Can men have a female pattern of androgenetic alopecia hair loss?

Female pattern hair loss, also known as androgenetic alopecia, is a common condition typically associated with women, characterized by a diffuse thinning of hair on the scalp due to an abnormal response of the hair follicles to androgens. However, this pattern of hair loss is not exclusive to women and can also occur in men, albeit less frequently. This essay explores the occurrence, characteristics, and implications of female pattern hair loss in men, drawing on recent research and case studies.

In an article, titled “Female-patterned alopecia in teenage brothers with unusual histologic features,” a case study is presented of two teenage brothers who exhibited female-patterned alopecia. The brothers, aged 21 and 18, showed a preservation of the frontal hairline but a significant progression of hair loss and miniaturization of hair in the crown area. Despite treatment with clobetasol and minoxidil, the hair loss continued unabated, suggesting a resistance to conventional treatments. The study also highlighted the presence of lymphocytic infiltrates in the follicular isthmic region, suggesting an inflammatory component to the hair loss.

The second document, “Female pattern baldness in men,” further elaborates on the occurrence of female pattern hair loss in men. The author, Ralph Trüeb, MD, presents two cases of men aged 39 and 28 who experienced baldness of the crown with preservation of the frontal hairline, a pattern typically associated with female pattern hair loss. The onset of hair loss in these patients was reported to have begun 20 and 10 years prior, respectively. Both patients had a normal masculine build and normal male sexual hair distribution, indicating that the female pattern hair loss was not associated with feminization or hormonal abnormalities. Interestingly, both patients reported a family history of male pattern baldness, suggesting a possible genetic predisposition to hair loss, albeit with a different pattern.

In a third more recent article titled “Female pattern hair loss in men: A distinct clinical variant of androgenetic alopecia” Kerkemeyer and colleagues present a study on the occurrence of female pattern hair loss (FPHL) in men. The study was conducted in a hair clinic between November 2017 and March 2020, and included men who exhibited diffuse hair loss on the mid-frontal aspect of the scalp with preservation of the frontal hairline. The diagnosis of androgenetic alopecia (AGA) was confirmed dermoscopically. All patients were treated with low-dose oral minoxidil (LDOM) and/or a 5α-reductase inhibitor (finasteride or dutasteride).

The study found that out of 2140 men with AGA seen in the center, 84 (3.9%) were diagnosed with FPHL. Blood test results were available for 36 (42.9%) patients, and low levels of total testosterone, free testosterone, 25-hydroxyvitamin D, and zinc were detected in some of these patients. Thirty-one patients (36.9%) completed at least 6 months of treatment, and most of them showed improvement in hair density. The study concludes that FPHL is a distinct variant of AGA in men that resembles FPHL in women, and further research is required to confirm the role of testosterone and vitamin D in the pathogenesis of FPHL in men.

The occurrence of female pattern hair loss in men, as evidenced by these studies, suggests a complex interplay of genetic, hormonal, and possibly inflammatory factors are involved. The preservation of the frontal hairline, a characteristic feature of female pattern hair loss, appears to be a consistent finding in these cases. However, the modest response to conventional treatments, such as clobetasol and minoxidil, indicates a need for further research into the underlying mechanisms and potential treatment strategies for this condition.

In conclusion, female pattern hair loss in men, while much less common than its male patterned counterpart, represents a unique manifestation of androgenetic alopecia. The cases presented highlight the need for increased awareness and understanding of this condition, particularly in the context of differential diagnosis and treatment planning. Further research is needed to elucidate the underlying mechanisms, assess the role of genetic and hormonal factors, and develop effective treatment strategies for female pattern hair loss in men.

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