What is androgenetic alopecia and how can it be treated?

Androgenetic alopecia, also known as male and female pattern hair loss, affects half of the male population and a quarter of the female population by the age of 50, making it the most common cause of hair loss globally.

What is Androgenetic Alopecia?

Generally, androgens are hormones that primarily stimulate the development of bones, muscles, and secondary sexual characteristics in both genders. These include the deepening of the voice, maturation of sexual organs and growth of hair in specific areas of the body such as the face, chest, armpits, and pubic region. However, androgens can also be responsible for the transformation of the androgen‐sensitive hair follicles at the frontal area or vertex region of the scalp. In androgenetic alopecia, these hair follicles in fact get smaller over time (miniaturization) which causes thinning and consequent the falling of hair strands.

How does it manifest itself and why?

Androgenetic alopecia can manifest itself at any time after puberty and is usually a disease that progresses slowly. As time passes the number of hair follicles in the telogen phase (resting phase of hair growth) increases, resulting in a shortened anagen (growth) phase for the patient, and therefore a shorter life for the hair strand.

In men, Androgenetic alopecia follows a receding hairline pattern that ultimately results in loss of hair at the vertex or the top of the head. Differently, in women the vertex is the first part to be affected with signs of hair thinning. As the hairline does not usually recede, this condition, unlike it doesn’t in men, rarely leads to complete baldness in women.

Although male pattern hair loss is associated with a combination of genetic predisposition and the hormone dihydrotestosterone, the cause of androgenetic alopecia in females remains unclear.

What are the treatment options available?

There are several popular treatment options currently available for the management of Androgenetic alopecia. Some of the most common and effective solutions include:

APPLICATION OF ESSENTIAL OILS AND HERBAL PRODUCTS:

Cedarwood, lavender, thyme, and rosemary oils have their unique beneficial role depending on different types of hair, as well as having relatively low – to no toxic – side effects. A study published in 2015 compared the effectiveness of rosemary oil to the medicinal minoxidil in individuals with androgenic type hair loss, and found that after six months, both treatments resulted in significant hair growth. However, the group assigned with rosemary oil treatment did not report any side effects to the treatment, unlike the minoxidil exposed group.

Saw palmetto is an herbal supplement known for its receptor blocking activity towards the hormone linked to hair loss. Its use is popular among men who avoid finasteride and other medicinal preparations due to their possible side effects. A clinical trial showed high positive outcomes (up to 60%) from the treatment of saw palmetto in men aging 23- 64 years of age.

MEDICATIONS:

Minoxidil

Currently, minoxidil and finasteride are the only two FDA-approved medicinal treatments for androgenetic hair loss. Minoxidil has proven advantages of slowing down Androgenetic alopecia and in some cases of also inducing new hair growth.

It works by prolonging the anagen phase of hair growth by activating potassium channels in the hair follicle, which results in an increased prostaglandin production that promotes hair growth. At least six months of treatment is estimated to be required to prevent further hair loss and to initiate hair growth.

Dermatologists usually suggest a 2% concentration preparation of minoxidil for women and a 5% concentration for men suffering from androgenetic alopecia.

Finasteride

Finasteride (Propecia) is a once-daily oral medication that is considered a gold standard treatment for Androgenetic alopecia in men. It inhibits the enzyme (5-alpha reductase inhibitor) that stimulates hair loss in men along with causing an increase in hair retention, the weight of hair, and regrowth.

A five year clinical trial on Finasteride concluded a 90% efficacy rate in the subjects in terms of hair gain and maintenance of present hair strands over the duration of the trial.

This drug is found to be highly effective in younger men in comparison to older men, and may not produce any significant results in men over the age of 60.

Rare side effects observed with finasteride use include decreased libido, and sexual function and an increased risk of prostate cancer. Results are visible after six weeks of initiating treatment. However, once the treatment is stopped, hair loss is mostly seen to resume.

Dutasteride:

Dutasteride belongs to the same class of drugs as finasteride with the only difference being its effectiveness in blocking testosterone conversion into Dihydrotestosterone (DHT). Finasteride is the older of the two drugs and is the only one approved by the FDA for the treatment of hair loss in men, whereas dutasteride is FDA approved for the treatment of benign prostatic hyperplasia. A study published in 2005 proved dutasteride to have more potential in blocking testosterone conversion (around 98% of DHT) on similar dosing as compared to finasteride (around 70% of DHT). Administration of dutasteride to women is contraindicated as it can affect the normal development of reproductive organs in male fetuses due to decreased DHT levels.

SURGICAL AND NON-SURGICAL PROCEDURES:

Low-Level Laser Therapy is known to promote effective hair growth in patients with androgenetic alopecia along with reversing the miniaturizing process this is typical of this type of hair loss. Multiple studies strongly recommend and support the effectiveness of LLLT for the treatment of androgenetic alopecia, as it’s a safe, painless and non-invasive procedure.

Surgical procedures to manage androgenetic alopecia can range from scalp flaps, hair loss reduction, follicle transplants, and hairline lowering options. Surgical procedures are generally expensive, painful, and also carry a risk of infections and secondary scarring. However, surgery is frequently sought by individuals who are self-conscious about their physical appearance. The transplanted hair falls out a few weeks after the surgery, but the hair that grows back in its place is strong and permanent.

Clinical studies have shown that approximately 85-95% of all implanted bulbs grow without problems in the transplanted area. This high percentage indicates that hair transplants, in general, have a high success rate. The visible results of a surgical procedure can be seen after six to eight months of surgery.

Find out more about what the reasons behind YOUR hairloss may be, and how to effectively treat it on other sections of Trichology.com

FAQs

1. What is the difference between androgenetic alopecia and other types of hair loss?

Androgenetic alopecia is driven by a genetic sensitivity to DHT (dihydrotestosterone), which causes hair follicles to miniaturize over time — producing thinner, shorter hairs until they stop growing. Unlike telogen effluvium (which is temporary and triggered by stress or illness), androgenetic alopecia is progressive and follows a predictable pattern: receding hairline and crown thinning in men, and diffuse thinning at the crown in women.

2. Can women get androgenetic alopecia?

Yes — it is also called female pattern hair loss (FPHL) and is more common than many people realize. In women it typically presents as widening of the part line and diffuse thinning across the crown, without the same dramatic hairline recession seen in men. The hormonal drivers in women are less well understood than in men, and treatment options differ slightly.

3. At what age does androgenetic alopecia typically start?

It can begin any time after puberty. In men, it often becomes noticeable in the 20s or 30s. In women it is more common after the age of 40, and post-menopausal hormonal shifts can accelerate it. The earlier it starts, the more aggressive the progression tends to be if left untreated.

4. Is androgenetic alopecia permanent?

The follicle miniaturization process is progressive, but it is not necessarily irreversible in early stages. Treatments like minoxidil, finasteride, and LLLT can slow or halt progression and, in some cases, stimulate regrowth — especially when started early. Once follicles have fully miniaturized, hair transplant is the most reliable option for restoring coverage.

5. How long does it take for treatments like minoxidil or finasteride to work?

Most treatments require at least 6 months before visible results are noticeable. It is common to experience a temporary increase in shedding in the first few weeks of minoxidil use — this is normal and does not mean the treatment is failing. Consistency is critical: stopping treatment typically results in the hair loss resuming within months.

6. When should I see a trichologist about pattern hair loss?

The sooner the better — androgenetic alopecia is easiest to manage when caught early. If you are noticing a receding hairline, thinning at the crown, or a widening part, a trichologist can confirm the diagnosis, rule out other causes, and recommend a treatment plan appropriate for your stage and pattern.

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