Androgenetic alopecia

Androgenetic Alopecia (Male pattern baldness, hereditary baldness) is the most common cause of hair loss. There is a different pattern of hair loss in men and women. For men who are affected by MPB, there is usually a progression from a receding hairline or it starts from the crown and if the hair loss continues, often these two regions merge. Such appearance of hair is called the “Hippocratic baldness”. In women, hair rarely falls out in this pattern cause women experience diffuse thinning of the hair.


A number of different factors cause hair loss and many of them are still unknown. Essentially there is an increased sensitivity to hormones called androgens particularly dihydrotestosterone (DHT). DHT causes gradual shortening of the active phase of hair growth, thinning of the hair and eventually hair falls out. The increased conversion of testosterone by enzyme 5 alpha reductase into its active form– dihydrotestosterone (DHT) leads to hair loss. Hair restoration is based on the theory that hairs on donor area (occipital area) do not contain the enzyme 5-alpha reductase and there is no effect of the hormone on these hairs. When hairs are transplanted, they retain this characteristics therefore they never fall out again. This is why hair transplant is a permanent solution to hair loss. On the other hand, the greatest effect of DHT is on hair follicles that have a specific enzyme (fronto-temporal regions and crown) and hair loss commonly affect these areas.



Men with androgenic alopecia typically have elevated values ​​of 5-alpha reductase inhibitors, including the free androgen DHT, free testosterone, but lower total testosterone. In addition to these hormones, prolactin plays a role in hair loss in men and can slow down hair growth. Androgenic hormones have an important role in the development of secondary sexual characteristics in men starting from puberty. One of those characteristics is also receding front line. Hair loss in men can be graded by Hamilton-Norwood scale, which has seven stages of hair loss. With aging, hair loss progresses due to variation of hormonal levels such as lower testosterone levels, decreased levels of DHT, 5-alpha reductase and androgen receptors. Also, with aging, androgenic hormones stimulate the growth of hair on the face, especially beard, while having negative the impact on hair loss, especially in the area of hairline and the crown, a phenomenon known as „androgen paradox“.



Change in the scalp skin with aging can lead to hair loss as there are several very important. First of all, it has been shown that the scalp skin is thinner in hair loss sufferers than in the person who has normal hair since the entire layer of the hypodermis (subcutaneous adipose tissue) shrinks. It is significant that the number of stem cells is equal in individuals with and without hair loss, only the activity of these cells is lower in people with alopecia. Furthermore, collagen fibers with aging are being increasingly deposited in the dermis (middle layer of skin). The newly formed fibrosis makes dermis quite stiff, with resistance to the walls of blood vessels and the consequent lack of nutrition of hair follicles. This lack of nutrition is permanent. Senile white hair directly reflects this effect. Therefore, it is believed that in the future stem cell therapy will have an important place in the treatment of hair loss.


Regarding latest genetic researches, it seems that the gene that causes hair loss is located on the X chromosome and can be inherited both by the male or female parent, as opposed to the adopted opinion that the inheritance of this gene is from the mother’s side. Recent research from 2009.reveals new data that there are genes on chromosome 3 and 7, which also contribute to hair loss. Further researches are definitely going in the direction of genetic engineering that may be able to change those genes.


Androgenetic alopecia affects women as well and causes diffuse hair loss and it is called female pattern hair loss. One of the typical clinical pictures resembles as a Christmas tree and thinning is most easily seen when the hair is parted in the midline. Hair loss in women can be caused by many other reasons (hormonal imbalances, menopause, pregnancy, etc.), but when it comes to androgenetic alopecia, it is usually graded by Ludwig’s scale. Detailed diagnostics of hair loss is required to rule out other causes of hair loss and to find adequate therapy.


dna-300x225Androgenetic alopecia may be prevented, if the therapy is started early. Therapy can certainly could slow down hair loss and make it less progressive. Nowadays, there are several therapies for hair loss-Minoxidil, Finasteride, laser therapy or PRP therapy. Scientist are working hard in order to find a cure so and we expect news from the field of cloning hair or on the significant role of stem cells in the treatment of hair loss. Hair transplantation still represents the only safe and permanent solution for hair loss and it is based on the fact that the hair in donor area (back side of the head) does not contain the enzyme 5 alpha reductase and cannot lead to hair loss once transplanted. When there is a lack of hairs in donor area (diffuse thinning, previous surgeries) body hair transplant can be done and hairs from beard or chest can be used.


If you are facing hair loss, it is important to see a doctor on time who will make the necessary diagnostics to determine the cause of your hair loss, and then determine therapy or decide whether you are a candidate for hair transplantation. For more information, contact us at [email protected]

Dr. Gorana Kuka Epstein je veoma aktivna na instragramu i dnevno objavljuje postove sa zanimljivim i edukativnim sadržajem. Možete je zapratiti klikom na @dr.gorana kako bi bili u toku sa svim novim informacijama.