Androgenetic alopecia (AGA) is the scientific name for male pattern baldness and female pattern baldness, and it’s the most common cause of hair loss in both men and women [1]. It affects approximately 85% of men and 50% of women by the time they’re 50 [2-3]. In fact, by the age of 35, two-thirds of men see some degree of noticeable hair loss.
Since pattern balding is so common, it’s normal to worry about whether your hair is thinning — or if you’re just paranoid. Some men start to lose hair in their teens or early twenties, so even if you’re young, you could already be seeing symptoms of androgenetic alopecia.
Androgenetic alopecia is a progressive condition that won’t get better without medical intervention. The earlier you seek treatment, the more likely you are to reduce and even stop your hair loss without needing a hair transplant.
Fortunately, there are many treatments available. In this guide, you’ll learn:
The exact cause of androgenetic alopecia is still being established, but most researchers agree AGA is caused by a combination of enzymes, hormones called androgens, and genetics.
Most people have an enzyme called 5-alpha reductase in their body, which converts testosterone to a male sex hormone or androgen known as dihydrotestosterone (DHT). DHT binds to androgen receptors in the hair follicles and causes them to miniaturise and stop producing hair [4-5]. When the hair follicle shrinks, it eventually stops producing hair which in turn leads to noticeable hair loss.
Androgens are male sex hormones that cause men to develop typically male sex characteristics, such as facial hair, body hair, a deep voice, and a prostate gland. The major androgen in male development is testosterone.
DHT is a testosterone derivative, and is usually considered a key contributing factor to AGA. Men produce far more DHT than women, which is why men lose hair to AGA more frequently than women.
DHT binds to androgen receptors in your hair follicles. If your follicles are highly sensitive to androgens, hair from these follicles will fall out and eventually stop growing altogether.
It should be noted that there are still some unanswered questions about how and why DHT causes androgenetic alopecia. Testosterone and other androgens cause hair growth in other areas of the body at the onset of puberty. So some researchers suggest that DHT should theoretically have the same impact on scalp hair — causing it to grow, rather than fall out [4].
A growing body of evidence suggests that AGA is linked to genetics [6-8]. One large study of more than 52,000 participants found more than 200 genetic risk factors for male pattern baldness, indicating a strong genetic link with AGA that had previously only been suggested by small studies [8].
Many other studies confirm this link between inherited genes and AGA:
Genes or hormones play a large part in the development of AGA. While most researchers agree that AGA is caused by a combination of both hormones and genetics, others are dissatisfied with this explanation, because androgens like DHT should theoretically cause hair to grow, not fall out [4].
An alternative theory suggests AGA is caused by pressure on the hair follicles created by the weight of the scalp [4, 13]. While you’re young, layers of fat under the skin protect the follicles from being pressed between the skin and the cranial bones. As you age, testosterone and its derivatives (such as DHT) cause this fat to erode. This compresses the hair follicles, leading them to stop producing hair. This explains why AGA only affects the hair on top of the head.
Lower prevalence and later onset hair loss in women is caused by high oestrogen levels, which protect the fat layers. Female pattern hair loss affects more women after menopause when oestrogen levels start to decrease.
However, this theory disregards the clear genetic influence on AGA development, which has been established in multiple studies [6-8]. Some researchers report that heredity accounts for approximately 80% of cases where the person is predisposed to AGA — so the importance of genes shouldn’t be underplayed [14].
All teenagers and adults can develop androgenetic alopecia, though it’s usually more common in men than women. This is because men have higher levels of testosterone and therefore produce more DHT.
However, some men are at higher risk than others. Many studies have noted differences in AGA prevalence between men of different races and ages [14-17]:
Androgenetic alopecia is known as pattern baldness because it starts and develops in a specific way. People with AGA have a distinctive pattern of hair loss that differs from almost every other type of alopecia. This pattern differs in men and women and is usually easier to diagnose in men.
Men with AGA lose hair across the temples and crown. There are many models that show this, but the most commonly used is the Norwood Scale [18].
The Norwood Scale categorises hair loss into 7 distinct stages.
Hair loss begins at the temples and recedes increasingly with each stage. In addition to a receding hairline, some men may also see a bald spot on their crown. AGA doesn’t usually affect the back and sides of the hair. At stages 6 and 7, hair loss on the temples and crown meet, causing partial or complete baldness across the scalp.
These celebrity hair transplant before and after photos show famous hairlines before they tackled their androgenetic alopecia. Here’s where they were on the Norwood Scale before their procedures:
Find out more about Rob Holding’s hair transplant at the Wimpole Clinic.
Elon Musk — Norwood stage 4 — learn more about Elon Musk’s hair transplant
Andros Townsend’s hair transplant — Norwood stage 3
Although AGA is the most common type of hair loss, it’s not the only one. If your hair loss doesn’t follow this pattern, you may have another type of hair loss, such as alopecia areata, or alopecia barbae.
When you attend a hair loss consultation, your consultant will diagnose which type of hair loss you have. If you do have androgenetic alopecia, they’ll be able to confirm your Norwood stage, and discuss your hair loss treatment options with you.
Androgenetic alopecia follows a different pattern in women and often presents as thinning hair. This is often more difficult to diagnose. The pattern starts at the parting and eventually spreads across the scalp. This widespread, diffuse hair loss is similar to that seen in telogen effluvium (shock or stress-related hair loss).
A trichologist can determine whether you have female pattern baldness, telogen effluvium, or another type of hair loss. They’ll ask if you’ve recently experienced any stressful events that may have led to shock hair loss. They’ll also use the Ludwig Scale to measure and analyse your hair loss.
Female pattern hair loss starts with thinning around the parting, before progressing into visible hair loss across the scalp. As in male pattern baldness, the back and sides are usually unaffected.
While androgenetic alopecia can be very distressing, it rarely impacts your general physical health.
Most of the risks are psychosocial. AGA can lead to mental health issues like anxiety and depression [14, 19]. Hair transplant statistics also show that 40% of women with hair loss experience problems in their marriage as a result, and 63% say it’s had an impact on their career [19]. Men often cope well with AGA symptoms, though those with extensive hair loss or early onset are more likely to be distressed by their condition [14].
AGA is also a risk factor for other serious health conditions, especially in men. Associated conditions include [8, 14]:
In women, female pattern hair loss is more likely to be associated with polycystic ovary syndrome (PCOS) and also hypertension and high aldosterone levels, which can lead to high blood pressure and low potassium levels [14, 20].
Unfortunately, AGA is permanent and irreversible. However, there are many treatments available to reduce and even prevent further hair loss.
Minoxidil is a topical solution that can reduce hair loss and stimulate hair growth when applied to the scalp every day. It’s available in 2 strengths — 2% and 5% — and is suitable for both men and women.
Minoxidil is often effective, especially in those with limited hair loss. One study found it to be at least moderately effective in 84% of AGA patients [21]. It’s also suitable for treating other hair loss conditions like telogen effluvium and alopecia areata.
Finasteride is a 5-alpha reductase inhibitor. Taken as a tablet, it suppresses the effects of the 5-alpha reductase enzyme, causing less testosterone to be converted to DHT [12].
Finasteride is one of the most effective treatments for AGA. One study found that taking 1mg of Finasteride a day prevented hair loss for up to 10 years without any other treatment or intervention [22].
It should be noted that Finasteride can cause serious side effects, including erectile dysfunction and excess hair shedding. As a result, many men consider taking Finasteride just 3 times a week. However, this isn’t recommended, as the dosage is formulated to be taken once a day. Lowering your dosage is less likely to stop or slow your hair loss.
Finasteride is usually only prescribed to men. Although it may be suitable for some women, 5-alpha reductase inhibitors can cause feminisation of male foetuses, and interfere with hormonal contraception [23-24]. So other hair loss treatments are usually preferred to avoid complications in contraception and pregnancy.
Dutasteride is another type of 5-alpha reductase inhibitor. While it works in a similar way to Finasteride, it has been shown to be slightly more effective [25-26]. In fact, a comparative study of Dutasteride, Finasteride, and Minoxidil found Dutasteride to be the most effective non-invasive treatment for androgenetic alopecia [27].
Find out more about the effectiveness of Finasteride vs Dutasteride for hair loss.
While 5-alpha reductase inhibitors are rarely suitable for women experiencing female pattern hair loss, anti-androgens and androgen receptor blockers are often effective. Drugs like Flutamide, Cimetidine, Cyproterone Acetate, and Spironolactone for hair loss have been shown to reduce AGA symptoms in women [23, 28].
These drugs work by lowering the androgen levels in your body or reducing androgen receptor sensitivity in the hair follicles. While they tend to be effective, there are often side effects, including sickness, breast tenderness, weight gain, and even liver damage. As a result, these aren’t usually first-line treatments for AGA patients.
Caffeine shampoo for hair loss is available over the counter, so it’s often one of the first treatments people try when they notice their hair falling out in the shower. Topical solutions containing caffeine can be effective for hair growth with sustained use over a 6 month period [29-30]. Some studies have found results comparable to Minoxidil, so this is an excellent option if you’re in the early stages of hair loss [31].
Learn more about caffeine and hair loss.
Botox for hair has been shown to successfully treat androgenetic alopecia in men. While this treatment isn’t a common treatment, it may be effective if you’ve exhausted other non-invasive solutions.
If you’re still young or don’t have extensive hair loss, it may be too early to get a hair transplant.
If your hair loss has already progressed beyond the initial stages on the Norwood or Ludwig Scale, a hair transplantation surgery is often the only way to restore your hair. Hair transplant success rates are often 90% or above, so it’s one of the most reliable, effective ways to tackle androgenetic alopecia.
Most AGA patients are good candidates for hair restoration surgery. Your eligibility will depend on how much hair you’ve lost, and how much hair you have in your donor area.
The average donor area contains 10,000-15,000 follicular units, and only 25% of this should be used in one procedure [32-33]. So if you need more grafts than this to cover your balding areas, you may not be an ideal candidate for hair transplantation surgery. In these cases, you may still be eligible for scalp micro-pigmentation, which gives you the appearance of full coverage if you wear your hair very short.
Find out when it’s too late to have a hair transplant.
If your androgenetic alopecia is causing you distress, it’s time to find out if you’re eligible for hair restoration surgery.
At the Wimpole Clinic, our hair transplants far surpass the average clinic success rates, with 97-100% success. Led by our principal surgeon Dr. Michael May, our team is ready to support you through the process — from diagnosis to treatment to aftercare.
Book a free consultation at the Wimpole Clinic on Harley Street and find out if you’re eligible for a hair transplant to treat your androgenetic alopecia.
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