Male vs. Female Pattern Baldness (Androgenetic Alopecia): What’s the Difference?

From causes to treatment options, androgenetic alopecia differs in men and women. Here are 5 ways that’s true, according to experts.

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Alopecia tends to cause hair thinning at the crown of the head in men, while it tends to cause hair loss at the top of the head in women.Shutterstock (2); Canva

Up to half of men and women will experience androgenetic alopecia. That’s the term for male and female pattern baldness, according to StatPearls. “Androgenetic hair loss is a hormonally induced genetic hair loss,” says John Browning, MD, a dermatologist with Texas Dermatology and Laser Specialists in San Antonio.

And while the condition can affect anyone, between people born male or female there are distinct differences on the age that thinning starts, what parts of the scalp it affects, and other health conditions associated with it. Knowing these differences can help you understand what’s going on with your own head of hair and learn what you and your healthcare team can do to treat it.

Here are five differences between male and female pattern baldness:

1. Compared With Women, Hair Loss Can Happen to Men at a Younger Age

While Dr. Browning will occasionally see male teens who have early-onset androgenetic alopecia, the most common age for hair loss to begin is in their thirties, he says. In fact, by age 35, two-thirds of American men will have some hair loss, according to the American Hair Loss Association.

Women typically hold onto their locks a little longer. “Women present with hair loss about 10 to 15 years later than men; women who are postmenopausal start to see more of the effects of hair loss," Browning says. For both men and women, the risk of hair loss increases with age, according to MedlinePlus.

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2. Hair Loss Affects Different Parts of the Scalp in Men vs. Women

Androgenetic alopecia does not affect every hair follicle on your scalp. That’s why men tend to thin in the front and crown of the head, while women thin on the top of scalp. What does this look like? Well, men may appear to have a receding hairline or balding spot.

For women, this pattern is different: “The frontal hairline is usually spared, and there is widening of the central part that progresses to more diffuse thinning,” says Shoshana Marmon, MD, PhD, assistant professor and director of clinical research in the department of dermatology at New York Medical College in New York City. Total baldness is rare, she adds.

You may notice that you get sunburned more easily in these areas, such as on a balding spot on the back of your head or on a part that’s growing wider to show more of your scalp, says Browning. If you’re a woman, you might pull your hair back into a braid or ponytail, only to notice that more of your scalp is peeking through or your hairline is now a bit further back.

3. In Men and Women, Different Health Conditions Tend to Play a Role

Genetics play a major role in the development of hair loss. If you have a variation of the AR gene, your hair follicles are more sensitive to an androgen called dihydrotestosterone (DHT), which is a derivative of testosterone. Higher levels of DHT leads to thinner and shorter hair follicles that eventually may stop growing hair.

Yet there are specific health conditions in men and women that may also factor into hair loss because they’re associated with higher androgen levels. In women, that’s polycystic ovary syndrome, or PCOS. In?past research, 22 of 254, or 22 percent, of women studied with PCOS also had androgenetic alopecia; in this study they were also more likely to have additional symptoms, such as acne and hirsutism. Hirustism is unwanted hair growth on the face, chest, and back, according to Mayo Clinic.

For men, prostate cancer also has potential links to male pattern baldness. One?systematic review and meta-analysis found that hair loss on the crown of the head, called the vertex, is associated with a 25 percent higher risk of prostate cancer compared with controls.

According to MedlinePlus,?male pattern baldness is also associated with coronary artery disease. But other research?suggests?that cardiovascular disease and its risk factors have been found to be associated with androgenetic alopecia in both men and women. Authors of one?past study recommend that among young patients with male or female pattern hair loss, doctors should consider early screening to detect those at risk for cardiovascular disease. Hormonal sensitivities, genetics, and inflammatory markers may be common in both people with this type of hair loss and cardiovascular problems.

4. Going on Testosterone Replacement Therapy May Promote Hair Loss in Men

In recent decades, the use of testosterone replacement therapy (TRT) in men has increased in the United States, research?notes. TRT is used to address symptoms of low-T in men, which include loss of sex drive, erectile dysfunction, loss of muscle mass, and mood problems, according to the Urology Care Foundation. (Women, too, may receive testosterone replacement to improve sexual functioning or relieve symptoms of menopause, but there is little evidence for doing so, according to Harvard Health Publishing.)

One potential side effect of TRT is hair loss on your head. “I often ask my patients who come into my office with androgenetic alopecia if they are taking any exogenous testosterone,” says Browning. Other signs may be the new development of acne or oilier-than-normal skin. The higher your testosterone levels, the more testosterone will get converted into DHT, per the?Society of Endocrinology, which can cause that miniaturization of hair follicles that leads to hair loss. If you are on TRT, make sure your T levels are being monitored closely by a healthcare professional.

5. Hair Loss Treatment Recommendations May Differ Between Men and Women

For both men and women, one of the gold standards of treatment of androgenetic alopecia is minoxidil. Minoxidil is commonly known by the brand name Rogaine, but it’s also used in other hair growth products. Men’s Rogaine is a topical that’s available in a 5 percent minoxidil strength. Women, however, will have the choice between 2 and 5 percent minoxidil products. And while these OTC options differ between both men and women, Browning advises women to also use the 5 percent product, as the 2 percent is “just not that effective,” he says.

There are also oral options that may differ between men and women. Finasteride (Propecia)?is approved by the U.S. Food and Drug Administration to treat hair loss in men. Because it may cause birth defects, it is not prescribed to women of reproductive age. It may be prescribed off-label for postmenopausal women. There is some evidence that postmenopausal women may benefit from using a topical finasteride-minoxidil combination, and these products are also readily available.

In terms of oral medication for hair loss, the antiandrogen spironolactone may be prescribed off label. Spironolactone may improve hair growth when used alone or in combination with other treatment, according to a research letter. Above all else, talk to your doctor about the treatment regimen that’s right for you.

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