Androgenetic alopecia is asymptomatic but often causes great psychological distress. Hair loss is gradual, and there are no surface changes on the scalp. The hairs become shorter and narrower and eventually fall out. In men, the frontotemporal scalp and vertex are most commonly involved, and progression to complete hair loss may occur. In general, hair density decline approximately 15% before it is noticed.

Women also experience androgenetic alopecia. Unlike in men, however, the pattern is more diffuse, although hair loss on the crown is common (Fig. 75-1). The pattern of hair loss in androgenetic alopecia in women has been described as resembling a christmas tree in which the top of the tree points toward the back of the scalp, and the region of hair loss widens toward the front of the scalp; the edges of the area of hair loss are uneven and wavy, much like the branches of a tree. Women only rarely develop male-pattern frontotemporal alopecia, and complete hair loss is rare.