Hereditary hair loss

Also known as male or female pattern hair loss or baldness, or androgenetic alopecia

Key points about normal hair loss

  • Normal hereditary hair loss runs in families and is most often seen in men, but also happens in women.
  • It affects your scalp the most but can also occur in other parts of your body and can be distressing.
  • There's no cure, but treatment may help to slow it down or stop it.
  • See your healthcare provider if your hair loss is sudden or doesn’t run in your family.
Balding middle-aged man pointing to his hair loss
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Normal hereditary hair loss is thinning hair that runs in families. It’s most often seen in adult men, but also happens in women. It’s also known as male or female pattern hair loss or baldness, or androgenetic alopecia.

The hair loss mainly affects your scalp but can also occur in other parts of your body. There’s no cure for normal hereditary hair loss, but treatment may help slow it down or stop it from getting worse.

Some medicines and some health conditions may lead to hair loss.

Read more about non-hereditary hair loss.

Male or female hereditary hair loss is caused by both genes and hormones. It’s also called androgenetic alopecia because it’s affected by hormones called androgens. Both men and women have androgens, but in different amounts. Alopecia is the medical word for hair loss.

Your chance of hereditary hair loss is higher if you have family or whānau who’ve experienced hair loss. There are lots of genes involved, and they come from both your mother and father. Your genetic blueprint for hair loss will affect things like:

  • how old you are when hair loss begins
  • how fast you lose hair
  • how much hair you lose, and from which parts of your head.


Male pattern hair loss

Hereditary hair loss in males is also known as male pattern hair loss. It affects half of Caucasian males by the age of 50 and is more common the older you get. It tends to happen later and more slowly in men with Japanese and Chinese ancestry. It accounts for 99% of hair loss in men.

Hair loss starts in men from about the age of 30 but can occur at any age past puberty.

Your genes affect how sensitive your scalp is to a hormone called dihydrotestosterone (DHT), which shortens the growth phase of your hair. Your hair follicles also become smaller in response to DHT and you start to make fewer and finer hairs.

Image credit: Canva


Female pattern hair loss

Female hereditary hair loss is also known as female pattern hair loss. Its cause isn’t clearly understood. It can start at any age but is more common after menopause. By 50 years of age at least 1 in 4 women (25%) experience some degree of hair thinning.

It’s thought that female pattern hair loss is also influenced by genetics and androgen hormones, although the link isn’t as strong as in male hereditary hair loss.

In female pattern hair loss, finer hairs with less colour are produced, and hairs in the resting phase of the hair cycle fall out more easily. Read more about the hair growth cycle.

Female pattern hair loss can occur in specific conditions where androgen levels are increased, such as polycystic ovary syndrome (PCOS). This condition is also associated with acne, increased facial hair, irregular periods and infertility.

Woman's scalp showing thinning hair

Image credit: Canva

Hereditary hair loss happens slowly over many years. You usually can’t feel anything, though some people find their skin a little itchy. The pattern of hair loss is different for males and females.


Male pattern hair loss

In males, hair loss usually begins with thinning at your hairline (receding hairline), followed by a thinned or bald spot on the crown of your head. The hair at the back and sides of your head stays for longer, so there is often a horseshoe shape of hair left.


Female pattern hair loss

Women with hereditary hair loss rarely develop bald patches. Instead, you’re likely to experience a general thinning of your hair, especially over the top of your head or crown, while keeping a frontal hairline. Complete hair loss is very rare for women.

If your hair loss is sudden or distressing, talk to your healthcare provider.

Your healthcare provider will ask you questions about your hair loss, including the pattern of your hair loss and whether you have any other medical conditions. They will also examine your hair.

No tests are needed to diagnose normal hereditary hair loss, but blood tests may be done to rule out other conditions that can cause hair loss. There's no reliable gene test.

Losing your hair slowly is a normal part of the ageing process for most men and some women. No treatment may be the best treatment. However if you wish to slow or stop the progression of hair loss, there are treatments available.


Medicines for hereditary hair loss

Finasteride and minoxidil are the main medicines currently available to treat hair loss. However, they're not funded in Aotearoa New Zealand, so you’ll need to pay for them. 

Medicines that are used to treat hair loss provide different results for different people. It's also not possible to predict who may or may not benefit from treatment. If it works, the medicine needs to be continued otherwise hair loss returns. 


Finasteride

This is a prescription-only treatment for hereditary hair loss in men. It is available as a tablet. It works by blocking the conversion of testosterone to dihydrotestosterone, so the hair follicles won’t be affected by this hormone and won’t shrink. Treatment needs to be continued for at least 6 months once started. If successful, the treatment must be continued to keep the effect.

Talk to your healthcare provider to find out whether finasteride is suitable for you. Read more about finasteride.


Minoxidil topical lotion or foam

Minoxidil can be bought from your local pharmacy as a liquid or foam. It can be used by both men and women. It needs to be applied twice daily to your scalp when it’s dry. Minoxidil is more effective in the earlier stages of hair loss. At first, you may notice more shedding of your hair, but this usually stops within 6 weeks and doesn't mean the treatment is making your hair loss worse. Treatment needs to be continued for at least 6 months once started. If it's successful, treatment is continued to maintain the effect.

Talk to your pharmacist to find out whether minoxidil is suitable for you. Read more about minoxidil


Spironolactone

This is a prescription-only medicine that may be beneficial for women with hereditary hair loss. Spironolactone shouldn't be used if you're pregnant or breastfeeding. If you've been prescribed spironolactone and you could get pregnant, you must use reliable birth control (contraceptives).

It's not used to treat hereditary hair loss in men because of its effects on male hormones.


Cosmetic options

  • Styling your hair to cover thinning areas.
  • Hair sprays or hair colouring products can be used to hide areas of thinning hair.
  • Apply electrostatic microfibres to bulk up your natural hair.
  • Wigs and hair pieces, either synthetic or natural. However these can be hot to wear and expensive.
  • Bandanas, hats and scarves.
  • Scalp micropigmentation/tattooing.
  • Hair transplantation – this surgery moves a hair follicle from a normal area to a thinned area. This is done by a private cosmetic surgeon, is expensive, and isn't suitable for everyone.

Hereditary hair loss is a normal part of the ageing process. However social expectations and ideas of youth, strength and beauty can make hair loss distressing, especially if it happens earlier in life for you than for your friends. Talking with others who are experiencing hair loss may help. You can also ask your healthcare provider about counselling available in your area.

The NZ Alopecia website(external link) provides information from fellow New Zealanders living with alopecia.


Use sun protection

Hair is important for protecting your scalp from sunlight. If your head is exposed to the sun, it’s important to cover any bald areas to prevent sunburn and lessen the risk of long-term sun damage.

The following links provide further information about hereditary hair loss. Be aware that websites from other countries may have information that differs from New Zealand recommendations.

Hair loss(external link) DermNet NZ
Male pattern hair loss(external link) DermNet NZ
Female pattern hair loss(external link) DermNet NZ
Hair loss(external link) NHS, UK
Androgenetic alopecia (pattern hair loss)(external link) Alopecia UK


Brochures

A little bit of everything about alopecia(external link) Alopecia UK – This handbook contains helpful information about living well with alopecia and also provides tips that may help you feel more comfortable with your appearance if you have hair loss.


References

  1. Alopecia(external link) Patient Info, UK, 2024
  2. Hair loss(external link) NHS, UK, 2024
  3. Male pattern hair loss(external link) DermNet NZ, 2015
  4. Female pattern hair loss(external link) DermNet NZ, 2015
  5. Hair loss female pattern (androgenetic alopecia)(external link) British Association of Dermatologists, UK, 2016
  6. Hair loss male pattern (androgenetic alopecia)(external link) British Association of Dermatologists, UK, 2024
  7. Patient education – androgenetic alopecia in men and women (beyond the basics)(external link) UpToDate, Wolters Kluwer, US, 2022

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Credits: Healthify editorial team. Healthify is brought to you by Health Navigator Charitable Trust.

Reviewed by: Dr Emma Dunning, Clinical Editor and Advisor

Last reviewed: