Androgenetic hair loss, or androgenetic alopecia, is a common form of hair loss in both men and women (including in pregnancy). It normally presents as a gradual thinning of hair. However, the pattern and severity depend on the patient’s sex and medical background. Whilst not completely reversible, treatment can slow down hair loss and even regrow some of the strands lost to androgenetic alopecia. Finding an effective treatment for androgenetic hair loss depends on understanding the causes, progression and early diagnosis.
What is Androgenetic Hair Loss?
This is a hormonal condition that results in the progressive thinning of hair in genetically predisposed individuals. In men, it typically appears as a receding hairline and thinning at the crown, hence the name “male pattern baldness”. By contrast, in women (or female pattern hair loss) it presents as diffuse thinning over the top of the scalp. In both sexes, androgenetic hair loss occurs due to the miniaturisation of hair follicles in response to androgen hormones. This leads to shorter and finer hair until the follicles eventually cease to produce new hair.
The risk of androgenetic alopecia increases with age. However, early onset does occur, especially if you have a strong family history of the condition. Approximately 50% of men will experience some degree of androgenetic hair loss by the age of 50. Similarly, around 40% of women will experience significant hair thinning by the age of 50. In general, male pattern baldness often starts in the late teens to early 20s. By contrast, female pattern hair loss typically begins later, often after menopause.
Causes of Androgenetic Alopecia
The primary cause of androgenetic hair loss is a genetic predisposition. It affects the hair follicles’ response to androgens, particularly dihydrotestosterone (DHT), which is a derivative of testosterone. In genetically susceptible people, DHT binds to receptors in the scalp’s hair follicles, which leads to their miniaturisation. This process gradually shortens the hair growth cycle, resulting in thinner and shorter hair strands. Without treatment, this continues until the follicles eventually stop producing new hair altogether. There are three main factors that trigger and amplify androgenetic hair loss:
- Genetics: the sensitivity of hair follicles to DHT is largely determined by specific genes, which you can inherit from either parent. So if one or both of your parents have androgenetic hair loss, you are at higher risk of a similar pattern.
- Hormones: androgens are hormones that regulate the development of male characteristics, but they also influence hair growth cycles. In genetically susceptible follicles, DHT drives the shrinking of hair follicles and a reduction in hair production. There are also various life stages where androgen levels shift and in turn impact hair growth. These include puberty, pregnancy and menopause, where hormonal fluctuations or shifts can lead to hair loss. The same is true for conditions like polycystic ovary syndrome, where raised androgens can trigger or worsen hair loss.
- Lifestyle and environment: chronic stress, poor diet and lack of exercise can all worsen androgenetic hair loss. Environmental factors such as pollution and exposure to harsh chemicals can cause scalp inflammation and oxidative stress, damaging hair follicles. Additionally, harsh hair treatments and styling can also cause increased shedding and breakage.
Diagnosis of Androgenetic Hair Loss
Early and accurate diagnosis of androgenetic hair loss is essential for effective treatment. It starts with being aware of the common signs and symptoms of androgenetic alopecia:
- Gradual thinning of hair on the scalp
- A receding hairline (more common in men)
- Increased hair shedding
- Widening of the part (more common in women)
Although you can manage some hair loss with over-the-counter treatments and lifestyle changes, it is worth seeking medical help early. This is especially the case if the hair loss is sudden, severe, painful, or occurs at a young age. In these cases, the cause may be something else. You can start by seeing your GP, who may refer you to a dermatologist if specialist input is needed.
The mainstay of diagnosis is a detailed medical history, followed by examination of the hair and scalp to assess the cause and severity. Your doctor may order blood tests if they suspect there is an underlying cause of your hair loss. These blood tests may also assess hormone levels (e.g. testosterone, DHT), thyroid function or nutritional deficiencies (e.g. iron), which can all cause androgenetic hair loss. They may occasionally use a dermoscope or perform a scalp biopsy, especially if they suspect an infective, inflammatory or autoimmune cause.
Androgenetic Hair Loss Treatment Options
A variety of treatments are available to manage androgenetic alopecia hair loss. The best treatment depends on the cause and severity of your hair loss, as well as your sex, age and health. The best known treatments for androgenetic hair loss in men and women include:
- Minoxidil: this is a topical treatment that promotes hair growth by boosting blood flow to hair follicles. It is also available over-the-counter at 5% or less. In prescription treatments, minoxidil can be combined with other hair growth stimulants including androgen blockers.
- Finasteride and dutasteride: these are oral or topical prescription medications. They reduce DHT levels, which slows hair loss and promotes regrowth. However, both can cause foetal abnormalities and serious side effects. As such, finasteride and dutasteride are normally only used in men and postmenopausal women.
- Spironolactone: this also inhibits androgens, which then reduces hair loss and promotes growth. As spironolactone can have feminising side effects in men, it is usually mainly used in women.
- Ketoconazole: ketoconazole is available in anti-dandruff shampoos and may have DHT blocking effects.
- Rosemary oil: there is some evidence that rosemary oil can help with hair regrowth and may even have similar effects to low strength minoxidil.
- Low-level laser therapy: there is good scientific evidence that these devices can stimulate hair growth. They are also approved by the FDA as a treatment for androgenetic hair loss in men and women.
- Platelet-rich plasma therapy: this involves injecting platelet-rich plasma from a patient’s own blood into the scalp to stimulate hair growth. It can also be effective in helping regrow hair after a hair transplant.
- Hair transplant surgery: this is associated with costs, down time, a variable success rate and risks, but can provide a permanent treatment when it works. It involves harvesting a strip of hair from the back of the scalp, then transplanting the follicles.
Health & Lifestyle
In addition to medical treatments, certain lifestyle modifications and home remedies can support hair health and minimise hair loss. Key measures that can help reduce the impact of androgenetic hair loss include:
- Dietary recommendations: eating a balanced diet rich in vitamins and minerals is essential for hair growth. Look for foods (and supplements) containing biotin, iron and zinc, as well as vitamins A, C and E. Incorporating protein-rich foods will also help to support hair structure.
- Hair care: avoid harsh hair treatments and excessive heat styling, as these can damage the hair and make it more likely to shed. Using gentle, sulphate-free shampoos and conditioners, as well as massaging the scalp, can help keep it clean, reduce irritation and boost circulation.
- Stress management: chronic stress can make hair loss worse. Practices such as yoga, meditation and regular exercise can help reduce stress levels. If you’re struggling with stress or the emotional fallout of living with hair loss, it is worth seeking professional help.
Androgenetic Alopecia During Pregnancy
Hormonal changes during pregnancy and the postpartum period can affect hair growth and shedding. As such, this period can have a significant impact on hair, which may manifest in a number of ways:
- Hair shedding may occur in the early stages of pregnancy and is usually due to effluvium hair loss.
- Hair growth may occur due to increased oestrogen during pregnancy. This can lead to thicker hair even in women with androgenetic alopecia.
- Hair loss may occur in women with androgenetic alopecia if circulating androgen levels are raised by pregnancy.
- Postpartum hair loss commonly occurs between three to six months after childbirth, when oestrogen levels reduce back to normal. This results in shedding of any newly regrown hairs from pregnancy. It is a temporary condition that usually resolves within a year.
Hair loss doesn’t usually require treatment during pregnancy. However, for patients who are badly affected, you will need to speak to a medical professional first. This is because many of the treatments needed to treat androgenetic alopecia are not safe to use during pregnancy or breastfeeding. For this reason, health, lifestyle and non-medication options are the main way to manage hair loss in pregnancy.
Androgenetic alopecia is a common type of hair loss that, whilst not reversible, has a number of effective treatment options. The best treatment will depend on factors like your overall health and the extent of the hair loss. Recognising the early signs and symptoms of androgenetic hair loss is key to diagnosis and starting treatment. Whilst there are lots of over the counter treatments, it’s wise to seek professional help for the correct diagnosis and best treatment.
We understand that hair regrowth is a deeply personal journey. This is why we created personalised medical hair loss treatments for men and women through our online clinic. Our doctors create custom hair loss treatments using actives such as minoxidil, spironolactone, finasteride, dutasteride and tretinoin where appropriate. To start your personalised plan, book a virtual video consultation or use our online consultation form. The journey towards great skin and hair starts here.
This article is intended for general informational purposes only and is not a substitute for medical advice, diagnosis or treatment. Always consult a qualified medical provider for any health concerns or questions you might have.
