This blog was originally published in August, 2021.

Recently, the word “alopecia” has been in the news, trending in online searches and watercooler conversations since the Oscar ceremonies and… well… the aftermath. And while the incident seen around the world has been shared and discussed publicly, the core discussion warrants a deeper look into what alopecia is and how it manifests in different patients.

What many don’t realize is that alopecia affects people in various ways. While the symptom of hair loss is what people most often think of, there are emotional and psychological ramifications worth discussing as well.  Not all types of alopecia are the same, so let’s look deeper into some causes, and what you can do if you think you may have alopecia.

There are many types of hair loss, from post-partum alopecia, which presents as hair loss in new moms, two-to-three months after birth, to alopecia areata – an autoimmune disease resulting in splotchy patches of hair loss – which has become more discussed in recent months. If left untreated, alopecia areata can become alopecia totalis, the total loss of hair from the entire scalp. And the most severe form of alopecia is alopecia universalis, which is the loss of hair from the whole body, including eyebrows and eyelashes.

While these different types of hair loss exist, androgenic alopecia is the most common and affects an estimated 50 million men and 30 million women in the US. But while hair loss is widespread, it can still significantly impact an individual’s well-being and self-image.

Board-certified dermatologist Dr. Kathryn Anderson discusses what causes androgenic alopecia and what treatments are most effective for this type of hair loss.

What is Androgenic Alopecia?

Also referred to as “age-related hair loss,” “male pattern hair loss,” and “female pattern hair loss,” androgenic alopecia is a hereditary condition that causes hair loss and thinning as a person ages. While this is typically observed in middle-aged and older patients, genetic hair thinning can start as early as a person’s teenage years.

The condition affects both men and women but typically manifests differently for each gender.

• In men, androgenic alopecia usually affects the back of the scalp and bilateral temples and progresses to involve the top of the head. This affects the shape of the hairline, resulting in a characteristic “M” shape. Particularly severe cases in men can manifest in their teens to twenties.
• In women, symptoms of androgenic alopecia most often appear by age 40. Typically, this involves a thinning of the top of the scalp, often noticed by a widened central part and hair loss around the crown. Receding hairlines at the scalp are less common in women.

While there is no cure, there are treatments that can address this hair loss and stop it from getting worse.

What Causes Genetic Hair Loss

Several factors cause androgenic alopecia. As the condition is hereditary, many patients with androgenic alopecia have a family member—male or female—with hair loss.

It is a condition affected by hormones, particularly dihydrotestosterone, a type of androgen. Androgens are hormones that are important for male development and regulate hair growth in both men and women. A high level of androgens in the body can lead to a shorter hair growth cycle, causing hair to fall out faster than it can be replaced.

Androgenic Alopecia Treatments

There are numerous treatment options for androgenic alopecia, including topical medications, oral prescription medications, oral supplements, and procedural treatments. Most treatment regimens for androgenic alopecia combine several therapies to optimize results.

You should be evaluated by a board-certified dermatologist to discuss the benefits, risks, and potential adverse effects of hair loss treatments to determine what treatment plan is best for you.

Here are some of the most common treatments for genetic hair loss:

• Topical treatments: 

  The most common treatment used for androgenic alopecia is topical minoxidil. This is an over-the-counter product that comes in a foam or liquid solution at a strength of either 2% or 5%.  Many other over-the-counter topical products benefit hair regrowth, but there is little to no scientific evidence behind these claims.

• Oral prescription treatments: 

  Several prescription medications are used off-label to benefit hair growth. Some prescription medicines work by decreasing the effects of hormones on the hair follicles that lead to hair thinning and hair loss. Oral minoxidil is a blood pressure medication that has the side effect of increased hair growth and has been used at low doses to treat hair loss.

• Oral supplements: 

  It is essential to be cautious when using over-the-counter supplements to treat hair loss. Supplements are not regulated by the FDA (Food and Drug Administration) and usually have little scientific evidence to support their use. For example, biotin is commonly marketed to help hair regrowth. Scientific studies have not supported this claim.   Additionally, biotin can alter blood work, including thyroid tests and troponin (the blood test performed when evaluating for a heart attack). Other ingredients have shown limited efficacy in treating hair loss, including saw palmetto, pumpkin seed oil, and marine complexes. It helps to speak to a board-certified dermatologist before starting any supplement.

• Procedural treatments: 

  Low-level laser light therapy (LLLT) is a procedural option for androgenic alopecia. Many of these devices are currently on the market, ranging from combs to helmets that patients can use at home to stimulate hair growth.

• Surgical treatment: 

  For severe hair loss, hair transplantation surgery is an option that uses one’s own hair from an alternate area of the scalp to replace hair in thinned areas. Follicles are harvested from a dense area on the scalp (usually the back). The individual follicular units are then surgically inserted in the areas of the scalp affected by androgenic alopecia.

Talk to a Dermatologist About Hair Loss Treatments

While there is no magic cure for hair loss, the earlier treatment begins, the easier it is to reverse. 

The best way to start treatment for hair loss is to have a formal consultation with a board-certified dermatologist. During your first visit, your dermatologist will examine your scalp, determine if any additional workup is warranted, and start formulating a custom treatment plan for your type of hair loss.

Disclaimer: This blog is not intended to substitute professional medical advice. Every patient is different, so talk with your dermatologist to learn what treatment options are best for you.