There are genetic tests, but they are not widely available any more. However, the most accurate evaluation and predication of hair loss in the present day and age is a careful history taken by an experienced clinician and a careful examination of the scalp. You can't beat this. Let me give you an analogy. I have an apple on my table in my office right now. If I send you a photo you can try to predict when that fruit will go rotten. However, there's a good chance your prediction will be wrong. However, if you get ask me when I bought the apple, whether I keep my office cool to prevent rotting of the apple, whether I took the apple out of the grocery bag or store it in there, what type of apple it actually is, where it came from, how soft it feels right now when you press on it .... you'll probably do a better job predicting when it will go rotten.Yes, we have genetic tests... but we also have vocal cords and eyes. Nothing yet trumps the 40-50 questions I can ask to get a sense of balding risks and the ability to look up close and examine the scale. Nothing.The following questions are 'key' to ask when assessing the likelihood and degree of progression of male pattern balding:What age did the hair loss start?What is the current age of the patient?How much progression has occurred in 6 months?How much progression has occurred in 12 monthsHow much progression has occurred in 5 years (if hair loss started more than 5 years ago)?What medications are used by the patient? What has been the results?How much hair loss does the patent's father has?What age (if any) did the patient's father start balding?Does the patient's mother have hair loss?What are the hair loss patterns of both grandfathers?Are there any males in the extended family who have a Hamilton Norwood above level VI? If yes, how many?What medications does the patient take now?What mediations were used in the past ? (anabolic steroids, isotretinoin)?Is the patient a smoker?What is the patients' health?What sun exposure has the patient had over the years?Is the patient obese?Does the patient have high cholesterol?Does the patient have diabetes?Does the patient have high stress?The following items are key to evaluate when assessing the scalp in order to evaluate the likelihood and degree of progression of male pattern balding:What is the current position of the frontal hairline? How much has it changed since age 12?How much temporal recession due to balding (not hairline maturation) is there? How much has it changed since age 12?What change have occurred in the crown?What changes have occurred in the area in front of the ear (pre auricular area)?Is there hair loss in the back of the scalp (occipital area)? Is the pattern of hair loss best described as 'diffuse unpatterned alopecia (DUPA)?What percent of hairs are miniaturized in the frontal, mid scalp, crown and occipital scalp?What changes in miniaturization have occurred in the past 6, 12 and 18 months?Is their seborrheic dermatitis present in the scalp? What other scalp conditions are present?
