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

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By Staff
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3. Hair Loss Is Linked to Different Health Conditions in Men and Women

Genetics — specifically, the androgen receptor gene — plays a major role in male and female hair loss. If you have a variation in this gene, your hair follicles are more sensitive to an androgen called dihydrotestosterone (DHT), which is a derivative of testosterone. Higher levels of DHT lead to thinner and shorter hair follicles (the tubelike structures that produce strands of hair), which may eventually stop growing hair altogether.

Androgen sensitivity, though, can be linked to different health conditions for men and women. Up to 67 percent of women with androgenetic alopecia, for example, also have polycystic ovary syndrome (PCOS), a hormone disorder that can cause hirsutism, or unwanted hair growth on the face, chest, and back.
Men who have androgenetic alopecia may have an increased risk of coronary artery disease, a type of heart disease in which the blood vessels that supply blood to the heart narrow and become blocked. In fact, one study suggested that androgenetic alopecia can be used as a screening method for coronary artery disease.

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. TRT is used to address symptoms of low T in men, including erectile dysfunction, loss of muscle mass, loss of sex drive, and mood problems. (While women, too, may receive testosterone replacement to improve sexual functioning or relieve symptoms of menopause, there is little evidence for doing so, so it is not widely prescribed.)

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 [supplemental] 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 be converted into DHT, which can cause the hair follicles to shrink and lead to hair loss. If you are on TRT, make sure your T levels are monitored closely by a healthcare professional.

5. Men and Women May Receive Different Treatment Recommendations

For both men and women, one of the gold standards of androgenetic alopecia treatment 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 solution that’s available in a 5 percent minoxidil strength. Women have the choice of 2 or 5 percent minoxidil products. Browning, though, advises women to 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, but because it may cause birth defects, it is not prescribed to women of reproductive age. It may be prescribed off label for postmenopausal women. Another option is an antiandrogen medication called spironolactone, which can also be prescribed off label. Spironolactone may improve hair growth when used alone or in combination with other treatments. (It may also be prescribed for women with PCOS, because they tend to make excess androgen.) Talk to your doctor about the treatment regimen that’s right for you.

6. Men’s and Women’s Experiences With Hair Loss Differ

Even though hair loss affects both men and women, women may deal with more stigma from it. “Androgenetic alopecia presents earlier in life for most men, compared to women,” says Kristen Lo Sicco, MD, a dermatologist at NYU Langone Dermatologic Associates in New York City. So, “Society often expects men to have hair loss at some point. … As a result, many men experiencing hair loss may not receive unsolicited comments regarding their health.

That’s not to say hair loss doesn’t affect men’s confidence. It absolutely can, she says, and could take a toll on both their personal and professional lives. But hair loss can be more serious for women, who may be asked more personal questions, such as whether they have cancer.

The beauty of a woman can sometimes be defined by her hair, says Ken L. Williams Jr., DO, a surgeon and the founder of Orange County Hair Restoration in Irvine, California. He treats more women than men. When hair loss happens to a woman, it can be devastating, he says.

Whether you’re a man or a woman, it’s important to know who you are, says Dr. Williams. “We are not defined by our appearance but who we are emotionally and spiritually.”

The Takeaway

  • Androgenetic alopecia affects both men and women, but the causes, manifestations, and even treatments may differ.
  • Men generally start losing hair at least a decade earlier than women. In men, hair loss is most often seen on the frontal hairline, while women will see it as a widening of the part.
  • Minoxidil is a common treatment for both men and women, but there are two strengths available for women.

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