What is androgenic alopecia and how can it be treated?

Androgenetic alopecia  overview

Androgenetic alopecia is non-cicatricial hair loss in men and women, the cause of which is a genetic predisposition. It occurs under the influence of androgens and is characterized by thinning of the hair making it look like fluff and a decrease in the amount of hair on the head. In almost all men, a recession along the line of hair growth occurs to a small extent during life, but in half of men and women in the age category over 40, this process progresses. The occurrence of androgenetic alopecia also called male pattern baldness, depends on whether such a pathology occurred in family members, and in particular, parents and relatives on the maternal side.

The main reason for this hair loss type is a combination of factors such as the excessive activity of androgens (steroid sex hormones), genetic predisposition, and external environmental conditions.

In this disease, androgens contribute to the conversion of testosterone to dihydrotestosterone, an active form, after which it binds to the dermal papilla, which activates the genes in the follicles of the frontal part and crown. And this leads to hair loss and baldness.

Symptoms of androgenic alopecia

Androgenetic alopecia in men begins with thinning of the hair on the frontal part, and then bald patches form on the temples, after which the baldness of the crown region appears. In women, hair loss begins at the crown of the head and, by the appearance of the bald patches, resembles a herringbone. The male type of hair loss can be in the female part of the population, just as the female type of alopecia can be found in men.

How is this disease diagnosed?

For the diagnosis of androgenetic alopecia, the following methods are used:

- Clinical inspection by a doctor (dermatologist, trichologist), consultation.
- Trichoscopy. This is one of the modern methods for diagnosing baldness due to which hair growth indicators are determined. It allows seeing signs that are characteristic of only this disease, which distinguishes it from other types of alopecia. Numerous macro photographs made during the test enable the doctor to evaluate the progression of the pathology and monitor treatment.
- Dermatoscopy. This is a non-invasive diagnosis method using a special optical device, a dermatoscope. Different, newly appeared skin formations have a complex of signs that are determined visually, called keys. Special devices that allow getting a 20-140x magnification of the subject in question (fully optical zoom, which can be controlled by the handle on the body and in the program itself) are used for this type of examination.
- Video dermatoscopy is recommended in the following cases: malignant skin tumors; precancerous neoplasms; all types of skin pathologies and hair problems; any neoplasms on the skin (which allows reducing errors in the diagnosis and deletions).
- Laboratory research includes tests for ferritin, TSH (thyroid-stimulating hormone), and vitamin. They are prescribed to determine and exclude other causes of hair loss. The level of testosterone and dihydrotestosterone in the blood is also determined in order to properly plan treatment methods. With obvious signs indicating hyperandrogenism (excess weight mostly accumulated in the upper body, excessive body hair, and others), tests for LH, FSH, progesterone, free testosterone, cortisol, prolactin, etc. are prescribed. Also, in this case, the patient needs to consult an endocrinologist.
- Punch biopsy. From a certain area of the skin under the hair, a small piece is taken for a pathomorphological analysis that helps to make a final diagnosis, since a histological characteristic is revealed and the number of terminal, gun, the anagen (growing) and telogen (dying) hairs in this area are shown. This diagnostic procedure makes it possible to obtain samples of all layers of the skin: the epidermis, dermis, and subcutaneous fat. In the process of punch biopsy, the instruments with a diameter of 1.5-8 millimeters are used.
Advantages of punch biopsy as a diagnostic method: no preliminary preparation is needed; allows to quickly and accurately make a diagnosis; there are practically no contraindications; taking a sample from a pathological site does not cause injury to surrounding healthy tissues.
A punch biopsy is recommended in the following cases: to clarify the diagnosis of any pathological changes in the skin; in chronic dermatoses with prolonged and frequent relapses; determination of malignant and benign neoplasms; systemic collagenoses; bullous types of pathologies; mycoses (fungal infection).
Contraindications for punch biopsy: allergic reactions to drugs and abnormalities in blood coagulation.

How is the treatment of androgenic alopecia done?

Androgenetic alopecia without adequate treatment begins to progress rapidly. Only qualified specialists can competently and professionally select the most appropriate treatment methodology according to the step by step method.

To treat this disease, external drugs are used that increase the anagen (growth) period and stimulate an increase in the thickness of the hair, and drugs that block certain enzymes. Each appointment is individual for a particular patient.

Besides topical medications, such drugs as Propecia (Finasteride and its generic versions) are used to suppress the enzyme that promotes the transformation of testosterone into dihydrotestosterone. These medicines are effective in 99% of cases. However, they have their drawbacks: the pills are contraindicated for women of childbearing age who plan to have children, for people whom Finasteride is not contraindicated, the medication is used every day for at least half of a year to see first results. Hair loss stop and restoration of hair growth is seen not sooner than after a year of the medication use and once the medication is no longer used, hair loss re-starts although not immediately in the same volume. The medications based on Finasteride are the most effective because they act directly on the hormone that promotes this type of hair loss. It is highly advised to start using it at the first signs of androgenic alopecia to maintain all hair and your usual hairline. It can be also used when the process is quite long but then the results can be less effective as some follicles that became dormant due to dihydrotestosterone are no longer able to grow hair. You can read more information about this drug including dosages, contraindications, and side effects on the product page on our website.

A surgical method for the treatment of androgenetic alopecia is a hair transplant to areas of baldness with the preservation of the number of follicles. This is another most effective method of treatment because the “alive” follicles are transferred to the areas where the follicles are dormant and unable to grow hair. However, the major drawback of this method is its high price.

Other additional medications for androgenic alopecia include

Post by: Jacob Hansen, General healthcare practitioner, National health centre, Stavanger, Norway