Female
Androgenetic Alopecia: A Separate Entity
Published
in Dermatology Surgery 2000
By O'Tar Norwood, MD and Blaine Lehr, MD
IN
SPITE OF their obvious differences, doctors have always
assumed that male pattern alopecia and female pattern alopecia
were the same disease. They explained the differences by
the fact that men have much more testosterone and they
assumed females metabolized testosterone differently. A close look shows that these two are
clearly entirely different diseases for the following reasons:
1. Male pattern alopecia begins with the recession of the hairline and results in complete hair loss. Female pattern alopecia causes diffuse thinning of the hair at and behind the hairline and there is no recession of the hairline.
2. Male pattern alopecia begins in the late teens and early 20's when the testosterone levels are high. Female pattern alopecia begins in the late 30's and reaches its peak after 50 when testosterone levels are falling.
3. Male pattern alopecia affects up to 70% of all males. Female pattern alopecia affects up to 30% of women. If they were the same disease, the incidence would be the same.
4. Females with predisposition for male pattern alopecia rapidly develop typical male pattern baldness if given high doses of testosterone.
5. A recent case report by Cullen & Messenger described young women with hypopituitarism who presented with clinical and histological features of female androgenetic alopecia in the absence of detectable levels of circulation androgens or other signs of post-pubertal androgenation showing this pattern of hair loss is not androgen dependent.
6. Treatment with 5a alpha-reductase inhibitors certainly helps male pattern alopecia and has no effect on female pattern alopecia.