Androgenic Alopecia: The Main Cause Of Baldness In The World

If you are a man and have baldness, this is almost certainly the cause, although if you are a woman you are not immune either. It is estimated that up to 70% of men and 40% of women will be affected by androgenic alopecia at some point in life, and the risk increases with age.

Let’s investigate the main cause of male and female pattern baldness, and find a way to overcome it!

How does androgenic alopecia occur?

In some parts of the body (such as the prostate, testes, adrenal glands, and hair follicles), an enzyme called 5α-reductase (read “five-alpha reductase”) converts testosterone into a much stronger version: dihydrotestosterone ( DHT) .

This hormone participates in various functions related to sexual development , such as the formation of the male genitalia during pregnancy, the development of primary and secondary sexual characteristics at puberty, and the activity of the prostate in adult men. Women also produce DHT, but in much lower amounts than men.

The problem is that in the scalp, DHT seems to promote the so-called follicular miniaturization : hair follicles that are reducing in size, the hair growth phase (anagen) is shorter and shorter, the resting phases (catagen and telogen ) are stretched and the strands become thinner and finer, and their growth can even be stopped completely ( For more information on the functioning of the hair follicles and the phases of the hair , click here ).

This process generates a common pattern of male pattern baldness : the “recesses” appear on the sides of the first line of hair growth, with a progressive thinning of the strands in the upper part of the head. As the problem progresses, the two areas of hair regression meet, leaving only a band of hair at the back and sides of the head, where hairs are generally not very sensitive to DHT.

The Norwood-Hamilton scale indicates the traditional patterns of progression of male pattern baldness, and is widely used in the diagnosis and evaluation of androgenic alopecia

On the contrary, the most frequent pattern of female pattern baldness involves more diffuse hair loss with more visible thinning of the hairs on the top of the head (the area that when separating the hair is “enlarged” and shows more and more skin underneath).

Apparently, female hormones help protect the hair from the action of DHT: with the decrease in the production of these hormones, especially after menopause , the loss can manifest itself more clearly.

The Ludwig and Savin scales illustrate the most common patterns of progression of female baldness: more diffuse thinning of the hairs and expansion of the width of the hair distribution. Some men have a similar progression

Diagnosis of the type of androgenic baldness

Some events are important clues to suspect that androgenic alopecia is the cause of hair loss:

• Family history of baldness (parents, uncles or grandparents, both maternal and paternal secondary);
• Slow and progressive hair loss , following the norms of traditional advancement of androgenic alopecia (Norwood-Hamilton, Ludwig and Savin scales);
• Women with polycystic ovary syndrome are more prone to developing androgenic alopecia (hair loss can be an important signal to discover the existence of the syndrome);
• Other health problems like anemia, hypothyroidism, nutritional deficiencies, hormonal imbalances, infections, etc.

The more information you bring to your doctor, the better the diagnosis. If you have, take pictures that show the difference in the length of your hair over time. The doctor will examine your scalp, take samples and discard the suspicion of other types of hair loss (such as the alopecia areata , telogen effluvium or scarring alopecia ).

Treatments for androgenic alopecia

Androgenic alopecia, as its name implies, is largely determined by our genetic profile, which means that the tendency to baldness is maintained throughout life. What currently available treatments do is minimize the delay or stop the manifestation of this trend.

Two important notes before starting treatment: first, if it is stopped, the genetic determination will manifest itself again and the hair loss returns normally; second, treatments take several months before they begin to show noticeable results. So the secret is to have persistence and patience. Many people give up when they are very close to success – don’t be part of this group! If your hair didn’t take just 10 days to fall out, it won’t take 10 days to grow back, right?

Systemic treatments

If the cause of the hair loss seems to be mainly hormonal, taking some medication to attack the hormones “culprits” of everything is fine, right? not exactly , when we intervene with a hormone that participates in hair loss, we affect all the other functions it performs, it is a delicate system that must be well balanced to work and not cause problems.

Any medication can present important side effects , especially of the systemic type (in operation within the body ), we alert you to the main problems of each of the most used medications for hair loss. Currently it is also possible to find most of these substances in formulations for topical use (superficial application , directly to the scalp) that are considered much safer , since they do not allow the active ingredients to be absorbed by the body at significant levels (despite that may see their effectiveness reduced).

It is worth remembering that any treatment must always be prescribed and supervised by a doctor who is in charge of evaluating the risks associated with your case and monitoring your health during the process. Never take any medication on your own.

Some of the treatment options at the systemic level are:

FINASTERIDE

Finasteride was initially developed to fight benign prostatic hyperplasia, but it also became one of the main options against androgenic alopecia. It inhibits the action of two of the three forms of the enzyme that makes DHT (5α-reductase types 2 and 3), reducing hormone levels by up to 70%. Treatment generally has significant results: reduction of the progression of baldness and recovery of the affected areas .

Because systemic use has an impact on the performance of DHT in the entire body (and not just in the hair follicles), there is concern that it could cause serious side effects such as decreased libido, erection problems, and decreased blood pressure. ejaculatory volume.

To avoid these risks, most doctors use the prescription of low concentrations for the treatment of androgenic alopecia, or choose to recommend formulas for topical application (which theoretically act in a more localized way and is less absorbed by the body).

In Europe and the United States, finasteride tablets are available in strengths of 1 mg and 5 mg (the latter only officially recommended for the treatment of benign prostatic hyperplasia).

For more information on finasteride , click here.

DUTASTERIDE

It is the “big sister” of finasteride (officially indicated only for the treatment of benign prostatic hyperplasia). The two substances work in a very similar way, but dutasteride is capable of inhibiting all three forms of the enzyme that makes DHT (5α-reductase types 1, 2 and 3), and can reduce hormone levels by 99% or more . Its action is more powerful and its effects are longer than those of finasteride, but the risks are also accentuated.

For more information on dutasteride , click here.

ANDROGEN RECEPTOR ANTAGONISTS

This long name includes three drugs used very often in the treatment of androgenic alopecia: flutamide, spironolactone, and cyproterone acetate .

Finasteride and dutasteride prevent testosterone from converting to DHT, but leave it free to perform other functions. Androgen receptor antagonists hinder the activity of testosterone like DHT and the connection of cells instead of hormones. Imagine a game of musical chairs: drugs run to sit and take testosterone and DHT out of the game, flutamide, spironolactone and cyproterone acetate connect to the androgen receptor, preventing them from acting on cells.

But there are two serious issues: The first is that the side effects can be heavy. One of the most worrisome is the possibility of causing liver damage. Cyproterone acetate is not approved by the FDA (Food and Drug Administration, the agency that controls drugs in the United States) due to its hepatotoxic potential (the drug is released in Europe and other countries), and flutamide has been linked with some cases of fulminant hepatitis. To avoid these risks, doctors must carefully monitor the patient’s health status throughout treatment.

The second serious issue is that, since they also inhibit the activity of testosterone (which is the main male hormone), these drugs can reduce the levels of androgen activity below what is desirable , causing, for example, decreased libido, muscle mass and energy levels of the individual.

This makes this kind of treatment more interesting for female pattern baldness (flutamide is contraindicated for women by some medical regulations in different countries). Since women have naturally lower androgen hormone levels, and in several cases of female pattern baldness they are exacerbated (as in polycystic ovary syndrome), medications can help rebalance the framework (Cyproterone acetate is found in the composition of some birth control pills). All of these drugs are contraindicated during pregnancy and lactation .

Topical treatments

Ointments, creams, lotions and other external use products are topical treatments.

MINOXIDIL

Widely used in combination with finasteride, minoxidil is one of the most widely prescribed products for treating hair loss. The substance seems to stimulate the absorption of nutrients and oxygen in the hair follicle , increasing its size and prolonging the growth phase (anagen) of the hair . It usually comes in the form of lotions, creams, or foams for application directly to the scalp.

For more information on minoxidil, click here.

KETOCONAZOLE

Science is not sure how it works, but one hypothesis is that topical ketoconazole (traditionally used to fight fungal infections, dandruff and seborrheic dermatitis, is used off-label in the treatment of androgenic alopecia) could inhibit the specific action of DHT on hair follicles , without affecting the performance of the hormone in the rest of the body. Several studies show positive effects in reducing the progression of androgenic alopecia, and increasing the density and thickness of the hairs , contributing to the recovery of the affected areas.

For more information on ketoconazole shampoos, click here.

Surgical treatments

HAIR TRANSPLANT

Procedure in which hair follicles are taken from a donor area of ​​the patient , usually on the neck or on the sides of the head, and transplanted to bald areas . The advantage is that as these follicles tend to be naturally less sensitive to DHT, the chances of miniaturization due to the action of the hormone after transplantation are lower. In two or three weeks, the hair in the transplanted area usually falls out, and in about 3 months the definitive ones will be born.

For more information on hair transplants , click here.

SCALP REDUCTION

Another option that is often used in conjunction with the hair implant is scalp reduction: the bald area is removed and the skin surrounding the scalp is drawn to cover the space, thus extending the effectively covered head area For the hair. The performance of the procedure depends on factors such as the general conditions of the patient, their health and the mobility of the skin.

Hair prostheses

In cases where the donor area is insufficient to achieve a successful implant or the patient is unable or unwilling to undergo a surgical procedure, hair replacement may be a good alternative. They are usually made with natural hair, which is implanted on a thin and flexible hypoallergenic material base. This is attached to the scalp with special glues that allow the user to carry out their normal activities (exercise, entering the pool, washing their head and sleeping, for example) without it being removed.

For more information on hair replacement , click here.

Can you live well with alopecia?

Male and female pattern baldness has a significant impact on the self-esteem of millions of affected people around the world, but with all the treatment options and aesthetic solutions available today, it is entirely possible to solve the problem and lead a normal life . Remember that science investigates androgenetic alopecia on an ongoing basis, so the chances of having even better treatment options in the future are immense.