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Female pattern hair loss (androgenetic alopecia in women): Pathogenesis, clinical features, and diagnosis

Amy McMichael, MD
Section Editor
Maria Hordinsky, MD
Deputy Editor
Abena O Ofori, MD


Female pattern hair loss (FPHL) is a common form of nonscarring hair loss that primarily occurs in adult women. The condition is characterized by the progressive loss of terminal hairs over the frontal and vertex regions of the scalp, resulting in a visible reduction in hair density (picture 1A-C). Unlike many cases of androgenetic alopecia in men (male pattern hair loss), the loss of terminal hairs in affected areas is usually incomplete and the frontal hairline is often spared.  

The pathogenesis, clinical manifestations, and diagnosis of FPHL will be reviewed here. Other forms of nonscarring hair loss and the treatment of FPHL are discussed separately. (See "Evaluation and diagnosis of hair loss" and "Androgenetic alopecia in men: Pathogenesis, clinical features, and diagnosis" and "Clinical manifestations and diagnosis of alopecia areata" and "Chemotherapy-induced alopecia" and "Telogen effluvium" and "Traction alopecia" and "Female pattern hair loss (androgenetic alopecia in women): Treatment and prognosis".)


In the past, the term "androgenetic alopecia" was the primary term used to refer to the appearance of the common, progressive loss of terminal hair on the frontal scalp and/or vertex of the scalp in both men and women. The term "andro" signified a hormonal etiology and "genetic" signified a contribution of heredity to the clinical phenotype.

Over the years, as more work on hair loss was published, "female pattern hair loss" became the preferred term for this form of hair loss in women. This newer terminology helps to distinguish the different clinical features of this process in women versus men and reflects the lack of evidence to support a hormonal contribution in all cases of the condition.

Further, some authors use the terms "androgen-dependent FPHL" and "androgen-independent FPHL" to separate women with FPHL due to androgen excess from women with FPHL and normal androgen levels [1]. The term "female pattern alopecia" has also been used in place of FPHL.


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Literature review current through: Sep 2016. | This topic last updated: Jan 27, 2016.
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  1. Atanaskova Mesinkovska N, Bergfeld WF. Hair: what is new in diagnosis and management? Female pattern hair loss update: diagnosis and treatment. Dermatol Clin 2013; 31:119.
  2. Norwood OT. Incidence of female androgenetic alopecia (female pattern alopecia). Dermatol Surg 2001; 27:53.
  3. Wang TL, Zhou C, Shen YW, et al. Prevalence of androgenetic alopecia in China: a community-based study in six cities. Br J Dermatol 2010; 162:843.
  4. Blume-Peytavi U, Blumeyer A, Tosti A, et al. S1 guideline for diagnostic evaluation in androgenetic alopecia in men, women and adolescents. Br J Dermatol 2011; 164:5.
  5. Gonzalez ME, Cantatore-Francis J, Orlow SJ. Androgenetic alopecia in the paediatric population: a retrospective review of 57 patients. Br J Dermatol 2010; 163:378.
  6. Birch MP, Messenger JF, Messenger AG. Hair density, hair diameter and the prevalence of female pattern hair loss. Br J Dermatol 2001; 144:297.
  7. Messenger AG, Sinclair R. Follicular miniaturization in female pattern hair loss: clinicopathological correlations. Br J Dermatol 2006; 155:926.
  8. Yip L, Rufaut N, Sinclair R. Role of genetics and sex steroid hormones in male androgenetic alopecia and female pattern hair loss: an update of what we now know. Australas J Dermatol 2011; 52:81.
  9. Price VH. Androgenetic alopecia in women. J Investig Dermatol Symp Proc 2003; 8:24.
  10. Futterweit W, Dunaif A, Yeh HC, Kingsley P. The prevalence of hyperandrogenism in 109 consecutive female patients with diffuse alopecia. J Am Acad Dermatol 1988; 19:831.
  11. Schmidt JB, Lindmaier A, Trenz A, et al. Hormone studies in females with androgenic hairloss. Gynecol Obstet Invest 1991; 31:235.
  12. Camacho-Martínez FM. Hair loss in women. Semin Cutan Med Surg 2009; 28:19.
  13. Yip L, Zaloumis S, Irwin D, et al. Gene-wide association study between the aromatase gene (CYP19A1) and female pattern hair loss. Br J Dermatol 2009; 161:289.
  14. Olsen EA. The midline part: an important physical clue to the clinical diagnosis of androgenetic alopecia in women. J Am Acad Dermatol 1999; 40:106.
  15. Olsen EA. Female pattern hair loss. J Am Acad Dermatol 2001; 45:S70.
  16. Ludwig E. Classification of the types of androgenetic alopecia (common baldness) occurring in the female sex. Br J Dermatol 1977; 97:247.
  17. Olsen EA, Messenger AG, Shapiro J, et al. Evaluation and treatment of male and female pattern hair loss. J Am Acad Dermatol 2005; 52:301.
  18. Venning VA, Dawber RP. Patterned androgenic alopecia in women. J Am Acad Dermatol 1988; 18:1073.
  19. Harries M, Tosti A, Bergfeld W, et al. Towards a consensus on how to diagnose and quantify female pattern hair loss - The 'Female Pattern Hair Loss Severity Index (FPHL-SI)'. J Eur Acad Dermatol Venereol 2016; 30:667.
  20. Cash TF. The psychosocial consequences of androgenetic alopecia: a review of the research literature. Br J Dermatol 1999; 141:398.
  21. Van Der Donk J, Hunfeld JA, Passchier J, et al. Quality of life and maladjustment associated with hair loss in women with alopecia androgenetica. Soc Sci Med 1994; 38:159.
  22. Cash TF, Price VH, Savin RC. Psychological effects of androgenetic alopecia on women: comparisons with balding men and with female control subjects. J Am Acad Dermatol 1993; 29:568.
  23. Price VH. Androgenetic alopecia in adolescents. Cutis 2003; 71:115.
  24. Reid EE, Haley AC, Borovicka JH, et al. Clinical severity does not reliably predict quality of life in women with alopecia areata, telogen effluvium, or androgenic alopecia. J Am Acad Dermatol 2012; 66:e97.
  25. Arias-Santiago S, Gutiérrez-Salmerón MT, Buendía-Eisman A, et al. Hypertension and aldosterone levels in women with early-onset androgenetic alopecia. Br J Dermatol 2010; 162:786.
  26. Hirsso P, Rajala U, Laakso M, et al. Health-related quality of life and physical well-being among a 63-year-old cohort of women with androgenetic alopecia; a Finnish population-based study. Health Qual Life Outcomes 2005; 3:49.
  27. Su LH, Chen LS, Lin SC, Chen HH. Association of androgenetic alopecia with mortality from diabetes mellitus and heart disease. JAMA Dermatol 2013; 149:601.
  28. Kang H, Kang TW, Lee SD, et al. The changing patterns of hair density and thickness in South Korean women with hair loss: clinical office-based phototrichogram analysis. Int J Dermatol 2009; 48:14.
  29. Zhang X, Caulloo S, Zhao Y, et al. Female pattern hair loss: clinico-laboratory findings and trichoscopy depending on disease severity. Int J Trichology 2012; 4:23.
  30. Inui S. Trichoscopy for common hair loss diseases: algorithmic method for diagnosis. J Dermatol 2011; 38:71.
  31. Whiting DA. Diagnostic and predictive value of horizontal sections of scalp biopsy specimens in male pattern androgenetic alopecia. J Am Acad Dermatol 1993; 28:755.
  32. Headington JT. Transverse microscopic anatomy of the human scalp. A basis for a morphometric approach to disorders of the hair follicle. Arch Dermatol 1984; 120:449.
  33. Horenstein MG, Jacob JS. Follicular streamers (stelae) in scarring and non-scarring alopecia. J Cutan Pathol 2008; 35:1115.
  34. Messenger AG. Androgenetic alopecia. In: Hair diseases: Medical, surgical, and cosmetic treatments, McMichael AJ, Hordinsky MK (Eds), Informa Healthcare, New York 2008. p.108.
  35. Sánchez LA, Pérez M, Centeno I, et al. Determining the time androgens and sex hormone-binding globulin take to return to baseline after discontinuation of oral contraceptives in women with polycystic ovary syndrome: a prospective study. Fertil Steril 2007; 87:712.
  36. Galliker NA, Trüeb RM. Value of trichoscopy versus trichogram for diagnosis of female androgenetic alopecia. Int J Trichology 2012; 4:19.
  37. Dhurat R. Phototrichogram. Indian J Dermatol Venereol Leprol 2006; 72:242.
  38. Riedel-Baima B, Riedel A. Use of the TrichoScan to assess female pattern hair loss. Dermatol Surg 2009; 35:651.
  39. Lee BS, Chan JY, Monselise A, et al. Assessment of hair density and caliber in Caucasian and Asian female subjects with female pattern hair loss by using the Folliscope. J Am Acad Dermatol 2012; 66:166.
  40. Van Neste D, Trüeb RM. Critical study of hair growth analysis with computer-assisted methods. J Eur Acad Dermatol Venereol 2006; 20:578.
  41. Gassmueller J, Rowold E, Frase T, Hughes-Formella B. Validation of TrichoScan technology as a fully-automated tool for evaluation of hair growth parameters. Eur J Dermatol 2009; 19:224.
  42. Saraogi PP, Dhurat RS. Automated Digital Image Analysis (TrichoScan®) for Human Hair Growth Analysis: Ease versus Errors. Int J Trichology 2010; 2:5.
  43. Chartier MB, Hoss DM, Grant-Kels JM. Approach to the adult female patient with diffuse nonscarring alopecia. J Am Acad Dermatol 2002; 47:809.
  44. Harrison S, Sinclair R. Telogen effluvium. Clin Exp Dermatol 2002; 27:389.
  45. Summers P, Kyei A, Bergfeld W. Central centrifugal cicatricial alopecia - an approach to diagnosis and management. Int J Dermatol 2011; 50:1457.
  46. MacDonald A, Clark C, Holmes S. Frontal fibrosing alopecia: a review of 60 cases. J Am Acad Dermatol 2012; 67:955.