Androgenetic Alopecia

Frequency

Androgenetic alopecia is a prevalent condition, impacting approximately 50% of men and at least 35% of women globally. This condition can begin as early as a person’s teenage years and tends to become more common with age. It’s noteworthy that over 50 percent of men aged 50 or older experience some degree of hair loss due to androgenetic alopecia. In women, the likelihood of hair loss from this condition is highest after menopause.

Causes

The development of androgenetic alopecia appears to be influenced by a complex interplay of genetic and environmental factors, although many of these factors remain unidentified despite ongoing research efforts. Notably, researchers have established a connection between this form of hair loss and hormones known as androgens, particularly one called dihydrotestosterone (DHT), especially in men. Androgens serve critical roles in both male and female bodies, including the regulation of hair growth and sexual drive.

Hair growth initiates within the skin’s follicles, with each hair strand typically going through a cycle of growth lasting 2 to 6 years, followed by a resting phase of several months, and ultimately shedding. The process restarts when a follicle begins to grow a new hair. Androgens influence and control this cycle. Excessive stimulation of hair follicles by androgens can result in a shorter growth period, leading to the emergence of shorter and thinner hair strands. Furthermore, the growth of new hair to replace shed strands is delayed, contributing to hair thinning or loss.

While researchers suspect that variations in multiple genes may contribute to androgenetic alopecia, only one gene, the AR gene, has been definitively linked to this condition. The AR gene encodes a protein called an androgen receptor, which enables the body to respond to DHT and other androgens. Studies suggest that variations in the AR gene may produce androgen receptors that are more sensitive to androgen stimulation than normal, leading to heightened activity in hair follicles. However, the precise mechanisms by which these genetic changes increase the risk of hair loss in individuals with androgenetic alopecia remain unclear.

Researchers continue to explore the relationship between androgenetic alopecia and other medical conditions, such as coronary heart disease and prostate cancer in men, as well as polycystic ovary syndrome in women. They suspect that elevated androgen levels may be a common link, helping to explain why these disorders often coincide with androgen-related hair loss.

Inheritance

The inheritance pattern of androgenetic alopecia remains unclear due to the complexity of factors, both genetic and environmental, that are likely involved. However, there is a tendency for this condition to run in families, suggesting a hereditary component. Having a close relative who experiences patterned hair loss appears to be a risk factor for developing the condition, indicating a possible genetic predisposition. Nonetheless, the precise genetic mechanisms and inheritance patterns contributing to androgenetic alopecia are still the subject of ongoing research.

Other names for this condition

• Androgenic alopecia
• Female pattern baldness
• Female-pattern hair loss
• Male pattern alopecia
• Male pattern hair loss
• Male-pattern baldness
• Pattern baldness

Treatment

Male pattern baldness is typically not considered a disease and is often addressed for cosmetic reasons. Individuals facing this condition can choose to embrace their new appearance or explore various treatment options. Here’s a detailed overview of one of the common treatment approaches for male pattern baldness: Topical Minoxidil and Finasteride

Living with male pattern baldness

Male pattern baldness can indeed be a significant aspect of aging for many men, and how one chooses to approach it varies from person to person. Here are some suggestions for coping with and embracing male pattern baldness:

1. Seek Support: If you’re struggling with the emotional impact of hair loss, consider sharing your feelings with someone you trust, be it a friend, partner, or a professional counselor or psychologist. Talking about your concerns can provide valuable emotional support.
2. Positive Perspective: Try to view male pattern baldness in a more positive light. It can symbolize maturity, masculinity, and wisdom. Embracing this natural part of aging can boost self-confidence.
3. Experiment with Style: Explore different hairstyles, hats, or headwear that complement your new look. Sometimes, a change in style can enhance your overall appearance and confidence.
4. Consider Shaving: If you’re comfortable with it, shaving your remaining hair can be a liberating experience. Many men find that a cleanly-shaven head can be an attractive and stylish choice.
5. Sun Protection: With less hair covering your scalp, it’s essential to protect your skin from the sun’s harmful UV rays. Apply sunscreen regularly to your head or wear a hat to reduce the risk of skin cancer.

6. Cold Weather: In colder months, consider wearing a hat or beanie to help keep warm. With less hair on your head, you may lose more heat, so proper headwear can provide both style and practicality.

Ultimately, how you choose to approach male pattern baldness is a personal decision. Embracing and celebrating your unique look can be empowering, and it’s essential to prioritize both your physical and emotional well-being during this process.

What are the symptoms of male pattern baldness?

Hair loss can manifest in various ways, and its signs and symptoms can vary based on the underlying cause. Here are some common indicators of hair loss:

1. Gradual Thinning on Top of the Head: This is the most common type of hair loss, often associated with aging. In men, it typically starts with a receding hairline at the forehead, while women may notice a broadening of the part in their hair. Older women may also experience a receding hairline, known as frontal fibrosing alopecia.

2. Circular or Patchy Bald Spots: Some individuals may develop circular or patchy bald spots on the scalp, beard, or eyebrows. Prior to hair loss, the affected skin may become itchy or painful.

3. Sudden Loosening of Hair: Physical or emotional shocks can trigger hair to loosen and fall out more easily. This can result in handfuls of hair coming out during activities like combing, washing, or even gentle tugging. While this type of hair loss often leads to overall hair thinning, it is usually temporary.

4. Full-Body Hair Loss: Certain medical conditions and treatments, such as chemotherapy for cancer, can cause hair loss throughout the entire body. In many cases, the hair eventually grows back after treatment is completed.

5. Patches of Scaling on the Scalp: Scaling on the scalp accompanied by broken hair, redness, swelling, and sometimes oozing can be indicative of ringworm, a fungal infection. This condition can lead to hair loss in the affected areas.

Understanding the specific signs and symptoms of hair loss can help individuals identify the cause and seek appropriate treatment or medical advice. If you are experiencing hair loss and are concerned about it, consulting with a healthcare professional or dermatologist is recommended to determine the underlying cause and explore potential treatment options.

Can hair loss be prevented?

Male pattern baldness is primarily influenced by genetic and hormonal factors, and there is no guaranteed way to prevent it. However, managing stress is a good practice for overall well-being and may indirectly help reduce the impact of hair loss. Here are some tips for stress reduction:

1. Relaxing Activities: Engage in relaxing activities like walking, yoga, meditation, or deep breathing exercises to alleviate stress and promote a sense of calm.

2. Calming Music: Listening to soothing and calming music can be an effective way to unwind and reduce stress levels.

3. Quiet Time: Set aside moments of quiet time for yourself to decompress, reflect, and recharge. This can involve reading, spending time in nature, or simply enjoying moments of solitude.

While stress reduction can be beneficial for various aspects of health, including hair health, it may not prevent male pattern baldness entirely since it is primarily a genetic and hormonal condition. If you are concerned about hair loss, it’s advisable to consult with a healthcare professional or dermatologist to explore potential treatment options and discuss your individual situation.

Physical examination

A comprehensive evaluation of the skin, including the face, scalp, and nails, is crucial when assessing hair loss. Here are some key points to consider during this examination:

1. Scalp Examination: When examining the scalp, pay attention to the distribution of hair loss, the thickness (caliber) of individual hairs, and other clinical characteristics. In male pattern hair loss, you typically observe a receding hairline and hair thinning on the frontal and vertex (crown) regions of the scalp. In women, the vertex and midfrontal scalp are often affected. A helpful technique is to compare the hair part on the central scalp with that of the occipital (back) scalp, which is usually unaffected. To assess hair miniaturization, you can use a sheet of paper as a backdrop and compare the thickness of adjacent hair shafts.

2. Scalp Conditions: Note the presence of any inflammation, scarring, or scaling of the scalp. Male and female pattern hair loss typically do not exhibit these signs. However, it’s essential to be aware that seborrheic dermatitis, a common scalp condition, can sometimes coexist with pattern hair loss. Seborrheic dermatitis often results in an oily scalp due to androgen stimulation of the sebaceous (oil) glands.

3. Nail and Nonscalp Hair Examination: Examine the nails for any abnormalities such as pitting, trachyonychia (rough and brittle nails), and longitudinal ridging. These nail changes may suggest underlying conditions unrelated to male or female pattern hair loss. Additionally, if there is patchy hair loss in areas outside the scalp, such as the eyebrows, it is inconsistent with the diagnosis of pattern hair loss and may warrant further investigation.

A thorough skin evaluation can help differentiate between various causes of hair loss and guide appropriate diagnosis and treatment. If you notice any concerning signs or have questions about hair loss, consulting a dermatologist or healthcare professional is advisable for a precise assessment and personalized management plan.

Hair-pull test

The hair-pull test is a diagnostic technique used to assess active hair loss. Here’s how it’s performed:

1. Grasp 50 to 60 hairs close to the scalp using the thumb, index, and middle fingers.
2. Slowly and gently pull on the hairs.
3. Count the number of hairs that come loose during the pull.

If six or more hairs are extracted during the test, it suggests that hair loss is currently active.

It’s worth noting that the extracted hairs can also be examined under a microscope to determine their type (e.g., broken or dystrophic) and phase (e.g., telogen for resting hair or anagen for growing hair). Typically, in cases of pattern hair loss, the hair-pull test is negative, meaning that few hairs come loose during the test. However, it can occasionally yield positive results, particularly in the early stages of hair loss, typically on the vertex (crown) or midfrontal areas of the scalp.

Importantly, the hair-pull test can provide valuable insights into the current state of hair loss and help healthcare professionals diagnose and monitor the condition.

Dermoscopy

 Dermoscopy, a technique involving the use of a dermatoscope, allows for a detailed examination of the scalp, revealing epidermal and dermal structures that are not easily visible to the naked eye. When assessing for male or female pattern hair loss, certain dermoscopic findings can be indicative of the condition. These findings include:

1. Diversity in Hair Diameter: Dermoscopy can show variations in the diameter of individual hair strands, a characteristic feature of pattern hair loss.

2. Yellow Dots (Sebaceous Glands): Yellow dots, representing sebaceous glands, may be observed through dermoscopy. These are consistent with the diagnosis of male or female pattern hair loss.

3. Perifollicular Pigmentation: The presence of perifollicular pigmentation around hair follicles can be a dermoscopic sign of pattern hair loss.

4. Lack of Scarring: Dermoscopic examination can help identify whether scarring is present

 or absent. The absence of scarring supports the diagnosis of non-scarring conditions like male or female pattern hair loss.

5. Small Focal Areas of Hair Loss: Dermoscopy may reveal small focal areas on the scalp where hair loss is complete or more pronounced. Skin pigmentation in these areas may vary due to sun exposure.

Dermoscopy is a valuable tool for dermatologists and healthcare professionals in diagnosing and monitoring various skin and hair conditions, including male and female pattern hair loss. It allows for a closer examination of the scalp, aiding in accurate diagnosis and treatment planning.