Think you know all about this common form of hair loss? Think again.

Most of us have a preconceived notion of what androgenetic alopecia is, but there are not so obvious nuances about the most common form of hair loss it behooves you to know, including that early diagnosis will leave you with by far the most options. Read on for my insights! Image by Freepik.

Androgenetic alopecia (aka: male and female pattern baldness) is the most common form of hair loss out there. Millions of men and women experience it and millions more will in the future. It can be a life changing shock or tentatively expected. Either way, understanding the causes and which treatments really work gives you the option now to have more choices available in the future. 

Wondering why your hair might be looking a little sparser? Do you really need a proper diagnosis? What questions should you ask if you seek out expert advice?

Read on!  

Androgenetic alopecia: What it is and isn’t 

Androgenetic alopecia is the condition that most comes to mind whenever hair loss comes up. Arguably the most well-known and understood, it’s the proper name for what’s often called male patterned hair loss. 

Contrary to popular belief (and the name), both men and women experience this form of hair loss – one large NIH study found that out of almost 1000 patients experiencing hair loss, androgenetic alopecia was the underlying cause in 67.1% of the men and 23.9% of the women. That means that out of all women who experience hair loss, ¼ will be attributed to this type. That’s significant. 

We also need to clear up the long-held misconception that androgenetic alopecia is X-chromosomally linked and therefore inherited from your mother if you're genetically male and by both parents if you’re genetically female. 

It’s not that simple. 

The gene that encodes for the human Androgen Receptor (AR) is located on the X chromosome (women have two, men have only one and a Y). That’s the receptor in hair follicles that dihydrotestosterone (DHT) binds to. Small changes (mutations) in the androgen receptor can slightly alter how it responds to DHT. Those small changes add up and can lead to a domino effect that culminates in hair miniaturization and eventual loss. 

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These particular AR mutations do follow a maternal inheritance pattern and – crucially – they’re very easy to track in family trees because they appear so frequently (every generation), and the inheritance pattern is strikingly direct.

There are two receptor genes on the X chromosomes that are associated with MPH and FPH, but I only wish it were that clean, clear, and simple. It would make identifying and diagnosing androgenetic alopecia that much easier! There are many, many other genes that contribute to hair loss. Image by svstudioart for Freepik.

The problem is that there are many, many more players. Only 2 genes associated with hair loss are located on the X chromosome. There are at least 11 other regions of your genome associated with hair loss and at last count we were up to roughly 60 odd genes. That’s because when DHT binds the AR receptor, it kicks off transcription in your DNA, which leads to a whole host of other genes and cellular processes being influenced – what cell biologists and geneticists call a cascade effect. It means that there are many other places for hair loss to be influenced. 

The other complicating factor is that though the underlying genes and cellular pathways (DHT/AR) are the same, the pattern of hair loss experienced by men and women with androgenetic alopecia are distinct, leading to people often (falsely) assuming that they are two different conditions.

The Ludwig scale is helpful for identifying how progressive female pattern hair loss is, but it isn’t all encompassing. There are many manifestations of hair loss patterns in women and men. Not two are exactly alike. Image by Freepik.  

In men, hair loss tends to follow the Hamilton-Norwood scale, whereas women tend to experience a more diffuse thinning summarized by the Ludwig scale. Though these patterns and gradations can be very useful in determining hair loss progression and best treatment plans, they can also cause confusion because no two people experience hair loss the exact same way. Assuming that if your hair loss doesn’t fall between these catalogued patterns means you don’t have androgenetic alopecia can lead to a delay in diagnosis and treatment, meaning fewer options later on when things have progressed. 

Why Getting a Diagnosis Is so Important

‘Assumptions are not your friend when it comes to hair loss’

We have many safe and effective resources available to treat androgenetic alopecia, but getting a proper diagnosis is crucial so other conditions can be ruled out. There are lots of reasons people lose their hair – some temporary, some permanent. Knowing what’s going on means you can make informed decisions on how to proceed, and even whether treatment is necessary. 

For example, telogen effluvium, the second most common form of hair loss which often accompanies illness or physical and emotional stress, is mostly temporary. Though it can benefit from growth support (such as my Feel Confident hair care set), in the vast majority of cases, it grows back spontaneously all on its own. 

Other forms of hair loss are not so direct. Alopecia areata (my class of hair loss) occurs when the immune system attacks your own hair follicles. Treatment is distinct and often trickier because it involves addressing the immune system. Another confounding factor is polycystic ovary syndrome (PCOS), which can complicate underlying forms of hair loss in women and people born female. Treating PCOS first can sometimes address hair loss without other medical interventions. 

And then there’s good old aging. As we get older, our hair just isn’t as good at the ‘growing’ part anymore. Most people will see their hair thin to varying degrees as they age. While hair growth support molecules and a medical therapy like minoxidil can help encourage miniaturized hairs to ‘reverse course’, we can’t yet stop the march of time. 

Again, knowing what’s happening at the hair follicle is crucial to devising an effective hair restoration plan. And understanding what results you can realistically expect?  That’s how we ensure a good result – and leads into what can help treat androgenetic alopecia...

Medical Therapy 

I would be remiss if I didn’t touch on medical therapy in a post about MPB and FPB. The underlying cause of androgenetic alopecia in both men and women is the same – an inherited genetic sensitivity to the hormone dihydrotestosterone (DHT) at the hair follicle that causes hairs to miniaturize and eventually fall out. The best treatment for androgenetic alopecia is medical therapy that targets the conversion of testosterone to DHT (finasteride or dutasteride) or inhibits DHT binding to the AR receptor (spironolactone for women). Oral minoxidil can do wonders to help reverse miniaturization and improve fullness, but for androgenetic alopecia, for best results you need to address DHT. Without that, hair loss will continue – 

And, as a final note – that’s ok. 

Many people now embrace baldness. It’s a great look. 

But, if you’re not quite ready to let go of your hair and want to explore your options, visit Feelconfident.com to see if medical hair loss therapy is right for you.   

 

The content of this newsletter is for entertainment and educational purposes only. This content is not meant to provide any medical advice or treat any medical conditions. Patients must be evaluated by an appropriate healthcare provider on an individual basis and treatment must be tailored to meet that patient’s needs. Results and particular outcomes are not guaranteed.