Hair loss in men and women shares some underlying biology but differs significantly in pattern, presentation, hormonal drivers, and treatment approach. Understanding the differences helps patients seek the right assessment and the right treatment rather than applying male-pattern frameworks to female hair loss or vice versa.
Pattern: Male androgenetic alopecia follows the Norwood scale — recession at the temples, thinning at the crown, and progressive loss that can extend to the entire top of the scalp. Female androgenetic alopecia (Ludwig pattern) typically presents as diffuse thinning across the top while the hairline remains relatively intact. This difference in pattern is important for surgical planning — women with Ludwig pattern loss rarely have the clear hairline recession that makes frontal transplantation straightforward.
Hormonal drivers: In men, DHT is the primary driver. In women, DHT plays a role but the hormonal picture is more complex — oestrogen levels, the oestrogen-to-androgen ratio, and conditions like PCOS that alter the hormonal environment all contribute. Post-menopausal oestrogen reduction is a major factor in female hair loss that has no direct male equivalent.
Investigation: Women presenting with hair loss typically warrant a more thorough hormonal investigation than men — iron, thyroid function, and a hormonal panel are standard in the initial assessment. The higher prevalence of nutritional and hormonal causes of diffuse hair loss in women makes investigation-before-treatment the appropriate sequence.
Treatment: Minoxidil is approved for women at 2% and 5% topical, and low-dose oral minoxidil is increasingly used. Finasteride is not approved for women of childbearing potential in the UK due to teratogenicity risk. Anti-androgens — spironolactone, cyproterone acetate — are used in women with androgenetic alopecia where elevated androgens are part of the picture.
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