Common Hair Balding in men and women (androgenetic alopecia or androgenic alopecia)

What is common hair balding ?

• It is the most common form of hair loss in both men and women.
• In men it is characterized with a hair loss extending backwards as well as thinning of hair in the vertex (classification according to Hamilton).
• In women, the hair loss is more diffuse and more located on top of the skull and contrarily to men, there is no loss of the hair implantation line (classification according to Ludwig). This condition is characterized by miniaturization of hairs with becoming untreatable if the hair loss is permanent.

What is the cause ?

• Genetic and hormonal factors, as well as age can participate in the development of androgenetic alopecia.
• In men, testosterone is converted into dihydrotestosterone by an enzyme called 5 alpha-reductase. Dihydrotestosterone acts on the hair follicle which results in miniaturization of the hair.
• In a small percentage of men and women, the hair loss can be the result of an increased production of male hormones secondary to medical (endocrinological) conditions.

How will I be affected ?

• Androgenetic alopecia can impair self-confidence. This can result in significant psychological stress.

How is the condition diagnosed ?

• Your doctor will ask questions and perform a complete physical examination.
• In some patients, lab tests may be needed to exclude other causes of hair loss.

How can androgenic alopecia be treated ?

• Local application of minoxidil (spray) and the oral intake of finasteride have shown scientific evidence of their efficacy in the treatment of common hair balding. They prevent the hair loss from progressing and stimulate the growth of hair.
• Additionally, vitamins and supplements can be added if the results remain unsatisfactory.

Minoxidil: How does it work and what are its side-effects ?

• Minoxidil is applied twice a day on the affected areas of the scalp.
• Minoxidil prolongs the growth phase of the hair and thickens it.
• Side effects include irritation of the scalp and appearance of dandruff.
• Paradoxically and although infrequent, initially hair loss can actually increase the first few months of treatment.

Finasteride: how does it work and what are its side-effects ?

• Finasteride is an inhibitor of the 5 alpha-reductase enzyme.
• This enables to decrease the concentrations of dihydrotestosterone which results in an increased growth phase and thickening of hair.
• Transient and infrequent erection difficulties may arise, again this is completely reversible if the treatment is stopped.
• Finasteride can be taken together with the majority of other drugs.
• Patients with a histors of Prostate Benign Hypertrophy must inform their doctor if they are taking finasteride.

How is androgenetic alopecia treated in women ?

• Local application of minoxidil has also been shown to be effective in the treatment of women with common balding.
• If indicated, spironolactone can also been used but it requires strict medical monitoring with frequent blood tests.
• Hormonal imbalances can also be treated.
• Finasteride is not normally used in women

When will I see results ?

• Hair loss usually stops progressing after three months of treatment.
• In a proportion of patients, new hair growth can be seen 6 months after beginning the treatment.

How long must the treatment be continued for ?

• To maintain the results, the treatment must be continued for life.
• If the treatment is stopped, the hair loss returns 3 to 6 months later. The new growth of hair will also be lost.

Can hair regrow if I am completely bald ?

• The current medication does not enable regrowth of hair in completely bald individuals.
• Early treatment, before permanent hair loss is recommended.

Are other solutions available ?

• Surgical options include capillary transplants and bald skin reduction.
• For patients with advanced balding, cosmetic aids such as dyes, wigs…can be suitable alternatives.

Talk with your doctor about the advantages and disadvantages of the different treatment alternatives.