VERIFIED CONTENTAuthor: Dominika Wilk

Androgenetic alopecia is one of the most common types of alopecia in both men and women. Caused, inter alia, by the body's excessive sensitivity to androgens leads to significant hair loss in women and complete baldness in men. In order to stop hair loss, a comprehensive therapy is necessary, including cosmetic procedures, daily care with specialized agents, as well as hormonal treatment.

Androgenetic alopecia (AGA)is a type of baldness that causes hair loss in the bends, then on the top of the head, and in the center of the skull in women. In this type of alopecia, the so-called male sex hormones - androgens.

These hormones are possessed by both men and women, but in men there are more of them. They are responsible for the functioning of the endocrine system, libido, as well as for the work of the sebaceous glands.

Alopecia and androgens

The main androgen is testosterone, which is broken down by the enzyme 5-alpha reductase into the more active androgen, dihydrotestosterone (DHT). Dihydrotetosterone acts on the androgen receptors found in the hair follicles on the scalp to shorten the anagen phase of hair growth.

The hair growth time is shortened with each cycle, which leads to gradual miniaturization of the hair, the formation of increasingly shorter and thinner hair shaft, and eventually the loss of the hair follicle. In androgenetic alopecia, the prolonged phase of the kenogen is also noticeable - that is, the time that passes from telogen (hair dying off) to anagen (its regrowth).

The longer this period, the slower the hair grows back. This explains why people with androgenetic alopecia notice the effects of the treatment so late.

Androgenetic alopecia in women - types of alopecia

Androgenetic alopecia in women can occur in two ways: either according to the male pattern of baldness or according to the type defined as female. Male pattern baldness is manifested by loss of hair in the frontal area (receding hairline), then at the top of the head, and also in the temples and parietal area. The severity of male pattern baldness is defined on a 7-point scaleHamilton-Norwood.

Female pattern baldness is defined according to the 3-point Ludwig scale . In women, hair loss is then visible on the top of the head, while the hair is retained in the forehead area.

  • The first degree of alopecia on the Ludwig scale means that there was a slight thinning of the hair above the crown area.
  • The second stage already shows a significant thinning in the crown area, therefore, in the very center of the head, the loss of a significant part of the hair is noticeable.
  • Stage III is a very visible hair loss in the center of the head while keeping the hair in line with the forehead.

Causes of androgenetic alopecia in women

One of the causes of androgenetic alopecia in women may be hormonal changes. Ladies from:

  • PCOS (polycystic ovary syndrome),
  • Cushing's syndrome
  • or adrenogenital syndrome.

In addition, the tendency to baldness may result from genetic conditions or the body's hypersensitivity to androgens. People with:

  • high testosterone levels,
  • diabetic,
  • hypertension
  • whether you are obese.

Stress, which strengthens 5-alpha reductase, also contributes to the increased risk of androgenetic alopecia.

Androgenetic alopecia diagnosis

Trichoscopy

The most popular diagnostic method in androgenetic alopecia is trichoscopy. It is a non-invasive examination which consists in examining the hair follicles and other trichological structures at the boundary of different layers of the skin at high magnification.

Thanks to the use of a dermatoscope, a specialist examining the scalp is able to achieve a 10x magnification, and using a videodermoscope can obtain even higher parameters.

This allows him to accurately assess the hair shaft, the vessels surrounding the hair follicles, or the follicles themselves. In this way, you can assess the proportions of broken, dystrophic (disturbed growth, coarser, worse styling) and falling out hair.

Trychogram

The trichogram is definitely more invasive than trichoscopy. It assesses the amount of hair torn out of our head, which means that the trichologist will deprive us of at least 100 hair torn from various areas of our head during this examination.

Then he will look at them under a microscope, which will allow to assess, for example, how much hair is in the anagen, catagen, telogen phase and the general condition of our hair.

Correct hair valuesThe individual phases should be as follows: 66-96% of the hair should be in anagen, 2-18% in telogen, and 0-6% in catagen. Dystrophic hair should not exceed 18% of the hair on our head.

Laboratory tests

In addition to examining the hair under a microscope, it is also worth doing blood tests in order to detect the underlying pathological alopecia. Perhaps it is related to hormonal disorders, hypothyroidism or diabetes, and proper treatment will help stop hair loss.

Recommended tests for androgenetic alopecia are:

  • blood count,
  • fasting glucose testing,
  • iron and ferritin (anemia can cause hair loss),
  • hormones: TSH, Ft4, prolactin, testosterone, androstenedione, progesterone, DHEA-S, estradiol,
  • ANA antinuclear antibodies,
  • triglycerides, total cholesterol, HDL and LDL cholesterol,
  • calcium,
  • vitamin D3.

Treatments for androgenetic alopecia

Treatment of androgenetic alopecia can be divided into conservative as well as surgical. The former will include, for example, the use of topical or oral preparations or treatments at the cosmetologist. For surgical purposes - hair follicle transplantation.

Topical preparations

The best known topical preparation used in the treatment of androgenetic alopecia in women is minoxidil. It was initially a drug administered orally to people suffering from hypertension.

It was noticed then that it gave side effects in the form of increased hair density, so it began to be administered to people who had problems with baldness. However, oral doses were found to have too many unwanted side effects, so it is only applied topically to the scalp.

Initial doses served to patients were 2% minoxidil in the form of e.g. a cream, then 5%. After 2022, oral minoxidil began to be introduced, in very small doses, as it was noticed that, for example, at 0.25 mg, it does not have so many side effects, and gives the desired effect of a thicker hairstyle.

The action of minoxidil is to extend the anagen phase and shorten the telogen phase and thicken the hair diameter. Thanks to the latter action, the effect of greater hair density is achieved without increasing the amount of hair.

Contraceptives

Topical application of minoxidil is effective, but sometimes the problem reappears after discontinuing the treatment. It may then be necessary to regulate your hormones with contraceptives.

In the case of androgenetic alopecia, women are given or preparations containingestrogens or cyproterone acetate.

Needle Mesotherapy

One of the forms supporting the treatment of androgenetic alopecia is needle mesotherapy. It is an invasive procedure performed in a cosmetology office consisting in injecting the scalp with a needle, which on the one hand stimulates blood circulation and increases blood supply to the hair follicles, and on the other hand helps to administer various nutrients under the skin, e.g. vitamins, minerals, amino acids, coenzymes or hyaluronic acid.

The goal of each scalp mesotherapy is to regenerate the epidermis, stimulate hair growth and extend the anagen phase, as well as improve the thickness of the hair shaft (e.g. by providing appropriate nutrients). The best results are achieved by mesotherapy combined with the topical application of minoxidil.

Mesotherapy with platelet-rich plasma

A separate form of mesotherapy that should be discussed in the treatment of androgenetic alopecia is mesotherapy with the use of platelet-rich plasma. Plasma is a component of the patient's blood - it is collected before the procedure.

As it is a proprietary material, there are no allergic reactions after it. The blood taken from the patient ends up in a special centrifuge, where the following blood components are separated from each other, such as:

  • erythrocytes,
  • thrombocytes,
  • leukocytes
  • and plasma.

And only the latter are injected into the scalp.

Plasma contains platelets that supply the area of ​​the hair follicles with concentrated growth factors, which - as shown in the research of Gentile et al. From 2015, positively influences the growth of the number of hair and improves its density.

In addition, it causes better blood supply and the growth of blood vessels around the hair follicles, allowing nutrients to reach them better and faster.

Carboxytherapy

Carboxytherapy is a treatment that helps to provide better blood to the scalp and nourish the tissues. It is based on the controlled administration of carbon dioxide with needles, which causes temporary ischemia of the tissues, and thus increased vasodilation after a while.

Thanks to this, the flow of blood, oxygen and nutrients is significantly improved. In order to achieve the effect of better nourishment of the scalp, and thus be able to inhibit baldness, you should perform at least 10 such treatments.

LLT therapy

LLT therapy - or low-level laser therapy involves emitting red light onto the scalp with a special laser. It has been known for a long time that light of this color supports regenerative processes and modifies different oneskind of reactions in cells that cause, for example, tissue renewal.

Until now, dermatologists, physiotherapists and rheumatologists have most often used the properties of red light, but more and more often such treatments can be found in aesthetic medicine clinics.

It is not fully known what mechanisms have a positive effect on hair growth, but it has been noticed that after such treatments there may be an extended phase of hair growth and the proliferation of hair cells is maintained.

Surgical procedures

An invasive method that can help with androgenetic alopecia is an autogenous hair follicle transplant. It consists in taking small fragments of the scalp from the occipital area and transplanting it into the area affected by baldness.

Why exactly from the occipital area? Because already in 1959, the American dermatologist Norman Rentreich noticed that the skin from these areas is not affected by alopecia, therefore, if it is moved to another place, it will continue to function, producing new hair. He was right. Only this procedure was very invasive and left scars. Also, hair was growing back in clumps, which looked unnatural.

Currently, individual hair follicles are transplanted (FUE method), and not the entire skin, which gives much better aesthetic results and is more acceptable for the patient. However, it is a much more demanding procedure, because in order to obtain a satisfactory result, about several thousand of such bellows must be moved.

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