Androgenetic Alopecia

Male and Female Pattern Loss

Androgenetic alopecia is a common type of hair loss seen both in both men and women. It usually starts with the receding of the frontal hairline and thinning on the vertex and progresses. Luckily for us women, advanced androgenetic alopecia is uncommon in women. Women usually start with the widening of the part and progressive thinning on top of the head, with the frontal hairline usually remaining intact.

Miniaturization of Hair Follicles. Courtesy of New Men Clinic

How It Happens

Scientifically, under hormonal control thick dark terminal hairs progressively “miniaturize” into fine baby vellus hairs. Usually, this progressively occurs over years or decades as illustrated in the diagram. In post-menopausal women, this occurs with increased levels of testosterone and DHEA and decreased levels of estrogen. The patterned loss tends to run in families, but only one exact genetic mutation is known, a mutation in the AR gene.

Female pattern loss. Courtesy of health.harvard.edu

Treatment Options

Treatment aims to increase active anagen growth of terminal hairs and to target hormonal changes that drive patterned loss. In advanced cases in younger women, we often check hormonal levels to make sure there is not an obvious abnormality.

Minoxidil (Rogaine).

Minoxidil was originally designed as a blood pressure pill. Those who took the pill grew excessive hair. It was another of those accidental discoveries. FDA approved in 1988; Rogaine can be safely used by men and women. There is no hormonal effect. There traditionally have been two or more formulations, labeled “men” and “women.” Differences in these products are differences in concentration and inactive ingredients, not differences in the active ingredient, minoxidil. Check out our prior post,
“Help, I’m Losing My Hair!” for tips on purchasing and using Rogaine.

Spironolactone

Spironolactone is a diuretic whose main side effect was feminization because it antagonized androgens. It is prescribed to females without the childbearing potential to antagonize the effect of androgens on the hair follicles. It often decreases hair loss on the scalp AND decreases hair growth in undesired areas. Electrolytes need to be monitored on a regular basis.

Finasteride (Propecia)

Finasteride blocks the effect of testosterone on hair. It is primarily given to men. The main side effect is erectile dysfunction. An extensive amount of research has concluded that finasteride decreases the risk of prostate cancer, but those who do have prostate cancer have a more aggressive case after taking finasteride.

Microneedling

Microneedling is a procedure that uses a device to puncture thousands of whole in the skin. There are a number of reports that show improvement of alopecia with microneedling followed by Platelet Rich Plasma (PRP) and/or minoxidil. However, these procedures are not well standardized and generally not more effective than standard treatment. Cost is significant and out of pocket for most patients.

Hair Transplant

Discussion of hair transplants is beyond my area of expertise but remains an area of promising technology.

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