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Androgenetic Alopecia

Updated: May 29, 2023

Androgenetic alopecia is the most common form of hair loss in men and women. It is a normal variant, more often just part of our genetic profile. White men are more commonly affected, with 30 percent affected by 30 years, 40 percent by 40 years, and 50 percent by 50 years of age. Although this condition is less common in women, 38 percent older than 70 years may have some level of hair loss. Family history is consistent with androgenetic alopecia.



Androgenetic alopecia is a sex-specific pattern. Men typically loose hair at the peaks of their temporal hairlines, as the man in the picture above. They may thin in the front and along the upper scalp, or maybe even experience complete hair loss with residual hair around the back and sides. Women though, tend to just have thinning on top, sparing their frontal hairline. Some women do experience thinning into the sides, although more rare. Thyroid disease, iron deficiency #anemia, and malnutrition may mimic this presentation, so should be ruled out if concerned.


Treatment for Androgenetic Alopecia


Treatment really comes down to what the client prefers. Topical medication is available, Minoxidil 2% or 5% solution, which is best for regrowth around the front and edges, but can take six to twelves months before real improvement is apparent. This treatment must continue indefinitely as well because once medication is stopped, hair will thin again. Women can also use Minoxidil, although the 2% solution is preferred over the 5% solution. It can cause irritation and contact dermatitis.


If Minoxidil is not effective, then Finasteride (Propecia) is another option, at about a milligram a day. This is a pill and approved for androgenetic alopecia for men. It can decrease libido and cause erectile dysfunction, and even enlarge breasts so beware (Hirshburg et al, 2016). These are the only two medications approved by the FDA currently. They both stimulate hair regrowth in some men, but are more effective in preventing additional hair loss so starting early is important for best results. Women are more frequently being offered Finasterile and Dutasteride for alopecia. This is absolutely not safe in pregnancy though. Increased body hair may result, as well as reduced libido, irregular menstrual cycles, and headaches (Hirshburg et al., 2016).


There are a number of additional treatments, but these aren't as supported in the evidence, which may simple be because profits aren't as grand.


References

Hirshburg, J. M., Kelsey, P. A., Therrien, C. A., Gavino, A. C., & Reichenberg, J. S. (2016). Adverse effects and safety of 5-alpha reductase inhibitors (Finasteride, Dutasteride): A systematic review. Clinical Aesthetic, (9)7, 56-62.

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