Androgenic Alopecia (Androgenetic Alopecia) in Women (For Professionals)

Androgenetic (androgenic) alopecia in women (for professionals)

Androgenetic alopecia and to a lesser extent Telogen effluvium are the two most frequent causes of hair loss in women.

To make the diagnosis:

General examination of the scalp

1. evaluate the distribution of the hair loss
2. are hair follicles present?
3. traction (does the hair go away easily?)
4. evaluate the quantity of the hair loss (trichogram)
5. éventually, do a biopsy (always in the direction of the hair follicle)

Specific clinical evaluation in the case of androgenetic alopecia

1. Distribution of the alopecia: male pattern according to Hamilton (I to VII) or female pattern according to Ludwig (I to III).
2. Severity: is the scalp visible. If yes, more than 50% of the total hair has been lost.
3. Exclude a Telogen effluvium: traction test (to evaluate if the hair falls off on all the scalp), loss of more than 100 hairs per day? (trichogram)

One word on Telogen effluvium

• Etiology:

1. deficiency in iron
2. post-delivery
3. dysfunction thyroid gland
4. Chronic disease
5. Stress
6. Infection…

• Etiology of a deficiency in iron (ferritin less than 30 micrograms per ml):

1. decreased intake
2. increase of needs (pregnancy…)
3. malabsorption
4. blood losses (menses, internal bleeding).

• Treatment of a deficiency in iron:

1. oral intake of 200mg per day. Control ferritin after 3 months. If it is higher than 40micrograms per ml, treatment can be stopped. If levels of ferritin remain low for two tests, it is advisable to investigate for an internal bleeding etiology.

Androgenetic alopecia

• Diagnosis

1. Clinical diagnosis (see specific clinical evaluation)
2. look for a hyperandrogenic state: early beginning, rapid start, hyperandrogenic state signs (hirstutism), history of polycystic disease…
3. hormonal blood tests: Testosterone, Dehydroepiandrostenedions (DHEA).

• Treatment

1. topical: minoxidil 2%, topical estrogens,  sprays to increase the volume of the hair (TopSecret, Mathis-Lucerne).
2. systemic: sprironolactone 50-100mg, cyproterone acetate.

This advice is for informational purposes  only and does not replace therapeutic judgement done by a skin doctor.

Source of information: Harms, “Trchologie” (french), Geneva University Hospital, 2010