Androgenic Alopecia, most commonly known as Male Pattern Hair loss effects as many as 50% of men. However, this genetic disorder also affects 15% of women, before menopause and increases in prevalence in the post-menopausal female. Almost all patients with androgenic alopecia will experience thinning of hair before their 40’s with most noticing differences before their 30s.
While the bald male has gained acceptance and even been regarded as alluring in recent decades, the condition can be detrimental to the psychological well-being of many men and women struggling with it.
Genetics are largely to blame for the progression of normal thick hairs to slowly decrease their growth cycle leading to shorter hairs that are lost more frequently and their eventual replacement with short, soft, colorless, vellus hairs or “baby hairs.” Male hair loss tends to progress in a predictable pattern beginning at the top of the head, then recession of the hair line at the temples and can progress to include the whole head. Females tend to thin first at the top of the head possibly progressing to and all over thinness with the hairline often preserved.
To exclude other causes of hair loss, blood work may be done to exclude iron deficiency and thyroid disorders. Some women may also benefit from blood levels of testosterone especially in women with unwanted hair growth in other areas such as the face, chest or abdomen. Rarely is biopsy necessary to make the diagnosis.
Currently there are 2 FDA approved treatments for Androgenic Alopecia, Minoxidil and Finasteride. Minoxidil is a topical vasodilator which lengthens the hairs growth time by increasing blood supply to the hair follicle. This treatment is approved for both men and women. Improvement may take 4 months or more of daily treatment. Discontinuing its use results in rapid loss of regrown hair. Possible side effects include allergic reaction, burning or redness at the site of application, and increased facial hair growth.
Finasteride, commonly used for benign prostate enlargement, is also approved in lower doses for men with this type of hair loss. Finasteride slows the progression of hair loss and in many cases can regrow hair. Unlike Minoxidil, when treatment is discontinued there is a more gradual reversal of the effect.
Other treatments under investigation include dutasteride, finasteride’s more potent cousin, and Latanoprost, the glaucoma eye drop which gave patients longer, thicker eye lashes (marketed as Latisse for just that purpose).
Laser treatment, another emerging technology, is available for at home use in the form of combs and caps or at hair loss clinics. These treatments have not been approved for hair loss treatment, but have been found effective especially in adjunct to other treatments including Minoxidil, dutasteride and may decrease inflammation after hair transplant.
Surgical correction of hair loss is also an option for many patients with this type of hair loss provided they have enough hair in their “donor” site. Hair transplantation with micro grafting of the hair follicle gives a more natural look than the hair plugs that many remember from hair transplantations infancy. Patients with less hair to donate may benefit from hair follicle cloning. Transplantation can also be successful in areas such as the eye brow, eye lashes and in scalp areas with scarring from surgery or from areas with repeating pulling out of hair.
For more information on hair loss and to find treatment in your area please visit:
International Society of Hair Restoration Surgery: www.ishrs.org/
Editor’s note: This article is only for informational purposes. For any medical issues, please consult your own physician.
(Dr. Alok K. Gupta is an Internist, a doctor for adults. He is a Board Certified in Internal Medicine. He completed his residency in Internal Medicine at Salem Hospital in Salem, Massachusetts. Part of the training was also at Massachusetts General Hospital. Dr. Gupta has been practicing Internal Medicine since 1998. He was in upstate New York for six years. Recently, he had been practicing in Manassas, and now is in practice in Gainesville. Visit them on the web at www.alokguptamd.com )