Hereditary Pattern Baldness occurs in specific patterns in both males and females and is a persistent and progressive condition. However, supportive treatment or measures can help control the amount of hair loss in either gender.
Female Pattern Baldness
Female Pattern Baldness, or the inherited form of hair loss in women, also known as Androgenetic Alopecia, is similar to the pattern baldness that occurs in males, with the only difference being in the pattern in which the hair loss occurs.
It is estimated that about two-thirds of the entire female population ultimately face hair loss problems in their lifetime. This could be attributed to hormonal disturbances, age, and a family history of hair loss.
In females, the most commonly involved sites for hair loss include the scalp’s frontal, parietal, and central zones.
Causes:
The main reasons for female pattern baldness are:
- Excessive Androgens:
As the name Androgenetic Alopecia implies, this condition sees the involvement of Androgens, which may in fact be present in higher than normal quantities in females suffering from hair loss. Possible reasons for this could be an underlying endocrinological tumor, ovarian tumor, pituitary tumor, etc.
Although excessive Androgens give rise to Alopecia, the mechanism behind this form of hair loss is still unclear. - Genetics:
Genes interfere with the normal life cycle of the hair, causing the Anagen (or Hair Growth phase) to be shortened, while the time between the shedding of old hair and the regrowth of new ones in their place is increased.
This disruption ultimately causes the entire hair cycle to malfunction, and the hair follicles, which stimulate hair growth, are affected as well.
- Polycystic Ovarian Syndrome:
This is the most common endocrinological abnormality that is linked with higher rates of this type of hair loss. Females who suffer from PCOS are very likely to experience this pattern baldness at one stage or the other in their lives.
Male Pattern Baldness
Male Pattern Baldness (MPB) is more common than Female Pattern Baldness. The reason behind it predominating one gender is quite obvious – males have Androgens as one of their principal hormones, and these very Androgens cause hair loss by affecting the quality of the hair follicles on the scalp.
Although MPB can affect any age group, it is most common in older men, with 50% of men over 50 bound to lose their hair to male pattern baldness in the USA alone.
In most cases, this condition manifests itself in either a single bald patch or an M-shaped line across the circumference of the head.
Causes:
The most common causes behind this hair loss include:
- Genetics:
Genetics plays a very important role in causing pattern baldness in males, and is its most common causative factor. The reason behind this is mainly Androgen-related. Men inherit a baldness-susceptible gene from their mothers. This gene causes more Androgens to be present within the scalp receptors and ultimately, hair follicles are subjected to insults by it. This results in the men becoming bald due to the presence of faulty hair follicles.
- Other Miscellaneous Causes:
Although uncommon, several diseases may give rise to pattern baldness in males, including Anemia, Scalp Diseases, Stress and Thyroid Issues.
Some men also experience hair loss as a result of Chemotherapy, Radiation Therapy, and several medicines including Blood Thinners and Steroids.
Symptoms of male and female pattern baldness
Thinning hair
Thinning hair, or Alopecia, is a condition in which the hair thins out or falls out, resulting in overall hair loss. In men, it often presents as a receding hairline and balding on the top of the head, while in women, it is usually characterized by overall thinning, although it can be more advanced in some cases. Androgenic Alopecia, or male and female pattern baldness, is the most common cause of thinning hair and hair loss in both men and women. Men are most likely to experience a receding hairline, thinning at the crown, and a bald spot at the back of the head. On the other hand, women tend to experience diffuse thinning, widening of the midline part, and Christmas tree pattern thinning. Other symptoms associated with androgenic Alopecia include:
- Increased hair shedding.
- Decreased hair volume.
- See-through appearance on the top of the scalp.
- The increased coarseness of facial hair.
Going bald
The symptoms of going bald vary depending on whether it is male or female pattern baldness.
For male pattern baldness, the most common symptom is a receding hairline that starts at the front of the head and recedes until the person is completely bald. In female pattern baldness, hair tends to thin out all over the head, starting at the part line. Other signs of baldness include decreased hair density, hair that breaks easily, and increased shedding of hair. Sometimes, there may be a see-through area at the top of the scalp.
Hair loss in symmetrical patterns
The symptoms of hair loss in symmetrical patterns for male pattern baldness are a decrease in hair density, balding in the central scalp, usually affecting the mid-frontal, temporal, and vertex regions, thinning of hair, and nonscarring loss of terminal hairs.
The symptoms of female pattern baldness include widespread thinning across the middle of the scalp and the distinctive “Christmas tree” pattern seen down the middle of the hair due to substantial thinning in the front of the scalp with little hairline involvement and bitemporal thinning. Both sexes usually experience these symptoms soon after puberty, with hair loss progressing slowly. The scalp is healthy without associated symptoms.
Decreased Hair Density
Hair density is a measure of how many strands of hair are present in a given area of the scalp. It is a key symptom of male and female pattern baldness, as it is often reduced in affected individuals. This is due to a decrease in androgen receptors, 5 alpha-reductase types I and II activity, and aromatase activity in the scalp – all of which are hormones that are believed to play a role in the development of the condition. In men, this results in a decrease of testosterone and its peripheral metabolite, DHT, which accelerates hair loss. Women, however, typically experience a decrease in hair density without a decrease in testosterone, which suggests that other hormones may be involved in the development of female pattern baldness.
Changes in Hair Texture
Male and female pattern baldness is associated with changes in hair texture, such as a decrease in the diameter of the hairs and a decrease in the number of hairs per tuft. As androgenetic Alopecia progresses, the tufts of hairs begin to lose their volume and become thinner, eventually leading to bald patches on the scalp. These bald patches tend to have an uneven shape and appear as smooth, round areas of skin between the hairs. The changes in hair texture can cause the hair to feel coarse and brittle. Additionally, the miniaturization of the follicles can cause the scalp to become very shiny.
Hair Thinning at the Crown
Hair thinning at the crown is a condition in which the hair gradually thins out on the top and crown of the scalp. In male pattern baldness, this is usually characterized by a receding hairline, an M-shaped pattern of loss, and eventual near or complete baldness. For women, hair thinning and hair loss is more subtle, as it begins at the crown of the head and occurs evenly across the entire scalp. The front hairline remains unaffected. Additionally, hair follicles shrink, leading the hair that does grow to be thinner and finer. Symptoms may also include widening of the part and increased thinning around it, thinning throughout with a see-through area at the top of the scalp, and easy breakage.
Loss of Eyebrow Hair
The symptom of loss of eyebrow hair in male and female pattern baldness is known as eyebrow thinning or eyebrow alopecia. It is characterized by a gradual loss of the eyebrow’s hair density in a symmetrical pattern. In men, it typically appears in the form of thinning of the lateral margins of the eyebrow, while in women, it affects the whole eyebrow area. The hormone dihydrotestosterone (DHT), which causes the hair follicles around the eyebrow to shrink, is what causes this form of hair loss.
Thinning Eyelashes
Thinning eyelashes in males and females can be identified through several symptoms. In males, the most common symptom is a receding hairline, which can be observed by a widening of the forehead. This is due to the thinning of hair strands in the temple area, and can progress over a span of 10-20 years, depending on the individual’s hair care and lifestyle habits. In females, thinning eyelashes can be identified through the Ludwig Classification, with Type I being a minimal thinning that can be camouflaged through hair styling techniques.
Increased Visible Scalp Skin
Male and female pattern baldness is characterized by a receding hairline, thin patches of hair, and increased scalp skin visibility. In male pattern baldness, the scalp gradually thins in the front and on the vertex, while in female pattern baldness, thinning is most noticeable in the vertex and mid-frontal scalp. With both, the hair part of the central scalp is always thinner than that of the occipital scalp which is generally spared.
What Are The Treatment Options?
With a detailed medical history and a proper evaluation of the baseline investigations, the underlying cause which is responsible for hair loss can be found and subsequently treated.
Most popularly, Minoxidil – a potent vasodilator used for hypertension is used to promote hair growth.
Several other cosmetic procedures such as Microneedling, Platelet-rich Plasma Therapy, and Hair Transplantation are also being commonly employed for the treatment of Pattern Baldness and provide long-term results to both males and females.
Can Pattern Baldness Be Reversed?
Unfortunately, being a genetic condition, both the male and female variants of pattern baldness have no permanent cure, and only supportive management is employed to promote hair growth. Other than that, there is no definitive cure for this disease because it is engraved in your genetic makeup.
References:
- Lolli, F., Pallotti, F., Rossi, A., Fortuna, M. C., Caro, G., Lenzi, A., Sansone, A., & Lombardo, F. (2017). Androgenetic alopecia: a review. Endocrine, 57(1), 9–17. https://doi.org/10.1007/s12020-017-1280-y
- Fabbrocini, G., Cantelli, M., Masarà , A., Annunziata, M. C., Marasca, C., & Cacciapuoti, S. (2018). Female pattern hair loss: A clinical, pathophysiologic, and therapeutic review. International journal of women’s dermatology, 4(4), 203–211. https://doi.org/10.1016/j.ijwd.2018.05.001
- Cranwell W, Sinclair R. Male Androgenetic Alopecia. [Updated 2016 Feb 29]. In: Feingold KR, Anawalt B, Boyce A, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK278957/
- Wirya, C. T., Wu, W., & Wu, K. (2017). Classification of Male-pattern Hair Loss. International journal of trichology, 9(3), 95–100. https://doi.org/10.4103/ijt.ijt_46_17