Androgenetic Alopecia

Androgenetic alopecia is the most common form of alopecia in men and one of the most common in women. Moreover, it can occur at all ages, even in children and adolescents.

The psychological, occupational and social impact of androgenetic alopecia can be significant in both sexes, and the age of onset can be even more burdensome for the sufferer. In men, where thick and strong hair has always been associated with youth, vigour and masculinity, premature baldness can affect the way they relate to the opposite sex and even how they view themselves in the professional arena. But even in women, for whom lush and strong hair has always been seen as an element of femininity and beauty, obvious thinning of the hair can negatively affect their self-confidence and socialization as well as their interaction with the opposite sex.

For all these reasons, it is important to diagnose early and initiate appropriate treatment for alopecia that can effectively and permanently address the problem.

Treatment choices

Four are the main choices for androgenetic alopecia treatment:

Non-Hormonal Treatment
Hormonal
Surgical
Non-invasive treatment

Hormonal therapy is most effective in young patients, up to 30 years of age, but also in early to mid-stages of alopecia I-IV, according to the Norwood-Hamilton scale.

At older ages it begins to be less effective due to the reduction of androgens in the blood. Administered as a treatment for androgenetic alopecia, it reduces blood levels of PSA, and thus may mask a possible prostate carcinoma. It is therefore advisable that hormone therapy is not given to men over the age of 50.

As a treatment in women it can be used after menopause. Hormonal treatment of androgenetic alopecia in women includes contraceptives when the cause of the alopecia is diseases such as polycystic ovaries. In postmenopausal women, hormonal replacement therapy with estrogen and progesterone may be given as treatment.

The only non-hormonal treatment with proven results, is minoxidil (in 2% or 5% solution) in the form of lotion or foam. Hair loss in its early stages may be slowed down or even reversed with topical use of 1 ml minoxidil twice a day. The drug is essentially a biological modifier which acts by increasing blood circulation to the scalp and should be applied for several months. Recent investigations have shown that minoxidil interferes in the mechanism of alopecia by prolonging the anagen phase of the hair, thereby increasing its lifetime.

The maximum effect of this treatment for androgenetic alopecia is achieved after at least six months of continuous use; upon discontinuation of the drug, the beneficial effects of the treatment are lost. It has been shown that stopping the use for 15 consecutive days leads to regression of the results and to resumption of hair loss. The side effects of minoxidil are not serious and include dryness, irritation, flaking scalp, facial hirsutism and, in rare cases, allergic dermatitis. These side effects limit its use as a treatment for hair loss in some patients.

Recent research has shown that minoxidil interferes with the mechanism of alopecia by prolonging the regenerative phase of the hair, thus increasing its lifespan. The maximum effect of this androgenetic alopecia treatment is achieved after at least 6 months of continuous use, and with discontinuation of the drug the beneficial effects in its treatment are lost.

Surgical treatment of androgenetic alopecia involves hair transplantation, which is also the only definitive treatment. The preferred method is FUE, which is painless, does not leave any scars or marks, does not require stitching, and gives a perfectly natural result.

FUE hair transplantation is indicated for both men and women suffering from androgenetic alopecia, regardless of the patient’s age or degree of progression. One other method that is still used to a significant degree, is the older hair transplant technique FUT, commonly known as Strip technique. Over recent years the use of FUT has become less popular, as more and more patients prefer the less traumatic FUE technique.

Modern non-invasive treatments include treatment with autologous growth factors which involves injection of activated ingredients from the patient’s blood into the affected region. After appropriate activation, the ingredients are injected into the scalp and by producing growth factors, lead to the development of new cells, improves blood supply to the scalp area and strengthens the affected hair follicles. As it takes advantage of the body’s own healing forces, it is one of the most effective modern treatments for androgenetic alopecia.

RESULTS

Hair loss treatment & Hair transplantation

ALOPECIA

Types & Diagnosis

Diagnosis in men

Classical androgenetic alopecia in men is characterized by loss of hair on the temples, thinning of hair on the crown of the head and a gradual recession of the hairline. Even in advanced stages, a strip of normal density remains in the lateral temporal regions and on the rear (occipital) part of the scalp. Total hair loss rarely appears.

Diagnosis in women

Androgenetic alopecia in women usually occurs as diffuse thinning of the hair, without recession of the hairline. In most cases, hair thinning is more intense at the top of the scalp. Unlike in men, total loss of hair in the affected area is rarely observed.

Phototrichogram

Phototrichorizogram is the most advanced method of diagnosing alopecia in men and women and is performed with the help of a special digital microcamera. The doctor uses Follysis software and proceeds to digital analysis of photographs from the area of alopecia and from the healthy scalp area, determining the extent of the affected area, the number of hair follicles and the average number of hairs per hair follicle, as well as the diameter of the hair, compared to reference values from the healthy scalp area. A reduction in hair diameter is an early diagnostic sign of the occurrence or progression of alopecia in the area under examination.

Classification of the degree and severity of androgenetic alopecia

For the classification of the degree and severity of androgenetic alopecia, Norwood-Hamilton scale is used for male androgenetic alopecia and the Ludwig scale for female androgenetic alopecia.

It is estimated that 70% of men and 40% of women will experience it at some point in their lives, and one in two men will suffer from it at the age of 50.

FAQs

Male androgenetic alopecia is due to the effect of androgens on the hair follicles, while there is also a genetic predisposition for its appearance. Androgens are important growth hormones of the male sex. They control the function of the sebaceous glands, stimulate the growth of body and facial hair, and suppress the growth of hair in the frontotemporal region, leading to androgenetic alopecia.

In men who suffer from androgenetic alopecia, the enzyme 5-alpha-reductase is increased. They also display elevated levels of free testosterone and dihydrotestosterone and reduced levels of total androgens. In the hair follicle, 5-alpha-reductase converts free testosterone into dihydrotestosterone (DHT), which plays a dominant role. Both genetic and environmental factors play a role in its emergence and development, while the full causes still remain unknown. Other factors that contribute to the development of androgenetic alopecia are mental illness, heart disease and prostate cancer.

The responsible genes are being investigated; the majority of these are located on the X chromosome and are recessive. This is why women more rarely suffer from androgenetic alopecia, as it requires the existence of pathological genes on both X chromosomes to manifest itself. In men, a single gene on the only X chromosome available suffices to exhibit the disorder. Recent research has shown that the hereditary substrate of androgenetic alopecia is even more complex; genes have been found that control, among others, the time of onset of androgenetic alopecia, the speed of its development and the manner of manifestation.

Apart from heredity, other factors that lead to female androgenetic alopecia are the reduction of female hormones during menopause, the polycystic ovary syndrome, the congenital adrenal hyperplasia, the virilising adrenal and ovarian tumours, Cushing‛s syndrome, chronic use of cortisone. A recent study in identical female twins revealed several factors that can be associated with an increased incidence of androgenetic alopecia in women. Such factors are diabetes mellitus, hypertension, lack of exercise, long hours of sleep and an unstable marital relationship. Also, not wearing a hat and overexposure to UV radiation contribute to the onset androgenetic alopecia in women. Finally, anxiety and stress accelerate the condition in both men and women.