Male- and Female-Pattern Hair Loss: Are They Predictable?

Is Male-Pattern Hair Loss in Your Future?

If you are an adult male with male-pattern hair loss in your close male relatives, you will probably want to know:

  • Am I going to lose hair also?
  • If so, when is hair loss likely to begin?
  • What pattern of hair loss can I expect?

You are justified in asking these questions because male-pattern hair loss is the male form of androgenetic alopecia-hair loss that occurs in genetically predisposed persons. The genetic predisposition is hereditary-that is, it "runs in families". (See About Hair Loss and Male Pattern Baldness).

The fact that male-pattern hair loss has a genetic basis does not, however, mean that (1) every male member of your family will experience male-pattern hair loss, (2) male-pattern hair loss will follow the same pattern in all male family members, or (3) male-pattern hair loss will occur at about the same time in all male family members in whom in occurs.

A higher degree of predictability may be possible in the future when research identifies (1) the specific gene or genes associated with androgenetic alopecia, and (2) the epigenetic mechanisms that regulate gene expression. Epigenetics is a fast-developing field of research that seeks to identify non-genetic mechanisms (such as regulatory proteins and ribonucleic acid [RNA] molecules) that turn genes on and off. (See Research Frontiers in Hair Loss and Hair Restoration on the See Science and Medical Articles page.)

Although the timing and pattern of male-pattern hair loss cannot be predicted with a high degree of accuracy for any individual male, there are well-documented probabilities. A physician hair restoration specialist who examines a patient's male-pattern hair loss will include these probabilities in the hair-loss assessment.

One probability is that you will be "skipped" by the genetic predisposition and experience minimal or no male-pattern hair loss. The probability is relatively low. But if male-pattern hair loss "runs in your family" and you have experienced no male-pattern hair loss by age 60, you have very probably been "skipped".

A classic study of male-pattern hair loss in adult men is that of Norwood, a principal author of the Norwood-Hamilton classification of male-pattern baldness (See About Hair Loss and Male Pattern Baldness for an illustration of the Norwood-Hamilton classification). The Norwood-Hamilton classification presents male-pattern hair loss in seven categories, with some sub-categories.

The classic Norwood study was of one thousand adult men with male-pattern hair loss who were classified by the type of male-pattern hair loss they had experienced, and at what age the hair loss occurred. Some of the findings:

  • All patterns of male-pattern hair loss tend to increase in incidence with the age of the man.
  • Types I and II, the patterns that have the least cosmetic significance, have their highest incidence in men aged 18 to 40 years. Type I is a minimal recession of hair from the frontal hairline near the temples. Type II is essentially an extension of Type I. The question that a physician hair restoration specialist will have: Is this Type I or II pattern the beginning or the end of your hair loss? Will your hair loss be progressive, and if so, how rapidly progressive and how eventually extensive? What recommendation should be made regarding hair restoration? Family history of male-pattern hair loss may be helpful in estimating probabilities for your future hair loss, but cannot be predictive with complete accuracy.
  • The "monk's tonsure" Norwood-Hamilton Type III pattern becomes more common as men age. Type III male-pattern hair loss plus recession of hair from the forehead (Types IV and V) also become more common with age.
  • Type VII, the most severe pattern of hair loss, occurred in no men under age 30 in the Norwood study, and became more prevalent in men older than age 60.

Other studies found differing percentages of hair-loss patterns by age, but the overall trends of hair loss patterns by age were similar to the Norwood study.

Female-Pattern Hair Loss

Female-pattern hair loss has been classified by Hamilton using the Norwood-Hamilton classification, and by Ludwig using a different classification of Grades 1 to 3 types of female-pattern hair loss. (See About Hair Loss and Female Pattern Baldness). The Ludwig classification emphasizes the diffuse nature of much female-pattern hair loss.

The patterns of hair loss due to androgenetic alopecia tend to be less clearly defined than those in men. Hair loss due to causes other than androgenetic alopecia are also more frequent in women but often closely resemble hair loss due to androgenetic alopecia. Hair loss in a woman-even when there is a family history of androgenetic alopecia-should never be assumed to be due to androgenetic alopecia. Examination and diagnosis by a physician hair restoration specialist is essential before any hair restoration is undertaken.

Three general patterns of female-pattern hair loss are:

1. A "Christmas tree" pattern of diffuse hair loss, with the "base" of the "tree" at the hairline and the "tip" of the "tree" at the center of the scalp, was first described in the 1990s. Since that time, the "Christmas tree" pattern has been identified as perhaps the dominant diffuse pattern of female-pattern hair loss.

2. Diffuse hair loss illustrated in the Ludwig classification. Some studies have indicated that a diffuse thinning of hair is experienced to some degree by a majority of premenopausal women and by a large majority of postmenopausal women. Whether postmenopausal hair loss is due to androgenetic alopecia may be difficult to determine as hair loss may also occur in association with aging in older women.

3. Hair loss that resembles, in some degree, male-pattern hair loss of Norwood-Hamilton Types I to VII. Female-pattern hair loss rarely progresses to Type VI and VII severity. Studies have found that a mild Norwood-Hamilton Type II recession of the hairline is experienced by many women in young adulthood, but the recession is less prominent in women than in men and may go unnoticed unless hair loss progresses. Progression to Norwood-Hamilton Type IV by age 50 to 60 was seen in some of the women studied.

Hair loss due to androgenetic alopecia occurs at all ages after puberty in women. However, onset of female-pattern hair loss appears to be most frequent at ages 20 to 30 and 40 to 50.

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