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Androgenetic alopecia

Androgenetic alopecia



Overview

Androgenetic alopecia is a common, genetically determined form of gradual hair loss driven by sensitivity to male sex hormones like dihydrotestosterone (DHT).

Symptoms

General Signs

Gradual onset: Hair loss develops slowly over years.No pain or itching: The scalp usually feels normal without redness, scaling, or irritation.

Hair miniaturization: Thick strands slowly turn into thin, short, wispy peach fuzz.

Symptoms in Men

Receding hairline: Hair starts pulling back at the temples.

M or U shape: The hairline forms a distinct "M" or "U" shape.

Crown thinning: Hair thins or forms a bald spot at the top back of the head (vertex).Symptoms in Women

Widening part: The center part in the hair gets broader over time.Preserved hairline: The front hairline usually stays in place.

Diffuse thinning: Volume decreases across the top of the head rather than creating smooth bald spots.

Causes

Hormones (DHT): An enzyme called 5-alpha-reductase converts testosterone into a stronger hormone called dihydrotestosterone (DHT). In sensitive scalps, DHT binds to hair follicle receptors.

Follicle Miniaturization: DHT causes hair follicles to shrink over time. This process shortens the hair growth phase, making hairs thinner, shorter, and eventually stopping growth.

Genetics: Heredity determines how sensitive your hair follicles are to DHT. If your family has a history of hair loss, you carry a higher risk.

Age: The risk and progression of pattern baldness increase as people get older.

Diagnosis

Pattern check: The doctor looks for a receding hairline and thinning at the crown in men, or a widening part and diffuse thinning on top of the head in women.

Family history: They ask if close relatives also experience pattern baldness.

Hair pull test: The provider gently tugs a small bundle of hair to see how easily hairs come out and check active shedding rates.

Trichoscopy (Dermoscopy): The doctor uses a special magnifying lens to look closely at your scalp.

Key signs: They look for varying hair shaft thickness (diameter diversity), an increase in thin or baby-like (vellus) hairs, and hair follicles that only produce a single hair instead of groups.

Blood tests: Panels for iron, ferritin, and thyroid function are often ordered to rule out other causes of hair loss. Hormone tests may be done if women show extra signs of high androgens (like severe acne or irregular periods).

Scalp biopsy: Rarely needed, a tiny skin sample is taken and checked under a microscope only if the diagnosis is unclear or a scarring condition is suspected.

Treatment

Treatments for Men

Minoxidil: A topical minoxidil foam or liquid (2% or 5%) applied to the scalp daily helps lengthen the hair growth cycle. You must use it continuously to maintain results.

Finasteride: An oral prescription pill (1 mg daily) that lowers dihydrotestosterone (DHT) levels by blocking the enzyme that converts testosterone..

Dutasteride: A stronger 5-alpha reductase inhibitor often used off-label when finasteride is insufficient.

Ketoconazole Shampoo: Used 2 to 3 times weekly as an adjunct anti-inflammatory treatment.

Treatments for Women

Minoxidil: Topical 2% or 5% minoxidil is the standard first-line treatment for female pattern hair loss.

Spironolactone: An oral anti-androgen prescription medication that blocks androgen production and receptor binding.

Oral Finasteride or Dutasteride: Sometimes prescribed off-label by dermatologists for women past childbearing age.

Procedures and Devices

Low-Level Laser Therapy (LLLT): Device combs or caps use specific light wavelengths to stimulate cellular activity in hair follicles.

Microneedling: Performed alongside topical treatments to boost absorption and trigger healing responses.

Hair Transplant Surgery: Moving healthy follicles from the donor area to balding zones provides permanent structural restoration.

Type of Doctor Department : A dermatologist , Hair Transplant Surgeon

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