Table of Contents

Androgenic Alopecia: Causes, Symptoms & Effective Treatments

Androgenic alopecia (AGA or androgenetic alopecia) is a type of hair loss that occurs due to genetics and androgen hormones. These factors lead to follicle miniaturization, causing hair loss in the upper scalp. Among the hair loss types, AGA is the most common one. Approximately 80% of men and 40% of women have androgenic alopecia.

In terms of race, Caucasian males have the highest prevalence with 50% by the age of 50. Japan and China follow them with 21%. Koreans and Africans have lower rates with 14%. However, Native Americans are the last people to have androgenetic alopecia.

Some of the key points from the article:

  • ANDROGENETIC ALOPECIA IS A HAIR LOSS TYPE THAT HAPPENS MAINLY DUE TO GENETIC FACTORS AND THE ROLE OF ANDROGEN HORMONES ON THE SCALP.
  • ANDROGENETIC ALOPECIA IS HEREDITARY.
  • AGA IS ALSO KNOWN AS MALE OR FEMALE PATTERN HAIR LOSS.
  • IT AFFECTS ONLY THE UPPER SCALP WHICH INCLUDES THE FRONTAL AREA, MID-SCALP, AND CROWN.
  • THE PATTERN IS DIFFERENT IN MALES AND FEMALES.
  • ITS SEVERITY CAN BE DETERMINED WITH HAMILTON-NORWOOD SCALE IN MEN AND LUDWIG SCALE IN WOMEN.

What Is Androgenetic Alopecia?

Androgenetic alopecia, also known as male or female pattern hair loss, is a condition that makes hair follicles undergo miniaturization, causing hair fall.

Hair miniaturization alters the hair growth cycle, causes follicles to get smaller, and decreases its ability to grow hair. The follicles that normally produce terminal hair (thick) start to produce vellus hair (thin) or totally lose their capability to grow hair.

androgenetic alopecia

Is Androgenetic Alopecia Genetic?

Yes, androgenetic alopecia is a kind of hair loss that is related to genetics. It is a polygenic condition, a recent research carried out by Dr. Molly Quinn and Dr. Kanade Shinkai that analyzes the genetic prediction of AGA found 287 genes that can be associated with baldness in androgenetic alopecia.

However, the most well-known gene that has the most significant connection to the AGA is the androgen receptor (AR) gene on the X chromosome.

Since we get our genes from our parents if your parents have AGA, you have a higher chance to have this condition. If you are a male and have AGA, the chances of your son having it are 6 times more than a person who doesn’t have the genes.

Is Androgenetic Alopecia Environmental?

Environmental factors are also found to have a role in the condition. Studies show that environmental factors such as smoking and drinking also contribute to AGA. 

A study conducted in 2020 on the implications of cigarette smoking on AGA shows that genetic hair loss is more commonly seen in smokers compared to non-smokers. Another study published in Clinical and Experimental Dermatology conducted on Korean patients found that smoking and drinking can affect the severity of AGA.

Is Androgenetic Alopecia an Autoimmune Disease?

No, androgenetic alopecia is not an autoimmune condition.

An autoimmune disease makes the immune system attack healthy cells. However, the immune system doesn’t have a role in androgenetic alopecia. It is related to genetics and hormones.

Symptoms of Androgenetic Alopecia

Symptoms of androgenetic alopecia are not the same in men and women. It shows itself with different patterns. Let’s e explore early and late AGA symptoms.

Early Symptoms

Early symptoms are the starting points of the androgenetic hair loss. If you realize the early symptoms and take action, you have a better chance of going back to the old thickness and density of the hair.

Early symptoms in males:

  • HAIR THINNING
  • DECREASE IN HAIR DENSITY
  • RECEDING HAIRLINE
  • VISIBLE HAIR WHORL

Early symptoms in females:

  • DIFFUSE THINNING OF HAIR
  • OPENING MIDDLE PART

Later-Stage Symptoms

If you are in the late stages of androgenetic hair loss, you can try to preserve the current condition of the hair by starting the treatment.

Male pattern hair loss at the late stages shows itself as baldness in:

  • FRONTAL AREA
  • MID-SCALP
  • CROWN (VERTEX)

Female pattern hair loss at late stages includes:

  • DIFFUSE HAIR LOSS ON THE UPPER SCALP
  • LOW HAIR DENSITY
  • VISIBLE SCALP

⚠️ NOTE: The hairline is preserved in females even at the late stages.

Which Spots Are Commonly Affected by Androgenic Alopecia?

The upper part of the scalp is affected by androgenetic hair loss, while no hair loss is seen on the lower part.

Upper scalp includes:

  • HAIRLINE
  • MID SCALP
  • VERTEX

Does Androgenetic Alopecia Affect Eyebrows?

No, androgenetic alopecia doesn’t affect eyebrows, it is specific to the scalp.

There are no studies that found an association between AGA and eyebrow loss. The type of hair loss that may affect eyebrows includes alopecia areata, telogen effluvium, and trichotillomania. 

Can You Lose All Your Hair with Androgenic Alopecia?

Androgenetic alopecia can make you lose all of the hair on the upper part of the scalp.

DHT (the androgen hormone that plays the main role in AGA) is more active on the top of the head, that’s why complete baldness is seen only on the upper part.

What Causes Androgenetic Alopecia?

As the name “andro-genetic” suggests, this kind of hair loss happens due to androgen hormones and genetics. However, androgenetic alopecia causes are not exactly the same in males, females, and children.

Males:

There are 2 main causes of male androgenetic alopecia, which are:

  • GENETICS
  • DIHYDROTESTOSTERONE (DHT)


In males, testosterone is converted to DHT with an enzyme called 5α-Reductase (5AR). If this enzyme is highly active, your body will transform more testosterone into DHT.
If you are genetically predisposed to AGA, this high level of DHT alters and shortens the natural hair cycle, and causes male pattern hair loss.

Females:

The causes of androgenetic alopecia in women are different from males and it is not clearly understood. It is considered to be related to:

  • GENETICS
  • HORMONES
  • ENVIRONMENTAL FACTORS


Genetics is an essential factor that causes female androgenetic alopecia. In a study published in Dermatologic Therapy, it was reported that more than 50% of female androgenic alopecia patients have another person with AGA in their families.

❗ The complicated part is that, unlike in males, androgen may not be the only reason.

➡️ Some studies show that high levels of androgens play a role in FPHL, and some show a small gap between androgen and estrogen can be the reason. Since aging results in hormonal differences in women’s bodies, the chances of AGA increase with age.

➡️ Environmental factors such as vitamin D deficiency also play a role in female androgenetic alopecia. Vitamin D deficiency is reported to be a common issue in female pattern hair loss.

Children:

The causes of androgenetic alopecia in children are not clearly understood either.

The main reason is thought to be genetic predisposition.

A study published in the Journal of the American Academy of Dermatology shows that 3 out of 4 children with androgenetic alopecia had a person with AGA in their families.

Can Stress Cause Androgenetic Alopecia?

No, androgenetic alopecia and stress are not related to each other. Stress can cause other types of hair loss, which include Telogen Effluvium, Alopecia Areata, and Trichotillomania.

⚠️ If you think you are having stress-related hair loss, you should consult your doctor to learn the right diagnosis.

Do PCOS Cause Androgenetic Alopecia?

Yes, PCOS (Polycystic ovary syndrome) can cause androgenetic alopecia. PCOS increases androgen levels, which can cause female pattern hair loss.

In a study conducted by Dr. Molly Quinn and Dr. Kanade Shinkai that examines the incidence of PCOS in androgenetic alopecia patients, it was seen that 22% of the women diagnosed with PCOS had AGA.

Can Androgenetic Alopecia Be Caused by Drugs?

No, androgenetic alopecia cannot be caused by drugs. The types of hair loss that can be caused by drugs are called anagen effluvium and telogen effluvium. For a proper diagnosis of drug-induced hair loss, you should consult your doctor.

At What Age Does Androgenetic Alopecia Start?

Androgenetic alopecia generally starts in the early 20s, after puberty, but the symptoms of hair loss are usually recognized in the 30s. The reason why AGA starts after puberty is the increase in testosterone hormone production in the body. 

There should be a sufficient amount of testosterone that can be converted to dihydrotestosterone (DHT) on the scalp for hair to undergo follicle miniaturization, causing hair fall. 

Does Androgenetic Alopecia Stop?

No, androgenetic alopecia doesn’t stop. AGA continues to progress unless the proper treatments are applied. Treatments can slow down or stop hair fall, but only for the time period that the medicine is used. 

The medicines cannot change genetics, they can regulate other factors that have a role in hair loss, and the effect of the medicines only lasts as long as they are used.  

Is Androgenetic Alopecia Reversible?

It is possible to reverse androgenetic alopecia to a certain degree. If the patient starts treatment in the early stages of AGA, the old thickness of the hair can be regained to a significant extent.

However, if the patient is in the late stages of androgenetic alopecia, the treatment can’t reverse it. It can preserve the hair’s current condition and prevent further hair thinning and loss.

Is Female Androgenetic Alopecia Reversible?

Female androgenetic alopecia can be reversed only if the patient starts the treatment in the early stages of hair loss. Treatments can bring the old thickness of hair and stimulate proper hair growth.

However, if the patient starts the treatment in a late stage, it is not possible to reverse the hair loss. After a point, the hair loses its ability to produce healthy hair. In a late stage, the treatment can help to maintain the current condition of the hair.

How to Diagnose Androgenetic Alopecia

Androgenetic alopecia diagnosis includes physical evaluation, examination of the hair roots, and certain tests that can show the reason for hair loss.

  • TRICHOSCOPY
  • NORWOOD-HAMILTON SCALE
  • LUDWIG SCALE
  • BLOOD TEST
  • HAIR PULL TEST

Trichoscopy

Trichoscopy is the examination of the scalp with dermoscopy. The tool used in the examination is a small handheld tool that is run through hair. It zooms on the scalp and shows the roots and the condition of roots and strands of hair.

Common signs of AGA of the diagnosis with trichoscopy:

  • A DIFFERENCE IN THE HAIR DIAMETER OF MORE THAN 20%
  • THE PRESENCE OF THIN HAIR IN MORE THAN 10%
  • INCREASE IN THE FOLLICLES THAT PRODUCE A SINGLE-STRAND

The Norwood-Hamilton scale (For Male)

Norwood-Hamilton scale is a classification method of androgenetic alopecia used for male patients. The scale has 7 stages, that show the severity of male pattern hair loss. These 7 androgenetic alopecia stages are:

  1. NO HAIR LOSS. SOME PEOPLE MAY HAVE A HAIRLINE IN A BIT HIGHER POSITION THAN NORMAL.
  2. STARTING POINT OF THE RECEDING HAIRLINE. IT CAN BE SLIGHTLY NOTICEABLE.
  3. RECEDING IS HIGHLY NOTICEABLE CREATING AN M SHAPE AND HAIR LOSS CAN BE SEEN IN THE CROWN.
  4. RECEDING AND HAIR LOSS ON THE CROWN PROCEED FURTHER.
  5. RECEDING CONTINUOUSLY, THE VERTEX BECOMES LARGER. ONLY THE MID-AREA HAS A SMALL AMOUNT OF HAIR ON THE UPPER SCALP.
  6. MID-HAIR BECOMES EVEN SMALLER AS IF IT IS A THIN LINE.
  7. HAIR IS LOST ALSO FROM THE SIDES, 1-2 FINGERS ABOVE THE EAR, AND THE UPPER PART IS ALMOST COMPLETELY BALD.
hair loss scale, norwood-hamilton scale, man hair loss stages, male hair loss scale

Ludwig’s scale (For Female)

Ludwig scale is used to determine the severity of female pattern hair loss. It has 3 stages, which are:

  1. SLIGHT THINNING OR LOSS IS SEEN ON THE TOP OF THE HEAD.
  2. THINNING AND LOSS PROCEED FURTHER, PARTING IS MORE OPEN, AND THE UPPER SCALP BECOMES MORE VISIBLE.
  3. SEVERE HAIR LOSS OR COMPLETE BALDNESS ON THE TOP OF THE HEAD AND THE SCALP IS DIRECTLY SEEN.
Female pattern Ludwig hair loss scale

Blood Test

Androgenetic alopecia blood tests mainly include hormone tests. High androgen or low estrogen levels are one of the signs of androgenetic alopecia, and a blood test can show this.

Hair Pulling Test

The AGA hair pull test is used to check whether the patient has hair loss at the moment or not.

About 50 hair strands are grasped with the thumb, index, and middle finger very close to the scalp.

After that, the hair is pulled up slightly and the fingers moved smoothly until the the end of hair strands. If the patient loses more than 10% of the pulled hair, there is active loss.

What to Do If You Have Androgenic Alopecia

A hair transplantation surgery is an effective solution for androgenic hair loss. Especially if the AGA treatments minoxidil and finasteride didn’t work for you, or you lost a lot of hair and the scalp became very visible, it can be the treatment you are looking for. 

Hair transplantat is a procedure where the hair is usually taken from the back of the scalp and transferred into the bald areas. With this procedure, the hair starts to grow again in the lost parts and covers the visibility of the scalp. 

Prevention Methods for AGA

AGA cannot be prevented totally, but further progression can be prevented by starting the treatment, especially in the early stages of hair loss. The treatment of androgenetic alopecia includes 2 medicines, which are;

  • MINOXIDIL
  • FINASTERIDE

These medicines will help to prevent further hair loss and thinning. 

Diet for Androgenetic Alopecia

According to a study published in 2020 that examines diet’s role in alopecia, the Mediterranean diet can stimulate hair growth and support hair health in genetic alopecia patients.

The Mediterranean diet mainly focuses on the intake of plant-based foods, including whole grains, legumes, vegetables, fruits, healthy oils, and fish.

The Mediterranean diet helps to reduce the 5α-reductase enzyme (5αR) activity on the scalp with the help of polyphenols, which are rich in plant-based foods that have antioxidant properties. The enzyme’s role is to convert testosterone to DHT, the hormone that is mainly responsible for AGA. The reduction of the 5αR activity can result in less testosterone conversion to DHT and help with AGA hair loss.

An Exemplary Diet for Androgenetic Alopecia

Below, we prepared an exemplary diet for androgenetic alopecia. 

Breakfast

Mid-Snack

Lunch

Mid-Snack

Dinner

Sunny side up

Seed bread

Orange juice

Veggie smoothie

Lentil soup

Tuna salad

Whole grain bread

Dried fruits

Broccoli soup

Lemon dill salmon 

Couscous

A diet that focuses on plant-based foods, especially the ones that are rich in antioxidants may help with androgenetic alopecia hair loss. 

Can I Dye My Hair If I Have Androgenetic Alopecia?

Yes, you can dye your hair if you have AGA, it won’t alter the hair growth. Hair dye affects the hair strands, not the follicles itself. Even though it can cause hair to become weaker, it doesn’t have an effect on the hair follicle function.

What Is the Difference Between Telogen Effluvium and Androgenetic Alopecia?

Androgenetic alopecia and telogen effluvium differ from each other in terms of their cause, duration, pattern, and the management of conditions

Here is a comparison of telogen effluvium vs androgenetic alopecia.

Telogen effluvium:

  • CAUSED BY PHYSICAL OR EMOTIONAL STRESS
  • TEMPORARY, LASTS AROUND 6 MONTHS
  • HAPPENS SUDDENLY, 1-3 MONTHS AFTER A STRESSFUL EVENT
  • STOPS ON ITS OWN
  • PATTERNED HAIR LOSS, A RECEDING HAIRLINE AND VERTEX HAIR LOSS IN MEN, DIFFUSE HAIR LOSS ON THE UPPER SCALP IN WOMEN

Androgenetic alopecia:

  • CAUSED BY GENETICS AND HORMONES 
  • PERMANENT
  • SLOW PROCESS, PROGRESSIVE, CAN CONTINUE FOR 25 YEARS
  • UNPATTERNED, DIFFUSE HAIR LOSS AT THE TOP OF SCALP
  • REQUIRES TREATMENT TO STOP HAIR LOSS

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