Abstract

Objective: This study aimed to characterize age at onset, family aggregation, diet-related perceptions, and treatment use regarding androgenetic alopecia (AGA) in a large Saudi sample, and to test age-specific associations and sex-stratified odds ratios.
Methods: A descriptive cross-sectional survey was conducted across the Northern, Southern, Eastern, Western, and Central regions of Saudi Arabia from 1st January to 30th November 2024. Recruitment combined an online questionnaire and in-person interviews in dermatology clinics at King Fahad Specialist Hospital-Dammam, and inpatient consultations at Johns Hopkins Aramco Healthcare Pediatrics and Internal Medicine departments. Residents aged ≥10 years were eligible; minors (10-17 years) participated through guardian consent/assent. Incomplete responses were excluded. The instrument captured demographics, family history, age at onset, diet-related perceptions, and treatments.
Results: Among 1,010 participants, 731 (72.4%) were women and 498 (49.3%) were aged 20-29 years. Onset clustered at 10-19 years (50.9%) and 20-29 years (23.3%). Familial aggregation was frequent (~71% had a first-degree relative or cousin affected). Shedding during combing was reported by 63.2% of women and 31.5% of men. Minoxidil use was limited (11.9% overall; 21.1% in men vs. 8.3% in women), and nearly half
reported doing nothing for their condition. Age-ordered χ² tests were significant in adolescents (p-value = 0.001), young adults (p < 0.001), and overall; the sex-specific odds ratio was highest at 20-29 years (OR = 3.97).
Conclusion: In this female-leaning Saudi resident cohort, AGA often began before age 30 years, showed strong familial tendencies, and low uptake of evidence-based therapies despite a meaningful symptom burden.

Key words: Androgenetic alopecia, early-onset hair loss, dihydrotestosterone, minoxidil, finasteride, Saudi residents.