Androgenetic alopecia is a hair loss linked to androgens, hormones, in people who are genetically predisposed. It sets in with time and affects the top of the scalp first. Understanding this mechanism makes it possible to name your situation, to know who to consult, and to tell the useful examinations from those that serve no purpose.
Temporary shedding and androgenetic alopecia do not follow the same logic. The diagnosis therefore starts with a precise observation, not with a guess. This article explains the mechanism, the classification stages, the medical pathway and the place of cosmetic care.
Androgenetic or androgenic alopecia: the same thing?
Yes. The two expressions designate one and the same reality. Dermatologists often speak of androgenetic alopecia, and many consumer websites write androgenic alopecia. Google treats the two together: the results overlap widely, and the query "androgenic or androgenetic alopecia" comes back as a related search. The adjective changes from one author to the next, not the condition.
The word itself tells the essentials. "Androgen" designates a hormone, and "genetic" refers to an inherited predisposition. Dermato-INFO, the reference of the French Society of Dermatology, reminds us that three factors are inseparable: androgens, genetic predisposition and time. These three elements act together, and it is their combination that describes the condition.
In everyday life, people speak of baldness. At the doctor's, it is written androgenetic alopecia. This article uses both terms, so that you recognise them in a medical report as in a press article.
Androgenetic alopecia: what DHT does to the hair
The mechanism reads like a chain. Each step prepares the next, and it is the repetition of those steps that drives the loss forward.
The first step concerns testosterone. Dermato-INFO explains that it can be converted into a more active form, called DHT. VIDAL confirms that DHT, or dihydrotestosterone, derives from testosterone. It is this converted hormone that acts, in the scalp, on the follicles of predisposed people.
The second step is miniaturisation. The follicle shrinks, and the hair it produces becomes finer, shorter, fewer in number and less pigmented. Dermato-INFO and VIDAL describe this process. The CMAJ speaks of a progressive miniaturisation, which cannot be seen from one day to the next. Dermato-INFO also notes that the progression worsens with age.
The third step affects the growth cycle. VIDAL puts it plainly: "the 20 to 25 cycles meant to last a whole lifetime are exhausted within a few years". The hair therefore has less time to grow. It ends up being replaced by down, then by an area where there is almost nothing left.
Why the top of the scalp only? VIDAL specifies that only this zone is concerned, because the follicles at the sides are less sensitive to the hormone. That is what the same article calls the "Hippocratic wreath": the band of hair that persists on the sides and at the back of the head.
In women, aromatase plays an important role. Dermato-INFO explains that it converts part of the testosterone into oestrogens, and thus reduces the formation of DHT. This may partly explain why the female form is often less marked. VIDAL describes, for its part, a diffuse loss over the top of the head, never complete, with a frontal edge sometimes spared. This difference in pattern has direct consequences on the way the stages are classified, as we shall see below.
This mechanism cannot be observed on a single hair. It is measured over time, by comparing photos taken in the same place and in the same light. Dermato-INFO presents standardised photos as a tool for monitoring progression, rather than a judgement passed on a single visit.
The stages of androgenetic alopecia: Norwood in men, Ludwig in women
A classification is there to describe a progression, to compare situations and to follow a change. It does not make a diagnosis on its own. To read it correctly, a clinical examination by a professional is needed, one that places the classification back into each person's history.
In men, the reference remains Norwood's classification. Norwood published in 1975 a classification of male baldness in successive stages, in the Southern Medical Journal (PubMed). In that scheme, thinning most often starts at the temples and progresses towards the crown, leaving a wreath on the sides and at the back. Dermato-INFO offers an illustration of it, under the name American classification of androgenetic alopecia.
In women, the reference is Ludwig's classification, published in 1977 and devoted to the types of androgenetic alopecia in the female sex (PubMed). Ludwig distinguishes three grades of rarefaction of the crown, the frontal edge remaining preserved. When the pattern is of the male type, rarer in women, Ludwig refers to Hamilton's scale, or to its modification by Ebling and Rook.
Dermato-INFO reminds us that these patterns are not strictly reserved to one sex. Fitting into a box is therefore not enough to conclude, and the doctor takes the whole picture into account. A stage announced without an examination does not allow any decision to be taken. The Norwood scale for men and the Ludwig grades for women are only tools for reading a situation.
For an early landmark in men, our article on early baldness in men details the first signs and how to observe them. If your loss follows that pattern, this landmark will help you prepare for your consultation.
Who to consult for androgenetic alopecia?
The diagnosis is first of all clinical. The doctor examines the scalp, looks at where the loss is located and compares the appearance of the hair with what is expected. The CMAJ, in its article devoted to women, presents this examination as the starting point, and Dermato-INFO confirms it.
The first contact is the general practitioner, or a dermatologist. The dermatologist becomes the right entry point when the picture is not typical, or when the loss comes with itching, burning or pain. The CMAJ points out that this opinion notably makes it possible to rule out scarring alopecias, which require a different kind of management.
A specialist opinion may be necessary in one specific case. Dermato-INFO indicates that a hormonal work-up is sometimes requested in case of irregular periods or signs suggesting a hormonal imbalance. The CMAJ cites, for its part, polycystic ovary syndrome and endocrine conditions among the risk factors. These signs prove nothing on their own, but they steer the work-up towards the hormonal.
For the consultation, it is useful to bring dated photos of your scalp, taken in the same place and in the same light. Also note what has changed in recent months, whether it is the loss, the texture or the density, as well as your family history. These elements help the doctor place the progression without waiting for a single visit.
Dermato-INFO finally reminds us that androgenetic alopecia is not a disease in the strict sense, but a natural and frequent process. That precision minimises nothing. It simply invites you to consult in order to obtain an accurate diagnosis, rather than drawing conclusions from a mirror.
Androgenetic alopecia: the useful work-up and the useless tests
The work-up starts with the clinical examination and goes no further without a reason. The table below sums up what each examination brings and when it is requested, according to the sources cited for each line.
| Examination | What it brings and when | Source |
|---|---|---|
| Clinical examination | distribution of the loss and appearance of the hair, first of all | Dermato-INFO, CMAJ |
| Dermoscopy | hairs of different diameters (anisotrichosis), in the practice, to confirm | Dermato-INFO |
| Parting test | width of the parting, at the centre and at the back of the scalp, in consultation | Dermato-INFO |
| Pull test | six hairs or more pulled out easily give a positive test, but the test is often negative or localised at the centre in this form | CMAJ |
| Trichogram | helps settle a doubt, in a specialist centre | Dermato-INFO |
| Routine blood work-up | generally not necessary | Dermato-INFO |
| Ferritin and TSH | search for another diagnosis, only if another cause is suspected | CMAJ |
| Androgen measurement | generally useless, because levels are most often normal | CMAJ |
| Hormonal work-up | in case of irregular periods or signs of hormonal imbalance | Dermato-INFO |
| Scalp biopsy | usually not indicated | CMAJ |
| Standardised photos | monitoring of the progression, at regular intervals | Dermato-INFO |
The pull test deserves a precision. A positive result does not necessarily mean androgenetic alopecia, and a negative result does not exclude it either. It comes as a complement to the clinical examination and the dermatoscope, never in their place.
These examinations are discussed with the doctor, who chooses the ones that are relevant to your situation. An overly broad work-up does not guarantee a better diagnosis. Above all, it can lead away from the essential, which is the observation of the scalp and of the change over time.
What androgenetic alopecia is not
Several kinds of hair loss resemble androgenetic alopecia without being it. Differential diagnosis consists precisely in ruling them out one by one.
Telogen effluvium is the main diagnosis to consider. It causes a diffuse loss, often triggered by stress, weight loss or iron deficiency, according to the CMAJ. It is therefore distinguished by its trigger and by the distribution of the loss. For diffuse causes and their landmarks, reading the page hair loss: when to worry and hair loss in women usefully completes this passage.
Scarring alopecias form another category. The CMAJ cites them among the reasons to ask for a dermatologist's opinion when the picture is atypical. These are situations that require a precise diagnosis, and the right reflex is not to wait.
Finally, two received ideas deserve to be stated. Dermato-INFO indicates that wearing a cap or a helmet does not make the loss worse, and that stress plays a modest role in androgenetic alopecia. These precisions avoid looking for the cause in the wrong place.
Treatments: what belongs to the doctor, what belongs to the cosmetic
The treatment of androgenetic alopecia is a medical decision. Dermato-INFO cites two options. Topical minoxidil is offered to men and to women alike. Oral finasteride is reserved to men for this indication. Dosages and frequency are set with the doctor, not with an article.
Dermato-INFO also specifies that the effect of these treatments depends on continuing them. Once stopped, the loss resumes its course. That is a reason to approach them from the outset as a long-term commitment, accepting that they require regular follow-up. For the full range of solutions and the care pathway, see the page on hair loss treatments.
The cosmetic has another place. A care product applied to the scalp can support a routine and make the gesture regular, which matters a great deal for follow-up. No cosmetic will regrow an area that has been bare for a long time, and it replaces neither a diagnosis nor medical follow-up.
This is the setting in which the ORVOVA Roll-On Hair Growth Serum sits, a cosmetic containing four dosed actives: rosemary 3%, Redensyl 3%, Aminexil 2% and Anagain 2%. It contains no minoxidil and no hormones, and it is intended for men as well as women. The 25 ml roll-on lasts about one month, at a rate of one application a day, morning or evening, without rinsing. Its ball is there to apply and spread the serum over the scalp. According to the brand, the first small hairs appear between 6 and 8 weeks, and the complete cycle is judged over 3 months.
The other products of the anti-hair-loss hair care range are gathered in our anti-hair-loss hair care.
Consult without waiting if the loss is sudden, if patches appear, if the scalp itches, burns or hurts, or if hormonal signs are added to the loss.
Frequently asked questions
How do you cure androgenetic alopecia?
Androgenetic alopecia cannot be cured today. Medical management can slow the progression and, sometimes, give a partial regrowth. Its effect depends on continuing it, according to Dermato-INFO. No cosmetic cures this form of hair loss.
How do you know if it is androgenetic alopecia?
The diagnosis rests on the clinical examination. The dermatoscope can reveal hairs of different diameters, called anisotrichosis (Dermato-INFO). The pull test is often negative or localised at the centre in this form (CMAJ). A consultation makes it possible to decide, taking the whole picture into account.
What is the main cause of androgenetic alopecia?
There is no single cause, but three inseparable factors: androgens, genetic predisposition and time (Dermato-INFO). DHT is the messenger of that chain, not an isolated cause that would explain everything on its own.
Does hair grow back after androgenetic alopecia?
A partial regrowth is possible under medical management (Dermato-INFO). No result is guaranteed in advance. The decision is taken with the doctor, who assesses your situation and the follow-up to put in place for your androgenetic alopecia.
