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.
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.
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.
Hormonal therapy of androgenetic alopecia in women includes contraceptives, if the cause of alopecia lies in diseases such as polycystic ovaries. Postmenopausal women may be treated with hormone replacement therapy with oestrogen and progesterone.
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.
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 Low Level Laser Treatment (LLLT) and 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.
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.