What is androgenetic alopecia?
Androgenic alopecia is a disorder that affects both male and females. In this condition, the hair follicles decrease in size and lead to baldness over time. It is the most common cause of hair loss in women and in men. This condition can be mediated with the presence of excess of androgen hormones. The testosterone which is an androgen hormone is converted into dihydrotestosterone (DHT). It usually starts after the onset of puberty. The risk of androgenetic alopecia is higher in those people that have a history of hair loss in the family.
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Male androgenetic alopecia:
Androgenetic alopecia in men is also known as “male pattern baldness” or “male pattern alopecia”. Its main characteristics can be gradual loss of hair from scalp and receding hairline. With time, this pattern hair loss forms an “M” shape appearance. It affects the males in their teenage years. Approximately 80% of Caucasian males are affected by this condition. The males become complete bald due to male pattern hair loss.
Female androgenetic alopecia:
In females, androgenetic alopecia is known as “female pattern baldness”. It affects women in their 40s or later. The females experience thinning of hair of the scalp with gradual hair loss at the crown. Androgenetic alopecia is rare in females but it leads to total baldness. This condition is most common after menopause. Studies have shown that up to 2/3 of the women lose hair after menopause. Women rarely become bald but mostly their hair will become thin in female androgenetic alopecia. Therefore, you should watch for pattern hair loss in women closely to have an early detection.
Types of androgenetic alopecia in females:
There are three main types that affect females.
- Type I: In this type, the hair thinning starts on a small area.
- Type II: This type affects the large area and thinning the hair around it.
- Type III: The thinning of hair is throughout the scalp, and it is visible at the top of your scalp.
Androgenetic alopecia is associated with genetic predisposition. It is primary due to DHT that is present in high concentration in men. Mainly, testosterone is converted into dihydrotestosterone with the help of 5 alpha reductase (5AR). The androgenetic alopecia occurs when the level of androgens hormones increases. This condition may be inherited and many genes can be involved in this situation. Overproduction of androgens and androgen secreting tumors can cause androgenetic alopecia.
There are 3 types of alpha reductase receptor isoenzymes. Type I and Type II are effective for the treatment of androgenetic alopecia. Type I is present in the skin including sebaceous gland and hair follicles, while type II is present in the inner roots of the hair follicles of scalp, chest, prostate gland, genitals and face.
The hair growth cycle is mainly affected in this genetically determined disorder. The hair growth decreases in some areas of the head. The pattern of hair loss is genetically predetermined. The impact of androgen is different on different hair sites. The hair present on the chest, genital areas and beard area produce pigmented hair in the presence of androgens hormones. Unfortunately, hair present on the head produces nonpigmented, thin hair in the presence of excess androgens.
There are three types of hair growth cycle:
- Anagen phase: It is the first phase of the hair growth. The hair growth begins and this stage lasts for 2 to 6 years.
- Catagen phase: It is the transition phase that lasts for 1 to 2 weeks.
- Telogen phase: It is the resting stage that lasts for 5 to 6 weeks. After this stage, the anagen phase begins again.
People with alopecia have smaller anagen phase and larger telogen phase. So, it can lead to shortening and thinning of hair and ultimately causes baldness.
Gene related to androgenic alopecia:
Research suspected many genes that take part in androgenetic alopecia. Currently, research finds only one gene “AR gene” . The AR gene gives instructions to make a protein known as an “androgen receptor”. The protein androgen receptor helps the body to respond properly to dihydrotestosterone and other androgens hormones. Slight variations in the AR gene lead to enhanced the activity of androgen receptor in the hair follicles. So, it increases the hair fall and causes androgenic alopecia.
Most affected areas of body:
Androgenetic alopecia mostly affects the scalp of both male as well as female. In male, this condition appears in the form of bald spots and receding hairline. While in females, the androgenetic alopecia affects the crown of the scalp and also thinning the hair.
There are many genetic and environmental factors that affect this disorder. Here are some common ones:
Androgens – The hormones androgens play an important role in the occurrence of androgenetic alopecia. The main androgen hormone is DHT which causes it. Androgens are important for male development before birth and during puberty. Other than that, androgens hormones perform many functions in male and female bodies such as regulate sex drive and hair growth.
Another most common cause of androgenetic alopecia is hereditary condition. Several genes are involved . Also, it can be inherited from both maternal and paternal sides.
Androgenetic alopecia also has a link with coronary heart diseases and prostate cancer in males, and polycystic ovary syndrome in women. In other words, both men and women are affected.
Shrinkage of follicles:
Hair growth starts from the hair follicles. In androgenetic alopecia, the size of hair follicles decreases that lead to baldness. Moreover, each hair has a growth cycle, this growth hair cycle starts to weaken that causes shrinkage of hair follicles and produces shorter strands of hair. Then, the growth cycle stops and leads to permanent baldness.
Nutritional disorders and fungal conditions can also cause androgenetic alopecia. It can be diagnosed by your medical history. Nutritional deficiencies can lead to thinning of hair and weakness of hair follicles. The deficiency of minerals (Iron, zinc, selenium), Vitamins (A, B, C), Arginine (amino acid) and Ferritin (an iron storage protein).
During menopause, the estrogen level drops and the testosterone level increases in the body. The estrogen to testosterone ratios disturbs and excess of testosterone causes hair loss in women. Androgenetic alopecia increases after the menopause.
Psychological effect on you:
Not only Alopecia can affect people physically, but can also affect them psychologically. People find hair attractive and virile. When pattern hair loss begins, people start losing their confidence and satisfaction regarding their physical appearance. The main factors can be young age, relationships and poor self-esteem that have psychological effects on the people. People may experience depression and anxiety due to their hair loss condition.
- Gradual thinning:
Gradual thinning of hair is the most common symptom of this disorder in ladies. In women, there is a broadening of the part of their hair. In males, air begins to recede at the hairline of the forehead.
- Circular bald spots:
Some people lose their hair in circular or patchy form. These circular bald spots appear on the scalp, eyebrows and beard areas. Sometimes, it causes itching and pain before the hair falls.
Telogen effluvium and androgenetic alopecia:
Telogen effluvium is the condition in which a large number of hairs enter into the telogen or resting phase. The shedding of hair usually occurs 3 to 4 months after the telogen phase. So, hair fall due to telogen effluvium can occur after a stressful incident. But in androgenetic alopecia, the hair loss increases in the early stage.
Telogen effluvium cannot cause permanent hair loss. But in the meanwhile, hair loss due to androgenetic alopecia is permanent. The people with genetically predisposed disorder can develop repeated cycles of hair loss. Hair loss due to genetically predisposed conditions can commonly occur in women but also affect the men.
Additionally, if you notice that longer hair is shedding, it is because of telogen effluvium. Hair affected by androgenetic alopecia are usually smaller in size.
The symptoms of telogen effluvium are noticed when more hair falls out when you brush or wash your hair. You may also find your hair on the pillow. While the symptoms are different in men and women. In male pattern alopecia, the hair loss starts from the temple and leads to total baldness. In female pattern baldness, hair becomes thin usually from the top of the head.
The causes of telogen effluvium are surgery, trauma, stress, changes in diet, pregnancy and infections. But the main cause of androgenetic alopecia is high level of androgens hormones which is basically sex hormones. Genetic components are also associated with androgenetic alopecia.
What is the difference between alopecia areata and androgenetic alopecia?
Alopecia areata is an autoimmune disease in which the immune system overreacts and attacks their own hair follicles. So, it is an inappropriate inflammatory response that affects hair follicles and causes hair loss. The most common symptoms of alopecia areata are:
- Patchy shedding of hair
- Coin sized patches of hair
It can affect the hair of the scalp, eyelashes or beard. The hair fall is sudden and causes itching and burning. Alopecia areata also affects the fingernails or toes.
The androgenetic alopecia is different from alopecia areata because it is not an autoimmune disease. Also, it mainly affects the scalp and causes baldness in male and females. Androgenetic alopecia can be due to many factors such as ovarian cysts, prostate cancer, menopause and cardiovascular diseases. Additionally, androgenetic alopecia is the condition in which hair follicles are affected by DTH while the alopecia aerate is an autoimmune disease.
Dandruff and androgenetic alopecia:
Dandruff does not directly associate with androgenetic alopecia. It may also have no effect on the production of dihydrotestosterone. Additionally, dandruff does not have any effect on other types of hair loss.
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Dandruff causes itching in the scalp. When we scratch the skin, it causes hair loss. This hair loss can be temporary or permanent. Therefore, dandruff does not stimulate or trigger androgenetic alopecia in men and in women.
Can female androgenetic alopecia be reversed?
In females, the androgenetic alopecia mostly starts after menopause. The other possible causes can be iron deficiency, hyperthyroidism and hypothyroidism.
The female androgenetic alopecia is usually permanent, it means that hair will never grow back after hair loss. The size of hair follicles shrinks, so the hair will never regrow again. Female pattern hair loss can be slowed down by using different oral treatment options including finasteride and topical treatment such as minoxidil.
Is androgenetic alopecia curable?
There is no way to cure androgenetic alopecia. But here are some ways that can help to slow down the process of hair fall. There are some medications in the market that can help to slow the progression. But the hair loss due to androgenetic alopecia is permanent and never grows back. Although you can prevent remaining hair by using these medications. Moreover, these medications can help some people to regrow new hair.
How to diagnose androgenetic alopecia?
The diagnosis of androgenetic alopecia is based on history and physical examination. If you notice thinning of hair from your scalp, it is best to see a doctor or dermatologist. The doctor can examine your scalp and also the pattern of hair loss. Physical examination includes checking the inflammation, sores or scarring on the scalp.
For female androgenetic alopecia, testing is not usually necessary. The doctor may use a pull test, some blood tests or biopsy to see the exact type of hair loss.
If the doctor is suspected that the cause of hair loss may be some medical condition such as vitamin or mineral deficiency, or a hormonal imbalance, then they prefer blood tests. For instance, a woman having thinning of hair from scalp is a hereditary condition, but it is also possible that it is due to iron deficiency. So, the blood tests are necessary.
Androgenetic alopecia is due to excess androgen levels in the body. It affects the hair on the scalp and leads to hair loss. Androgens also include testosterone hormone. The common signs of excess androgens are baldness, thinning of hair, acne and irregular menstrual cycle (in ladies). So, this condition can be determined by performing a blood test.
The pull test is mainly used to determine the severity of the hair loss. In the pull test, the dermatologist grasps almost 40 strands of your hair from different parts of your scalp and tugs them. If more than six strands fall out, it means that you have an active hair loss problem.
Pull test is usually done to determine the hair androgenetic alopecia in people.
Most of the time, dermatologists can determine the form of hair loss during physical examination. But more information about the scalp or hair follicles is needed, they perform biopsy.
For instance, if there are lesions in the scalp that involve several forms of hair loss. The doctor may perform a biopsy in this case.
The technique is called a “punch biopsy”. Dermatologists can use a device to puncture the scalp and remove the tissue sample. This sample is delivered to the laboratory and the puncture area can be treated with stitches.
Natural ways to slow down the progression of androgenetic alopecia:
Dealing with androgenetic alopecia is a very stressful condition. You should try these natural ways that can help by slowing down the progression of androgenetic alopecia.
Panax ginseng is an herb which is found to be effective to prevent hair loss. It regulates the blood supply to the scalp and promotes hair growth. The extract of panax ginseng is present in the form of powder and capsules. So, the normal recommendation of this herb is 100-200 gm. You should also consult your doctor or dermatologist before using this herb.
Rosemary is a popular herb which has been used as traditional herbal medicines for centuries. Rosemary contains phytochemicals which can be helpful because they reduce the activity of enzyme 5 alpha reductase. The enzyme which converts testosterone into dihydrotestosterone. So, rosemary oil is effective because it blocks the activity of enzymes and also stimulates hair growth. It is an important component that fights against hair loss and androgenetic alopecia.
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Several studies have shown that saw palmetto is effective against androgenetic alopecia. It is helpful to stimulate the hair growth from the vertex region of the scalp. Saw palmetto is an herb which is grown in North America. It has the ability to block the activity of enzyme 5 alpha reductase that can lead to androgenetic alopecia.
You can orally consume saw palmetto or use it in the form of oil to massage your scalp. The regular use of it can bring positive results against androgenetic alopecia. Saw palmetto is effective for both male and female pattern baldness.
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Grape seed extract:
Grape seed extract can be effective against hair loss. It contains vitamin E, linoleic acid and flavonoids that can help to stimulate hair growth. Grape seed extract can help to slow down the process of androgenetic alopecia and also strengthen the hair. The capsules of grape seed extract vary from 200 mg to 450 mg. There are some side effects such as dizziness, nausea or headache due to using these capsules. So, it is important to consult the doctor before taking the capsules of grape seed extract.
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Pumpkin seed oil:
Pumpkin seed oil is also found beneficial against the male and female pattern baldness. Consuming 400 mg pumpkin seed oil for 24 weeks can help you to fight against hair loss and also stimulate new hair growth.
You can also apply pumpkin seed oil on your hair and massage your scalp regularly. It slows down the hair thinning process.
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Treatment options for androgenetic alopecia:
There are some treatments that help to slow down the disorder’s progression. They are:
Minoxidil was the first drug which was approved by the Food and Drug Administration (FDA) to treat androgenetic alopecia. It is present in many forms such as 2% solution, 5% solution and 5% foam. The 5% solution of minoxidil is more effective than the 2% solution. Minoxidil is mainly used to stimulate hair regrowth. In almost 50% of men, the use of minoxidil stops the hair loss and also stimulates some hair regrowth.
The main mechanism of minoxidil for hair growth is unknown. But it helps to amplify the number of hair follicles in the anagen phase that increases hair growth. Minoxidil is effective to treat frontal or vertex alopecia in males. Additionally, minoxidil is safe for use in patients with this genetic disorder.
By the use of minoxidil, the vellus hair is enlarged and also converted into terminal hair. A dropper is used to apply minoxidil onto the scalp twice a day. You should also wash your hands after the application to avoid unintentionally applying to the other parts of the body.
You should apply minoxidil on those areas where your hair is thin. Gentle massage your scalp with your fingers to reach it to the hair follicles. Then, leave it for a few hours. It is also important to not shampoo your hair for at least 4 hours afterwards.
There are some side effects of using minoxidil including:
- Sometimes, hair can also grow on unwanted areas such as cheeks.
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Low level laser therapy:
Low level laser therapy is also an effective treatment for androgenetic alopecia. In this procedure, different wavelengths of laser are used to stimulate the hair growth. There are many devices such as the comb, a helmet or a hood that easily fits on the head.
HairMax Laser Comb is the only laser device which is approved by the FDA. It is a surgical treatment for androgenetic alopecia. Low level laser therapy is used with drug therapy that can improve its effect. It also enhances the effect of minoxidil to prevent hair loss. Adding low level laser therapy to 5% minoxidil can be helpful to treat the disorder and also stimulate hair growth.
Ketoconazole is an effective drug in those cases of androgenetic alopecia in which hair loss is due to inflammation of hair follicles. Ketoconazole is helpful to reduce the inflammation and provides strengthening to your hair. It is also available in shampoo form.
Nizoral is the product that contains low concentration of ketoconazole. It can be beneficial to use for your disorder condition. You can easily purchase Nizoral from Amazon.
Androgen hormones include testosterones and other male hormones that can enhance hair loss in women. Those people in which minoxidil cannot show effective results, anti-androgens are given to those people. Anti-androgen drug is spironolactone that can be used to treat androgenetic alopecia.
It is mainly recommended for those ladies that are suffering from polycystic ovary syndrome (PCOS). It is due to the reason that androgen levels increase in PCOS. It is recommended that spironolactone is given with an oral contraceptive for females in their reproductive age.
The common side effects of taking this drug can be:
- Weight gain
- Loss of libido
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Exogenous estrogen is used less often, but it is also a treatment approach for androgenetic alopecia. In fertile women, you should give androgenic progestin such as norgestimate, desogestrel or norethindrone.
If hair loss starts due to hormone imbalance. In this case, doctors can recommend hormone replacement therapy to balance the hormones in the body.
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Viviscal is a two-part hair care system that promotes hair growth. These are supplements that can be used in androgenetic alopecia to slow down the hair loss. Viviscal contains amino acids that can be effective to accelerate hair growth. These supplements are famous because of their beneficial results. It contains many important ingredients including silica, fish oil, biotin, niacin, zinc and vitamin C. Most people find effective results by taking Viviscal supplements.
You should take these supplements twice a day daily for six months. Most people see the results after two to four months of using these supplements. Viviscal is also used with a combination of platelet rich plasma (PRP), laser light therapy and hair transplantation. The results are more prominent when you use multiple procedures for treatment of androgenetic alopecia.
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The side effects of using Viviscal supplements are:
- People having fish or shellfish allergies should avoid Viviscal supplements.
- It also contains millet seeds, so people with celiac disease cannot use these supplements.
Oral finasteride is also used to treat androgenetic alopecia. Finasteride is an inhibitor of the type II 5 alpha reductase isoenzyme. When it blocks activity of 5 alpha reductase, it also inhibits the conversion of testosterone to dihydrotestosterone.
So, Finasteride helps to reduce hair loss. Men with vertex to mid scalp hair loss can get benefits by taking this drug. This drug is approved by the Food and Drug Administration (FDA). It is mostly recommended for people ages between 18 to 41 and having moderate male pattern alopecia.
You can use finasteride alone or in combination with minoxidil to improve the hair growth over time. This drug is recommended for only male pattern alopecia and does not give to the female.
The common side effects of finasteride are:
- Hot flashes
- Decrease sex drive
Hair transplant is a more permanent option for treating androgenetic alopecia. It is a common and effective method that is performed by a surgeon. In this method, the hair follicles are taken from those areas of scalp that are androgen resistant. Then, these hair follicles are transplanted to those areas of scalp that are androgen dependent. It usually takes 5 to 6 months to see the improvements. Hair transplant is a costly procedure and also not suitable for everyone.
The most common technique is “follicular unit transplantation”, 90% of the surgeons use this technique these days. In this procedure, the surgeon removes the strip from the scalp and then divides it into tiny grafts. Each graft contains just a few hairs. Now, each graft is planted into the scalp with the help of needles. So, hair can grow naturally and the cluster of follicles are called “follicular units”.
Microneedling is a popular procedure and can be beneficial to stimulate hair growth. It is used to deliver topical drugs to the scalp. In microneedling, the small needles are attached to the roller that create tiny punctures in the skin. It releases growth factors and also promotes the expression of Wnt protein. Wnt protein is found helpful in stimulation of hair growth. Microneedling is used with the combination of minoxidil or PRP. Use of microneedling with minoxidil enhances the results. It seems that microneedling increases the penetration of topical drugs and promotes hair growth.
Platelet rich plasma (PRP):
Platelet rich plasma (PRP) is a new procedure which is used to treat androgenetic alopecia. In this therapy, platelets are collected from the blood and prepared through several methods. Then, these platelets are injected into the scalp. Injections of platelet rich plasma are helpful to reduce hair loss. It also increases the density and diameter of each hair. This procedure is offered by many dermatologists and hair replacement specialists these days.
Diet is also important because a poor diet can cause nutrient deficiencies that affect the hair follicles. The balanced nutrients in the diet are important to prevent hair loss. The diet contains minerals and vitamins that can help in androgenetic alopecia. This diet can also help to reduce the risk of developing minerals and vitamins in males.
If you do not get enough vitamins and minerals from your diet, it is important to take supplements for this purpose. These supplements of minerals and vitamins help to reduce hair loss and also prevent hair thinning. Hair growth can be stimulated by zinc, riboflavin, folic acid, vitamin E and biotin. So, you should take these supplements to prevent androgenetic alopecia.
Moreover, you can expose yourself in the sunlight to get vitamin D. Otherwise, you can take vitamin D supplements or eat food that contain vitamin D such as milk and eggs. If your hair becomes thin, you should check your vitamin D level.
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Another ingredient is iron which is very beneficial. Basically, iron is a mineral which is present in meat and spinach. Iron deficiency is more common in women. So, it is necessary to check your iron level. Also, take iron supplements to fulfil the requirement of iron in the body. The balanced amount of vitamin D and iron can improve the symptoms of androgenetic alopecia. These minerals and vitamins help to reduce hair loss in women and also stimulate new hair growth.
Nutrafol is a hair supplement that reduces the negative effect of dihydrotestosterone. It contains saw palmetto and reishi that can reduce the activity of 5 alpha reductase enzyme, the enzyme that converts testosterone hormone into dihydrotestosterone. So, it is very effective to treat androgenetic alopecia. It also contains ashwagandha that reduces the cortisol level and increases blood circulation of the scalp.
Nutrafol supports healthy scalp and also stimulates hair growth. An excellent result is observed by using these supplements. It improves hair growth and also provides thickening to the hair. Nutrafol can help to improve the function of hair follicles that increase hair growth. It shows very positive results in the treatment of androgenetic alopecia. It is important to consult your doctor before taking any supplements.
There are some side effects of using Nutrafol that are following:
- Dry mouth
- Upset the stomach
Myths about androgenetic alopecia:
Here are some common myths:
Genetic condition passed down from the father:
It is true that male pattern baldness is hereditary, but it can be inherited from both the mother or father sides. Androgenetic alopecia also involves a number of genes that cause hair loss. So, if you have many people in your family that lose their hair, there is a chance that you can also develop this disorder and lose your hair.
Affects only older men:
Another myth is that androgenetic alopecia affects only older men. It is not true because male pattern alopecia begins during puberty. But it has slow progression, so it takes time to reach the severe stage. After puberty, male pattern alopecia (baldness) affects men of any age.
Hair loss start in random manner:
Hair loss does not start in a random manner. Hair loss with androgenetic alopecia starts in a definite pattern. In males, it starts from the temple and the forehead, also forming an “M” shape appearance. In females, the hair thinning starts from the top of the head and spreads in “U” form.
Treatment approach for hair loss doesn’t work:
Some treatments for hair loss are very effective. It includes pharmaceutical medications and hair transplant. The use of over-the-counter products on the scalp and prescription pills can be effective to stimulate hair growth. These treatments can slow down the hair loss and also sometimes stimulate the hair regrowth. The results are even more prominent if you use these products in starting stages of androgenetic alopecia.
It is also a misconception that androgenetic alopecia is a contagious condition. You cannot catch this disorder from someone else. So, it is not contagious and hence dont be scare.
Androgenetic alopecia is a condition of hair loss that affects both male as well as females. In males, this condition is known as male pattern baldness. In women, androgenetic alopecia is known as female pattern baldness. Its characteristics are different in both genders.
For instance, male pattern androgenetic alopecia can cause complete baldness in male. While in females, it causes thinning of hair. In this disease, hair follicles decrease in size and lead to hair loss.
It is mainly due to an increase in androgens hormones including testosterone. It is an irreversible disease that can never be stopped. But there are some ways that can help you to slow down the progression of androgenetic alopecia. Many factors trigger this situation but mainly it is due to genetics and androgens hormones. There are some topical drugs that are FDA approved. These products show effective results in many people. All treatments are not suitable for everyone.
The hair loss due to androgenetic alopecia is permanent and never reversible. In some cases, when people use products to treat androgenetic alopecia, it also helps to stimulate the regrowth of new hair.
Androgenetic alopecia is a very stressful condition, but you should not lose hope and be patient. It takes time but the products show some improvement that can help to reduce hair loss in women and in men.
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