Androgenetic Alopecia: Is it Age or Hormones?
The majority of otherwise healthy people—both male and female—experience some hair thinning with advanced age without any underlying medical condition to explain it.16 So how can you tell if your progressively thinning hair is related to androgen hormones (male pattern balding or female pattern hair loss) or simply a biological effect of getting older?
Although less obvious in senescent hair loss, hair loss from age and hormones both show that as the terminal scalp hairs go through the hair growth cycle the hair follicles miniaturize and the new hairs progressively get shorter and shorter, in effect reverting to the vellus hairs seen at birth until they disappear. This is because the growth phase (anagen) in hair becomes briefer while the resting phase gets longer.13, 22
Some clinicians have argued against purely age-related (senescent) balding, especially since androgenetic hair loss (AGA) is typically found in older adults. However, genetic studies conducted at the Veterans Medical Center Dermatology Clinic in Cleveland, Ohio provide strong evidence supporting that there is a difference between senescent and AGA hair loss. Researchers discovered 431 genes associated with aging hair. In contrast, over 1700 genes were expressed in AGA balding.16
If you have an endocrine disorder that causes excess androgen secretions (such as Cushing’s disease, diabetes, thyroid conditions, or polycystic ovary syndrome), most likely your hair loss is androgenetic alopecia. If there is no underlying condition, the most obvious clue to the cause of your thinning hair is how old you are. Age-related hair loss begins after age 60, while AGA balding can begin as early as the teenage years. Another indication of hormonally driven hair loss is the distinctive patterns associated with male and female androgenetic alopecia. Typically all-over hair thinning associated only with age tends to be more diffuse rather than patterned.16
Tests to Expect
In a woman with female (or, rarely, male pattern balding) and other signs of hyperandrogenism, a number of different blood and urine tests can be conducted to determine the cause. For example, adrenal gland tumors may or may not be related to Cushing’s syndrome. Testing urinary and serum cortisol levels will help distinguish between Cushing’s, congenital adrenal hyperplasia, and polycystic ovary syndrome (PCOS).30, 81
Another lab test that is useful in identifying ovarian or adrenal causes of female androgenetic hair loss is a diagnostic tool typically used to find prostate problems in men—the prostatic-specific antigen (PSA) test. PSA levels higher than normal for premenopausal and postmenopausal women are associated with conditions where the ovaries or adrenal glands produce excess androgens.30
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Normal levels ≤ 0.02 ng/mL.
Normal levels ≤ 0.04 ng/mL