Androgenetic alopecia (male pattern hair loss, commonly baldness) is the most common form of alopecia in men and one of the most common in women.
Androgenetic Alopecia appears in:
of men over 50 years old
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.
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.
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.
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.