The patient without a family history of AGA
Clinical studies have taught us over and over that what patients report is not always reflective of the reality. For example, patients in research studies frequently overestimate their height; other parameters like weight and family histories of a range of conditions are often inaccurate.
Information we receive from patients about the patterns and degree of hair loss in their family must always be cautiously interpreted. Patients generally underestimate the degree of balding in the family. They may not mean to, but they often do. A patient who says “nobody in my family has balding” may be correct. I would estimate that 30 % -50 % of the time they are correct but 30 % -50 % of the time they are not.
Here are some scenarios to consider:
1) Some patients truly don’t have a strong family history and this reflects that fact that for some genetics is far more complex than we understand.
There are certainly some patients that just don’t have a strong family history. They are right on when they say “Dr. Donovan, nobody in my family is balding, so why am I balding?” This scenario arises more commonly in a female patient than a male patient and reflects that fact that genetic hair loss is pretty complex in how it develops. The genetics is not so simple for some.
2) The patient thinks they don’t have a family history (but they actually do) because they perceive balding as normal, especially in men.
There are some patients I see who truly feel they don’t have a strong family history. Some may be quite adamant about the whole thing. When I ask for any recent photos of grandparents, or uncles, they pull out their phones and show me the family.
What I often see is an elderly gentleman - let’s say the grandfather - with some pretty typical male balding. Not all that advanced mind you, but massive reduced density than he would have had at age 16. This is genetic hair loss. Careful examination of the photos off other members of the family may show similar patterns. This is androgenetic alopecia.
Patients often ask me “I know grandfather is thinning but, isn’t this just normal hair loss?”
To this I might reply “It’s certainly normal to see this pattern of hair loss in many men because genetic hair loss is so common - but there is no such thing as normal hair loss.”
Many patients perceive hair thinning in their parents and grandparents as normal and don't often attribute it to androgenetic alopecia.
3) The patient thinks they don’t have a family history (but they actually do) because they really never thought about it.
The next scenario sounds similar to the above, but it’s actually quite a bit different because the patient has never really thought carefully about the patterns of loss in their family.
When I ask for any recent photos of grandparents, or uncles, they pull out their phones and show me the family. Again, what I often see is an elderly gentleman - let’s say the grandfather - with some pretty typical male balding. Not all that advanced mind you, but massive reduced density than he would have had at age 16. This is genetic hair loss. Careful examination of the photos off other members of the family may show similar patterns. This is androgenetic alopecia.
The scenario might be even more direct. Sometimes the patient has a family member with them right then and there in the examination room. Dad or mom might be sitting right next to the patient when the patient asks me:
“How can I have genetic hair loss when my dad here has good hair?”
Often I will explain (with permission of the father), “Well, your father has some genetic hair loss too”
Patients are often surprised to learn that members of their family have androgenetic alopecia. They never really thought about it. They might see their parents or grandparents or uncles or aunts or grandmothers countless number of times and never really clued in to the fact their their hair has thinned.
Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887