Androgenetic alopecia - What is it and what treatments are there?

Androgenetic or androgenic alopecia is the most common alopecia in the world and is what we know as common baldness.

It is currently estimated that practically 50% of the population in Spain suffers from alopecia , and more than 90% of alopecia is of the androgenic type, that is, caused by genetic predisposition and hormonal changes.

Although many people do not know it, androgenetic alopecia is not due to excessive hair loss but rather because the hair becomes increasingly thin .

In this article I explain what androgenetic alopecia is and above all, what you can do to combat it.

What is androgenetic alopecia?

Androgenetic alopecia is the progressive loss of hair density due to this “miniaturization” of the hair . As the hair becomes finer, areas appear, especially on the top of the head, that “lighten.”

Androgenetic alopecia affects 50% of men aged 50 and up to 80% of those aged 70. In women, the percentage exceeds 50% with the entry into menopause . Undoubtedly, it is a very common problem that affects a large part of the population.

Causes of androgenetic alopecia

Androgenetic alopecia, as its name indicates, appears mainly due to two causes: genetic predisposition and the action of androgens, the male sex hormones.

• Genetic predisposition:

• Hormonal action of androgens:

The increased action of these male hormones can affect the most sensitive hair follicles and generate increasingly fine and fragile hair that sometimes cannot even penetrate the scalp .

The effect of this hormone is more common in men . However, women can also experience it when they are in certain circumstances such as menopause or when they experience an increase in testosterone levels. Most treatments for androgenetic alopecia , therefore, are focused on solving this hormonal condition.

Other factors that can also be treated such as oxidative stress, diet or lifestyle can influence the development of androgenetic alopecia .

Female pattern and male pattern

Hair loss due to androgenetic alopecia in women and men occurs in different ways:

• female pattern

  Hair loss is diffuse and presents as thinning hair on the front and crown of the scalp.

• Male pattern.

  Hair is lost selectively from some specific areas, especially in the frontal area, in the receding area and on the crown of the head.

Treatments for androgenetic alopecia

Focusing, then, on the treatment of androgenetic alopecia, we distinguish three types of treatments:

1. Antiandrogenic - hormonal treatments

• 5 alpha reductase enzyme inhibitors

This treatment for androgenetic alopecia stands out especially in men . The enzyme 5 alpha reductase converts testosterone into DHT (the hormone responsible for hair thinning and shrinking follicles). By blocking it, we prevent its effect.

Within this category we include drugs such as finasteride and dutasteride . The latter is more powerful but without express approval today by regulatory agencies.

They are very effective drugs in the treatment of androgenetic alopecia and with few side effects . However, in some cases (very few) sexual problems or gynecomastia (increase in breast size) may appear, especially in young men. However, these effects are reversed when treatment is suspended or reduced .

In premenopausal women, these drugs are used less because they must be accompanied by contraceptives and even continue taking them 6 months after stopping treatment. In the specific case of dutasteride, it is also harmful to the correct development of the fetus.

• Androgen receptor blockers

Also as antiandrogens, but in this case blocking their transporter and preventing them from reaching the site where they produce miniaturization, two drugs stand out: spironolactone and bicalutamide.

Spironolactone is a diuretic that, in addition to treating androgenetic alopecia, is also used for other dermatological pathologies such as acne or hirsutism. Bicalutamide, for its part, is an antiandrogen that is used in prostate cancer, but whose use in low doses in cases of female androgenetic alopecia has proven effective.

Both treatments require correct management by specialists and may present adverse effects such as dizziness, menstrual irregularities, edema or elevation of liver enzymes that, although rare, require expert monitoring and treatment.

• Nutraceuticals

Another therapeutic option to treat androgenetic alopecia that acts by inhibiting the 5 alpha reductase enzyme is nutraceuticals.

Nutraceuticals are food supplements made from natural ingredients such as Saw Palmetto (serenoa repens), Pygeum Africanum, pumpkin seeds (cucurbita pepo) or pure licorice extract that have proven effective in inhibiting the 5 alpha reductase enzyme. They are a very good option to treat androgenetic alopecia.

2. Anti-inflammatory - vascular treatments

Minoxidil and platelet-rich plasma stand out mainly.

• Minoxidil

Minoxidil is a drug that “opens” the blood vessels that reach the follicle , providing it with more “food” and the ability to grow strong. It is probably the most used drug in androgenetic alopecia , especially in female alopecia. The most characteristic side effect is hair growth in other areas (sideburns, arms...).

• platelet rich plasma

Platelet-rich plasma (PRP) is obtained by centrifuging the patient's own blood and obtaining the part rich in platelets that contain factors that stimulate hair growth. It is usually administered with microinjections into the scalp (mesotherapy) and due to its compatibility (the patient's own blood) it has almost no side effects .

All of the treatments mentioned to treat androgenetic alopecia , except for PRP and some other exceptions, can be administered topically or orally. The latter are usually more effective, but are more likely to cause side effects.

3. Surgical treatments

• hair transplant

Hair transplantation stands out , probably currently being one of the most talked about treatments for androgenetic alopecia in the world of trichology.

Hair transplantation consists of “taking” hair from a specific area (donor area) and “placing” it in the area that you want to repopulate (recipient area). The donor area is usually the occipital area , since its follicles are more “resistant” to miniaturization. This treatment does not correct the cause of miniaturization, so it is always advisable to accompany it with the medical treatment mentioned above.

It is very important to know what androgenetic alopecia consists of, its causes and origin, as well as receive a correct diagnosis and medical treatment that helps us reverse the process . Therefore, whenever you have doubts, visit your dermatologist to recommend the most appropriate treatment for your specific case.