Androgenetic alopecia is the most common form of baldness. It manifests itself with a progressive thinning of the hair that tends to worsen over time. This condition affects both men and women, although to a lesser extent in the latter. It can appear during adolescence and progressively advance to complete baldness . Men over 50 are among the most affected, while in women the phenomenon intensifies particularly after menopause .
In the United States, approximately 50 million men and 30 million women suffer from hair loss. In Italy, scalp thinning affects 7 out of 10 men and 4 out of 10 women .
Despite its widespread diffusion, androgenetic alopecia is not considered a disease, but a physiological condition . However, those who suffer from it, especially women, can experience a strong condition of psychological discomfort and rejection.
Hair thinning in men follows a well-defined pattern. The process usually begins at the temples , with a receding hairline that creates the classic M -shape . At the same time, the hair also thins on the crown of the head , progressing toward the front and leading to partial baldness , or hair loss on the top of the head. Only in rare cases, the loss extends to the sides and back, causing total baldness .
In men, this process often leads to significant hair loss , while in women the phenomenon develops differently. In women, thinning is generalized and does not affect specific areas; it rarely reaches total baldness . The most affected area is usually the top of the scalp , which can be severely thinned, but almost never completely bald.
Although it is not considered a disease because it does not cause physical symptoms or pain, androgenetic alopecia is a pathological condition . Recently, it has been associated with other medical conditions. In men, for example, a correlation has been found with pathologies such as coronary heart disease , enlarged prostate , type 2 diabetes , obesity and high blood pressure .
In women, however, this correlation often manifests itself in the presence of polycystic ovary syndrome , characterized by a hormonal imbalance that leads to irregular periods, hirsutism (excessive hair growth in some areas of the body) and obesity.
We will now explore every aspect of this condition, in order to provide a complete and understandable guide for anyone who wants to delve deeper into the topic without leaving out important details. Despite the level of depth, we will try to keep everything in accessible language. Sources can be consulted through the links in the specific sections.
In the first part, we will immediately address the main causes of androgenetic alopecia . Although this condition affects men more, several risk factors contribute to its development. Although some causes remain unknown, studies have highlighted a strong genetic correlation .
The causes of androgenetic alopecia
It is widely recognized that androgenetic alopecia affects men more than women. Several risk factors contribute to the onset of this condition , although many of them remain partially unknown. Experts have paid particular attention to genetic causes , highlighting a strong family correlation .
Recent studies have shown that the predisposition to androgenetic alopecia can be inherited, with a key role played by genes related to sensitivity to dihydrotestosterone (DHT), a derivative of testosterone that negatively affects hair follicles. Although research continues, it is now clear that the genetic component plays a determining role in the development of this condition.
The closest link in androgenetic alopecia is with androgen hormones , in particular with dihydrotestosterone (DHT), a derivative of testosterone that plays a crucial role in the hair thinning process.
Androgen hormones are essential both during the prenatal phase and in puberty, influencing numerous vital functions. These include sexual desire and the regulation of hair growth and body hair. Excess DHT, however, can negatively interfere with hair follicles, leading to their progressive weakening and hair loss.
Let’s see in a simple and concise way what are the hypotheses that could explain the causes of androgenetic alopecia , focusing on the interaction between the hormones responsible for this imbalance.
Hair grows thanks to hair follicles , which are located under the skin. The growth cycle of a hair generally lasts between two and seven years. At the end of this period, a growth stasis phase follows, and after a few months the hair falls out naturally. This cyclical process is analyzed in more detail in a dedicated section.
The growth cycle always starts from the follicle, stimulated by androgens . However, when the levels of these hormones increase, the sensitive follicles undergo alterations: the growth cycle becomes shorter, the hair is thinner and more fragile, and the process of replacing lost hair slows down. This is the first sign of thinning.
Now, let’s try to go even deeper to identify a possible genetic cause , considering that it is only one of the many factors attributed to androgenetic alopecia .
So far we have described a mechanical process, but at the genetic level , the main culprit seems to be the AR gene . This gene provides the instructions for the production of a protein that acts as an androgen receptor . When there is an alteration in the number of AR genes, the activity of androgen receptors increases in hair follicles. Despite this, research has not yet been able to fully explain why increased stimulation of these receptors leads to miniaturization of follicles and progressive hair loss.
Current studies also focus on the correlations between androgenetic alopecia and other pathologies (already mentioned above), to better understand what causes the increase in androgens.
The AR Gene: A Genetic Cause to Explore
It is not always necessary to delve into the genetics to understand the causes of androgenetic alopecia , but it may still be interesting to address a topic that is rarely discussed during diagnosis: the role of the AR gene .
The AR gene is responsible for producing a protein that acts as a receptor for androgens , hormones linked to hair loss. When the AR gene is altered, hair follicles become more sensitive to dihydrotestosterone (DHT) , the main hormone involved in hair miniaturization. This process leads to shorter growth cycles and increasingly thin, brittle hair.
Although this genetic detail is not always mentioned during an initial diagnosis, it is relevant because it can explain the predisposition of some people to baldness. Andro Genetic is committed to providing comprehensive information and effective solutions to address androgenetic alopecia , taking into account genetic causes and offering personalized treatments for each individual.
The AR gene remains the most studied of the genetic factors contributing to androgenetic alopecia , and it is therefore useful to clarify what its natural function is for a more complete understanding.
The job of the AR gene is to produce a protein called androgen receptor . Androgens , the best known of which is testosterone , are hormones that are essential in the development of male sexual characteristics during key stages of growth. These receptors are crucial for regulating several functions, including hair growth. However, an alteration of the AR gene can increase the sensitivity of hair follicles to androgens, particularly dihydrotestosterone (DHT) , causing the phenomenon of hair miniaturization, typical of androgenetic alopecia.
Androgen receptors in the human body are responsible for responding to hormonal stimuli by binding to androgens present in many tissues. These receptors, through DNA , regulate the activity of genes that direct the development of male sexual characteristics and, as already mentioned, also control hair growth and sexual desire, both in men and women.
In the AR gene , the DNA contains several segments, including one known as CAG , which repeats itself anywhere from 10 to 36 times. This repetition is the focus of scientific investigation, as it is believed that a variation in this pattern can cause the imbalance that causes hair follicles to function abnormally. In practice, the input sent to the follicles is incorrect, generating problems in their normal activity.
The AR gene is located on the X chromosome , which means that it is inherited from mother to son. Having relatives affected by baldness, whether in direct line or second degree, increases the likelihood of developing this disorder. However, because androgenetic alopecia involves multiple genes, it is a polygenetic condition , and its transmission is not easy to predict.
What are the consequences?
In subjects affected by androgenetic alopecia, the hair follicles of the scalp progressively reduce, producing increasingly fine hair, less pigmented and with a shorter growth phase, which leads to premature hair loss.
The hair growth cycle is divided into several phases:
- Anagen Phase : This is the active growth stage, during which hair grows at an average of 0.3-0.4 mm per day. The duration of the Anagen phase can vary from 2 to 7 years, influenced by hereditary factors and sex, being longer in women than in men.
- Catagen Phase : This is the involution phase, during which hair growth stops. The follicle stops producing active hair, and this period lasts about 2-3 weeks.
- Telogen Phase : This is the resting phase, in which the follicle is no longer active. During this stage, the bonds between the follicle and the hair progressively weaken, leading to hair loss. The Telogen phase lasts about 3 months, after which the growth cycle begins again with a new Anagen phase .
If you want to learn more about the phases of hair growth, you can read the article dedicated to the hair life cycle .
While hair loss in men follows a specific pattern, there is no such pattern in women. In the next section, we will explore these differences in more detail and analyze the symptoms that lead to the development of baldness .
How to recognize the symptoms of androgenetic alopecia?
Alopecia areata is caused by a problem with the immune system , which mistakenly attacks the hair follicles , not recognizing them as part of the body. This causes patchy hair loss in the affected areas. In more advanced forms, alopecia can extend to the entire face, causing what is known as alopecia totalis , and, in more severe cases, it can affect all the hair on the body, giving rise to alopecia universalis .
Although we often talk about hair loss , in reality the hair tends to become progressively thinner and shorter , until it reaches a size that is no longer visible. For this reason, it would be more correct to speak of thinning caused by the miniaturization of the hair follicle .
In women, the temples are not affected as much as the upper part of the scalp, where the thinning is more evident. In the advanced stage, the bulb atrophies, making the recovery intervention much more complicated.
During the diagnostic phase, certain measurement scales are used to evaluate the stage the patient is in. These scales vary depending on whether it is female or male alopecia , and this is what we will analyze in the following two paragraphs.
Stages of Male Pattern Baldness – Norwood-Hamilton Scale
In the 1950s, James B. Hamilton developed a code to describe the state of androgenetic alopecia in a male. Hair thinning mainly affects the frontoparietal lobes and the top of the head. Hamilton’s scale included 5 progressive stages.
About twenty years later, another researcher named Norwood added intermediate stages, arriving at a total of 7. The reference scale for male pattern baldness today is the Norwood scale .
Interestingly, in the first stage there is no real baldness yet, but only a hint identifiable with the classic receding hairline , in which hair loss is practically absent.
- Second stage : the frontal hairline begins to recede, starting the progression of androgenetic alopecia, which can last for several years.
- Stage II A : an intermediate phenomenon between the second and third stages, in which the thinning is more marked.
- Third stage : Baldness is considered to be overt, evident in both the elderly and young people with an early evolution. Hair loss is extensive and the receding hairline appears symmetrical.
- Stage Four : Hair loss is significant even at the top of the scalp.
- Fifth stage : The temple area is hairless and connects with the upper part of the crown.
- Sixth stage : the affected areas are now hairless, and we quickly reach the last stage, which corresponds to the absence of hair in the two typical areas of male pattern baldness. In this stage, a semi-crown of hair can be seen in the back, which goes from ear to ear.
BASP Classification
In 2007, a new classification of baldness was introduced, called BASP (Basic and Specific). The concept behind this classification is that there is a common evolution for all those who suffer from this pathology, but also a more specific component for each individual. In essence, the receding hairline represents the element that all affected subjects have in common, while the vertex area presents some differences.
The researcher who proposed this classification is Lee , in collaboration with researchers from the American Academy of Dermatology . This new scale offers an additional way to represent the different levels of baldness, allowing a more detailed understanding of the various manifestations of the pathology.
Stages of Baldness in Women – Ludwig Scale
As already mentioned, androgenetic alopecia in women occurs mainly in the upper part of the scalp. The degree of intensity of hair loss was measured by Ludwig . His scale, which was arbitrarily defined, consists of three progressive levels. In the first stage, a slight thinning is evident in the crown area, while in the third stage the thinning is significantly more advanced and intense.
The Ludwig scale was introduced in 1977 and has been updated over time with revisions that, although they introduce changes, are based on the same methodology. In addition, the Savin scale expands the Ludwig scale by creating subcategories. In 2006, researcher Sinclair further simplified the Ludwig scale, proposing five stages of thinning of hair intensity in the upper area.
The diagnosis
It is essential to avoid a do-it-yourself approach in diagnosing baldness. Specialized baldness centers are distributed throughout the country, making it essential to carry out in-depth examinations to determine the causes of hair loss. Only in this way can you avoid making errors of assessment and obtain adequate treatment.
The dermatological visit is the first fundamental step to ascertain the patient’s clinical history, also taking into account the family history . It is important to proceed with caution, also exploring any other pathologies. This approach allows to exclude that the cause of hair loss may derive from other sources of hormonal disorders .
We will then try to exclude pathologies such as thyroid , diabetes , lupus and psoriasis , since all these conditions can be related to hair loss . To carry out this exclusion, a simple blood test will suffice .
Trichological tests are essential to formulate a specific diagnosis, since they highlight the probable causes of baldness. The test consists of taking hair samples to obtain a microscopic image of the hair bulb.
A frequently asked question by specialists concerns the prevention of androgenetic alopecia. Currently, there is no clear preventive path, since genetic and hormonal causes manifest themselves independently of lifestyle. However, it is possible to adopt virtuous behaviors to delay the process of androgenetic alopecia, such as:
- Avoid traumatizing your hair with harsh chemicals (such as dyes).
- Avoid excessive washing.
- Avoid treatments and straightening (including overly intense combing).
Although these indications are generic, they can help delay the effects of androgenetic alopecia, but they are not the triggering cause, which, as we have seen, has genetic origins.
What are the main types of alopecia?
It is important to clarify the topic of baldness by identifying the various types of alopecia , differentiating them from androgenetic alopecia, which is only one of its variants. The term “alopecia” generally indicates the loss or lack of hair (and body hair in general), whether diffuse or localized.
Non-androgenetic alopecia can manifest itself in different forms:
Alopecia areata
In this case, the hair follicles are not recognized by the immune system, which attacks them. It is an autoimmune disease characterized by patchy hair loss. The term “areata” comes from the fact that the hair is lost in limited areas, as large as the diameter of a coin. There is no distinction of age or sex, and it can appear in any part of the body. Compared to androgenetic alopecia, you can see hair regrowth , initially of a light color, and then return to the natural color.
Total alopecia
This form represents a more advanced version of alopecia areata and affects the entire scalp, also involving facial hair.
Alopecia universalis
The most severe form of alopecia areata is alopecia universalis, in which hair loss is generalized throughout the body. The cause is attributable to a progressive chromosomal mutation . There are currently no curative treatments, although cases of spontaneous regrowth of hair and body hair have been observed.
Stress-induced alopecia
Also known as psychogenic alopecia , this variant is difficult to identify as it is closely linked to the psychophysical state of the subject. Furthermore, it can manifest itself with symptoms that can be confused with those of alopecia areata and androgenetic alopecia.
Cicatricial alopecia
A rare disease in which hair loss occurs as a result of an inflammatory process, leading to atrophy and destruction of the hair follicle, replaced by scar tissue . It affects both men and women, but is generally not seen in children. It is irreversible, as the follicle is completely destroyed.
Alopecia barbae
It affects men in the face and neck area, manifesting itself with visible bald patches in the beard.
Traction alopecia
This form is not related to hormonal changes or genetic abnormalities, but is simply the consequence of too invasive hair styles. Excessive traction initially causes inflammation of the follicle, and if it continues over time, it can lead to actual hair loss and the formation of alopecic areas. Fortunately, this condition is reversible : just change your hairstyle! 😊
How to Implement Defense Against Common Baldness
Androgenetic alopecia can be addressed specifically through a path that attempts to ascertain the triggering causes . Often, the stress factor is mistakenly attributed as the main role in this condition, but a specialist has various tests available to thoroughly analyze the situation.
It is essential not to rely on rumors or miracle cures promoted by self-styled doctors or pseudo-specialists present online and on social networks. In addition to the indicated path, an in-depth analysis, such as a DNA test , can reveal a future predisposition to develop baldness.
At the pharmacological level , we must refer to the only two active ingredients that have passed FDA control and have been approved for hair care. The first is minoxidil , known since the 80s for the treatment of hypertension . Among its side effects is also hair growth . Its use, for this purpose, is topical , applied locally on the upper part of the scalp, where it has proven to have a certain efficacy .
The second active ingredient is finasteride , sold under the trade name Propecia , which has been administered orally to combat androgenetic alopecia since 1997.
In particular, this drug was developed to combat benign prostatic hypertrophy , acting as an inhibitor of the enzyme 5 alpha reductase , which has the task of converting testosterone into dihydrotestosterone (DHT). Taking this drug, you can observe a slowdown in hair loss , while the thinner ones begin to increase their diameter . These effects appear after at least 3 or 4 months of taking it, but they are not guaranteed for all patients. Unfortunately, it is necessary to continue taking the drug for years and, as the most common side effect, a decrease in libido is recorded , although this occurs in a low percentage of cases.
In women of childbearing age, there is an explicit prohibition to even accidentally come into contact with the drug, to prevent possible malformations of the male fetus . The side effects, however, are reversible once you stop taking the drug. From what has been exposed, the importance of direct control by a specialist and periodic analyses clearly emerges .
As mentioned, DHT is the main responsible for the miniaturization of the hair follicle , which leads to atrophy , especially in genetically predisposed people.
These two drugs should therefore be referred to for the treatment of common baldness. However, numerous other remedies are suggested online that, at first glance, seem to have miraculous effects. It is essential to always contact a dermatologist , possibly specialized in trichology , to avoid incurring drugs that, in the best of cases, produce no effect and, in the worst, could cause unwanted effects .
Hair transplant with FUT and FUE techniques
For many, the onset of baldness represents a psychological and social problem , which compromises serenity. In addition to the pharmacological treatments we have discussed, there are other procedures that have now become common.
It is important to clarify that these are not actual treatments, but rather interventions that fall within cosmetic surgery .
To recover your hair mass, depending on the stage of thinning you are in, you can turn to medical techniques that refer to the practice of transplantation .
The hair transplant technique called FUT (Follicular Unit Transplantation) consists of taking a strip of scalp from a safe area, not sensitive to DHT (where the hair follicles are still active and healthy), and transplanting it into an area where androgenetic alopecia has reached an advanced stage.
The donor area is then stitched, and thanks to modern surgical techniques, the scar is practically invisible . In the rare cases where some signs are visible (for example, with shaved hair), you can easily resort to tricopigmentation , a technique that allows you to cover scars in a discreet and effective way.
The hair transplant technique called FUT (Follicular Unit Transplantation) involves an extremely precise follicular collection, which is performed as quickly as possible and then proceeds with the grafting. Speed is crucial, as it directly affects the chances of success of the repopulation technique.
The procedure lasts an average of 5 hours and, theoretically, does not require a pharmacological phase either before or after the operation. However, drugs for the treatment of androgenetic alopecia can help preserve the transplanted hair and, above all, are useful for protecting the hair itself, which would otherwise continue to miniaturize and disappear. This would compromise the aesthetic result of the transplant, which is why many clinics recommend following pharmacological therapies even after the operation.
The more recently developed FUE (Follicular Unit Extraction) technique initially had a lower success rate than FUT. Today, thanks to improved extraction tools, called punches , the gap between FUE and FUT has narrowed significantly. In simple terms, FUE involves directly extracting hair follicles , one at a time, as if taking hair from a doll. Sessions are longer, lasting up to 8 or 9 hours in the most severe cases. Punches can be manual or motorized. The advantage of FUE is that it leaves no visible scars on the back of the head, and post-operative recovery is much quicker.
Both techniques have their advantages, and the choice between FUT and FUE depends on the stage of the hair loss and the type of hair remaining. FUT is generally considered safer, but both are valid options.
After the transplant, the phenomenon of shock loss may occur , a temporary loss of existing hair caused by the stress suffered by the follicles during the surgery. This usually occurs within 2-3 weeks of the operation, and may concern hair that is already weakened. To avoid or reduce this phenomenon, many surgeons recommend taking finasteride for at least 6 months before the surgery.
Although transplant techniques offer good initial results, androgenetic alopecia will continue to progress over time. For this reason, continuous drug therapy remains essential to maintain the results obtained.
Psychological Effects of Androgenetic Alopecia
The psychological impact of hair loss is never discussed enough. For many, baldness represents a loss of self-esteem that can lead to anxiety or depression . This does not only concern women, who are notoriously more exposed to aesthetic judgment, but also men, especially if the condition manifests itself at a young age.
Hair is often associated with social status , well-being and health. In men, in particular, hair loss can be perceived as a loss of physical prowess. This leads to withdrawal and psychological distress, which can manifest even before baldness becomes apparent.
In middle-aged men, the insecurity that comes from baldness adds to the natural hair loss, often causing a depressive state . The only way to deal with this condition is to try to accept the phenomenon as part of the natural aging process.
The growing acceptance of very short haircuts and the positive image of bald public figures are helping to reduce negative sentiment towards baldness, especially among men. For women, however, androgenetic alopecia still represents a more complex psychological challenge.
The Future of Androgenetic Alopecia Research
Recent discoveries in the field of stem cells and the new analytical tools associated with this research give hope for a future in which androgenetic alopecia can be prevented or definitively cured.
To date, several studies have explored the use of stem cells from adipose tissue to stimulate hair regrowth. However, research is now moving towards stem cells from the hair follicle , which have a different embryonic origin.
This new approach could have a significant impact on both the success rate of the treatment and the durability of its results over time.
Since these are stem cells , there is no risk of rejection, and the treatment lasts from 3 to 6 months , making it necessary to repeat it over time.
Studies and experimentation are also underway in our country, and are not limited to stem cells. It is believed that the new approaches may soon represent a real alternative to the corrective interventions currently used .
A curious fact that has aroused much interest is the news that egg yolk has anti-baldness properties. This comes from a study published in the “Journal of Medicinal Food” by a group of researchers from the University of Osaka in Japan.
The observation arises from the rapid appearance of feathers in chickens, which occurs already in the first 14 or 15 days of life. The results of tests conducted on mice give hope that this could open a new path in the fight against baldness .
Before starting to shampoo with eggs, it is advisable to wait for further clinical results and tested products, which demonstrate the effectiveness of the active ingredient.
It is important to remember that, in the past, many substances, often exotic, have been associated with hair regrowth without any scientific evidence .
Baldness , whether male or female, can be classified as androgenetic or non – androgenetic. Regardless of the type, it has a significant psychological impact, leading to a loss of psychological well-being .
To address this discomfort, numerous studies have been developed that have led to effective pharmacological treatments and aesthetic interventions such as hair transplants .
The main treatment remains pharmacological, which slows down the miniaturization of the hair follicle, while other solutions, such as transplantation, are of an aesthetic nature.
The new frontiers of research are very promising, but it is likely that we will have to wait at least ten years to see a real replacement of current techniques.
Although the cause of androgenetic alopecia is now clear, there are still many hoaxes that lead people to believe in miracle solutions.
One of these hoaxes is the idea that certain substances can regenerate hair follicles. However, the number of follicles is already determined in the fetal development phase and cannot be increased. Transplantation does not increase the number of follicles either, since it is simply a matter of moving them from one area to another.
The myth that baldness is related to the way you comb your hair is equally unfounded. Although using a comb is preferable to a brush to avoid split ends , the force needed to damage the hair follicle would be so great that it would also cause damage to the scalp.
In short, hair care is about its shine and softness, but androgenetic alopecia is genetic and hormonal in nature . Currently, there are only two drugs that are truly effective in slowing hair loss.
In general, we lose between 40 and 120 hairs every day , which is insignificant compared to the total of approximately 110,000. In the case of androgenetic alopecia , the problem is not so much the quantity of hair lost, but rather the fact that the hairs that grow back are increasingly thinner until they do not grow back at all.
Being a mass phenomenon, baldness attracts a lot of attention also from a commercial point of view, so it is important to pay attention to the sources and not believe in overly simplistic solutions .
The offers of low-cost surgeries , performed in unregulated clinics abroad, are a worrying and out of control phenomenon.
Knowing the nature of baldness is essential to support those who suffer from it. The psychological effects are particularly intense among young people and women , who need not only treatment, but also emotional support.