Baldness (Alopecia)

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Hereditary Hair Thinning (Androgenetic Alopecia)

Hereditary thinning is known by many different names: androgenetic, or androgen-dependent alopecia; common baldness; diffuse hair loss; and male or female pattern baldness.

Hereditary thinning is, by far, the most common kind of baldness. About half of all men over the age of 40 experience hair loss due to male pattern baldness. In fact, it is so common that many people think it is a normal part of the aging process.

Although hereditary baldness is not as common among women, as many as 20 million American women and 30% of all Caucasian women are affected by female pattern baldness.

Causes

People who inherit genes for baldness (or thinning) from either parent are likely to experience hair loss or thinning during their adult life.

Androgenetic alopecia is also androgen dependent. Androgens are the hormones that stimulate the development of male sex characteristics. Testosterone is one type of androgen. Androgens induce alopecia by shortening the anagen phase and increasing the number of hairs that are in the telogen phase. Some women with androgenetic alopecia have abnormally elevated levels of androgens in their bodies as a result of underlying ovarian or adrenal gland disorders.

Signs and Symptoms

Men with androgenetic alopecia typically have a receding hairline and moderate to extensive loss of hair, especially on the front and top of the head. The remaining hair tends to feel a little finer and shorter than normal. Male pattern baldness can start as early as the teenage years.

Women with androgenetic alopecia experience overall thinning of their hair. For example, where there used to be five hairs, there may only be two. Most of the hair that's lost is on the crown of the head or at the hairline. Female pattern baldness usually starts around age 30 and becomes noticeable around age 40.

Treatment

There is no cure for hereditary hair loss, but there are three types of medical treatments that may be helpful for some people, either alone or in combination: minoxidil, finasteride, and surgery.

Minoxidil

Minoxidil is an over-the-counter drug approved by the FDA for stimulating new hair growth and preventing further hair loss in cases of hereditary balding. Minoxidil is rubbed into the scalp twice a day. The extra strength 5% solution (Rogaine® Extra Strength for Men) is for men only; the regular strength 2% solution (Rogaine® Regular Strength for Men, Rogaine® for Women) is for both men and women.

About one-quarter of men and one-fifth of women who use regular-strength minoxidil experience some hair regrowth, which may take 2 to 4 months. The extra-strength version for men can be 45% more effective than the regular-strength product. The new hair is usually thinner and lighter in color than normal hair. Rarely does all of the hair grow back, but there is often enough to hide the bald spots or thin areas. Minoxidil may be more effective in the earlier stages of hereditary baldness. Minoxidil needs to be taken regularly and continually; when it is discontinued, the new hair usually falls out within a few months.

Patients considering taking minoxidil should tell their health care provider if they are taking any other medicines, especially high blood pressure medication. It is also important to tell the health care provider about any other hair products being used and any other existing medical conditions.

Side effects include dryness and irritation of the scalp.

Oral finasteride

Oral finasteride (Propecia®, Proscar®) is an FDA-approved drug for baldness and the only one available in pill form (one pill a day). Finasteride blocks the formation of the hormone dihydrotes-tosterone (DHT), which is responsible for shrinking hair follicles and is believed to be a significant factor in hereditary baldness or thinning.

Finasteride is a prescription drug for men only. It is not effective for women and can cause serious birth defects.

Researchers estimate that more than 80% of men who take finasteride notice that their hair loss has slowed, and more than 60% notice regrowth. It usually takes several months before the hair starts to grow back. Finasteride has not been on the market long enough to assess its long-term effects nor has it proven effective for nonhereditary baldness, hair loss that occurs as a result of illness or after childbirth, or for children or adolescents.

Rarely, finasteride leads to diminished libido and sexual dysfunction.

Surgery

During hair transplantation, the dermatologist removes a small "punch" of skin with full hair thickness from one part of the body (usually the back or side of the scalp) and transplants it into a bald patch. Several surgeries are usually performed over a few months.

Hair transplantation is expensive, time consuming, and sometimes painful. A very small percentage of patients suffer chronic head pain afterward. Potential complications include permanent scarring and chronic infection.

Scalp reduction involves reducing the size of the scalp. The doctor stretches the skin on the top of the head and cuts some of it away, thereby reducing the total area of bald skin. In a procedure known as a "flap," the doctor stretches a piece of skin that has hair on it and folds it over the bald area. Scalp reduction is often combined with hair transplantation.

Baldness (Alopecia), Hereditary Hair Thinning (Androgenetic Alopecia) reprinted with permission from dermatologychannel.net
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