Clinically, Androgenetic alopecia (AGA) progresses differently in men and women, with different classification scales.
While the cause may be similar in both sexes, the evidence for androgens is stronger in men.
In men, it usually begins with a recession of the frontal hairline and loss in the crown that progressively converges in the parietal area, the most common pattern being called Mediterranean pattern, however, there are other types of patterns such as the Semitic pattern where the predominant affectation is in the frontal region with respect to the crown and the Nordic or Anglo-Saxon pattern which is characterized by presenting loss in both the receding hairline, parietal area and crown but respecting a frontal strand.
While in women it presents as a diffuse thinning in the central area of the scalp (frontoparietal region), many patients begin to perceive it as a «widening of the hairline»
Among the first signs of androgenetic alopecia are decreased hair density in certain areas, increased visibility of the scalp, and the appearance of thinner, more fragile hair.
All of these signs are very common reasons for consultations. However, to make a correct diagnosis, a specialist evaluation with a trichoscope is necessary. This is a device that allows us to observe the condition of hair follicles and differentiate this condition from other causes of hair loss.
Fortunately, today we have multiple options to treat androgenetic alopecia and improve hair quality.
Among them:
Minoxidil is one of the most widely used, as it acts by prolonging the hair growth phase and increasing the thickness of the follicles.
Finasteride and dutasteride are antiandrogen drugs that inhibit 5-alpha reductase, which reduce DHT levels and help prevent hair miniaturization.
According to scientific evidence, dutasteride is more effective and has similar safety compared to finasteride, demonstrated in clinical trials and meta-analyses, as it inhibits the 5-alpha reductase enzymes types I and II, while finasteride only inhibits type II.
Spironolactone, used especially in women of childbearing age, is an excellent alternative for patients with associated symptoms such as seborrhea, acne, and hirsutism.
Microinjections: One of the best current strategies is the administration of drugs through intradermal microinjections, which allows for greater effectiveness by acting directly on the follicles, enhancing the results of oral and topical treatments, with a high rate of effectiveness and fewer side effects by avoiding systemic absorption.
Regenerative therapies, both platelet-rich plasma (PRP) and exosomes, have revolutionized the treatment of alopecia. Platelet-rich plasma (PRP): obtained from the patient’s own blood, stimulates follicle vascularization, improving its quality and promoting hair growth. Exosomes, being a newer treatment, also contain growth factors that promote hair follicle regeneration.
Botulinum toxin: scientific evidence suggests it also helps improve scalp microcirculation and reduce muscle tension, which can contribute to hair loss.
Low-level laser (LLLT): all of the treatments explained above can be complemented by low-level laser, which among its benefits includes increased circulation in the scalp, stimulating hair follicle activity. It also reduces inflammation and prolongs the hair growth phase.
Natural supplements can be a great ally in hair care. Ingredients like saw palmetto and curcumin have anti-androgenic properties that can help reduce the impact of DHT on hair follicles.
Although its primary cause is genetic, there are external factors that can accelerate its progression, such as stress, poor diet, or lack of physical activity. Therefore, improving this condition involves not only proper treatment, which is of utmost importance, but also maintaining a healthy lifestyle.
Conclusions
In conclusion, androgenetic alopecia is a treatable condition if detected early and managed appropriately. With current treatments and a series of healthy habits, it is possible to slow its progression and maintain stronger, healthier hair. If you notice signs of hair thinning, it is advisable to consult a trichology specialist to evaluate your case and find the best strategy to maintain your hair’s health.
Literature
Grimalt R, Rocha N, Vañó-Galván S, Saceda-Corralo D, Alonso-Castro L, Jiménez-Cauhé J, et al. Recommendations on the clinical management of patients with androgenetic alopecia. Actas Dermosifiliogr. 2023. doi:10.1016/j.ad.2023.12.008
Lopes de Faria J, Sinclair R, Vañó-Galván S, Trüeb R, Pirmez R, Goren A, et al. Practical recommendations for the use of oral minoxidil in the management of hair disorders: A consensus statement from the International Journal of Trichology and the Hair Research Society of India. JAAD Int 2023;13:78–83. doi:10.1016/j.jdin.2023.08.003
Shapiro J, Ho A, Sukhdeo K, Yin L, Lo Sicco K. Evaluation of platelet-rich plasma as a treatment for androgenetic alopecia: A randomized controlled trial. J Am Acad Dermatol. 2020;83(5):1298-1303. doi:10.1016/j.jaad.2020.07.006.
