Symptoms
Hereditary hair loss in men begins at the temples (“receding hairline”) and continues to the crown and back of the head, with progressive thinning and the typical M-shaped pattern. Over time, all that may remain of the once lush head of hair is a bald spot and a crown of hair. Unlike telogen effluvium, hair does not fall out excessively, but gradually over years. Hereditary hair loss is not a disease, but a normal variant that is common in the population. However, since full and healthy hair has an important communication function and is considered important for physical attractiveness, hair loss can be a psychosocial and emotional problem for those affected. This is also because it can begin during or after puberty.
Causes
Characteristic of androgenetic alopecia is the reduction in size (so-called miniaturization) of the hair follicles, which subsequently form greatly reduced, fine and thin hairs. The growth phase (anagen phase) of the follicles becomes increasingly shorter. This process is caused by increased activity of the androgen dihydrotestosterone (DHT), which is formed in the follicle by 5α-reductase from testosterone. Systemic androgen excess, on the other hand, is not present. Hair loss is clustered in families because it has a hereditary component involving multiple genes.
Diagnosis
The diagnosis can be made in (dermatological) medical treatment usually already on the basis of the clinical picture and the patient’s history. At the same time, other causes of hair loss must be excluded (e.g., medications, magel conditions, fungal infections, and others).
Non-drug treatment
Since this is a benign change, treatment is not mandatory. Non-drug methods include:
- Wearing a head covering or wig
- Hair transplant
- Conceal with existing hair
- Shaving, wearing a bald head
Drug treatment
In many countries, minoxidil (Regaine, generics), finasteride (Propecia, generics) and dietary supplements (e.g. Priorin) are approved as drugs for treatment. Generally, continuous therapy is necessary. If the drug is discontinued, hair loss returns. Minoxidil (Regaine, generics) is applied topically twice daily and can inhibit further progression and promote new hair growth within weeks to months. The most common adverse effects include mild eczema of the scalp. Minoxidil is a vasodilator and was developed as a blood pressure lowering agent. This must be taken into account during treatment. Finasteride (Propecia, generics) is a 5α-reductase inhibitor that inhibits the formation of dihydrotestosterone. It is used at varying doses to treat symptoms of benign enlarged prostate (5 mg) and to treat hereditary hair loss in men (1 mg). The medicine is taken once a day regardless of meals. Women should not come into contact with the active substance because it can be harmful to fertility. The most common possible adverse effects include decreased libido, impotence, erectile dysfunction, ejaculation disorders, breast tenderness to touch, breast enlargement, and skin rash. In Germany, the externally administered 5α-reductase inhibitor alfatradiol (Ell-Cranell) is commercially available. For the treatment of hair loss, numerous other products, cosmetics and dietary supplements are on the market. However, clinical proof of efficacy is lacking for many products.