Androgenetic Alopecia

Diagnose androgenetic alopecia clinically when gradual patterned density loss is accompanied by progressive conversion of terminal hairs to thinner, shorter, and ultimately vellus hairs in involved scalp. In men, androgen-dependent follicular miniaturization and dihydrotestosterone are central therapeutic targets; in women, androgenetic alopecia remains a key cause of chronic patterned thinning but must be distinguished from chronic telogen effluvium, diffuse alopecia areata, and scarring alopecias. Wolters Kluwer+2Wolters KluwerANDROGENETIC ALOPECIA - CURRENT STATUS : Indian Journal of DermatologyPubMedFinasteride in the treatment of men with androgenetic alopecia. Finasteride Male Pattern Hair Loss Study Group - PubMedPubMedAndrogenetic Alopecia in Women: A Narrative Review of Pathophysiology, Clinical Evaluation, and Treatments - PubMed

Perform trichoscopy at frontal/vertex and occipital reference sites when the pattern is subtle, diffuse, or accompanied by active shedding. Hair-shaft diameter diversity supports androgenetic alopecia; yellow dots and thin hairs are also reported features. In female-patterned loss, two major criteria—more yellow dots, more thin hairs, or reduced average frontal hair thickness—or one major plus two minor criteria are diagnostic in the cited trichoscopy study, with 92% specificity. Nature+1NatureTrichoscopy criteria for diagnosing female androgenic alopecia. | Nature PrecedingsPubMedDiagnostic Yield and Clinical Impact of Trichoscopy in Alopecia: A Cross-Sectional Study From a Rural Tertiary Care Centre - PMC

Do not label diffuse shedding as androgenetic alopecia solely from crown predominance. A positive pull test with regular telogen roots can support acute telogen effluvium in the appropriate exposure setting, whereas anagen roots in pulled hairs should raise concern for active scarring disease; in the reported cases, biopsy confirmed lichen planopilaris. Dystrophic hairs can be an early clue to alopecia areata incognita. WileyWileyTrichoscopy‐assisted hair pull test: A helpful adjunct to trichoscopy for diagnosing and managing alopecias - Tsiogka - 2021 - Australasian Journal of Dermatology - Wiley Online Library

For men with androgenetic alopecia, topical minoxidil 5%, oral finasteride 1 mg daily, and low-level laser therapy have randomized-trial or meta-analytic evidence for improving hair growth relative to placebo. The finasteride pivotal program enrolled men aged 18 to 41 years and found improvement by hair count, patient and investigator assessment, and expert photographic review at 1 and 2 years with 1 mg daily. ScienceDirect+1ScienceDirectThe effectiveness of treatments for androgenetic alopecia: A systematic review and meta-analysis - ScienceDirectPubMedFinasteride in the treatment of men with androgenetic alopecia. Finasteride Male Pattern Hair Loss Study Group - PubMed

Discuss treatment as maintenance therapy rather than a finite course. Continued topical minoxidil use maintains its effect and slows further loss, while stopping minoxidil leads to rapid shedding of minoxidil-dependent hairs. Establish standardized baseline photographs before treatment so follow-up assesses trajectory rather than day-to-day perceived shedding. ScienceDirect+1ScienceDirectAndrogenetic alopecia in men and women - ScienceDirectWolters KluwerANDROGENETIC ALOPECIA - CURRENT STATUS : Indian Journal of Dermatology

Choose finasteride when an oral 5-alpha-reductase inhibitor is acceptable after counseling, and choose topical minoxidil when avoiding systemic antiandrogen exposure is prioritized. Combination therapy is a reasonable evidence-informed option because trials and reviews include combined oral finasteride plus topical minoxidil; however, patients should understand that both therapies require durable adherence. Wiley+1WileyEfficacy of non‐surgical treatments for androgenetic alopecia: a systematic review and network meta‐analysis - Gupta - 2018 - Journal of the European Academy of Dermatology and Venereology - Wiley Online LibraryPubMedFinasteride in the treatment of men with androgenetic alopecia. Finasteride Male Pattern Hair Loss Study Group - PubMed

Topical minoxidil is the FDA-approved treatment for female androgenetic alopecia, and randomized evidence supports 2% topical minoxidil in women. In a cited clinical review, topical minoxidil arrested hair loss or induced mild-to-moderate regrowth in approximately 60% of women; continued therapy is required because withdrawal causes loss of minoxidil-dependent hair. ScienceDirect+2ScienceDirectThe effectiveness of treatments for androgenetic alopecia: A systematic review and meta-analysis - ScienceDirectPubMedAndrogenetic Alopecia in Women: A Narrative Review of Pathophysiology, Clinical Evaluation, and Treatments - PubMedScienceDirectAndrogenetic alopecia in men and women - ScienceDirect

Low-dose oral minoxidil, spironolactone, finasteride, dutasteride, hair transplantation, low-level light therapy, and platelet-rich plasma are described as off-label or adjunctive approaches for female pattern hair loss. Their use should follow confirmation of diagnosis and a patient-specific discussion of reproductive potential, systemic exposure, and the more limited or heterogeneous evidence base compared with topical minoxidil. Wiley+1WileyEfficacy of non‐surgical treatments for androgenetic alopecia: a systematic review and network meta‐analysis - Gupta - 2018 - Journal of the European Academy of Dermatology and Venereology - Wiley Online LibraryPubMedAndrogenetic Alopecia in Women: A Narrative Review of Pathophysiology, Clinical Evaluation, and Treatments - PubMed

When diffuse shedding is prominent, do not use androgenetic alopecia treatment response as the diagnostic test. Trichoscopy-assisted pull testing can separate a telogen-root pattern consistent with telogen effluvium from dystrophic hairs suggestive of alopecia areata incognita or anagen roots suggestive of scarring disease; treat the coexisting process rather than attributing all shedding to female pattern hair loss. WileyWileyTrichoscopy‐assisted hair pull test: A helpful adjunct to trichoscopy for diagnosing and managing alopecias - Tsiogka - 2021 - Australasian Journal of Dermatology - Wiley Online Library

Use baseline and serial standardized scalp photographs together with the same patterned-area clinical and trichoscopic assessment. Trial outcomes in finasteride studies used hair counts, patient and investigator assessments, and expert photographic review; in routine practice, reproducible photography and visible stabilization or regrowth are practical longitudinal measures. PubMedPubMedFinasteride in the treatment of men with androgenetic alopecia. Finasteride Male Pattern Hair Loss Study Group - PubMed

At follow-up, first determine whether treatment was continued, because interruption of topical minoxidil can produce rapid shedding of treatment-dependent hair. If shedding accelerates despite continued therapy, repeat pull testing and trichoscopy rather than automatically intensifying androgenetic alopecia treatment; new dystrophic hairs, anagen roots, or loss of follicular openings shift management toward alopecia areata or scarring alopecia evaluation. ScienceDirect+2ScienceDirectAndrogenetic alopecia in men and women - ScienceDirectWileyTrichoscopy‐assisted hair pull test: A helpful adjunct to trichoscopy for diagnosing and managing alopecias - Tsiogka - 2021 - Australasian Journal of Dermatology - Wiley Online LibraryPubMedDiagnostic Yield and Clinical Impact of Trichoscopy in Alopecia: A Cross-Sectional Study From a Rural Tertiary Care Centre - PMC

Consider hair transplantation for advanced stable androgenetic alopecia when medical therapy has been used to preserve remaining native hair and the patient accepts that surgery redistributes follicles rather than halting progression. Hair transplantation is recognized as a surgical option, including in advanced disease, but it does not replace ongoing management of progressive miniaturization. ScienceDirect+2ScienceDirectAndrogenetic alopecia in men and women - ScienceDirectWileyPediatric androgenetic alopecia: an updated review - Gomes - 2023PubMedAndrogenetic Alopecia in Women: A Narrative Review of Pathophysiology, Clinical Evaluation, and Treatments - PubMed