Androgenetic alopecia is the most common cause of hair loss and follows a characteristic pattern of thinning in both men and women.
Regardless of age, individuals of both sexes with androgenetic alopecia often experience psychological effects, as along with their hair, they may also lose their self-confidence, leading to a negative impact on their quality of life.
Androgenetic alopecia is characterized by progressive hair loss and thinning, which follows a different pattern depending on gender. In men, the most commonly affected areas are the frontal hairline, the temples (temporal regions), and the vertex (crown area). The most widely used scales for evaluating the degree of androgenetic alopecia in men are the Norwood and Hamilton classifications. In contrast, women typically experience a more diffuse thinning of the hair rather than localized bald patches. The Ludwig and Sinclair scales are commonly used to classify female pattern hair loss.
Androgenetic alopecia in men is typically associated with genetic predisposition, according to scientific evidence. Androgens—particularly dihydrotestosterone (DHT)—play a key role in its pathogenesis, with changes in their levels, metabolism, and activity at the level of the hair follicle. Similarly, in women, androgens also appear to influence its onset, and there is a hereditary component as well. Its incidence increases significantly after the onset of menopause. In both sexes, the condition may worsen during periods of physical or psychological stress.
For diagnosis, taking a thorough medical history, conducting a clinical examination, and performing appropriate laboratory tests are very important. The assessment includes both traditional diagnostic methods—such as the hair pull test—and more advanced techniques, with trichoscopy being the most prominent. Trichoscopy involves the use of high-resolution digital dermoscopy to detect follicular abnormalities, helping to confirm the diagnosis. Trichoscopy combined with digital trichogram analysis also allows for evaluation of hair follicle thickness, quality, and hair density.
In the diagnostic workup, it is essential to rule out other systemic causes of hair loss, such as thyroid disorders or iron-deficiency anemia. When indicated, the dermatologist may deem it necessary to perform a diagnostic skin and hair follicle biopsy in order to exclude other causes of hair loss with a similar clinical presentation.
For the treatment of alopecia, the two therapies approved by regulatory agencies are topical minoxidil and oral finasteride. The choice of therapeutic agent and regimen varies between the two sexes. In men, both medications can be used. However, in women, minoxidil is used at a lower concentration, while the use of finasteride in women of reproductive age must be approached with great caution. In such cases, concurrent use of contraceptives is recommended when finasteride is deemed necessary. In recent years, other treatments such as oral minoxidil have been used off-label, though broader studies are needed to determine their efficacy and safety.
Additionally, the method of autologous mesotherapy—specifically the collection and injection of Platelet-Rich Plasma (PRP)—has shown encouraging results in improving the quality of hair growth. Finally, for individuals seeking a quantitative restoration of hair loss due to androgenetic alopecia, the only recommended method is hair transplantation. However, a thorough examination is essential to assess the candidate’s suitability for the procedure, along with honest counseling about the expectations and potential outcomes.
A balanced food selection, in line with the principles of the Mediterranean diet—which does not exclude food groups and includes a wide variety of fruits and vegetables—contributes positively to a person’s overall health.
Meat and fish are good sources of zinc. Meat, poultry, and fish are among the best sources of iron. Fish also provides essential fatty acids for the body. Fruits and vegetables are rich in antioxidants.
All of these nutrients are beneficial for both the scalp and hair health. However, dietary changes alone are not sufficient to stop the progression of early-stage androgenetic alopecia without the concurrent initiation of appropriate treatment.
In cases where patients diagnosed with androgenetic alopecia choose not to follow—or are unable to follow—the treatment recommended by their dermatologist, it is likely that their clinical condition may worsen.
Treatment is the most important preventive measure against the further progression of the condition.
Treatments for androgenetic alopecia are long-term and usually need to be followed for at least 6 months.
Patience is required on the part of the patient, as the effectiveness of the treatment cannot be properly assessed before 3 months.
In any case, the primary goal is to halt the progression of the condition and to improve the quality of the existing hair.