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| Androgenetic Alopecia - Male and Female Pattern Hair Loss Most cases of hair loss are due to androgenetic alopecia (AGA). Fifty percent of men over the age of 50 and of post-menopausal women have some degree of AGA. Hair loss is gradual, with miniaturization of genetically programmed hair follicles. Uptake, metabolism, and conversion of testosterone to dihydrotestosterone by 5-alphareductase is increased in balding hair follicles. AGA affects men and women differently. In men with AGA, hair loss occurs in the fronto-temporal regions and on the vertex of the scalp, depending on severity. In female AGA patients, it is more diffuse and located centroparietally. The frontal hairline is usually intact in women. Treatment Options Treatment is either medical or surgical. Medical The only proven medications that are indicated for AGA are topical minoxidil (Rogaine®) and oral finasteride (Propecia®). Minoxidil's success for cosmetically acceptable re-growth is approximately 10% in men. In women, 50% show minimal re-growth and 13% moderate re-growth. Treatment is life-long. Seven percent of patients may experience some irritation (burning, itching, redness) from the minoxidil solution. The 5% minoxidil solution is more effective than the 2% minoxidil solution (Rogaine®). Finasteride has been shown to produce significant results in the treatment of male AGA. It works by blocking 5-alpha reductase, which is responsible for the conversion of testosterone to dihydrotestosterone (DHT). DHT is an important factor in the cause of AGA. Finasteride reversed hair loss in 66% of men - 30% experienced mild regrowth, 31% experienced moderate regrowth, 5% experienced great regrowth - and stopped hair loss in 83% of men after two years of follow-up. Finasteride is not indicated in women. Instead, the use of a systemic antiandrogen such as spironolactone (Aldactone®) 50 to 200 mg per day, cyproterone acetate (Androcur®), or flutamide (Eulexin®) may have some benefit in reducing the amount of hair thinning. Surgical Transplantation of permanent hairs from the back and sides of the scalp to balding areas in the front is a successful procedure, but usually requires three to four sessions over two years to fill in an area with adequate density. Mini- and micrografting have revolutionized hair transplantation by yielding more natural-looking results that eliminate clumping or tufting. Donor harvesting with strips rather than plugs has made the donor site more cosmetically acceptable. Hair transplantation is effective for both men and women. Androgenetic Alopecia - photos |
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