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Review

Male and female pattern hair loss: Treatable and worth treating

Nina L. Tamashunas, BS and Wilma F. Bergfeld, MD, FAAD
Cleveland Clinic Journal of Medicine March 2021, 88 (3) 173-182; DOI: https://doi.org/10.3949/ccjm.88a.20014
Nina L. Tamashunas
Department of Dermatology, Cleveland Clinic, Cleveland, OH; Case Western Reserve University School of Medicine, Cleveland, OH
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  • For correspondence: [email protected]
Wilma F. Bergfeld
Senior Dermatologist, and Director, Dermatopathology Fellowship, Departments of Dermatology and Pathology, Cleveland Clinic, Cleveland, OH; Past President, American Academy of Dermatology, American Society of Dermatopathology, and the American Dermatologic Association
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    Figure 1

    Male pattern hair loss.

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    Figure 2

    Female pattern hair loss.

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    Figure 3

    Differential diagnosis for pattern hair loss. A, patchy alopecia areata; B, alopecia totalis; C, traction alopecia; D, trichotillomania; E, central centrifugal cicatricial alopecia; F, lichen planopilaris; G, frontal fibrosing alopecia.

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    TABLE 1

    Workup of pattern hair loss in men and women

    History
    Age of onset, time course, severity, hair loss distribution, progression (periods of shedding), accompanying symptoms
    Medical history
    Gynecologic history
    Medication and supplement list
    Family history of hair loss, androgen excess, and metabolic disease
    Physical examination
    Distribution of hair loss
    Hair caliber and texture
    Clinical features of scalp
    Nail changes
    Hair-pull test
    Dermoscopy
    Scalp biopsy
    Laboratory testing
    Complete blood cell count
    Comprehensive metabolic panel
    Antithyroid antibody testing
    Thyroid-stimulating hormone with or without free thyroxine
    Iron evaluation (serum ferritin, serum iron, total iron-binding capacity)
    Free and/or total testosterone
    Dehydroepiandrosterone sulfate
    Serum prolactin
    Zinc
    Hydroxy-25 vitamin D
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Cleveland Clinic Journal of Medicine: 88 (3)
Cleveland Clinic Journal of Medicine
Vol. 88, Issue 3
1 Mar 2021
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Male and female pattern hair loss: Treatable and worth treating
Nina L. Tamashunas, Wilma F. Bergfeld
Cleveland Clinic Journal of Medicine Mar 2021, 88 (3) 173-182; DOI: 10.3949/ccjm.88a.20014

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Male and female pattern hair loss: Treatable and worth treating
Nina L. Tamashunas, Wilma F. Bergfeld
Cleveland Clinic Journal of Medicine Mar 2021, 88 (3) 173-182; DOI: 10.3949/ccjm.88a.20014
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  • Article
    • ABSTRACT
    • MANY NAMES FOR IT
    • GENES PLAY A ROLE
    • LINKED TO ANDROGEN EXCESS IN MEN
    • UNCLEAR RELATIONSHIP WITH HORMONES IN WOMEN
    • CAN BEGIN EARLY
    • A CLINICAL DIAGNOSIS
    • DIFFERENTIAL DIAGNOSIS
    • LOWER SELF-ESTEEM
    • LOSS IS PROGRESSIVE
    • TREATMENT
    • DISCLOSURES
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