Androgenetic alopecia is a common form of hair loss in both men and women. In men, this condition is also known as male-pattern baldness. Hair is lost in a well-defined pattern, beginning above both temples. Over time, the hairline recedes to form a characteristic "M" shape. Hair also thins at the crown (near the top of the head), often progressing to partial or complete baldness.
The pattern of hair loss in women differs from male-pattern baldness. In women, the hair becomes thinner all over the head, and the hairline does not recede. Androgenetic alopecia in women rarely leads to total baldness.
Androgenetic alopecia in men has been associated with several other medical conditions including coronary heart disease and enlargement of the prostate. Additionally, prostate cancer, disorders of insulin resistance (such as diabetes and obesity), and high blood pressure (hypertension) have been related to androgenetic alopecia. In women, this form of hair loss is associated with an increased risk of polycystic ovary syndrome (PCOS). PCOS is characterized by a hormonal imbalance that can lead to irregular menstruation, acne, excess hair elsewhere on the body (hirsutism), and weight gain.
Androgenetic alopecia is a frequent cause of hair loss in both men and women. This form of hair loss affects an estimated 50 million men and 30 million women in the United States. Androgenetic alopecia can start as early as a person's teens and risk increases with age; more than 50 percent of men over age 50 have some degree of hair loss. In women, hair loss is most likely after menopause.
There are many different potential causes of alopecia. Hair loss - temporary or permanent - can be triggered by any number of factors. These can include allergies, irritants, toxins, burns, injuries, and infections. We also know that certain medications (especially anabolic steroids), chronic kidney failure, radiation, and chemotherapy can cause hair to fall out. Sometimes, hair loss may be due to a vitamin A overdose, iron deficiency anemia, a malfunctioning thyroid gland, fever, or pregnancy.
Symptoms and Complications
Thinning hair is the most obvious symptom of androgenic alopecia. In men, it begins at the crown, temples, or both. They also tend to get a "high forehead" that's associated with a receding hairline. This is less common in women. While men can go completely bald, women don't usually lose all the hair on the crown of the head.
Alopecia areata appears as sudden losses of small round patches of hair, usually from the scalp, but sometimes from the face or body. The fingernails may be lightly pitted or stippled. The disease often comes and goes in cycles, with regrowth in between.
Treatment and Prevention
While there's no way to prevent most types of hair loss, it's sometimes possible to stop or slow the alopecia.
Medications are available that encourage regrowth of hair. These medications, such as minoxidil* and finasteride, are not appropriate for everyone with hair loss. Hair growth medications work to varying degrees in different people, and only trigger complete regrowth in a minority of individuals. They work best for people who have smaller amounts of hair loss. Hair loss returns if you stop taking the medication. Finasteride is not appropriate for women.
Corticosteroids are another type of medication that may be used for some types of hair loss. Less severe cases of alopecia areata are sometimes treated with corticosteroids injected into the affected area. Systemic (pill-form) corticosteroids have long-term side effects and are reserved for more severe cases.
Another treatment for unresponsive alopecia areata is to deliberately provoke an allergic reaction (contact dermatitis) with a chemical applied to the scalp. A rash develops, and hair often grows back in the same spot a few months later. It can be uncomfortable, though.
Some people with hair loss have slightly low iron or zinc levels and may benefit from iron and zinc supplements.
For severe alopecia of any type, medication may improve the condition, but not cure it. The remaining options are to undergo surgery or wear a wig or hairpiece. The other option is to learn to live with the condition and not pursue medical options.
Surgery usually means a hair transplant. Small plugs of scalp, each with two or three hairs attached, are taken from areas of thick hair, and planted in the affected part of the scalp. Fewer hairs per square inch are needed for people with wavy or curly hair, or people whose hair and skin colours match.
Unfortunately, further hair loss can ruin any transplant, and leave you without enough donor hairs. The least successful candidates for transplant are men in their 20s who are balding fast. Such men, especially those whose fathers were or are bald by the age of 55 years, should know that a very expensive transplant won't last forever.
Although wigs may not sound like the best option, they often are. Good quality modern hairpieces can be undetectable (though expensive). Many grip by vacuum and won't fall off - even during contact sports.