NEW YORK — Despite the fact that numerous studies have identified androgenetic alopecia (AGA) as the most common form of hair loss in teenagers, clinicians commonly overlook this diagnosis, according to an expert.

“It probably does not come quickly to mind when evaluating younger patients, but this is probably the best time to make the diagnosis and might be the best time to do something about it,” said Seth J. Orlow, MD, PhD, Samuel Weinberg Professor of Pediatric Dermatology and chairman of the Ronald O. Perelman Department of Dermatology at New York University Langone Health, New York City.

In one series of cases, AGA represented 42% of alopecia cases in teenagers with hair loss ranging from 12 to 19 years old. In this series, which Orlow coauthored, the second and third most common diagnoses were alopecia areata (34%) and telogen effluvium (11%). No other cause represented more than 10% of the cases.

Teenage AGA Is Not Rare

The prevalence of AGA in adolescents, which might be increasing, is substantial. Studies report rates of 10% or more, according to data cited by Orlow. In a 2025 retrospective review of 203 patients younger than 18 years presenting with AGA, the mean age of diagnosis was 14.5 years, but Orlow noted that risk appears to increase with age. In one study, the proportion of teenagers with AGA jumped from 9.3% at age 15 to 16.8% at age 17. 

Although more common in boys, AGA is also seen in teenage girls, according to Orlow, who spoke on this topic at the Annual Atlantic Dermatological Conference. He said boys are about three times more likely than girls to seek treatment for this diagnosis.

In teenagers, as in adults, the most common pattern of AGA is male-pattern baldness with hair loss starting at the crown. However, AGA can also involve diffuse hair loss in either sex, Orlow said at the meeting.

Yet Orlow cautioned that receding hairlines should not be mistaken for evidence of androgenicity. Receding hairlines are common and normal during adolescence in both boys and girls. In the absence of concomitant hair thinning, they may simply represent a normal adolescent transition.

Recommending trichoscopy in the workup, Orlow said that the key findings include an increased proportion of vellus hair (> 10%), variability in the diameter of hair, and the presence of the brown halo known as the peripilar sign. 

Suspicion of androgenetic hair loss should increase with a family history of this diagnosis and can be reinforced by a positive hair pull (six or more strands removed with a gentle tug of 40-60 hair strands).

Environmental Factors May Contribute to Risk

However, there are environmental factors that can precipitate AGA. These factors, such as isotretinoin exposure or starting an oral contraceptive, should be assessed when taking a history along with a survey of potential nutritional deficiencies, including those of iron, vitamin B, and vitamin A.

Endocrine and metabolic abnormalities, including hyper- or hypothyroidism, polyendocrine metabolic ovarian syndrome (formerly known as polycystic ovary syndrome), insulin resistance, and adrenal gland disorders, are also part of the workup. In the 203-patient retrospective review of AGA published in 2025, 24.1% were obese and 24.8% were overweight, defined as the 85th-95th percentile for weight by age.

It was further noted in this survey that 8.3% of the patients, of which 71% were girls, developed AGA prior to puberty.

Lab studies are critical for identifying contributing abnormalities that might play a role in a comprehensive intervention designed to lower the risk for progression. In addition to vitamin levels, insulin levels, iron levels, and thyroid function, Orlow recommended a lipid profile and an assessment of sex hormones, such as prolactin, follicle-stimulating hormone, and luteinizing hormone.

There are no FDA-approved therapies for AGA in adolescents. Minoxidil in either low-dose oral forms or topical formulations is often used off-label, particularly in boys. Spironolactone is sometimes associated with benefits in girls, Orlow said. Low-energy laser devices and the 1565-nm nonablative fractional laser have some utility in stimulating hair growth, he added.

The limited number of studies of AGA is reflected in a survey of review articles published over the past 20 years. When recent studies are compared with older articles, not much has changed. In a 2023 review of 145 patients under the age of 18 (mean age, 16 years), 72% were boys, hair shaft thickness variability on trichoscopy was observed in 100% of cases, vitamin D deficiency was found in 84%, and insulin resistance was found in 33%. Many of these same findings were reflected in a 2023 summary of AGA in adolescents.

The substantial prevalence of AGA and the reasonable presumption that hair loss during adolescence imposes a meaningful psychological burden suggest that there is a major unmet need for research in the causes and potential treatments for AGA, Orlow said. 

That opinion was seconded by George Han, MD, PhD, adjunct associate professor of dermatology in the Icahn School of Medicine at Mount Sinai and director of research at NYC Health + Hospitals/Elmhurst, both in New York City.

“A lot of us are seeing more androgenetic alopecia in teenagers than we have in the past,” said Han, who acknowledged that it is unclear whether this is a product of a growing prevalence or growing awareness.

Without FDA-approved therapies, “this can be a challenge because we have such limited treatment options,” he told Medscape Medical News. Agreeing with Orlow that addressing the condition with early intervention is likely important for reducing risk for progression, he indicated that greater attention to this disease is warranted.

Orlow reported having financial relationships with Almirall, Evommune, R2 Technologies, and Veradermics. Han reported having financial relationships with AbbVie, Athenex, Boehringer Ingelheim, Bond Avillion, Bristol Myers Squibb, Celgene, DermTech, Incyte, Janssen, Leo, Lilly, MC2, Novartis, Ortho, PellerPharm, Pfizer, Regeneron, Sanofi, Sun, and UCB.