OBJECTIVES: To evaluate the association of androgenetic alopecia (AGA) with smoking and to estimate its prevalence among Asian men. DESIGN: Population-based cross-sectional survey. SETTING: Tainan County, Taiwan. PARTICIPANTS: The eligible population consisted of all male residents 40 years or older in Tainan County. A total of 740 subjects aged 40 to 91 years participated in the survey between April 10, 2005, and June 12, 2005. MAIN OUTCOME MEASURES: Norwood and Ludwig classifications were used to assess the degree of hair loss. Information on smoking, together with other possible risk factors and age at onset of AGA, was collected using a questionnaire interview. RESULTS: After controlling for age and family history, statistically significant positive associations were noted between moderate or severe AGA (Norwood types > or =IV) and smoking status (odds ratio [OR], 1.77; 95% confidence interval [CI], 1.14-2.76), current cigarette smoking of 20 cigarettes or more per day (OR, 2.34; 95% CI, 1.19-4.59), and smoking intensity (OR, 1.78; 95% CI, 1.03-3.07). The OR of early-onset history for AGA grades increased in a dose-response pattern. Risk for moderate or severe AGA increased for family history of first-degree and second-degree relatives, as well as for paternal relatives. CONCLUSIONS: The age-specific prevalence of AGA in Taiwan was compatible to that among Korean men but was lower than that among persons of white race/ethnicity. Smoking status, current amount of cigarette smoking, and smoking intensity were statistically significant factors responsible for AGA after controlling for age and family history. Patients with early-onset AGA should receive advice early to prevent more advanced progression.