ndrogenetic alopecia (male pattern hair loss, commonly baldness) is the most common form of alopecia in men and one of the most common in women. 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. Androgenetic alopecia is due to the effect of androgens on the hair follicles, while there is also a genetic predisposition for its appearance. Both genetic and environmental factors play a role in its emergence and development, while the full causes still remain unknown.

Appearance of Androgenetic Alopecia






Men till 50 years old

    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.

Androgenetic Alopecia – Clinical picture

    The clinical picture of androgenetic alopecia varies in men and women. Classical androgenetic alopecia in men is characterised by

  • loss of hair on the temples
  • thinning of hair on the crown of the head
  • 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, and complete hair loss rarely appears. 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. Other factors that contribute to the development of androgenetic alopecia are

  • mental illness
  • heart disease
  • prostate cancer

    Female androgenetic alopecia 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. Apart from heredity, there are also other factors that lead to female androgenetic alopecia, such as:
  • reduction of female hormones during menopause
  • polycystic ovary syndrome
  • congenital adrenal hyperplasia
  • 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 exposure to UV radiation contribute to the onset androgenetic alopecia in women. Finally, anxiety and stress accelerate the condition in both men and women.

    The psychological impact of androgenetic alopecia is enormous in both men and women. Rich and strong hair has always been regarded as an important element of beauty. Patients who suffer from hair loss have low self confidence, are less sociable and often have difficulties in their interaction with the opposite sex. This explains why people with androgenetic alopecia have always been seeking solutions to their problem.

Androgenetic Alopecia – Diagnosis

    The diagnosis is, basically, clinical. The trichogram is one of the oldest techniques for the diagnosis of androgenetic alopecia and shows a very large increase in telogen and dystrophic hairs, compared to anagen hairs. A full haematological and hormonal check is advisable, in order to exclude underlying disease, especially in female androgenetic alopecia. Trichoscopy is a new method, diagnostically equivalent to dermoscopy. The process uses a digital microcamera that shows the affected area and takes a photo-trichogram. In case of doubt, a scalp skin biopsy may be required in order to differentiate androgenetic alopecia from alopecia areata or cicatricial alopecia.

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

Androgenetic alopecia – Treatment

    Treatment of androgenetic alopecia is a matter of great interest to the patients, as it is a serious aesthetic issue with significant psychological consequences. The need to find an effective treatment is reflected by the multitude of substances (from topical creams and lotions to vitamins pills and shampoos) that have been used in the past and continue to be used, promising successful treatment. Treatment of androgenetic alopecia can be divided into non-hormonal therapy, hormonal therapy and surgical therapy.

Non-Hormonal Treatment
Hormonal Treatment
Surgical Treatment

    Other modern treatments include low level laser treatment (LLLT) and treatment with PRP (Platelet Rich Plasma), which involves injection of plasma from the patient’s blood into the affected region. After appropriate activation, the plasma is injected into the scalp and by producing growth factors, leads 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.