When you think of someone who is bald or balding, chances are that an old man with gray hair comes to mind. Or perhaps you’ve thought of a public figure — like Donald Trump and his combover, or Vin Diesel’s shaved head. You certainly don’t think of baldness affecting young men… or, for that matter, young women.
But balding at a young age is unfortunately possible. The most common cause of balding, pattern hair loss, affects 16% of men between 18 and 29 years of age. Women, on the other hand, are much more likely to be affected by this condition later on in life. But both men and women can be affected by other forms of hair loss, like alopecia areata, that can cause baldness.
Causes of Early Onset Hair Loss and Balding
Hair loss can occur for many different reasons, including exposure to toxins, overactive immune system responses, genetics, hormones, pregnancy, and even stress. Common conditions that cause alopecia include pattern baldness, autoimmune forms of hair loss, and stress-related hair loss. These types of hair loss can affect people at any age. (2,3)
While several types of hair loss can cause permanent patches of hair loss, there are two main forms that can result in complete baldness: androgenetic alopecia and alopecia areata. (1,4) Androgenetic alopecia, commonly known as pattern hair loss, causes progressive hair loss over time. Male pattern hair loss starts with a receding hairline around the temples, giving the hairline an M-shaped appearance before balding occurs at the top of the head. (1)
Alopecia areata, an autoimmune form of hair loss, often causes circular patches of hair loss. This can occur anywhere on the scalp and can be any size. Less common forms of this condition include alopecia totalis (hair loss affecting the entire scalp) and alopecia universalis (hair loss affecting the entire body). Balding caused by alopecia areata looks very different from androgenic alopecia. (4) Luckily, there are treatments available for alopecia areata, so if you see this type of hair loss, consider seeing a dermatologist for an evaluation.
Who Gets Early-Onset Androgenetic Alopecia?
The most common cause of hair loss and primary cause of balding is androgenetic alopecia, commonly known as pattern hair loss. Pattern hair loss, which is primarily caused by both genetics and hormones, affects both men and women. However, men can be affected when they’re very young — as early as in their teens — while women are primarily affected in middle age, or after menopause.
Male pattern hair loss occurs in (1):
- 16% of men between the ages of 18 and 29
- 30% of men between the ages of 30 to 39
- 50% of men between the ages of 40 and 49
- 80% of men between the ages of 70 and 79
In contrast, female pattern hair loss occurs in 40% of women by the age of 70. It’s about three times more likely to occur to postmenopausal women than premenopausal women. (5)
While premature menopause occurs in about 1 percent of women before 40, it only affects 0.1% of women in their 20s. (5) This means that any female signs of balding at 20 are unlikely to be due to androgenetic alopecia. That being said, it’s rare, but not impossible.
It’s also possible for transgender individuals transitioning from female to male to experience pattern hair loss. Androgen therapy can increase their likelihood of going bald. (17)
When male and female pattern hair loss occur at such a young age, it’s known as early-onset androgenetic alopecia. While rare, there are a number of compounding factors that can increase the risk of this type of hair loss affecting you.
Unhealthy Lifestyle Habits Accelerate Androgenetic Alopecia
Pattern hair loss is unlikely to cause balding in young people, but it can still happen. A number of contributing factors can affect the likelihood of being affected by early-onset androgenetic alopecia. These include unhealthy lifestyle habits like:
- An unhealthy diet lacking in essential vitamins and minerals
- Regular alcohol consumption, especially in excessive amounts
- Smoking, including the use of e-cigarettes and vape pens
You’ve likely heard lots of people talk about the importance of consuming a healthy, nutritious diet. Your diet is important for hair growth. Healthy hair can’t grow without the proper nutrients, which come from the foods you eat. And excessive alcohol consumption actually prevents nutrient absorption. (2,3,6)
Interestingly, smoking has also been shown to affect nutrient absorption. (7) Additionally, both cigarettes and e-cigarette alternatives also contain toxic chemicals like nicotine, which have been proven to negatively affect your health, particularly the health of your skin and hair. (7-10)
While smoking doesn’t cause androgenetic alopecia, nicotine and other chemicals seem to accelerate the progression of this type of hair loss. (9) This makes it more likely for you to start balding at an early age. (9) Similarly, a poor diet and drinking too much alcohol can also result in diffuse hair loss, as your body perceives this as a physiological stressor. (3) This can also increase your chance of being affected by pattern hair loss and accelerate its progression in causing baldness.
Stress Can Lead To Hair Loss
In addition to these unhealthy lifestyle habits, it’s possible for both physiological and emotional stress to affect your hair’s health. Stress-related hair loss is also known as telogen effluvium. (1-3)
Life stressors are not always controllable, but it’s still good to be conscious of their presence in your life. Stressors can be particularly harmful to your hair when they occur regularly, affect your mental health, or are managed through the use of unhealthy coping mechanisms, like drinking and smoking.
Both physiological stress — like pregnancy or a car accident — and emotional stress can cause telogen effluvium. This type of diffuse hair loss affects the hair growth cycle. It causes an increase in the number of hairs you shed each day, which leads to hair thinning. (1-3)
Telogen effluvium isn’t usually permanent. However, it can take many months for lost hair to grow back. And if you’re already starting to see the signs of androgenetic alopecia, stress-related hair loss can speed up how quickly you start to go bald.
Poor Hair Care Practices Speed Up Androgenetic Alopecia
The way you treat your hair can also affect your scalp and hair health. A number of hair care practices can increase your likelihood of hair loss, including:
- Regular bleaching, dyeing, or chemical processing
- Regularly wearing tight hairstyles that pull on the scalp
- Not washing your scalp and hair regularly
- Excessive use of products that can clog hair follicles, like dry shampoo and gels
Poor hair care practices won’t affect you much if they’re occasional. But in excess, these unhealthy hair habits can be very damaging to your hair. For example, irregular washing combined with excessive styling product use can affect the health of your scalp, clogging your hair follicles and impeding healthy hair production.
Similarly, regular use of bleach, dye, and other chemicals can damage even the healthiest hair. While these products are meant to be applied to hair and not the scalp, they can also affect your scalp skin. They can even cause burns if used improperly or left on for too long.
And constant use of tight hairstyles — particularly tight ponytails, ballerina buns, micro-braids, cornrows, and any styles that are worn for weeks or even months — can cause traction alopecia. These hairstyles damage your follicles because they pull on the scalp and apply tension that damages them. Over time, this can cause permanent hair loss to the parts of your scalp affected by the tension these hairstyles cause. (2,3)
While pattern hair loss is primarily due to hormones and genetics, poor hair care can exacerbate the progression of this condition. This can make your pattern hair loss symptoms more obvious and speed up the rate at which you go bald.
What Does Early-Onset Androgenetic Alopecia Look Like?
Officially, early-onset androgenetic alopecia refers to people who have developed moderate pattern hair loss symptoms by the time they’re in their 30s. Technically, the hair of men diagnosed with this condition needs to be categorized as Norwood-Hamilton stage 3 or higher, while women’s hair needs to be categorized as Ludwig stage 2 or higher. These two classification systems are the main ways of grading the severity of pattern balding. (11,12)
Male Signs of Balding at 20
According to the American Hair Loss Association, about 25% of men start seeing the first signs of androgenetic alopecia before they’re 21. (13) For men in their 20s, the signs of early-onset balding will typically follow the sequence of the first three Norwood-Hamilton stages. This means that you’ll see symptoms like (1):
- Slower hair growth
- An increase in hair shedding
- A decrease in hair volume
- Thinning hair
- Frail, weak hairs that break easily, particularly around the temples and crown
- A receding hairline (which, in teenagers, should not be confused with the natural transition from a young hairline to a mature adult hairline)
- A patchy, uneven hairline that may even look like your hairline is receding on one side
- The start of hair loss around the temples, causing the hairline to recede around them
- The quintessential ‘M’ shaped hairline begins to form as temple hair loss worsens
- The start of hair loss at the crown (the scalp’s vertex at the top of your head)
- Increased scalp sensitivity and likelihood to sunburn
Female Signs of Balding at 20
Many of the signs of early-onset androgenetic alopecia are the same for women. For example, issues like slower hair growth, increased hair shedding, decreased hair volume, and weak hair will be the same for both men and women. However, women don’t usually lose hair at their temples the way men do. Instead, female pattern hair loss targets the top of the head, like where you part your hair. (1)
If you’re a woman with early-onset androgenetic alopecia, you won’t see many changes to your temples or hairline. Instead, most of your hair loss will occur at the top of your head. As your hair loss gets worse, you’ll see a noticeable decrease in volume and an increase in hair thinning. You’ll also find that your scalp is much more visible when you part your hair down the middle or at either side. Hair loss that gets worse than this tends to look like diffuse thinning. (1)
Who Gets Alopecia Areata?
Alopecia areata is a less common condition compared to androgenetic alopecia, but it can affect anyone at any point in life – even young children. The chances of it happening to you is just around 2%. Alopecia areata and telogen effluvium are the next most common forms of hair loss after androgenetic alopecia. (14)
For most people who experience small areas of hair loss from alopecia areata, hair loss goes away in less than 6 months. Unfortunately, though, alopecia areata can also continue to periodically affect you throughout life after the first time it occurs. In some people, it can become more severe over time. (14)
Men and women are equally likely to suffer from alopecia areata. But men tend to experience this type of hair loss at an earlier age than women. They’re also more likely to have other family members with this condition. (14)
Alopecia areata predominantly affects younger adults and children. You’re most likely to be affected between the ages of 21 and 40, with between 82.6% and 88% of people experiencing their first alopecia areata symptoms before age 40. The next most common age group to experience this form of hair loss are children, teenagers, and young adults aged 20 and younger. Around 40% of people experience alopecia areata before age 20. (14)
Notably, experiencing alopecia areata when you’re 20 or younger makes you more likely to experience a more severe form of this type of hair loss. And although alopecia totalis and alopecia universalis only occur to around 7% of people with alopecia areata, they always occur in younger people before they’ve reached 30 years of age. (14)
What Does Balding From Alopecia Areata Look Like?
Alopecia areata tends to appear as one or more round circles, ovals, or patches of hair loss. It most commonly affects the scalp – though it can also affect body hair and facial hair. The most common region affected is the back of the scalp (known as the occipital region). (14)
When alopecia areata causes baldness, it can start off as an increase in the number of patches of hair loss or an increase in the size of the existing patches of hair loss. It can also occur in a diffuse manner – resembling stress-related hair loss or female pattern hair loss. (4,14)
When alopecia areata causes complete baldness, it’s referred to as alopecia totalis. People with alopecia totalis have no hair growth on their scalps at all. The same thing occurs to people with alopecia universalis. However, people with the universalis type lose hair across their entire bodies, including their arms, legs, eyebrows, eyelashes, and even the hairs inside their nose. (4,14)
Alopecia areata can be nerve-wracking, but fortunately, there are treatments available. Dermatologists can offer corticosteroid creams or injections, or for more severe cases, oral pulse corticosteroids (once a month). There’s also the newest drug, baricitinib, an immunosuppressant that is now the first FDA-approved systemic treatment for alopecia areata. (18)
How to Stop Balding at 20
Balding at a young age is unfortunate, but in most cases, it’s completely treatable. Men and women with early-onset androgenetic alopecia can use FDA-approved hair loss treatments like low-level laser therapy devices or apply topical minoxidil liquid or foam. Men can also use finasteride, a prescription-only pill that works to counteract the hormonal component of pattern hair loss. (1,15,16)
It’s also important to make sure that you’re taking good care of your hair and body. This means treating your hair gently, reducing alcohol consumption, quitting smoking, and eating nutritious foods regularly. Making these changes are just as important for your hair’s health as starting a hair loss treatment.
Several other hair loss procedures, however, are not recommended for younger adults. Getting a hair transplant at 20, for example, isn’t usually advisable. You’ll want your hair loss to reach a certain point and stabilize before you have such a surgery. Since pattern hair loss is always progressive, this is also the case for a less-extensive surgery, like a hairline transplant.
If you’re losing hair due to alopecia areata, your hair may grow back on its own, especially if you only have small circles of baldness. If it doesn’t grow back, your dermatologist may offer treatments such as corticosteroids. Minoxidil is also sometimes used off-label to treat this type of hair loss. Alopecia totalis and alopecia universalis are considered to be particularly challenging to treat. However, the new oral medication baricitinib has shown excellent results so far and is now FDA-approved for alopecia areata. Talk to your doctor for more information. (4,14,18)
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Last updated October 2023