The Genetics of Balding

Author: Joseph L. Hill Jr., MD

Hair loss, also known as alopecia, can be devastating to genetically predisposed men and women.  Current scientific data suggests it is a polygenic trait meaning multiple genes are involved.  Moreover, there have been associations reported between male patterned hair loss and the androgen receptor gene located on the X chromosome.  Males receive their X chromosome from their mother.  As such, a common association between male patterned baldness and a mother’s family history of hair loss is widely presumed.1

Male Patterned Baldness Hair Loss

Male patterned baldness is typically described as androgenic alopecia (AGA) because it is related to circulating androgens.  Testosterone is an example of an androgen.  While people with AGA have normal levels of circulating testosterone, they have increased levels of dihydrotestosterone (DHT), a by-product of the activity of the enzyme 5-alpha reductase on testosterone.  Exposure of the hair follicles to elevated levels of DHT results in hair loss.  In fact, a balding scalp contains elevated levels of 5 alpha reductase enzyme, DHT, and DHT androgen receptor. 1

Norwood classified AGA into seven groups.  Early AGA involves temporal scalp recession (I).  It progresses to include the frontal scalp, then the crown of the scalp, and finally the entire apex of the scalp (VII). 2

Female Patterned Hair Loss

Female patterned hair loss (FPHL) is not necessarily related to androgens.  In fact, some woman without detectable amounts of circulating androgens may also develop FPHL suggesting a role for a non-androgen-dependent alopecia process. 1

Ludwig classified FPHL into three groups.  It progresses from general thinning on the apex of the scalp maintaining a frontal hairline (I) to compete baldness of the apex of the scalp also maintaining a frontal hairline (III). 3

Treatment Options

Fortunately, there is treatment for both conditions.  The drug finasteride (Propecia), inhibits 5 alpha reductase activity thereby lowering DHT levels.  As such, studies have shown that up to 90% of patients obtain positive effects related to hair growth.   It is only FDA approved for use by men.  Another drug, Minoxidil (Rogaine), is a topical medication shown to increase hair growth.  Its mechanism of action is unknown and can be used by both men and woman. 1

Beyond medicines, there has been good results seen with injection of platelet rich plasma (PRP) into the scalp.  PRP has been proven to increase follicular counts in thinning areas of the scalp.  Platelets contain many growth factors.  When growth factors are released from platelets into the scalp environment, they are thought to act on the follicle and stimulate it to begin hair growth. 1

Finally, hair transplantation offers patients a means for adding many follicles to an area of alopecia.  Modern technique employs the use of an individual follicular unit.  These individual units can be harvested via a strip method, whereby an area of scalp is surgically excised and closed with staples or sutures.  A more technologically advanced technique is called NeoGraft.  It uses a hand-held device to remove individual follicular units from the scalp thereby avoiding the need for surgery.  This also avoids an unseemly scar that is obvious as well as wound healing complications at the surgical site.

Genetic predisposition to hair loss is an ongoing process.  As such, treatment for AGA or FPHL is lifelong.  Fortunately, with the appropriate treatment regimen, individuals can achieve life long, satisfying results.  Dr. Joseph Hill is a board certified plastic surgeon, dedicated to helping patients attain the type of results they desire related to hair loss.  Please contact Plastic Surgeons of Lexington, to learn more and to schedule a consultation.

  1. Vogel, James E., et al. Hair Restoration Surgery: The State of the Art.  Aesthetic Surgery Journal.    2013; 33: 128-151.
  2. Norwood, OT. Male pattern baldness: classification and incidence. Southern Med J. 1975; 68:1359-1365.
  3. Ludwig, E. Classification of the types of androgenetic alopecia (common baldness) occurring in the females sex. Br J Dermatol. 1977; 97: 247-254.

Disclaimer: The content within this site is not intended to provide diagnosis, treatment or specific medical advice. The products and claims made about specific products and treatments through this article have not been evaluated by the United States Food and Drug Administration and are not approved to diagnose, treat, cure or prevent disease. Please consult with a NeoGraft Certified Physician or other healthcare professionals regarding any medical or health-related diagnosis.

About Joseph L. Hill Jr., MD

NeoGraft with Dr. Joseph Hill

Joseph L. Hill Jr. M.D. is a Board Certified Plastic Surgeon in private practice in Lexington, Ky. Dr. Hill specializes in all areas of plastic surgery including aesthetic surgery of the eyelidsface, breast and body; reconstructive surgery of the entire body; surgery of the breast; and surgery related to skin cancer.

Dr. Hill is a native Kentuckian and was raised in Lexington, Ky. He graduated cum laude from Centre College in Danville, Ky. Dr. Hill received his medical degree from the University of Kentucky where he graduated With Distinction. During his residency he received numerous awards including the Resident Teaching Award and second place in the Kentucky Society of Plastic Surgery Resident Research Competition.

Dr. Hill is licensed to practice by the state of Kentucky. He serves as Clinical Faculty at the University of Kentucky and as Chief of Plastic Surgery at St. Joseph Hospital. Dr. Hill is certified by the American Board of Plastic Surgery. He is a member of the American Society for Aesthetic Plastic Surgery, American Society of Plastic Surgeons, the Southeastern Society of Plastic and Reconstructive Surgeons, the Kentucky Society of Plastic Surgeons, the Lexington Medical Society, and the Kentucky Medical Association. He has been appointed to the active medical staff for the Kentucky Commission for Children with Special Health Care Needs.

Dr. Hill is affiliated with the following institutions: Baptist Hospital Lexington, Lexington Surgery Center, St. Joseph Hospital, and St. Joseph East Hospital.

Dr. Hill is married to Cecilia Hill. They have three children, Lee, Shelby, and Mary Barber.