According to abbreviationfinder, alopecia androgenetica is a hormonal hereditary hair loss that is caused by a congenital hypersensitivity of the hair follicles to the male sex hormone testosterone. Around 80 percent of men and almost 50 percent of women suffer from hormonal hair loss in the course of their lives.
What is hormonal hair loss?
Hormonal -hereditary hair loss (alopecia androgenetica) is hair loss from the scalp that is due to genetic hypersensitivity of the hair follicles to male sex hormones ( androgens ), especially testosterone, and which primarily affects men.
In the case of androgenetic alopecia, a distinction is made between the male and female types. The male type of alopecia androgenetica usually begins in early adulthood, possibly already during puberty (alopecia praematura), and manifests itself at the beginning on both sides frontotemporal (on the lateral foreheads) through the so-called receding hairline.
The initially slowly progressing hair loss in the crown area develops in the further course in chronic episodes into a bald head (calvities) with a recess of a rear, lateral hair fringe (tonsure). The female type of hereditary hormonal hair loss has a later onset, usually during or after the menopause due to hormonal changes. Alopecia androgenetica of the female type manifests itself as a diffuse clearing in the crown area with a frontal strip of hair missing.
Alopecia androgenetica is polygenic hair loss (caused by several genes), which is due to hypersensitivity of the hair follicles to male sex hormones (androgens), in particular to the active form of testosterone, dihydrotestosterone.
The hypersensitivity leads to a disturbance in hair growth and to a shortened growth (anagen phase) and life phase of the hair follicles, which increasingly atrophy (shrink) and produce thin, short woolly hair (vellus hair) that may fall out without new hair growing.
As a result of the hormonal change during the menopause, the estrogen level decreases and the influence of male sex hormones, which are also produced in small amounts by the female organism, increases. This altered testosterone-estrogen ratio can not only lead to the so-called lady’s beard, but also to hormonal hair loss.
Symptoms, Ailments & Signs
Those affected usually notice noticeable hair loss. You can lose more than 100 hairs a day. In most cases, hormonal hereditary hair loss begins with a visible thinning of the individual hairs. At the same time, they don’t grow as fast as they used to. Those affected sometimes also notice this when the hair takes a long time to grow back after a visit to the hairdresser.
Typically, there is also a downy formation of so-called vellus hair on the top of the head. In general, the hair is no longer as dense as before. Sometimes there are also individual spots that are completely bald. This usually begins with the so-called receding hairline on the side of the forehead above the temples. Then it gradually spreads to other areas.
In both men and women, this can also affect the back of the head. In some cases, a fringe of hair can form on the sides of the head and the lower back of the head. Rarely, hormonal hereditary hair loss in an advanced stage leads to baldness. The hormonal hereditary hair loss affects only the hair on the head. Eyelashes, eyebrows, beard hair, intimate and body hair are usually not affected.
Diagnosis & History
Androgenetic alopecia can be diagnosed during a physical exam based on the pattern of hair thinning. The diagnosis can be secured with the help of a trichogram. In a trichogram, epilated hair (removed with a clip over the forehead) is analyzed with regard to its hair root status, hair distribution pattern and growth behavior.
In the case of hormonal-hereditary hair loss, for example, there is a shortened anagen phase (growth phase). In addition, a trichogram allows a statement to be made regarding the intensity of androgenetic alopecia.
Course and prognosis is difficult to predict in the case of hormonal-hereditary hair loss, since the different therapeutic measures result in individually different therapeutic success. If left untreated, hair loss in alopecia androgenetica continues gradually.
As a rule, hair loss does not represent a health-endangering condition for the patient and therefore does not lead to any particular complications or complaints that could negatively affect the patient’s health. However, in many cases, hair loss leads to psychological problems and thus to depression. Most people feel uncomfortable with hair loss and suffer from reduced self-esteem as a result.
In the worst case, it can even lead to suicidal thoughts. Children in particular can be bullied or teased by this disease. It is not uncommon for hair loss to also lead to the development of so-called receding hairlines, which can also lead to feelings of shame. As a result, many of those affected no longer actively participate in social life or are marginalized.
Hair loss can be treated relatively well with the help of medication or a transplant and does not lead to any further complications. However, there is no guarantee that the disease will progress positively. It is not uncommon for the drugs used to lead to various side effects in the patient. However, the hair loss does not affect the life expectancy of the patient.
When should you go to the doctor?
When hair loss begins, a doctor should always be consulted to determine the cause. Since the symptoms can have various causes, an examination is recommended. In some cases, a medical condition with serious consequences may be present and this should be ruled out. If the hair loss causes emotional or psychological impairments, it is advisable to see a doctor. Swelling of the scalp, redness, itching or scarring on the scalp must be examined and treated.
In the case of inflammation, pimples or cracks on the head, a doctor’s visit is advisable. If you have trouble sleeping, low self-esteem, or headaches, you need a doctor. A doctor should be consulted in the event of changed behavior, depressive or melancholic phases or social withdrawal behavior. If changes in personality develop as a result of the visual flaw and well-being decreases immensely, a visit to a doctor is recommended.
People who experience a reduction in quality of life or persistent discomfort due to hair loss should seek medical or therapeutic help. Since from a medical point of view there is no health-threatening condition, especially in the case of hormonal hereditary hair loss, a cosmetic surgeon can achieve permanent aesthetic changes in many patients. It is therefore advisable to use a consultation and information session about the various options.
Treatment & Therapy
Various therapeutic measures are available for hormonal -hereditary hair loss. Since the hair follicles at the back of the head are not affected by hypersensitivity to testosterone in the event of hormonal hereditary hair loss, residual hair from this area can be transplanted to the bald areas as part of a hair transplant.
In addition, there is the possibility of a hair transplant with artificial hair. In addition to these cosmetic surgical procedures, drug therapy can stabilize the progression of hair loss. Initially, hair tinctures with anti-androgenic active ingredients such as minoxidil or 17-alpha-estradiol are regularly massaged into the scalp. If there is no improvement after three to six months, therapy with tablets may be indicated, with different active substances being used in the case of hereditary hormonal hair loss, depending on gender.
If the activity of the hair follicles is sufficiently high, finasteride can be used in men with androgenetic alopecia. As a result of finasteride inhibiting the synthesis of active dihydrotestosterone from testosterone, hormone-related hair loss (about 80 to 90 percent) is stabilized in the majority of those affected and hair thickening is caused in a good half.
However, at higher doses, finasteride can negatively affect libido and potency. In female sufferers, female sex hormones (gestagens, estrogens), which have an antiandrogenic effect, are usually used. For example, combined preparations of chlormadinone (gestagen) and ethinylestradiol (synthetic estrogen) and individual preparations with chlormadinone, ethinylestradiol, dienogest have achieved good therapeutic results in postmenopausal women in androgenetic alopecia.
Outlook & Forecast
The chances of curbing hair loss are difficult to estimate prognostically. Some patients respond little or not at all to medication. In other men and women, drug therapy approaches lead to a reduction in symptoms. It is not clear until six months after starting intake whether the form of therapy was successful or whether the process of hair loss is increasing again.
A complete regeneration of the previous hair density is prognostically impossible. Treatment attempts without a prescription lead to visible successes against the progression of hair loss in the long term. However, the positive prognosis depends on regular use and the tolerability of such tinctures. As with medicines, the treatment of the scalp over the next few years is necessary without a break in use.
If left untreated, males will sooner or later go bald. This can only be eliminated by a complex hair transplant and often leaves behind visible signs of artificial production. In women, hair fullness can improve again overall. Nevertheless, the intact hair remains thinner than before due to hereditary predisposition. Alleviation of the symptoms is quite possible after the definitive entry into the menopause . However, the hormonal-hereditary cause of hair loss should be diagnosed as early as possible at the beginning of the menopause.
So far, there are no preventive measures against hormonal-hereditary hair loss.
The aftercare of a hormonal-hereditary hair loss depends on the respective therapy. If the affected person has been treated with hormonal drugs, their quantity and application as well as their effects must be checked again and again and permanently. Monitoring is important to document progress or lack thereof and to change treatment if necessary.
In the case of a transplant, it is also advisable to regularly examine the scalp and the appearance of the hair. The transplant sites and sutures must also be checked closely immediately after the procedure, and then at longer intervals. If the hair pattern changes in other areas over time, the transplanted areas and the new bald areas no longer match and advice must be given on how to proceed.
If, on the other hand, no treatment or therapy has worked or nothing further has been done, the person concerned can make do with a wig for the future, whereby first-class wig studios are preferable in order to achieve a good look. In the case of hereditary hair loss, you have the right to one prescription for a human hair wig per calendar year. The dermatologist or family doctor can issue this prescription. The person concerned may have to make additional payments if a higher-priced model is selected.
You can do that yourself
People with hormonal hereditary hair loss can resort to a variety of measures, home remedies and aids to alleviate or at least conceal the symptoms. First of all, however, you should go to the family doctor with the ailment. The doctor can determine without a doubt whether it is actually hormonal hereditary hair loss and then suggest suitable therapy measures.
In general, a healthy and balanced diet is recommended. Eating a lot of fruit and vegetables and drinking enough water strengthens the hair roots and prevents hair loss in a natural way. Regular exercise has a similar effect. Sport strengthens the immune system and prevents stress – a major factor in hair loss.
Proven remedies from nature include aloe vera or amla oil. A classic base treatment can also reduce hair loss and make the hair thicker. A household resource: beer. The drink is applied to the scalp as a shampoo and revives the hair roots in a natural way thanks to its strengthening ingredients. Another home remedy is an infusion of diced onions and rubbing alcohol. Also massaged into the scalp, the brew reduces hair loss and also prevents dandruff.