenal gland tumors.
Rapid onset of a receding hair line type baldness in women was reported by Beek in 1946. He found this form of hair loss occured after birth or miscarriage, first developing about 6 to 7 months after the event, but he claimed the hair loss was not permanent and normally recovered by 9 months. He distingushed this form of hair loss from diffuse hair loss due to pregnancy, that we would now describe as telogen effluvium.
Can a woman develop a male pattern of baldness?
Yes sometimes. Most women with androgenetic alopecia have a diffuse hair loss pattern all over the top and sides of the scalp. They do not normally have any recession of the frontal hairline, nor do they typically have a distinct bald patch on the scalp vertex. However, a few women do develop a male pattern alopecia with a receding frontal hairline. Sometimes the hair loss becomes so extensive that it looks similar to the Hamilton and Norwood type V patterns with hair loss in the vertex too.
When developing scales of androgenetic alopecia hair loss, both Hamilton and Norwood noted that some women could develop a male pattern of alopecia. Hamilton claimed that up to 25% of women developed type IV pattern scalps when over the age of 50. He did not observe male pattern alopecia in women more extensive than his type IV pattern.
Despite his observations, Hamilton developed his classification system based primarily on his observation of male hair loss. He indicated that limited hair loss in women, that today we would describe as diffuse hair loss, was equivalent to the type II pattern in his classification. In contrast, the Ludwig scale of female pattern alopecia is limited to showing diffuse hair loss. The only classification system that does include the observations that women can have a male pattern of hair loss comes from Ebling who shows diffuse hair loss for premenopausal women and a more male type alopecia for postmenopausal women.
The realization that women can have a male pattern of alopecia was first reported with supporting evidence back in 1946. Beek claimed that frontal hair loss could be seen in up to 27% of women age 35-40 who had some form of androgenetic alopecia. This rose to 64% in women age 40-70 and 100% in women over 70 years old. Looking at a a sample of the general population with or without hair loss he noted diffuse hair loss in 20% of women age 25-45 years with little variation due to age. In contrast, he found frontal hair loss rose from 0% in women younger than 25 to 26% in women age 35-45.
In a more recent and more extensive study, 564 Caucasian women were examined for their degree of hair loss and the pattern compared to the Hamilton classification system. The results revealed that male pattern baldness occurred in about 15% of those with androgenetic hair loss who were less than 50 years of age. Above 50 years of age, after menopause, the frequency of male pattern alopecia observations increased to over 30%, reaching 37% in women aged 80-89 that had some form of androgenetic alopecia.
Women can develop a male hair loss pattern when when abnormally high testosterone levels are produced. This may occur simply because an individual woman has genetics for high production rates or testosterone and/or DHEAS which can be converted to testosterone by enzymes in the steroid pathway. High testosterone levels may also develop during disease. Polycystic ovary syndrome (PCOS) is the most common disease that causes a significant elevation in testosterone concentration. Tumors in the adrenal glands or ovaries may also cause increased steroid production and male pattern alopecia.
Created in
February 2003 by Paul Boulus
Last Updated
8/03/05