Androgenetic Alopecia: Causes, Diagnosis & Treatment

How is androgenetic alopecia diagnosed?

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.

Androgenetic alopecia diagnosis in men

Men with AGA lose their 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. 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 widespread 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:

Rob Holding — Norwood stage 3. 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 telogen effluvium, 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 treatment options with you.

Androgenetic alopecia diagnosis in women

Androgenetic alopecia follows a different pattern in women. 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.

Wimpole Clinic patients’ female androgenetic alopecia prior to hair transplant surgery.

What happens if you don’t treat androgenetic alopecia?

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]:

• Cardiovascular disease
• Melanoma and non-melanoma skin cancer of the scalp (due to sun exposure)
• Prostate cancer
• High cholesterol
• Ischemic heart disease
• High blood pressure.

In women, AGA is more likely to be associated with hypertension and high aldosterone levels, which can lead to high blood pressure and low potassium levels [14, 20].

Treatments for androgenetic alopecia

AGA is permanent and irreversible — but there are many treatments available to reduce and even prevent further hair loss.

Minoxidil

Minoxidil is a topical solution that can reduce hair loss and promote regrowth 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

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].

But 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. But 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

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.

Anti-androgens for women

While 5-alpha reductase inhibitors are rarely suitable for women experiencing androgenetic alopecia, 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

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 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.

Hair transplants for androgenetic alopecia

If you’re still young, or don’t have extensive hair loss, it may be too early to get a hair transplant. But if your hair loss has already progressed beyond the initial stages on the Norwood or Ludwig Scale, a hair transplant 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.

Can anyone with androgenetic alopecia have a hair transplant?

Most AGA patients are good hair transplant candidates. But your eligibility depends 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 hair transplant candidate. In these cases, you may still be eligible for scalp micropigmentation, 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.

Are you eligible for a hair transplant?

If your androgenetic alopecia is causing you distress, it’s time to find out if you’re eligible for a hair transplant. 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.