Androgenetic Alopecia

Androgenetic Alopecia: Origins, Medical Interventions, and Length of Treatment

Androgenetic alopecia (AGA), in particular, is a common form of hair loss in both men and women, affecting millions of individuals worldwide. This disorder may affect women at different levels of hair pattern loss, though it is more common in men.
Fortunately, a variety of medicinal therapy options are available for androgenetic alopecia that may impede its progression as well as, in some cases, stimulate hair growth.

Androgenetic Hair Loss

Androgenetic alopecia is a progressive balding condition characterized by hair thinning. It is influenced by both genetic predilection and androgenic (male hormones) factors.

The Impact of Hormones
Androgens such as dihydrotestosterone (DHT) have a major impact on androgenetic alopecia. DHT, a metabolic product of testosterone, is needed to develop secondary sexual characteristics in males, but it also hurts hair follicles. Over time, hair follicles that are genetically sensitive to DHT shrink (miniaturization), which shortens the anagen or growth phase of hair and eventually leads to thinner, shorter hair that eventually stops growing altogether.

Hereditary Propensity

Androgenetic alopecia is often inherited. Some genes make hair follicles more sensitive to DHT, leading to the gradual thinning typical of AGA. This complex pattern of inheritance involving multiple genes may be passed on via the family’s paternal or maternal line.

Hair Loss Pattern

Men normally develop androgenetic alopecia with the first sign of a crown or recession of the hairline, eventually resulting in baldness atop the head. Crown thinning in women is often diffuse, but the frontal hairline is preserved.

What are the available medical treatments for androgenetic hair loss?

There are several medicinal treatments for androgenetic alopecia. The two treatments aim to encourage new hair growth or reduce hair loss, and both are commonly recommended.

Minoxidil( Topical): Although some people choose oral forms (pills), Minoxidil is mostly used as a topical agent approved by the FDA for the treatment of androgenetic alopecia in both men and women. It works as a vasodilator, improving blood flow to the hair follicles, which prolongs the anagen (growth) phase of the hair cycle. The exact mechanism through which Minoxidil promotes hair growth is not clear, but many users find it effective.
Administration: Topically, on the incidences, scalps once to twice daily with 2% and 5% solution. However, the 5% solution is sometimes prescribed for women, too. For women, the recommendation would be to use the 2% solution to maximize the reduced risk of side effects, while men would be recommended for the 5% solution.
Effectiveness: Minoxidil is effective in stimulating the growth of new hair in most users but works best within five years of hair loss. However, results can vary, and not everyone will experience significant regrowth.
Adverse events: Women may experience dryness, scalp irritation, or, rarely, an increase in facial hair growth. To avoid adverse effects, Minoxidil must be applied precisely as recommended.

Males Finasteride By Mouth Treatment
Mechanism: Oral agent finasteride approved by the FDA for use in male androgenetic alopecia. It works by blocking the conversion of testosterone to DHT by the 5-alpha reductase enzyme. Finasteride reduces DHT levels, slowing the shrinking of hair follicles and allowing for thicker, longer hair.
Dosage: 1 mg finasteride daily. While effective in men, it is not approved for women due to risks that it may cause congenital disabilities in a pregnant woman or in a woman who may become pregnant.
Effectiveness: Studies show that finasteride can significantly reduce hair loss and, in most cases, stimulate regrowth. Its effects are often seen after three to six months of consistent use.
Some users complain of side effects like erectile dysfunction, changes in mood and loss of libido. These side effects are rare and generally resolve after product discontinuation but can sometimes persist for a long time.

Topical Finasteride Treatment
Mechanism: Like oral finasteride, topical finasteride works by inhibiting the 5-alpha reductase that converts testosterone into DHT, but it is applied topically to the scalp. This not only discourages DHT from attacking hair follicles associated with androgenetic alopecia but also allows for fuller, thicker, and healthier hair as DHT is directly reduced in the dermis level at the scalp.
Dosing: Topical finasteride is usually offered in different strengths (generally around 0.1-0.25%) and administered once daily. It may also be used along with other topical agents, such as Minoxidil, for added benefit.
Efficacy: Research has indicated that topical finasteride can effectively reduce hair loss and stimulate hair regrowth while avoiding the side effects associated with oral finasteride. Improvements can be visible after three to six months of regular use.
Adverse Effects: Finasteride topical is designed to reduce the negative effects observed with oral finasteride, like sexual disorders and state of mind shifts. Nonetheless, a tiny minority of users might still experience mild effects relating to systemic absorption.

For Men: Off-Label Treatment: Dutasteride
The definition of DHT and Dutasteride’s Mechanism of action: Dutasteride is a type of 5-alpha reductase inhibitor which blocks both types of 5-alpha reductase enzymes. It works better than finasteride. It is sometimes used off-label for androgenetic alopecia, especially in men who are unresponsive to finasteride.
Dutasteride is taken orally as tablets, usually at 0.5 mg/day. However, although clinical studies have shown positive results, it is not FDA-approved for treating hair loss, so it is always best to consult a physician before using it.
Efficacy: Dutasteride may be more effective for some individuals than finasteride because it substantially decreases DHT levels. However, its increased potency also increases the risk of side effects.
Possible Side Effects: Due to finasteride’s more significant impact on DHT levels, side effects could also be more frequent than those caused by finasteride.
Spironolactone for women
Mechanism: The anti-androgen spironolactone is commonly prescribed off-label to women with androgenetic alopecia. Blocking androgen receptors mitigates the impact of androgens such as DHT on hair follicles.
Dosage/Application: The standard oral doses of spironolactone vary from 50 mg to 200 mg/day, depending on the patient population and severity of alopecia.
Efficacy: For women whose high androgen activity leads to symptoms such as hirsutism or acne, spironolactone can be pretty effective. It may promote some regrowth and may help decrease loss over time.
Side Effects: Possible side effects include fatigue, breast tenderness, and menstrual irregularities. Because of its ability to affect fetal development, spironolactone should be avoided in women who are pregnant or trying to conceive.

LLLT mechanism: Low-level laser therapy uses laser or LED light to increase blood flow to the scalp and stimulate hair follicles. LLLT stimulates hair growth by increasing cellular activity in hair follicles.
Application: Laser treatments are not only given in clinics; LT devices, as they are also known, can be used at home in the form of laser combs, hats, and helmets. The treatment is completed several times a week, but the frequency varies by individual.
Survivability: LLLT is ineffective as a standalone therapy for hairstyle regrowth and lessens with every relevant food, similar to finasteride or Minoxidil. You must do it regularly for there to be any benefits, but FWIW, your results may vary.

Negative impacts: Overall, LLLT is considered low-risk with only a few negative impacts, although some users may encounter small scalp irritation.

Indications for Starting Treatment for Androgenetic Alopecia

Timing of treatment is important in managing androgenetic alopecia. Roughly when to start treatment is a simple rule of thumb.
The timeliness of early intervention is also crucial.
More generally, if symptoms of androgenetic alopecia have already started to appear, treatment should begin as quickly as possible. Early treatments slow down the hair loss process, which allows for better long-term outcomes. Since once hair is gone, it is likely more difficult to regain than to keep, early treatment also ensures retention of existing hair.

Seeking Advice from an Expert

Before starting any treatment, it is better to talk with a dermatologist or hair loss expert. A professional can assess your condition, recommend treatment options, and advise on potential side effects and results.
Consistency Is Crucial

Androgenetic alopecia requires long-term treatment. Complying with the treatment regimen is essential, as results will not be seen if treatment is not performed; treatment will inevitably halt, and baseline hair loss will reoccur.
How Long to Use It: Treatment Duration
How fast androgenetic alopecia is cured totally depends on the sort of treatment and the response of the individual.

Minoxidil

Minoxidil is only effective when used; to maintain results, you must use it regularly. If you stop taking it, any regrown hair will usually disappear within a few months, and hair loss will return. As such, Minoxidil is often perceived as a long-term solution for androgenetic alopecia.
Secondly, dutasteride and finasteride
In the same way, dutasteride and finasteride treatment have to be continuous for the effects to be retained. When these drugs are stopped, DHT levels rise again, leading to more hair loss. While regular check-ups with a doctor are recommended to screen for possible downstream adverse effects, a significant proportion of men opt to use these medications, ageratum.

SpironolactoneSpirolactone is similarly utilized in females for a prolonged period. Stopping spironolactone will result in reverting to the previous symptoms of androgenetic alopecia. While most women have been on this medication for decades, it is essential to find the correct dose and monitor for side effects with a healthcare provider.
Low-Level Laser Therapy (LT)
LLLT should be performed several times a week for several months to see results. However, maintenance sessions are often necessary to maintain any progress. As with other therapies, if LLLT is discontinued, hair loss may return.
While androgenetic alopecia is an insidious and often distressing condition, there exists an array of medical therapies which may be employed to adequately manage the condition and slow its progression. And because treatments are most successful when started in the early stages of loss, early intervention is crucial. While Minoxidil, finasteride, dutasteride, spironolactone and low-level laser still have hope, they need to be continued indefinitely.