What is Androgenetic Alopecia?
Pattern or androgenetic alopecia is a hair loss condition that is largely dictated by genes and it excessively reacts to a type of hormone called androgens. Around half of both men and women might experience this. This condition causes gradual hair loss from the scalp, which usually starts after puberty, and it happens in a predictable pattern for both sexes.
For men, the most noticeable hair loss is on the top of the head (vertex) and the area at the sides just above the temples (frontotemporal regions). In contrast, women usually keep their hairline at the front of their head intact, but they experience a thinning of hair at the top of the head (diffuse apical hair), making the front of their hair look wider (broader appearance of the anterior part of the hair).
What Causes Androgenetic Alopecia?
Androgenetic alopecia, or hair loss that’s influenced by age, hormones, and genes, has strong genetic connections. The name itself hints that it is mainly caused by an extreme response to androgens, which are male sex hormones. This type of hair loss is complex, with many different factors contributing to its onset, including both mother’s and father’s genes. A family history of androgenetic alopecia can greatly increase one’s risk. For example, if a father experienced hair loss, his sons are 5 to 6 times more likely to face the same issue.
The appearance of this type of hair loss usually starts after puberty, and it relies on the activation of androgen receptors, which are proteins that respond to androgens. This explains why individuals who have been castrated before puberty or those with a condition called androgen insensitivity syndrome, where their bodies can’t respond to androgens, do not experience this type of hair loss. Thus, it’s clear that the metabolism of hormones and the androgen receptors are crucial in the development of androgenetic alopecia.
Risk Factors and Frequency for Androgenetic Alopecia
Caucasian people are more likely to be affected by this condition, followed by Asian and African American people. Native Americans and Inuits also experience this issue, but not as much. Age plays a big part in the incidence of this condition among Caucasian men, with about half affected by age 50 and almost 80% by age 70. This condition is also common in women, especially after menopause.
androgenetic alopecia.
Signs and Symptoms of Androgenetic Alopecia
Androgenetic alopecia, also known as pattern hair loss, usually begins after puberty and gradually progresses over time. In men, it usually starts with thinning of the hair at the temples and then spreads to the top of the head. On the other hand, women typically experience a more even thinning of the hair, predominantly on the top of the head, but the hairline at the front of the scalp usually remains intact.
When a healthcare provider is checking a person for signs of androgenetic alopecia, they’ll look at the pattern and extent of hair loss. They typically use something called the Norwood-Hamilton scale for men, and the Ludwig scale for women. These scales help to determine how severe the hair loss is and help to decide the best treatment approach.
The healthcare provider may also look for signs of increased hair loss, smaller than normal hair follicles, and the overall health of your scalp. A special magnifying tool, used in a noninvasive technique known as dermoscopy, enables them to look at your hair follicles more closely and confirm a diagnosis of androgenetic alopecia.
It’s also worth noting that androgenetic alopecia is the most common cause of hair loss, but it isn’t the only one. Medical conditions, medications, and stress can also contribute to hair thinning and loss. For example, women may experience a temporary hair loss condition known as telogen effluvium, which is caused by stress and results in an increased number of hair follicles in the shedding phase. There’s also a condition in men, known as early androgenetic alopecia, which usually starts before the age of 30 and is considered the male equivalent to polycystic ovarian syndrome in women.
Testing for Androgenetic Alopecia
Androgenetic alopecia, or common balding, can generally be diagnosed by looking at a patient’s medical and family history, as well as observing the gradual loss of hair after puberty. A biopsy is usually not required, unless the cause of hair loss is still uncertain. Using a tool called a dermoscope, doctors can pick up on signs like miniaturized hair ad brown perihilar casts that can help distinguish it from a different kind of hair loss known as diffuse alopecia areata, which also resembles male pattern baldness. The latter often shows signs like tapered fractures, also known as “exclamation point hairs”.
Doctors will also perform a detailed check of the patient’s overall health, previous illnesses, and current medication. This is to rule out other potential reasons for hair loss and to uncover any possible triggers for androgenetic alopecia. Extra tests may include checking the thyroid, conducting a complete blood count, and looking for signs of iron deficiency by measuring the levels of iron in the blood, the total capacity of iron binding, and the levels of serum ferritin – a protein that stores iron in the body.
In some cases, if syphilis is suspected, the patient may also be screened for it. Additionally, brief evaluations of mental health can be made as part of the diagnosis process, checking for signs of depression or other psychiatric disorders. This is due to the psychological impact that hair loss can have on patients.
Treatment Options for Androgenetic Alopecia
The FDA has approved two treatments for pattern baldness, which is hair loss that follows a specific pattern: minoxidil, which is a topical treatment applied to the scalp, and finasteride, which is a pill taken orally. These treatments should be used consistently for at least 4 to 6 months before you start to see improvements, and you’ll need to keep using them indefinitely to maintain the results.
Minoxidil is available without a prescription in different strengths. The stronger the solution, the more effective it is likely to be. The most common side effects are itching and local irritation, which can cause flaking. Minoxidil works by enlarging your blood vessels, which is thought to deliver more oxygen, blood, and nutrients to your hair follicles, stimulating hair growth.
Finasteride, on the other hand, inhibits a specific enzyme involved in hair loss. It’s especially effective in promoting hair regrowth at the top of the scalp. There’s less certainty about how well finasteride works in women, and it’s not safe for women who could become pregnant. Potential side effects include sexual dysfunction, which usually improves over time, and a slightly increased risk of aggressive prostate cancer. There have also been reports of decreased sex drive and erectile dysfunction in some cases.
There are medications used to treat pattern baldness that have not been approved by the FDA. Dutasteride is often used if finasteride doesn’t provide satisfactory results. Its side effects are similar to those of finasteride.
Spironolactone is an oral medication often used for women with pattern baldness. It works by blocking a potent form of testosterone and promoting the conversion of testosterone to estrogen. The most commonly reported side effects include irregular periods, dizziness or headaches, excessive hair growth on the face, rash, and high potassium levels. But research indicates these side effects are usually temporary and manageable. Men who use spironolactone may experience side effects like enlarged breast tissue, decreased sex drive, and mild impotence. It’s important to discuss these potential side effects with a healthcare professional if you’re considering taking spironolactone for pattern baldness.
Red light or laser therapy has also been shown to effectively treat hair loss and is available without a prescription. Hair transplantation can work well for certain patients, provided they have enough hair to transplant to the bald areas.
Other proposed treatments for pattern baldness include saw palmetto extract, prostaglandin analogs like latanoprost and bimatoprost, and various growth factors. Platelet-rich plasma and adipose-derived stem cells are also sometimes used, supposedly for their potential to enhance hair growth. However, these treatments are generally not used on their own, but in combination with other established treatments for pattern baldness.
What else can Androgenetic Alopecia be?
When trying to identify the cause of hair loss, doctors will check whether the hair loss is due to androgenetic alopecia or a different condition. Other disorders that can cause hair loss include:
- Alopecia areata
- Anagen effluvium
- Syphilis
- Systemic diseases
- Telogen effluvium
What to expect with Androgenetic Alopecia
Androgenetic alopecia, or male-pattern baldness, isn’t a condition that causes direct harm to your life. However, in some cases, it may be linked to other serious health conditions that could harm a person’s health.
There are several factors that can affect the progress and outcome of androgenetic alopecia. These include how early it starts, the person’s gender, the amount of scalp affected, family history, the treatments chosen, how well the person follows the treatment regime, and various lifestyle factors. The outlook for someone with androgenetic alopecia can greatly vary from one person to another.
Androgenetic alopecia is a long-term condition that can progress over time, but starting treatment early and managing it correctly can help slow down hair loss. This may mean better results for you in the long run.
Possible Complications When Diagnosed with Androgenetic Alopecia
While rapid hair loss leading to complete baldness might occur in some men, others may see reduced hair thickness on the scalp. Among women, hair loss is usually at the top of the head and full baldness is less common. When hair is lost, the scalp is more exposed to the sun’s UV rays. Studies suggest that this could increase the risk of developing actinic keratosis, a skin disorder caused by sun exposure.
Research has shown a significant link between baldness patterns, particularly early onset or hair loss at the top of the head, and heart diseases, especially in men. Conditions associated with baldness include high blood pressure, heart attacks, resistance to insulin, death due to diabetes or heart diseases, abnormal cholesterol levels, obesity, and infertility.
In women, hair loss has been connected to polycystic ovarian disease, which can cause various health problems. This emphasizes the importance of in-depth health checks in such cases.
Studies about the link between hair loss and non-cancerous prostate enlargement have mixed results. However, there seems to be twice as much risk of prostate cancer and higher death rates from prostate cancer in individuals with hair loss. Additionally, these individuals may face a slightly increased risk of colon cancer and developing kidney stones.
Medical Risks:
- Sun exposure leading to skin disorders
- High blood pressure
- Heart attacks
- Resistance to insulin
- Death due to diabetes or heart diseases
- Abnormal cholesterol levels
- Obesity
- Infertility
- Polycystic ovarian disease
- Prostate cancer
- Colon cancer
- Kidney stones
