Androgenetic alopecia affects both men and women, but the pattern, hormonal mechanisms, treatment options, and surgical candidacy differ significantly between the sexes. Approximately 50% of men and 40% of women experience some degree of androgenetic alopecia by age 50, making it the most common cause of hair loss in both groups.
This comparison covers the key differences that affect diagnosis and treatment decisions.
How the Hair Loss Pattern Differs
The most visible difference between male and female androgenetic alopecia is how and where hair thins.
Male Pattern (Norwood Scale)
Men lose hair in a predictable, staged pattern classified by the Norwood scale:
- Recession begins at the temples, creating an M-shaped hairline
- The crown (vertex) begins thinning independently
- The two areas merge over time
- The final result is the classic "horseshoe" pattern of remaining hair
The Norwood scale grades this progression from stage 1 (no loss) to stage 7 (most extensive loss, requiring 5,500-7,500 grafts for full restoration). The frontal hairline is almost always affected.
Female Pattern (Ludwig Scale)
Women typically experience:
- Diffuse thinning across the top of the scalp
- Widening of the central part
- The frontal hairline is usually preserved
- Thinning may extend to the sides but rarely reaches the horseshoe pattern
The Ludwig scale classifies female pattern hair loss into three grades:
- Ludwig I: Mild thinning at the part line
- Ludwig II: Moderate thinning with visible scalp through the hair
- Ludwig III: Extensive thinning across the entire crown with a thin, see-through appearance
Some women present with a "Christmas tree" pattern (wider thinning toward the front of the part line), described by the Olsen classification.
Hormonal Mechanisms: Same Condition, Different Drivers
In Men
DHT is the primary culprit. The enzyme 5-alpha reductase converts testosterone into DHT, which binds to androgen receptors in susceptible follicles. This causes progressive miniaturization: each hair cycle produces a thinner, shorter, lighter hair until the follicle produces only vellus (invisible) hair.
Men have 10 to 20 times more circulating testosterone than women, producing correspondingly more DHT. This explains why male pattern loss is more aggressive and more common.
In Women
The hormonal picture is more complex:
- Androgens play a role, but circulating levels are much lower
- Estrogen is protective: It extends the anagen (growth) phase. Estrogen decline during menopause often triggers or accelerates female pattern loss
- DHEA-S, androstenedione, and free testosterone may be elevated in some women with androgenetic alopecia
- Polycystic ovary syndrome (PCOS) is a common underlying condition in premenopausal women with this type of hair loss
- Thyroid dysfunction must be ruled out, as it mimics androgenetic alopecia in women
Misdiagnosis of hair loss type leads to wrong treatment in 28% of cases. This rate is likely higher in women because the diffuse pattern of female androgenetic alopecia overlaps with telogen effluvium, iron deficiency hair loss, and thyroid-related shedding.
Diagnostic Differences
| Diagnostic Factor | Men | Women |
|---|---|---|
| Primary classification | Norwood scale (stages 1-7) | Ludwig scale (grades I-III) |
| Typical onset age | Late teens to mid-20s | 30s-40s, accelerates at menopause |
| Blood work needed | Usually not required | Often essential (hormones, iron, thyroid) |
| Scalp biopsy | Rarely needed | More frequently needed to rule out other causes |
| Family history pattern | Follows maternal grandfather pattern | Less predictable inheritance |
| Frontal hairline | Usually affected | Usually preserved |
Women presenting with hair loss should have a complete workup including: free and total testosterone, DHEA-S, ferritin, TSH, free T4, and a complete blood count. In men, blood work is typically only needed if the pattern is atypical or onset is very early.
Treatment Differences
Medications
| Treatment | Men | Women |
|---|---|---|
| Finasteride 1mg oral | First-line (80-90% halt loss) | Contraindicated in childbearing age; may be used post-menopause |
| Minoxidil topical | 5% recommended | 2% or 5% (5% more effective but may cause facial hair) |
| Oral minoxidil (low-dose) | Increasingly prescribed | Increasingly prescribed |
| Spironolactone | Not typically used | First-line anti-androgen (100-200mg daily) |
| Dutasteride | Off-label second-line | Rarely used |
| Oral contraceptives | Not applicable | Can help if PCOS or elevated androgens |
The most significant difference is that finasteride, the single most effective oral medication for androgenetic alopecia in men, cannot be used by women who may become pregnant due to the risk of birth defects in male fetuses. This limits the treatment arsenal for premenopausal women considerably.
PRP Therapy
PRP therapy ($500-$2,000 per session) appears to work for both sexes. Some studies suggest women may respond better to PRP than men because their follicles are more often in a dormant state rather than fully miniaturized. Initial protocols require 3-4 sessions followed by maintenance every 3-6 months.
Hair Transplant Suitability: A Major Divide
This is where the differences between male and female androgenetic alopecia have the most practical impact.
Why Men Are Usually Good Candidates
Men with androgenetic alopecia have a key anatomical advantage: their donor area (the horseshoe of hair around the sides and back) is resistant to DHT. These follicles maintain their characteristics permanently after transplantation. This is the fundamental principle that makes hair transplants work.
- FUE: Up to 5,000 grafts per session, 90-95% survival rate, 7-10 day recovery
- FUT: Up to 4,000 grafts per session, 90-95% survival rate, 10-14 day recovery
- DHI: Up to 3,500 grafts per session, 90-95% survival rate, uses Choi Implanter Pen
Graft requirements by Norwood stage: N2 (800-1,500), N3 (1,500-2,200), N4 (2,500-3,500), N5 (3,000-4,500), N6 (4,000-6,000), N7 (5,500-7,500).
Why Women Are Often Poor Candidates
Female androgenetic alopecia creates a problem for transplant surgery:
- Diffuse donor thinning: Unlike men, women's donor area may also be affected. Transplanting already-miniaturizing follicles produces poor results.
- No clear "safe zone": The DHT-resistant horseshoe pattern that men have is less defined in women with diffuse loss.
- Coverage challenges: Diffuse thinning requires density throughout the scalp rather than filling a defined bald area. This demands far more grafts than the donor can supply.
Women who are good transplant candidates typically have:
- A clearly defined donor area with good density
- Frontal hairline preservation with localized thinning
- A pattern that resembles male-pattern loss (sometimes called "female androgenetic alopecia with male pattern")
- Stable loss confirmed by trichoscopy showing a stable donor zone
Only about 20-30% of women with androgenetic alopecia are considered suitable transplant candidates, compared to roughly 80% of men.
Psychological and Social Impact
Research consistently shows that hair loss causes more psychological distress in women than in men, largely because:
- Female hair loss is less socially normalized
- Fewer visible role models exist for women with thinning hair
- Hairstyling options to conceal diffuse thinning are limited
- The condition is less discussed, leading to greater feelings of isolation
Both men and women benefit from early intervention. Starting treatment before significant loss occurs preserves more native hair and keeps more options available.
Age of Onset and Progression
| Factor | Men | Women |
|---|---|---|
| Earliest typical onset | 17-20 years | Mid-20s to 30s |
| Peak progression period | 25-35 years | Perimenopause (45-55) |
| Lifetime prevalence by 50 | ~50% | ~40% |
| Rate of progression | Often faster | Usually slower, more gradual |
| Complete baldness possible | Yes (Norwood 7) | Very rare (Ludwig III still retains some coverage) |
Men tend to experience more dramatic, staged loss. Women experience more gradual, diffuse change that may be harder to detect in early stages but is less likely to result in complete baldness.
Getting the Right Diagnosis
Whether you are male or female, the first step is accurately identifying your type and stage of hair loss. Different conditions require entirely different treatment approaches, and androgenetic alopecia in women in particular requires ruling out other causes before starting treatment.
Get a free AI hair loss assessment at myhairline.ai/analyze to identify your hair loss pattern and understand your options before your next dermatology appointment.
Medical Disclaimer: This article is for informational purposes only and does not constitute medical advice. Consult a board-certified dermatologist or hair restoration specialist before starting any treatment. Individual results vary based on genetics, health status, and treatment adherence.