Androgenetic Alopecia

Understanding Androgenetic Alopecia: Causes, Symptoms, and Treatment Options

Hair loss is a common problem that impacts people worldwide, regardless of age or gender. The most common type of hair loss is androgenetic alopecia (AGA), or, more commonly known as, male pattern baldness (MPB). Thinning hair or a receding hairline is the warning sign for AGA. This condition can have a significant impact on an individual’s self-esteem and confidence.

What is Androgenetic Alopecia

Androgenetic alopecia is commonly referred to as male or female pattern baldness. It is a hereditary condition that causes a gradual loss of hair due to genetic and hormonal factors. AGA is the most common type of hair loss for both men and women. While it impacts both genders, the pattern of hair loss differs between men and women, as listed below:

In Men

AGA typically starts with a receding hairline, often forming an “M” shape.
Hair loss then progresses to thinning at the crown (top) of the head, leading to a “bald spot.”
Over time, these areas of hair loss may expand, eventually leaving a horseshoe-shaped pattern of hair around the sides and back of the head.

In Women

Female pattern baldness usually presents as diffuse thinning of hair across the crown of the head.
Unlike men, women rarely develop a receding hairline or complete baldness. Instead, they experience a widening part or overall hair thinning.

Causes of Androgenetic Alopecia

Androgenetic alopecia is primarily caused by a combination of genetic and hormonal factors. The most common causes are listed below:

Genetic Predisposition

Genetic predisposition influences how hair follicles respond to androgens, particularly dihydrotestosterone (DHT). Individuals with a family history of AGA inherit specific genes that make their hair follicles more sensitive to DHT, a hormone that shrinks hair follicles and shortens the hair growth cycle. As a result, hair becomes progressively thinner and weaker, leading to the typical signs of AGA, such as a receding hairline or thinning crown in men and diffuse thinning across the scalp in women. AGA is influenced by multiple genes, and though it is more common in men, it can also affect women, with genetic factors often being inherited from both sides of the family, particularly the maternal side.

Hormonal Influence

AGA is closely linked to the presence of androgens, particularly dihydrotestosterone (DHT), which is derived from testosterone. DHT affects hair follicles by shortening the hair growth phase and causing them to shrink over time, resulting in thinner, weaker hair. In men, elevated levels of DHT contribute to the characteristic pattern of receding hairlines and thinning at the crown. In women, hormonal changes such as those occurring during menopause can also lead to AGA, as a decline in estrogen levels may cause an imbalance between androgens and other hormones, triggering hair thinning. This hormonal influence is a key factor in the progression of AGA, explaining why the condition often worsens with age and can be more prominent during periods of significant hormonal change.

Age

As individuals age, the natural hair growth cycle slows down, and hair follicles may become less efficient at producing new hair. Over time, the hair growth phase shortens, while the shedding phase lengthens, leading to thinner, weaker hair. In men, this often results in a receding hairline and bald patches, while women typically experience diffuse thinning across the scalp. Age-related hormonal changes, such as decreased levels of estrogen in women during menopause, can also exacerbate AGA. The gradual impact of aging on hair follicles and hormones contributes to the increased likelihood of experiencing hair loss as people grow older, with the condition often becoming more pronounced in middle age and beyond.

Gender

In men, AGA typically presents as a receding hairline and bald patches on the crown, often starting in their late teens to early twenties. This pattern of hair loss is largely driven by the action of dihydrotestosterone (DHT), a hormone that affects male hair follicles more significantly. In women, AGA usually leads to diffuse thinning across the scalp, particularly around the crown, and tends to occur later in life, often after menopause when hormone levels, especially estrogen, decline. While both men and women are affected by hormonal changes, the patterns and progression of AGA differ due to the distinct ways androgens impact male and female hair follicles. Gender differences in hormone levels and genetic predisposition result in varying experiences of hair loss, with men typically seeing more noticeable baldness earlier, while women experience more gradual thinning over time.

Hormonal Changes

In both men and women, fluctuations in hormone levels can trigger or exacerbate hair loss. In men, increased levels of dihydrotestosterone (DHT), a byproduct of testosterone, can shrink hair follicles and shorten the hair growth cycle, leading to thinning and receding hairlines. For women, hormonal changes during events such as pregnancy, childbirth, and especially menopause, when estrogen levels decrease, can disrupt the balance between androgens and other hormones. This imbalance can result in hair thinning, particularly around the crown and temples. Additionally, conditions such as polycystic ovary syndrome (PCOS), which causes an increase in male hormones, can also lead to AGA in women. These hormonal shifts can accelerate hair loss and contribute to the progression of AGA over time.

Environmental Factors

Exposure to pollutants, harsh chemicals, and environmental stressors such as extreme weather conditions can damage hair follicles and contribute to hair thinning. Pollutants in the air, such as toxins and heavy metals, can weaken hair strands and disrupt the natural growth cycle, making hair more prone to shedding. Additionally, the quality of water, especially in areas with high mineral content or chlorinated water, can affect scalp health and potentially lead to hair loss. Lifestyle factors, including poor diet, lack of sleep, and chronic stress, can further exacerbate hair thinning, as they may interfere with the body’s ability to maintain healthy hair growth. While environmental factors may not be the primary cause of AGA, they can certainly accelerate the condition and contribute to more noticeable hair loss over time.

Although androgenetic alopecia’s exact causes are not fully understood, it’s generally understood that it’s attributed to genetics and hormones. It’s recommended to consult with a healthcare professional or dermatologist to be properly diagnosed. Early intervention and treatments offer the best chance of maintaining the hair and stimulating regrowth.

Symptoms of Androgenetic Alopecia

The primary symptom of androgenetic alopecia is hair loss; however, the specific symptoms and patterns can differ. Some of the common associated symptoms for each gender are listed below:

In Men

RECEDING HAIRLINE
Men with AGA often notice their hairline receding from the forehead, forming an “M” shape. The hairline may gradually move further back over time.

BALDING AT THE CROWN
Hair loss typically occurs at the crown (the top of the head), resulting in a circular or oval-shaped bald spot. This balding at the crown is often referred to as a “bald spot” or “bald patch.”

THINNING HAIR
In addition to receding hairlines and crown balding, men with AGA may also experience general thinning of the hair throughout the top of the scalp. The hair becomes finer, shorter, and less dense.

PATTERNED HAIR LOSS
AGA in men follows a characteristic pattern, with the hair loss usually occurring in a specific sequence: receding hairline, crown balding, and then progressive thinning on top.

In Women

DIFFUSE THINNING
Female pattern baldness typically presents as diffuse hair thinning across the crown of the head, rather than receding hairlines or bald patches. Women may notice that their part widens, and their hair becomes noticeably thinner.

MAINTAINED HAIRLINE
Unlike men, women with AGA usually maintain their natural hairline, which doesn’t recede significantly.

WIDENED PART
The part in a woman’s hair may appear wider and more noticeable as the hair becomes thinner.

HAIR MINIATURIZATION
Hair in affected areas may become finer, shorter, and less pigmented. This phenomenon is known as “hair miniaturization.”

OVERALL HAIR LOSS
While women tend to experience more diffuse thinning, in severe cases, AGA can lead to noticeable hair loss throughout the top of the scalp.

It’s important to note that the severity and progression of androgenetic alopecia can vary from person to person. Some individuals may experience mild thinning, while others may have more pronounced hair loss.

Treatment Options for Androgenetic Alopecia

Treatment options for androgenetic alopecia are aimed at slowing down hair loss, maintaining existing hair, and promoting new hair growth. The effectiveness of these treatments can vary between individuals, and not everyone will respond to all treatments.

FDA Approved Hair Loss Treatments

MINOXIDIL
Minoxidil is an over-the-counter topical medication available in liquid or foam forms. It is one of the most used treatments for androgenetic alopecia. When applied directly to the scalp, minoxidil can help stimulate hair follicles, increase blood flow, and promote hair growth. It is available without a prescription.

FINASTERIDE
Finasteride is an oral prescription medication that works by reducing the levels of dihydrotestosterone (DHT), a hormone associated with hair follicle shrinkage and hair loss. It is typically more effective in men than in women. Women of childbearing age should avoid using finasteride due to potential birth defects.

PLATELET-RICH PLASMA THERAPY (PRP)
PRP therapy involves drawing a small amount of the patient’s blood, processing it to concentrate the platelets, and then injecting the platelet-rich plasma into the scalp. PRP stimulates hair follicles and encourages hair growth.

LOW-LEVEL LASER THERAPY (LLLT)
LLLT devices, such as laser combs or helmets, emit low-energy laser light that stimulates hair follicles and promote hair growth. Studies show that LLLT can be effective in slowing hair loss and promoting hair regrowth, especially when used regularly.

HAIR TRANSPLANT SURGERY
In cases of advanced androgenetic alopecia, hair transplant surgery can be an effective option. This procedure involves removing hair follicles from a donor area (typically the back of the head) and transplanting them into areas with thinning or no hair. There are different techniques, including follicular unit transplantation (FUT) and follicular unit extraction (FUE).

Non-FDA Approved Hair Loss Treatments

MINOXIDIL & DERMAROLLING
Minoxidil is an over-the-counter topical medication available in liquid or foam forms. When combined with dermarolling or microneedling, it can increase absorption of the minoxidil. The combined treatments can have a synergistic effect on treating hair loss.

SETIPIPRANT & PGE2
Setipiprant works by inhibiting PGD2, which contributes to hair follicle miniaturization, which treats hair loss. In contrast, PGE2 encourages hair growth by increasing PGE2 levels. The combination of setipiprant and PGE2 can have synergistic benefits to treating hair loss.

RU-58841
RU-58841 is a topical antiandrogen blocker that works by blocking the effects of dihydrotestosterone (DHT), a hormone linked to hair follicle miniaturization.

CB-03-01
CB-03-01 works by blocking androgens, such as DHT, to prevent miniaturization of hair follicles.

PYRILUTAMIDE
Pyrilutamide is an androgen receptor antagonists. It works by blocking the androgen receptors in the hair follicles, inhibiting hair loss.

SPIRONOLACTONE
Sprinolactone is an anti-androgen that works by blocking the effects of testosterone and DHT. By blocking these androgens, it works to slow down and halt hair loss.

LATANOPROST
Users have explored lanatoprost as an off-label treatment for hair loss due to it’s side effect of increasing eyelash length and thickness.

KETOCONAZOLE
Ketoconazole is an antifungal and treats dandruff and seborrheic dermatitis. This creates a healthier environment for hair growth.

FLURIDIL
Fluridil is a topical anti-androgen that targets hair loss by preventing DHT from binding to androgen receptors on hair follicles.

PROCYANIDIN B2
Procyanidin B2 is believed to stimulate hair follicles and extend their growth phase. It also possesses antioxidant properties that protect hair follicles from oxidative stress.

STEMOXYDINE
Stemoxydine is thought to activate dormant hair follicles, increasing hair density and thickness.

Natural Hair Loss Treatments

SCALP MASSAGES
Scalp massages can promote hair loss by improving blood circulation and nourishing the hair follicles.

ALOE VERA
Aloe vera is rich in vitamins, minerals, and amino acids that can strengthen hair strands and reduce breakage. It has anti-inflammatory and moisturizing properties that provide an optimal environment to encourage new hair growth.

ONION JUICE
Onion juice helps treat hair loss due to it’s high sulfur content, which is essential for regeneration of hair follicles.

GREEN TEA
Green tea is rich in antioxidants, particularly catechins like epigallocatechin gallate (EGCG). These compounds stimulate hair follicles and promote regrowth.

SAW PALMETTO
Saw palmetto combats hair loss with its ability to inhibit 5-alpha-reductase, which is the enzyme responsible for converting testosterone into DHT.

PUMPKIN SEEDS
Pumpkin seeds are rich in nutrients like zinc and fatty acids, which are essential for hair growth, repair, and promoting hair thickness.

ESSENTIAL OILS
Essential oils treat hair loss by stimulating blood circulation, balancing the scalp health, and nourishing hair follicles, depending on the essential oil(s) being used.

COCONUT OIL
Coconut oil is rich in medium-chain fatty acids, particularly lauric acid, which is know to penetrate the hair shaft effectively. This property allows coconut oil to nourish and strengthen hair, and reduce protein loss.

It’s essential to consult with a healthcare professional or dermatologist before starting any treatment for androgenetic alopecia. They can assess your condition, provide a proper diagnosis, and recommend the most suitable treatment options based on your specific needs.

Conclusion

Androgenetic alopecia is a common cause of hair loss that affects both men and women of all ages. While it is primarily driven by genetic factors and hormonal imbalances, there are effective treatment options available to slow down hair loss and promote regrowth. Knowing the cause of your hair loss is the first step to help you treat it and bring back your self-confidence!

If you are concerned about AGA, consult a healthcare professional or dermatologist who can provide a personalized treatment plan to address your specific needs.