History and exam

Key diagnostic factors

common

family history of baldness

The risk of androgenetic alopecia increases with a positive family history in the father, mother, and/or maternal grandfather.[4][5][6]

gradual receding of frontal hairline, central, and crown (vertex)

Typical pattern in men.[4][5][15]

diffuse thinning of the central scalp with preservation of frontotemporal hairline

More common among women than men.[4][5][6][7][15]

Risk factors

strong

family history of baldness

The risk of androgenetic alopecia increases with a positive family history in the father, mother, and/or maternal grandfather.[4][5][6]

advancing age

Pattern hair loss is an age-dependent disorder. Based on the prevalence of data available, about 30% of men by the age of 30 years will be affected. This will rise to about 50% by the age of 50 years and to about 80% by the age of 70 years.[3][4][5] The incidence of pattern hair loss increases in women around the time of menopause and may affect up to 56% of women over the age of 70 years.[7]

polycystic ovary syndrome in women

In women, pattern hair loss is associated with an increased risk of polycystic ovary syndrome (PCOS).[7] A study of 89 women of mixed ethnic origin with pattern hair loss reported a 67% prevalence of PCOS.[14]

white ethnicity

Pattern hair loss is four times more prevalent in white people compared with African-Americans, where prevalence is similar to that of Indian and Asian men.[5][6]

weak

insulin resistance

Some studies have found an association between insulin resistance and androgenetic alopecia in men with early onset hair loss (before 35 years of age).[20][21]​​​ However, other studies have not replicated this finding​.[22]​ Insulin resistance may also increase the risk of female-pattern hair loss.[23]​ This association in women may be independent of hyperandrogenemia.[24]​​

prostate cancer

There is an association between the vertex baldness and prostate cancer, most likely related to shared androgen pathways.[25]

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