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Can
a woman develop a male pattern of baldness
Yes sometimes. Most women with androgenetic alopecia have a diffuse
hair loss pattern all over the top and sides of the scalp. They
do not normally have any recession of the frontal hairline, nor
do they typically have a distinct bald patch on the scalp vertex.
However, a few women do develop a male pattern alopecia with a receding
frontal hairline. Sometimes the hair loss becomes so extensive that
it looks similar to the Hamilton and Norwood type V patterns with
hair loss in the vertex too.
When developing scales of androgenetic alopecia hair loss, both
Hamilton and Norwood noted that some women could develop a male
pattern of alopecia. Hamilton claimed that up to 25% of women developed
type IV pattern scalps when over the age of 50. He did not observe
male pattern alopecia in women more extensive than his type IV pattern.
Despite his observations, Hamilton developed his classification
system based primarily on his observation of male hair loss. He
indicated that limited hair loss in women, that today we would describe
as diffuse hair loss, was equivalent to the type II pattern in his
classification. In contrast, the Ludwig scale of female pattern
alopecia is limited to showing diffuse hair loss. The only classification
system that does include the observations that women can have a
male pattern of hair loss comes from Ebling who shows diffuse hair
loss for premenopausal women and a more male type alopecia for postmenopausal
women.
The realization that women can have a male pattern of alopecia
was first reported with supporting evidence back in 1946. Beek claimed
that frontal hair loss could be seen in up to 27% of women age 35-40
who had some form of androgenetic alopecia. This rose to 64% in
women age 40-70 and 100% in women over 70 years old. Looking at
a a sample of the general population with or without hair loss he
noted diffuse hair loss in 20% of women age 25-45 years with little
variation due to age. In contrast, he found frontal hair loss rose
from 0% in women younger than 25 to 26% in women age 35-45.
In a more recent and more extensive study, 564 Caucasian women
were examined for their degree of hair loss and the pattern compared
to the Hamilton classification system. The results revealed that
male pattern baldness occurred in about 15% of those with androgenetic
hair loss who were less than 50 years of age. Above 50 years of
age, after menopause, the frequency of male pattern alopecia observations
increased to over 30%, reaching 37% in women aged 80-89 that had
some form of androgenetic alopecia.
Women can develop a male hair loss pattern when when abnormally
high testosterone levels are produced. This may occur simply because
an individual woman has genetics for high production rates or testosterone
and/or DHEAS which can be converted to testosterone by enzymes in
the steroid pathway. High testosterone levels may also develop during
disease. Polycystic ovary syndrome (PCOS) is the most common disease
that causes a significant elevation in testosterone concentration.
Tumors in the adrenal glands or ovaries may also cause increased
steroid production and male pattern alopecia.
Can
a woman develop a male pattern of baldness references
- Beek
CH. Calvities frontalis bei frauen. Dermatologica. 1946;3(4):213-8
- Hamilton
JB. Patterned loss of hair in man: types and incidence. Ana N
Y Acad Dermatol 1951:53;708-28
- Venning
VA, Dawber RP. Patterned androgenic alopecia in women. J Am Acad
Dermatol. 1988 May;18(5 Pt 1):1073-7.
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