ANDROGENETIC & ANDROGENIC ALOPECIAS IN WOMEN

As medical /scientific research continues, current expert opinion expressed herein may change.

Androgen-related hair loss

Permanent hair-loss caused by the action of androgens on genetically susceptible follicles.

Androgenetic Alopecia is non-reversible genetically determined hair loss. Androgen presence is necessary for its progression. It is genetically either:
i)  dominant - a single gene is inherited.
ii) polygenic - a number of genes are inherited.

Androgenic Alopecia in women is caused by follicular miniaturisation associated with endocrine changes and increased androgen presence. Accompanying factors may include: Polycystic ovarian syndrome, virilisation (and hirsutism), irregular menstruation, infertility, acne, seborrhoea oleosa.
Menopausal Alopecia (androgenic alopecia) is associated with hormone changes. As estrogen reduces, hair-follicles become increasingly vulnerable to the effects of androgen exposure. Anti-androgen therapy may reduce further hair loss, but is currently unlikely to initiate the return of the lost hair.
Androgenic Alopecia in women is a multi-factorial condition in which genetic predisposition + circulating androgens viz testosterone androsteinedione, and dihydrotestosterone (DHT) are key factors in a process of progressive hair follicle miniaturisation and reduction in the anagen (hair growing) phase. Follicles effectively 'shrink' to produce vellus hairs. Caucasoids have a higher susceptibility than Afroid's or Mongoloids. This condition may warrant endocrinological investigation.

How the condition differs from that in men:
i)   The progression is slower - possibly due to a level of 'follicular protection' afforded by estrogen.
ii)  Hairloss is diffuse and does not conform to the traditional patterns of loss in males.
iii) Hairloss may worsen following menopause with the development of baldness especially at the vertices.
iv) In men the condition is due to genetic predisposition and is usually age related.
v)  In women the condition can present at any time associated with underlying medical conditions. viz:  polycystic ovarian syndrome, thyroid disorders, anaemia, chronic illness, use of certain medications.

Expert opinion currently doubts that the condition in women is the same as that in men.

Correct diagnosis is essential, and may require blood tests, or scalp biopsy.

Things to do
Until recently, no effective treatments have been available for certain alopecias in women.
Current options however may include the following drugs which may limit hair loss:
Systemic anti-androgen drugs e.g.
Spironolactone: Aldactone® Spiroctan®, Diatensec®.
Cyproterone acetate (Androcur®) Diane® or
Flutamide (Eulexin®).

Minoxidil: Regaine®
Finasteride: Propecia® is not currently indicated in women. However 5-alpha-reductase inhibitors (which prevent testosterone conversion and subsequent baldness in men) are currently being considered for female use. This may bring renewed possibilities in the treatment of this distressing disorder

Surgical Hair Restoration may be an option (see transplantation techniques)
Counselling

© 2004 - B Stevens FTTS    Contact the author