Androgenetic alopecia, also known as genetic baldness, is the main cause of both male and female hair loss.
It affects 50% of men by the age of 50 and up to 85% by the age of 70.
After menopause, up to 40% may be affected.
Androgenetic alopecia is an inherited condition whose first symptoms usually start after puberty.
Androgenetic alopecia has a gradual and variable evolution.
It seems to manifest itself differently in various races and people.
Caucasians tend to have the earliest and most intense presentation.
African Americans and Asians commonly have a milder presentation, including less chance to develop a receding hairline.
Causes of androgenetic alopecia
The main causes of androgenetic alopecia are hormonal disturbances and genetics.
There is scientific evidence of the contribution of environmental factors, but it is not clear the mechanisms by which they contribute to hair loss.
It has been proposed that external factors are associated with earlier onset and faster progression.
In this case, external factors such as stress increase free radicals, which lead to faster cellular aging.
Free radicals are highly reactive compounds originated by oxidative stress, as a result of harm from internal or external agents.
Free radicals react with cells and tissues, provoking damages which can change cellular functions.
The cumulative damages lead to the cellular aging related to hair loss.
Genetic predisposition to androgenetic alopecia
Androgenetic alopecia is largely heredity.
Genetics accounts for approximately 80% of a person’s chance to develop baldness.
Although androgenetic alopecia is strongly associated to genetics, it is not completely understood.
The most well known hair loss gene, the androgen receptor gene, comes from the mother. This fact created the myth of baldness as a maternal trace.
In fact, there are other genes involved that are not associated with just the mother.
Some has already been discovered, but there are still more to be revealed.
Hormones in androgenetic alopecia
The hair loss in androgenetic alopecia is related to male hormones, called androgens.
Dihydrotestosterone, or DHT, is the main androgen associated with genetic hair loss.
Testosterone is converted in DHT by 5-alpha-redutase enzyme.
There are 2 subforms of 5-alpha- redutase. Type 2 is more linked to hair loss than type 1.
Although hormones are definitely related to hair loss, it is not a perfect correlation.
Even normal androgen levels are enough to cause hair loss in genetically predisposed individuals.
Mechanisms of androgenetic alopecia
The main mechanisms involved in androgenetic alopecia development are hair cycle alterations and follicle miniaturization.
In general, the hair of individuals with androgenetic alopecia becomes shorter and sheds earlier than normal.
This earlier hair loss is related to the shortening of the hair growing phase.
Besides that, there is also a hair shrinking process, called miniaturization.
Miniaturization is the most important mechanism of androgenetic alopecia.
Miniaturization is the process of hair thinning and shortening induced by the male hormone DHT.
Usually, miniaturization is progressive. The hair shafts become thin or even absent, which characterizes the permanent hair loss.
Psychological impact of androgenetic alopecia
Hair is an essential part of self image, which directly interferes with social life.
Therefore, the consequences of androgenetic alopecia are predominantly psychological.
There are some studies showing the negative impacts on self-esteem and quality of life of those individuals.
Anxiety and depression are common feelings associated with hair loss.
Since adolescence is a transitional time of identity formation, teenagers are specially affected.
The emotional impact of hair loss in women can be devastating.
Relationships, work and even professional career can be affected by hair loss.
Clinical features: differences between male and female alopecia
Men typically present receding hairlines, hair loss on the crown or any other part on the top of the head.
It is also typical to preserve a rim of hair at the sides and rear of the head.
Women usually have a diffuse thinning of the hair, with exposure of the scalp mainly on the sides and top of the head.
Hairline is often preserved in females.
When women comb their hair, splitting it on the top middle, sometimes it is possible to see the characteristic sign of a “Christmas tree”.
Although it is not common, some women may present “male” pattern hair loss, including receding hairline.
Hair loss degree
It is not expected that women have large areas of baldness, but rather thinner hair, in reduced quantity.
Age of onset
Men often present an early hair loss onset.
Unlike men, women often have a later onset of hair loss, with faster progression after menopause.
Hair loss evolution
Although it is not a rule, women usually have a slower hair loss progression in comparison to men.
The slower hair loss progression in women is partly responsible for their later perception of baldness.
Associated medical conditions
Scientific studies have suggested an association between androgenetic alopecia and health medical conditions.
According to scientific data, people with baldness are likely to present hypertension, heart attack, diabetes, higher cholesterol levels, atherosclerosis and cancer.
Men also have an additional risk of infertility, benign prostate enlargement, intestinal and prostate cancer.
Androgenetic alopecia: treatment
There are efficient therapies for prevention, control and recovery of hair loss in androgenetic alopecia.
Since treatments are properly prescribed and executed, the results are excellent.
In order to get the best treatment option, it is recommended to evaluate the hair loss degree and extension.
Mild or moderate hair loss is often well responsive to medical devices, oral and topical medications.
In cases of more advanced hair loss, scalp reconstruction is recommended.
The scalp reconstruction may be performed with surgical hair transplantation or non-surgical hair replacement methods.
The decision regarding the best treatment depends on the correct diagnosis.
Therefore, it is important to schedule a medical appointment as soon as you notice the first signs of hair loss.
Doppio Clinic is headed by a hair loss specialist physician who leads a team of professionals prepared to help with your hair problems.
Make an appointment today to get information and advice about your hair loss.