Androgenic Alopecia 

Alopecia due to androgen excess. In men, it is called male pattern alopecia, commonly known as bald head. In women, female pattern alopecia or hair loss. In men, it can start as early as their twenties and lose hair from the frontal and crown area and become bald.

Pathology

Hair grows in three phases. Anagen or growing phase will be for 3-6 yrs where the hair grows, followed by the Catagen phase or transitional phase of 3-4 weeks. It is followed by the telogen phase or shedding phase, where the shrilled hair follicle falls off, and new hair grows in the next anagen phase. In Androgenic Alopecia, the Anlagen Phase reduces to few weeks. Hence, the follicle’s growth is short and fine, leading to gradual miniaturization and permanently shedding the follicle.

Causes

The cause for this type of hair loss is multifactorial. It can be genetic for people who have a family history. Androgens, i.e., male hormones, are responsible for hair thinning and shedding. Testosterone and its metabolite Dihydrotestosterone (DHT) are responsible.

Treatment

Medical Treatments

• Correction of Vitamin Deficiency – We can correct vitamin deficiency through nutritional supplements.
• Androgen Receptor Blockers – Androgen, or 5 alpha-reductase inhibitors like finasteride and dutasteride, will block testosterone conversion to active DHT.
• Topicals

• • Minoxidil – Minoxidil lotion topical application will help convert the hair follicles to anaphase or growing stage, prolong the anaphase and help the hair grow.
  • Peptides – We will give a combination of peptides to stimulate hair growth.

Procedural Treatments

• Platelet Rich Plasma (PRP) – PRP is a regenerative treatment to stimulate the regressing hair follicle. Platelets are rich in growth factors. PRP therapy stimulates different singling pathways and peptides. They lead to stem cell differentiation of dermal papilla, stimulating new hair follicles and hair thickness. There will be a 30-40% increase in hair density and number after 4-6 PRP sessions. PRP is usually done once a month. But, you may need a maintenance treatment thrice or four times yearly.
• Mesotherapy – This is also called intradermal drug delivery. Using various growth factors, vitamins, and other nutritional supplements and medicines, also helps regrowth and healthy hair. 
• Low-Level Laser Therapy – These lights will increase blood flow to the hair and improve hair growth. Used two to three times a week for few months. 
• Hair Transplant – In severe grades of alopecia, where most hair follicles regress, leaving bald areas, Hair transplant is the treatment of choice.

Camouflage

• Hair Fiber – This is used to cover bald areas and improve aesthetic appearance.
• You can use wigs and hairpieces.

In female pattern hair loss, identifying the reason for androgen excess is important. Tests to rule out PCOS, other adrenal and pituitary, and thyroid hormones are necessary whenever required and corrected accordingly. Besides topical minoxidil, oral nutritional supplements, anti-androgens like spironolactone, cyproterone acetate, and finasteride are given to treat the androgen excess. PRP, Mesotherapy, and Low-Level Laser are the mainstays.