Androgenic Alopecia – Causes, Treatment, And More

Androgenic alopecia occurs in about 50% of the world’s population. It is a genetically predetermined hair loss condition that impacts women and men. The hair growth cycle is progressively slower in this type of hair loss. Here, hair follicles shrink down and obstruct new hair growth. Even when new hair finally does grow, it looks weak and thin. This condition is commonly noticed in women during menopause (1). Keep reading to know the symptoms, triggers, causes, and treatments for androgenic alopecia.

What Is Androgenic Alopecia? 

Androgenic alopecia (AGA) is a genetic condition in which both men and women experience hair loss differently (1),(2). It is also known as female pattern hair loss and is characterized by reduced hair density all over the crown and the frontal scalp (3).

Androgenic alopecia or female pattern hair loss is classified into three grades of severity. These are also known as Ludwig grades (3):

• Grade I: A small but gradual hair thinning on the crown.
• Grade II: The hair thinning becomes pronounced on the crown.
• Grade III: Complete baldness on the crown.

There are several underlying causes of female pattern hair loss or androgenic alopecia.

Androgenic Alopecia: What Are The Causes? 

Genetic and environmental factors can lead to androgenetic alopecia. Increased male hormones or androgens in genetically susceptible women are among the main causes of androgenic alopecia (2).

Androgens, such as testosterone and its derivative dihydrotestosterone (DHT), are present in both men and women and regulate the hair growth cycle. The DHT binds to the androgen receptors present in the hair follicles. This shortens the anagen phase (growth phase), and the hair follicles shrink, leading to shorter and finer hair (2).

Women with androgenic alopecia also have high levels of 5-alpha-reductase (converts testosterone to DHT) and androgen receptors in the hair follicles (2). The hair thinning is often diffused in women. Here is how it may look like.

Signs And Symptoms Of Androgenic Alopecia

• Gradual hair loss is a common symptom. Women with androgenic alopecia usually have thin, wispy hair that does not grow long.

• Hair thinning may start on the crown. You may notice a wide hair parting.

• The hair growth phase slows down, and when the hair grows, you may notice thin and fine new hair. Such hair is prone to breakage.

Heather, a blogger, shares her experience with hair loss on her blog and vividly describes the moment she first realized the extent of the issue, saying, “My hair was pulled back in a braid and I realized at that moment just how thin my hair was. I could see my scalp perfectly and for the first time I realized that I didn’t just have “thin” hair, but I was actually blading. I took my braid out of my hair and ran my hand through it. Every time I did that several strands came out. I did it again and again, the hair wouldn’t stop coming off of my head (i).”

If you are experiencing hair loss and suspect it to be androgenic alopecia, consult a doctor for a proper diagnosis.

Diagnosing Androgenic Alopecia 

The doctor may check:

• The family history of alopecia and find any underlying cause
• Diet pattern
• Medical history
• Hormone levels

They may conduct a physical and dermatoscopic examinations. It is done in three parts:

• Scalp examination to find evidence of inflammation, scaling, and erythema
• Hair density test and assessment of hair distribution
• Hair shaft examination to determine its strength, fragility, and shape

The doctor may also conduct a hair pull test to assess the severity of hair loss. They may grab a section of about 50-60 hair strands and gently pull. If more than six strands fall out, it indicates active hair loss. The treatment will be determined as per the severity of your condition.

Treatment Options For Androgenic Alopecia 

1. Topical Minoxidil (Rogaine): Topical minoxidil 2% is approved by the FDA to treat androgenic alopecia or female pattern hair loss. Minoxidil promotes hair regrowth to a great extent and shows results in a few months (3).
2. Finasteride (Propecia): Your doctor may prescribe Finasteride for hair loss. It inhibits 5-alpha-reductase, which, in turn, inhibits the conversion of testosterone to DHT, minimizing hair loss. Topical finasteride is more effective than the oral drug. Although the FDA approved it to treat men’s hair loss, finasteride is also used to treat female pattern hair loss with mixed results (3), (4). Further studies are required to ascertain its safety for women.

In a study, 1,153 dermatologists were surveyed in Italy and asked about their views on the effectiveness of 1 mg/day finasteride as oral therapy for androgenetic alopecia (AGA). The results revealed that 91% of them considered the therapy highly effective.

3. Dutasteride (Avodart): This is another powerful type one and two 5-alpha-reductase inhibitor that significantly improves female pattern hair loss. However, further studies are needed to determine its effectiveness (3).
4. Ketoconazole: Shampoos with 2% ketoconazole can help promote hair growth in androgenic alopecia (5).
5. Spironolactone: Although it is commonly used as a diuretic, spironolactone can reduce androgen levels. Thus, it has been used to treat androgenic alopecia. However, it may cause side effects like fatigue, irregular periods, and birth defects (3).
6. Laser Therapy: Low-level laser therapy (helmets and laser combs) is a non-invasive method to stimulate hair growth. The doctor may combine laser therapy with other drugs to treat hair loss.
7. Microneedling: Microneedling is a cosmetic procedure that may promote hair regrowth. Tiny needles are used to deliver drugs more effectively. The punctures in the scalp trigger repair proteins and growth factors that help hair regrowth (3).
8. Hair Transplantation: In severe cases, the doctor may suggest hair transplantation. The hair follicles or donor plugs are used to cover areas with sparse growth.

Pro Tip

Try to include complementary treatments like taking biotin supplements, and using essential oils like peppermint oils to enhance the process of hair regrowth (6), (7).

Hair loss and female pattern baldness can be distressing. But, is it preventable? Find out next.

Can You Prevent Female Pattern Baldness?

Mild to moderate hair loss can be prevented and reversed to certain extent with proper treatment and medication during the early stages of the condition. However, you may not prevent or reverse female pattern baldness during the advanced stages. You can take care of your hair and scalp to minimize hair fall and breakage. Here is how you can care for your scalp and hair:

• Follow the prescribed treatment and medications to prevent hair loss.
• Have a healthy and balanced diet. Consume foods rich in omega 3 and 6 fatty acids and antioxidants to promote hair growth (8).
• Talk to the doctor to know the side effects of any medication you are using. If any of them cause hair loss, ask your doctor for an alternative.
• Take care of your scalp and hair. Avoid excessive sun exposure and use mild shampoos or doctor-prescribed products. 

Quick Tip

Avoid excessive heat styling to prevent hair breakage and thinning. Ensure not to tie your hair too tightly.

Risk Factors For Androgenic Alopecia 

Although genetic predisposition is a major reason for androgenic alopecia, research links it to various medical conditions, such as:

• Endocrine and thyroid disorders in females, such as PCOS (9)
• High blood pressure or cardiovascular condition (10)
• Insulin resistance and diabetes (11)
• Higher lipid and triglyceride values and fat levels (12) 

Understanding the type of hair loss is essential in treating it. However, androgenic alopecia is sometimes misdiagnosed as telogen effluvium. Check out the next section to learn the key differences between them.

Difference Between Telogen Effluvium And Androgenetic Alopecia

Androgenetic alopecia is a permanent form of hair loss characterized by a gradual receding of hair around the temples and a bald patch near the crown due to genetic factors. On the other hand, telogen effluvium is temporary hair loss characterized by diffuse hair loss across the entire scalp, leaving the hairline intact and creating an overall thin appearance. Unlike the slow progression of androgenetic alopecia over years or decades, telogen effluvium can occur suddenly with hair shedding as the primary symptom, usually without any other accompanying signs. In this condition, the shedding phase lasts for less than six months (13).

Frequently Asked Questions

Can vitamin D cause androgenic alopecia?

Yes. A vitamin D deficiency can cause premature androgenic alopecia.

Is androgenic alopecia caused by stress?

High levels of stress may increase androgen production, leading to an increased production of DHT, which causes androgenic alopecia or DHT hair loss.

Does biotin help androgenic alopecia?

Biotin is one of the most recommended supplements for androgenic alopecia, but there is little evidence backing this claim.

Does androgenetic alopecia happen suddenly?

Depending on the cause, androgenic alopecia can occur suddenly or develop gradually.

Is alopecia hair loss permanent?

With the right treatments and medication, you can stimulate hair regrowth if you have androgenic alopecia.

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Reviewer Author Editor Fact Checker

Dr. Shruti ChavanMBBS

   

Dr. Shruti Chavan is a consulting dermatologist at Dr.Sheth's Skin and Hair Clinic since 6 years. She is a co-committee member of CDSI (Cosmetic dermatologist Society of India). She is highly skilled in non-surgical facial skin rejuvenation and face lift by the use of injection treatments and lasers.

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Annie JangamBeauty & Lifestyle Writer

 

Annie Jangam is a researcher-turned-content writer with 11 years of experience. She enjoys dissecting complex clinical studies and shuffling through the scientific jargon to make science interesting and easy to understand.

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Eshna DasAssociate Editor

Eshna is an associate editor and a certified skin care coach. She has over three years of experience, a triple main bachelor’s degree in psychology, English, and journalism from Mount Carmel College, Bengaluru, and a master’s degree in psychology from Sampurna Montfort College, Bengaluru.

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Monomita ChakrabortyBeauty & Lifestyle Writer

Monomita has a graduate degree in mass communication and video production from St. Anthony's College, Shillong, and a master’s degree in journalism and mass communication from the Royal Global University, Guwahati. She is also a certified skincare coach with a keen interest in skin, hair, tattoos, nail art, and lifestyle trends.

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