History and exam

Key diagnostic factors

common

presence of risk factors

Strong risk factors include family history of baldness, advancing age, polycystic ovary syndrome, and white ethnicity.

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 the 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 hyperandrogenaemia.[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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