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Androgenetic alopecia
Background
Overview
Definition
Androgenetic alopecia, also known as male or female pattern baldness, is a common form of hair loss in both genders.
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Pathophysiology
The pathophysiology of androgenetic alopecia involves both genetic and hormonal factors. The condition is known to depend on the presence of the androgen dihydrotestosterone and a genetic predisposition, with the androgen receptor gene playing a significant role.
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Epidemiology
Androgenetic alopecia is estimated to affect about 0.2-2% of the population worldwide.
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Risk factors
Risk factors for androgenetic alopecia include a genetic predisposition, specifically a susceptibility locus at chromosome 20p11.22, advancing age, and hormonal influences.
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Disease course
Clinically, it is characterized by a progressive loss of hair, with a specific pattern of baldness. In men, it often presents as hairline recession at the temples and balding at the top of the head. In women, it typically manifests as a general thinning of hair across the entire scalp, with preservation of the frontal hairline.
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Prognosis and risk of recurrence
The prognosis of androgenetic alopecia is chronic and progressive. While treatments can slow the progression and improve hair density, there is currently no known cure. The hair loss typically continues over time.
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Guidelines
Key sources
The following summarized guidelines for the evaluation and management of androgenetic alopecia are prepared by our editorial team based on guidelines from the American Academy of Family Physicians (AAFP 2024,2009), the European Dermatology Forum (EDF 2018), and the Japanese Dermatological Association (JDA 2018).
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Diagnostic investigations
Laboratory evaluation: as per AAFP 2009 guidelines, obtain targeted endocrine evaluation (testosterone, DHEAS, and prolactin levels) in female patients presenting with hair loss associated with abnormal menses, history of infertility, hirsutism, unresponsive cystic acne, virilization, or galactorrhea.
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Medical management
Topical minoxidil, male-pattern hair loss: as per AAFP 2024 guidelines, offer topical minoxidil for the treatment of adult patients with androgenetic alopecia.
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Topical minoxidil (female-pattern hair loss)
Other topical therapies
Oral minoxidil
5-alpha-reductase inhibitors (male-pattern hair loss)
5-alpha-reductase inhibitors (female-pattern hair loss)
Hormonal therapy (male-pattern hair loss)
Hormonal therapy (female-pattern hair loss)
Therapies with no evidence for benefit
Nonpharmacologic interventions
Therapeutic procedures
Laser therapy
As per EDF 2018 guidelines:
Consider offering low-level laser therapy (with devices using energy levels shown to be effective in randomized-controlled clinical trials) as an ancillary therapy in patients with androgenetic alopecia.
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Insufficient evidence to recommend for or against treatment for > 6 months with low-level laser therapy.
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Surgical interventions
Self-hair transplantation, male-pattern hair loss
As per EDF 2018 guidelines:
Consider offering follicular unit transplantation in male patients with androgenetic alopecia with sufficient donor hair.
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Consider combining follicular unit transplantation with finasteride 1 mg/day to achieve a better clinical outcome.
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More topics in this section
Self-hair transplantation (female-pattern hair loss)
Prosthetic hair transplantation