MALE-TYPE LOSS IN WOMEN AND MEN (ANDROGENETIC ALOPEPE)
Androgenetic alopecia, popularly known as baldness, is a genetic hair loss seen in both men and women. The type seen in men is called male-type shedding, and the type seen in women is called female-type shedding. However, in daily speech, it is called male pattern shedding, regardless of male or female. It is a genetic form of shedding and it is manifested by the transformation of thick dark hair into fine, quince hair over time. This type of spill has a typical appearance:
Male type (Hamilton-Norwood)
In male patients, it begins as thinning of the hair on the sides of the anterior line of the scalp. Accordingly, the front hairline is pulled back from the sides. The front part of the hair takes the shape of a triangle with the top placed on the forehead. Then it continues with shedding at the top.
female type (Ludwig)
In this type, the front line of the hair remains in its normal state, while the middle part of the crown is opened.
Women may also experience a Christmas tree type shedding. In the Christmas tree type shedding, the top part of the hair is opened again, but the front hairline has disappeared.
Androgenetic alopecia occurs in roughly 50% of men. Symptoms begin to appear during puberty in men. Androgenetic alopecia in women has 2 different onset ages: One is puberty and the other is post-menopausal. While it affects approximately 13% of premenopausal women, its incidence increases significantly after menopause. It occurs in 80% of men and 42% of women after the age of 70.
What is the cause of androgenetic alopecia?
It shows an androgen-dependent feature in men. The hair root becomes sensitive to dihydrotestosterone, which is stronger than testosterone. Dihydrotestosterone shortens the growth phase of the hair and causes the thick hair called terminal hair to become quince hair. Androgenetic alopecia in men is mostly genetic. In the analyzes of male androgenetic alopecia, the risk of androgenetic alopecia in boys was found to be high if the father has baldness.
In women, less is known about the cause. The relationship to androgens (testosterone) is unclear. Probably other factors are also involved. However, in a group of patients with androgenetic alopecia, androgenetic alopecia and hormonal disorder coexist. Therefore, hormonal tests should be performed in necessary patients.
Androgenetic alopecia is basically a cosmetic problem. Apart from its psychological effect, due to the thinning of the hair, the sun’s rays reach the scalp and cause sun-related damage. There may be an increased risk of heart attack in male androgenetic alopecia. This type of shedding has also been associated with prostate enlargement.
Androgenetic alopecia is diagnosed by clinical examination. Sometimes it can be confused with different types of hair loss. In this case, the diagnosis is confirmed by scalp biopsy.
How is androgenetic alopecia treated?
Treatment in androgenetic alopecia has 2 goals: to stop the progression and to allow new hair to grow.
Minoxidil: Minoxidil is marketed as a blood pressure medication. Hair growth has been observed as a side effect. It is the first product approved by the FDA for the treatment of androgentic alopecia in men and women. It is used in the form of a medicine. There are spray and foam forms.
Finasteride: It is a drug in tablet form that is approved for use in men. Its effect can be evaluated after 6 months.
Hormonal therapies: Scientific data on their usefulness are insufficient.
Mesotherapy: In this form of treatment, vasodilating agents such as vitamins, minerals, minoxidil are injected into the scalp. Hair loss stops and existing hair thickens. There are not enough studies on mesotherapy.
Hair transplantation: Its effectiveness has been proven by clinical studies. The results were found to be quite successful with appropriate patient selection.
Other options:
1. Amino acids: Especially cysteine is thought to cause an increase in growth factors.
2. Trace elements: Zinc and copper have been suggested to increase the nourishment of the hair. Conflicting results have been found regarding the reduction of iron stores in patients with androgenic alopecia. There is insufficient evidence for iron supplementation without iron deficiency.
3. Vitamins: In particular, the effects of biotin and niacin on hair growth have been suggested and have positive effects on hair nutrition.
4. Proanthocyanidins: Procyanidin B is also included in this group. Procyanidin B is one of the flavonoids with antioxidant properties. Procyanidin B has been shown to cause a significant increase in hair count in men after 6 months of use.
5. Millet seed: Millet seeds are a natural product containing silicic acid, amino acids, minerals and vitamins. An oral medication containing millet seed extract, cysteine, and calcium pantothenate has been shown to increase growth stage rates.
6. There are no studies on ginko bloba, aloe vera, ginseng, bergamot, hibiscus, or sorphora.
7. Caffeine: Found in some hair care products and has been suggested to stop the progression of androgenetic alopecia and grow hair. However, there is no study that proves this.
8. Melatonin: In a study, it was shown that melatonin applied as a rub for 6 months is beneficial in female patients with androgenic alopecia or diffuse hair loss.
9. Low level laser comb: Few studies have been done. It has been suggested that it may be useful.
10. Black snake root: It has positive effects on estrogen levels. It is used for post-menopausal complaints in female patients. It may be beneficial in androgenetic alopecia, but this has not been studied.
11. Other agents that act by blocking dihydrotestosterone are saw palmetto, beta sitosterol, green tea or polysorbate 60. A significant change in hair count was observed in a study on saw palmetto in androgenetic alopecia.
12. Aminexil. It has a similar mechanism to minoxidil, but there is no study that it is effective.
13. Prostaglandin analogues: It is thought to be effective by dilation of the vessels.
