Androgenic Alopecia

Androgenic alopecia is also known as “male-pattern baldness”. Women actually lose hair at about the same rate as men. However, they don’t lose it in a male pattern – but more generally, female pattern hair loss

About 25% of women have cosmetically significant androgenic alopecia by the age of 40

• Signs and symptoms
  • Hairs become thinner
• Treatment of female pattern hair loss
  • No cure
  • Often just a case of slowing natural progression
  • Topical minoxidil +/- tretinoin
  • Oral antiandrogens (e.g., spironolactone, 25mg – 100mg BD). Can cause menstrual irregularities at higher doses. Oral contraceptives may be an appropriate alternative. Can be used in combination with spironolactone)
  • Finasteride is used occasionally, but is often not very effective in women
• Treatment of male pattern baldness
  • Finasteride is the mainstay of treatment. Other anti-androgens are associated with a high risk of side effects
    • Need to use for 6-12 months to notice an improvement
    • 1% of patients will get gynaecomastia or impotence
    • Can be started as young as age 16
    • Be wary of a family history of early-onset prostate cancer. Finasteride makes PSA unreliable
  • Minoxidil – orally 0.5mg – often compounded with spironolactone
    • Can cause excess hair growth at other sites (e.g., hairier arms and chests)
  • Topical minoxidil
    • 30% will have moderate re-growth
    • 30% will slow hair loss
    • 30% will not make any difference
    • Need to use it for more than 6 months
    • Mechanism – moves hair follicles into anagen. Follicles will only remain in anagen whilst on the minoxidil!
  • If doing a biopsy of the scalp – needs to be at least 4mm, and >1 biopsy is useful for the pathologist (and often may need >1 biopsy for a diagnosis)