Could hair loss in a lifelong weight trainer with poor diet and no aerobic exercise be due to a condition other than peripheral arterial disease (PAD) or atherosclerosis?

Hair Loss in Lower Extremities: Alternative Diagnoses to PAD

While distal hair loss is recognized as a sign of severe PAD, your pattern of hair loss—particularly the preservation of significant scalp hair and absence of other critical PAD symptoms—strongly suggests androgenetic alopecia (male pattern baldness) affecting body hair rather than arterial insufficiency. 1

Why PAD is Less Likely in Your Case

Missing Critical PAD Features

The ACC/AHA guidelines specify that hair loss from PAD occurs as part of a constellation of findings in severe peripheral arterial disease, specifically alongside 1:

• Ischemic rest pain (pain in lower leg/foot when lying down, relieved by dependency)
• Non-healing wounds or ulcerations on feet or toes
• Diminished or absent pulses at dorsalis pedis and posterior tibial sites
• Cool skin temperature in affected areas
• Trophic skin changes (shiny, atrophic skin)
• Hypertrophic nails
• Pallor on elevation of the limb

You describe none of these symptoms, which makes PAD-related hair loss highly unlikely 1, 2.

The Nature of PAD-Related Hair Loss

The European Society of Cardiology clarifies that "calf hair loss" in PAD specifically refers to the lower leg (calf region), not the pattern you describe across multiple body regions including scalp 1. PAD causes hair loss through chronic severe ischemia in a distal distribution (feet, toes, lower legs), not the scattered pattern affecting upper legs, lower back, and scalp that you report 1.

Most Likely Explanation: Androgenetic Alopecia

Why This Fits Your Pattern

Your hair loss pattern—affecting scalp (30% loss), body hair across multiple regions, but sparing areas that would be most affected by PAD (you don't mention foot ulcers, rest pain, or cold feet)—is classic for age-related androgenetic alopecia extending to body hair 3.

Key supporting factors:

• Decades-long progression (gradual onset from 20s-60s)
• Multiple body regions affected including scalp
• No functional limitations from leg symptoms
• Vigorous exercise tolerance maintained throughout (weight training requires adequate limb perfusion)

Weight Training and Cardiovascular Protection

Your assumption about weight training providing aerobic benefit has some merit, but the ACC/AHA emphasizes that resistance training alone does not provide the same cardiovascular protection as aerobic exercise for preventing atherosclerosis 1. However, your ability to perform vigorous lower body weight training for decades argues against significant PAD, as severe enough arterial disease to cause hair loss would have caused exercise-limiting claudication (leg pain with exertion relieved by rest) 1, 4.

What You Should Do Now

Immediate Assessment Required

Despite androgenetic alopecia being most likely, your risk factor profile (poor diet over decades, no aerobic exercise, now in your 60s+) places you at significant risk for systemic atherosclerosis even without PAD symptoms 1, 5.

You need evaluation for cardiovascular disease regardless of the hair loss cause 1:

1. Ankle-brachial index (ABI) measurement - Simple, office-based test that takes 10 minutes and definitively rules out PAD (normal is >0.90) 1, 4

2. Pulse examination - Palpation of femoral, popliteal, dorsalis pedis, and posterior tibial pulses bilaterally 1

3. Cardiovascular risk assessment including:

   • Lipid panel
   • Blood pressure measurement in both arms
   • Fasting glucose or HbA1c
   • Assessment for coronary artery disease symptoms 1, 5

Critical Point About Systemic Atherosclerosis

The ACC/AHA emphasizes that PAD is a marker of systemic atherosclerosis - patients with PAD have 2-4 times higher risk of myocardial infarction and stroke than limb complications 1. Even if you don't have PAD, your risk factors warrant aggressive cardiovascular risk modification 1, 5.

Common Pitfall to Avoid

Do not assume that absence of classic claudication means absence of PAD - only 10-30% of PAD patients have typical claudication symptoms, and up to 50% are completely asymptomatic 5, 3, 4. However, PAD severe enough to cause hair loss is not asymptomatic - it presents with rest pain, wounds, or critical limb ischemia 1, 2.

Bottom Line

Your hair loss pattern is most consistent with androgenetic alopecia, not PAD, but you require cardiovascular screening given your risk factor profile 1, 5. Schedule an appointment for ABI measurement and comprehensive cardiovascular risk assessment. If ABI is normal (>0.90), PAD is effectively ruled out and your hair loss has a benign cause 1, 4.