Androgenic alopecia

Androgenic alopecia is a form of chronic hair loss, the main cause of which is an imbalance of sex hormones and increased sensitivity of hair follicles to androgens. There is also the concept of androgenetic alopecia, which is hereditary and occurs in people genetically predisposed to this type of hair loss.

It is a misconception that the androgenetic type of baldness affects only men. Indeed, men are much more likely to suffer from androgenic hair loss: in the presence of a genetic predisposition, the first symptoms can appear as early as 20–25 years of age. Even without this predisposition, age-related hormonal changes lead to visible alopecia in 50–80% of men over 50. As for women, they encounter androgenic baldness less frequently and at a more mature age: most often during hormonal changes associated with menopause or after childbirth.

The main cause of androgenic alopecia is a hormonal imbalance, when excessive conversion of testosterone into dihydrotestosterone (DHT) occurs under the influence of androgens. How this affects the condition of hair:

• DHT binds to receptors in hair follicles;
• this leads to a shortening of the hair growth phase (anagen), follicles decrease in size (miniaturize);
• hair becomes thinner, shorter, and lighter until it stops growing completely.

Accordingly, the mechanism of androgenic baldness is an elevated level of androgens in the body (more common in men), while androgenetic alopecia is genetically determined increased sensitivity of hair follicles to DHT, even at normal androgen levels (often seen in women).

Causes of androgenetic alopecia in men:

• Heredity: mutation in genes related to androgen receptors.
• Physiological increase in androgens during adolescence and young adulthood.
• Active work of the enzyme 5-alpha-reductase, which converts testosterone into DHT.
• Aggravating factors include chronic diseases, stress, poor nutrition, and age.

Causes of androgenetic alopecia in women include hereditary predisposition. Aggravating factors:

• Hormonal disorders, particularly:
  • polycystic ovary syndrome (PCOS),
  • postmenopause (natural decline in estrogen levels and relative increase in androgens),
  • hyperandrogenism.
• Pregnancy and childbirth — may temporarily trigger increased hair loss.
• Sensitivity of follicles to androgens despite normal hormone levels.

Important! Diagnosis and treatment of androgenic alopecia in women are more challenging, as they more often exhibit the second mechanism of disease development — normal androgen levels but increased sensitivity of hair follicles to DHT.

Androgenic alopecia develops gradually. Unlike other forms of hair loss, it is not characterized by itching, inflammation, or flaking of the skin.

Common symptoms of androgenic alopecia:

1. Gradual hair thinning. Hair becomes thinner, softer, loses pigment and volume. At the same time, hair density is maintained in some areas, while in others the scalp becomes clearly visible.
2. Disruption of the hair growth cycle. Hair falls out before reaching its previous length, and new hair grows back less frequently.
3. Slow but steady progression. Without treatment, hair loss may worsen over the years, but progresses according to an individual scenario.

Androgenic hair loss in men begins with hair thinning in the forehead and temple areas: the hairline gradually recedes, and characteristic receding hairlines appear. Later, the crown area becomes involved — forming an “island” of hair surrounded by bald patches. In the later stages of progression, hair remains only in the occipital and lateral areas, forming a horseshoe shape.

Androgenic hair loss in men is classified according to the Norwood scale: there are 7 stages — from mild frontal recession to complete hair loss on the crown and front part of the head.

Depending on the cause of hair loss, the first signs can appear as early as 20–25 years of age, and without treatment, it may develop into pronounced alopecia by 40–50 years.

Androgenic alopecia in women does not lead to complete baldness as it does in men. Its main feature is the even thinning of hair in the central part of the scalp, especially along the parting, while the frontal hairline is usually preserved.

Without timely treatment, hair loss progresses through three stages:

1. Initially, slight thinning in the crown area is observed.
2. Then the area of hair loss expands.
3. In the final stage, there is noticeable severe thinning, reduced density, and visible scalp.

If androgenic alopecia in women is suspected, diagnosis by a trichologist and related specialists is necessary in the following situations:

• Sparse, brittle hair on the top of the head, especially along the parting;
• Signs of hormonal imbalance (acne, irregular menstrual cycle, increased hair growth on the body);
• Increased hair loss after childbirth, during menopause, or in ovarian conditions (e.g., PCOS).

In most cases, androgenetic alopecia develops according to a typical pattern: in men — receding hairlines and baldness of the crown, in women — thinning of hair along the central parting. However, rare and atypical forms do exist.

1. Androgenic alopecia in children. The risk of developing androgenic baldness during puberty is explained by hormonal imbalances, but in rare cases, its signs may appear in adolescents or even in children. Causes of its occurrence in childhood include:

• Congenital hyperandrogenism (including congenital adrenal hyperplasia);
• Early puberty;
• Genetic predisposition;
• Hormone-related diseases (e.g., tumors producing androgens).

In children, alopecia may manifest as thinning and hair loss in the crown area, slowed hair growth on the scalp with normal or increased body hair growth.

2. Androgenic alopecia on the beard. Causes of this condition may include:

• Local hypersensitivity of beard follicles to dihydrotestosterone (DHT);
• Autoimmune component (androgenetic alopecia is often combined with alopecia areata);
• Genetic features of hair growth pattern development.

Alopecia may present as clearly defined bald patches on the cheeks, chin, or neck, thinning and cessation of beard growth, and expansion of hairless areas.

3. Male-pattern baldness in women. Women with androgenetic alopecia typically experience diffuse hair thinning with preservation of the frontal hairline. However, sometimes hair loss in women follows a male-pattern scenario:

• Formation of receding hairlines at the temples;
• Pronounced thinning in the crown area, up to visible scalp;
• Overall reduction in hair density with preservation on the crown.

This condition may be caused by the use of androgens or anabolic steroids and may also be a symptom of polycystic ovary syndrome (PCOS), ovarian or adrenal tumors.

4. Androgenic alopecia in men with a “female pattern”. This is extremely rare and presents as uniform thinning of hair across the entire scalp without the formation of characteristic receding hairlines or a crown “island.” Causes of this type of hair loss may include low androgen levels, individual follicle sensitivity to hormones, and hereditary factors on the maternal side.

Heredity is one of the main risk factors for the development of alopecia. The presence of a “baldness gene” does not guarantee early hair loss, but under the influence of external and internal triggers it can “activate.” Therefore, people with a family history of androgenic alopecia should pay close attention to the condition of their hair, undergo regular check-ups, and, if necessary, start preventive therapy.

The baldness gene in men can be inherited from both the maternal and paternal lines, although it was long believed to be passed only through the X chromosome from the mother. A person may have a genetic predisposition, but alopecia develops only in the presence of triggering factors:

• Hormonal changes (puberty, thyroid disorders); hereditary hair loss in women can be activated by pregnancy or menopause.
• Age — follicle sensitivity increases with age.
• Stress, chronic diseases, vitamin deficiencies can accelerate the onset of alopecia.
• Metabolic disorders, especially carbohydrate metabolism (insulin resistance).

Comprehensive diagnostics allow not only to confirm the presence of androgenetic alopecia but also to identify its cause and severity. Such an assessment may include:

• Patient interview — the doctor clarifies when hair loss began, how quickly it is progressing, whether there are cases of baldness in the family, associated diseases, stress, or hormonal disorders.
• Visual examination — the doctor assesses the condition of the hair and scalp.
• Trichoscopy — examination of the scalp using a special device. This procedure makes it possible to observe the condition of follicles, hair density, and hair diameter. In androgenic alopecia, miniaturization of follicles and uneven hair thickness are revealed.
• Laboratory tests to assess hormonal status: testosterone, dihydrotestosterone (DHT), prolactin, LH, FSH, thyroid hormones. In women, estrogen levels and the presence of polycystic ovary syndrome (PCOS) are additionally checked.
• Consideration of genetic factors. In families with cases of baldness, the risk of developing androgenic alopecia is higher, so genetic testing may be performed to assess sensitivity to androgens.

Androgenetic alopecia is not considered a fully curable condition, but with timely diagnosis and a proper approach, it can be effectively managed, its progression slowed, and lost hair volume partially restored.

In the early stages, hair loss is partially reversible. While hair follicles are only thinning (miniaturization process), their growth can be stimulated through therapy. Hair becomes thicker, denser, and more abundant. In later stages, the process is irreversible: if follicles have completely atrophied and stopped functioning, they cannot be restored. In such cases, only hair transplantation helps.

What can help slow hair loss is determined by the doctor after diagnosis. A therapeutic maintenance plan may include:

• Medication — prolongs the hair growth phase, reduces DHT levels by blocking its destructive effect on follicles.
• Local procedures and care: mesotherapy, platelet-rich plasma therapy (PRP).
• Lifestyle adjustments: stress reduction, sleep normalization, nutrition rich in vitamins B group, D3, zinc, iron, and omega-3.

With a diagnosis of “androgenic alopecia,” it is important to identify the cause of hormonal imbalance and focus maximum effort on its elimination. After hormonal stabilization, a treatment course is prescribed.

To reduce the risk of developing androgenic alopecia, it is important to maintain a healthy lifestyle, eat a balanced diet, avoid stress and micronutrient deficiencies, pay attention to signs of hormonal imbalances, and consult a trichologist and endocrinologist in a timely manner. Proper home care also plays an important role in prevention. If androgenic baldness is suspected (at the very first signs of hair thinning), it is important to see a specialist—early diagnosis increases the effectiveness of treatment.