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Androgenetic alopecia is a genetic disease that occurs mainly in men, but female androgenetic alopecia is also known. Androgenetic alopecia occurs in at least 50% of men over the age of 50 and in 40% of women over the age of 70. Androgenetic alopecia, due to its occurrence primarily among men, is sometimes referred to as male pattern baldness. In the case of alopecia under the age of 36, a visit to a cardiologist should be considered, as hair loss at such an early age is a significant risk factor for coronary heart disease.
Androgenetic alopecia – causes
The causes of androgenetic alopecia are mainly hypersensitivity to DHT – a derivative of the male hormone testosterone. DHT is produced from testosterone and acts on the androgen receptors of the hair follicles, gradually leading to their disappearance. This results in a shorter hair growth phase, and new hair grows weaker and shorter, until it finally stops showing up.
A symptom accompanying androgenetic alopecia is oily scalp caused by overproduction of sebum. The cause of androgenetic alopecia is also, apart from genetic tendencies, too much tension of the scalp.
Although androgenetic alopecia mainly affects men over 50, its first symptoms can sometimes be observed in teenage boys. The easiest symptom of this condition is the process of receding the hairline – it begins at the temples and forehead of the patient, then moves towards the parietal and deeper at the temples. According to the Hamilton and Norwood classification, we can distinguish as many as 7 stages of male androgenic alopecia development.
- Grade 1 – is a natural so-called teenage hairline, without deep receding;
- Grade 2 – gentle recession of the front hairline, gentle bends, the so-called mature hairline;
- Grade 3 – deepening the hairline, further withdrawing the front hairline, early phase of baldness;
- Grade 4 – clearly receding hairline, thinning in the parietal part, a strip separating the front from the apex;
- Grade 5 – the strip separating the top from the parietal part becomes narrower, visible thinning;
- Grade 6 – areas of baldness merge into one, their surface area increases. Grade 7 – hair is present on the occipital part, there is no or very rare hair on the rest of the hair.
Women’s androgenic alopecia
The condition of androgenetic alopecia also occurs in women, but its course differs significantly from that of male androgenic alopecia. In women, this disease manifests itself as a loss of hair density at the top of the head, but without shifting the hairline itself. Women’s androgenic alopecia is often a condition that accompanies other diseases, in particular hormonal disorders such as ovarian or adrenal tumors, polycystic ovary syndrome, adrenogenital syndrome or Cushing’s syndrome.
Read more: Women’s baldness. Why does hair fall out of power? The expert explains
Androgenetic alopecia – diagnosis
Male androgenic alopecia is diagnosed on the basis of the clinical picture typical of this disease entity. The doctor first examines the hairy scalp very carefully, which shows the features of non-scarring alopecia. In addition, the so-called a pull test involving pulling the hair at the edge of the focus. In case of doubt, a biopsy is also used.
In the case of suspected androgenetic alopecia, a trichogram or a trichoscopy is performed as supplementary tests. The trichogram is a microscopic examination of the hair. About 50 to 100 hairs are collected during the test. Thanks to this, it is possible to determine the proportions of the individual phases of the hair cycle (anagen, catagen, telogen). Trichoscopy, on the other hand, is based on the assessment of the hair using the videodermoscopy method. There is no need to pull your hair out during the test.
It is worth adding that another method that is also used is in vivo reflection confocal scanning microscopy, i.e. non-invasive imaging of hair and hairy skin (this method, however, requires further research).
If you notice your hair falling out, strengthen it with the Klimuszko Herbal Liquid Hair Treatment. The preparation stimulates the hair follicles, preventing baldness, reducing seborrhea and dandruff.
Androgenetic alopecia – medications
The condition is often left untreated, but there is another possibility. Androgenetic alopecia can be treated both topically and generally. In the first option, a drug called minoxidil is used, which dilates the vessels of the hair follicles, thereby stimulating the mitosis of the cells in the hair follicle. The general drug for androgenetic alopecia is finasteride, which inhibits the 5-reductase enzyme responsible for this disease.
In addition, spironolactone is also used in androgenetic alopecia, which also reduces the production of hormones that contribute to androgenetic alopecia. Women with androgenetic alopecia who do not respond to minoxidil may benefit from taking spironolactone.
For some patients, there may be an option surgical treatment of hair loss. Surgical options include hair transplant, in which healthy hair follicles from other parts of the scalp are transplanted into the areas affected by alopecia. Scalp reduction is another procedure that is sometimes performed. In this case, the baldness is removed and the remaining skin is sewn together.
Read more: Drugs for hair loss – over-the-counter, therapy
Sometimes laser therapy with laser combs is also usedwhich can help with hair growth in some people with androgenetic alopecia. These combs are typically used about three times a week for a few minutes. However, more research is needed to discover how best to use laser therapy and determine if it has long-term benefits.
Androgenetic alopecia is not a death sentence, and its diagnosis is the first step to treatment. If you notice the first symptoms of this condition, it won’t hurt to do the pull test by lightly pulling 40-60 hairs. This test should be repeated in three places on the scalp.
If at least 3 hairs fall out in each location, or if more than 10 hairs in total, it is considered a case of androgenetic alopecia. Due to the fact that female androgenetic alopecia occurs quite often, women should also pay attention to the condition of the scalp, especially since in their case such a disorder may also be associated with much more severe health problems.
Hair transplant – price
Androgenetic alopecia – side effects of treatment
Medications for androgenetic alopecia – Minoxidil
Minoxidil causes several side effects. Occasionally, the scalp may become red or irritated, causing itchiness. Whole body side effects are possible if minoxidil is absorbed through cracks or cuts in the scalp. Especially people struggling with heart disease should pay attention to systemic side effects, such as increased heart rate, swelling of the hands or feet, and weight gain.
Medications for androgenetic alopecia – Finasteride
Side effects can include weakness and dizziness. Higher doses of finasteride (such as those used to treat certain prostate conditions) may cause side effects including erectile dysfunction and decreased libido. However, such side effects are rarely seen with the 1 mg dose used to treat hair loss.
Finasteride is not safe for use in women who may become pregnant due to concerns over the development of abnormal genitals in a male fetus. Pregnant women should not even handle the finasteride tablets.
Medications for androgenic alopecia – Spironolactone
Potential side effects include dizziness, drowsiness, breast tenderness, and increased levels of potassium in the blood. Patients should talk to their doctor about potential side effects before taking spironolactone.
Like finasteride, spironolactone should not be used during pregnancy. Women who could become pregnant must use effective contraception while taking this drug.
Androgenetic alopecia – epidemiology
Androgenetic alopecia is an extremely common disorder that affects approximately 50% of men and probably the same number of women over the age of 40. As many as 13% of premenopausal women are said to have symptoms of androgenetic alopecia. However, the incidence of androgenetic alopecia increases significantly in postmenopausal women and, according to one author, it may affect 75% of women over 65 years of age.
A community study of androgenetic alopecia in 6 cities in China found that the incidence of androgenetic alopecia in both Chinese men and women was lower than that seen in whites, but similar to the incidence among Koreans.
The incidence and severity of androgenetic alopecia is usually highest in white men, second highest in Asians and African Americans, and lowest in Native Americans and Inuit.
Almost all patients with androgenetic alopecia begin before the age of 40, although many patients (both men and women) show signs of the disease by the age of 30.
An alternative method of treating androgenetic alopecia are hair transplants that can be performed in aesthetic medicine clinics. Their offers and prices can be found on the website clinics.pl.
Check: Hair transplant – how does it work and how much does it cost?
Androgenetic alopecia – psychological and physical aspect
Most men with androgenetic alopecia experience psychosocial effects. Hair loss, in particular, affects the feeling of attractiveness and satisfaction with the outward appearance of a balding person and can affect how others perceive it.
Hair is an important determinant of physical attractiveness and a means of expressing individuality. Throughout history, profuse body hair has symbolized vitality, health, and masculinity, while hair loss or removal may have signified subjugation, loss of individuality, impotence, and / or weakness.
The negative effect of hair loss on the perception of self-attractiveness has been observed in several studies of androgenetic alopecia in men. In all studies, factors associated with a higher risk of psychiatric disorders related to hair loss include young age, lack of a romantic relationship, strong reliance on physical appearance as a source of self-esteem, and prior poor self-esteem.
In addition to affecting a balding man’s self-esteem, hair loss can also affect the perception of a balding person by others. In comparative studies, individual individuals’ initial impressions of sketches or photos of balding versus non-balding men, balding men were consistently rated as less physically and socially attractive, older, less likeable, and less masculine. However, the extent to which these first impressions of balding men have evolved over time has not been studied.
It is worth adding that although androgenetic alopecia is not life threatening, it can lead to physical injury. Hair protects against sunburn, cold and mechanical injuries. Since male androgenetic alopecia in men is associated with a loss (due to a lack of hair) of the scalp’s protection from ultraviolet light, it may increase the risk of sunburn and cell damage that underlies skin cancer.