Alopecia androgenetica is hormonal hereditary hair loss caused by an inborn hypersensitivity of hair follicles to the male sex hormone testosterone. Approximately 80 percent of men and nearly 50 percent of women suffer from hormone-hereditary hair loss during their lifetime.
What is hormonal hereditary hair loss?
Hormonal hereditary hair loss (alopecia androgenetica) is hair loss of the scalp that is due to a genetically determined hypersensitivity of the hair follicles to male sex hormones (androgens), especially testosterone, and primarily affects men. In the case of alopecia androgenetica, a distinction is made between the male and female types. The male type of alopecia androgenetica usually begins in early adulthood, possibly already during puberty (alopecia praematura), and manifests itself at the beginning on both sides frontotemporally (at the lateral forehead roots) by the so-called receding hairline. The initially slowly progressing hair loss in the vertex area develops in the further course chronically-intermittently to a bald head (calvities) with a recess of a posterior, lateral hair crown (tonsure). The female type of hormonal hereditary hair loss has a later onset, usually during or after the menopause as a result of hormonal changes. Female-type alopecia androgenetica is manifested by diffuse clearing in the parietal region with omission of a frontal hair strip.
Causes
Alopecia androgenetica is a polygenic (caused by multiple genes) hair loss due to hypersensitivity of hair follicles to male sex hormones (androgens), particularly the active form dihydrotestosterone of testosterone. The hypersensitivity leads to a disturbance of hair growth and to a shortened growth (anagen phase) and life phase of the hair follicles, which increasingly atrophy (shrink) and produce thin short woolly hairs (vellus hairs), which may fall out without new hair growing back. As a result of hormonal changes during the menopause, estrogen levels decrease and the influence of male sex hormones, which are also produced in small quantities by the female organism, increases. This altered testosterone-estrogen ratio can lead not only to the so-called lady’s beard, but also to hormonally induced hair loss.
Symptoms, complaints and signs
Affected individuals usually notice noticeable hair loss. They may lose more than 100 hairs a day. In most cases, hormonal hereditary hair loss begins with a visible thinning of the individual hairs. At the same time, these also no longer grow as quickly as they did before. Those affected sometimes also notice this when the hair takes a long time to grow back after a visit to the hairdresser. Typically, there is also a fluffing of so-called vellus hair on the top of the head. In general, the hair is no longer as dense as before. In some cases, there are also individual areas that are completely bald. This usually starts with the so-called receding hairline at the sides of the forehead above the temples. Then it gradually spreads to other areas. In both men and women, this can also affect the back of the head. In some cases, a ring of hair may form on the sides of the head and the lower back of the head. Rarely, hormonal hereditary hair loss leads to baldness in its advanced stages. Hormonal hereditary hair loss affects only the hair on the head. Eyelashes, eyebrows, beard hair, intimate and body hair are usually not affected.
Diagnosis and course
Alopecia androgenetica can be diagnosed during a physical examination based on the pattern of hair thinning. The diagnosis can be confirmed with the use of a trichogram. In a trichogram, epilated hairs (taken with a clamp above the forehead) are analyzed for their hair root status, hair distribution pattern, and growth pattern. In the case of hormonal hereditary hair loss, for example, there is a shortened anagen phase (growth phase).In addition, a trichogram allows a statement regarding the intensity of alopecia androgenetica. The course and prognosis of hormonal hereditary hair loss is difficult to predict, as the various therapeutic measures result in individually varying therapeutic success. If left untreated, hair loss in alopecia androgenetica continues gradually.
Complications
As a rule, hair loss does not represent a health-threatening condition for the patient and thus does not lead to any particular complications or discomfort that could negatively affect the patient’s health. However, hair loss in many cases leads to psychological discomfort and thus depression. Most people feel uncomfortable due to the hair loss and suffer from a lowered self-esteem as a result. In the worst case, this can even lead to suicidal thoughts. Especially children can be bullied or teased by this disease. Not infrequently, the hair loss also leads to the development of the so-called Geheimratsecken, which can also lead to feelings of shame. Many affected people therefore no longer actively participate in social life or are ostracized. Hair loss can be treated relatively well with the help of medication or by transplantation and does not itself lead to any further complications. However, there is no guarantee about a positive course of the disease. It is not uncommon for the medications used to cause various side effects in patients. However, hair loss does not affect the life expectancy of the patient.
When should one go to the doctor?
To clarify the cause, a doctor should always be consulted when hair loss begins. Since the symptoms can have various causes, an examination is recommended. In some cases, a disease with serious consequences may be present and this should be ruled out. If the hair loss causes emotional or mental disturbances, a visit to the doctor is advisable. Swelling of the scalp, redness, itching or scarring on the scalp should be examined and treated. In case of inflammation, pimples or cracks on the head, a visit to the doctor is advisable. If sleep disturbances, reduced self-esteem or headaches occur, a doctor is needed. In case of altered behavior, depressive or melancholic phases as well as social withdrawal, a doctor should be consulted. If changes in the personality develop due to the optical blemish and the well-being decreases immensely, a visit to a doctor is recommended. People who experience a reduction in quality of life or a persistent feeling of discomfort due to hair loss should seek medical or therapeutic help. Since hormonal hereditary hair loss in particular is not a health-threatening condition from a medical point of view, a cosmetic surgeon can achieve permanent aesthetic changes in many patients. It is therefore advisable to take advantage of a consultation and information about the various options.
Treatment and therapy
Various therapeutic measures are available for hormonal-hereditary hair loss. Since the hair follicles of the back of the head are not affected by hypersensitivity to testosterone in hormonal-hereditary hair loss, residual hair from this area can be transplanted to the bald spots as part of an autologous hair transplant. In addition, there is the possibility of hair transplantation with artificial hair. In addition to these cosmetic surgery procedures, the progression of hair loss can be stabilized by drug therapy. In this case, hair tinctures with anti-androgenic active ingredients such as minoxidil or 17-alpha-estradiol are initially massaged into the scalp on a regular basis. If there is no improvement after three to six months, a therapy with tablets may be indicated. Depending on the sex, different active substances are used for hormonal hereditary hair loss. If the activity of the hair follicles is sufficiently high, finasteride can be used in men with alopecia androgenetica. As a result of the synthesis of active dihydrotestosterone from testosterone inhibited by finasteride, the hormone-related hair loss is stabilized in a large proportion of those affected (around 80 to 90 percent) and hair thickening is achieved in a good half.However, finasteride can negatively affect libido and potency at higher doses. In female sufferers, female sex hormones (progestins, estrogens), which have an antiandrogenic effect, are usually used. For example, combination preparations of chlormadinone (progestin) and ethinylestradiol (synthetic estrogen) as well as single preparations of chlormadinone, ethinylestradiol, dienogest have been shown to have good therapeutic results in post-menopausal women with alopecia androgenetica.
Prospect and prognosis
The chances of curbing hair loss are difficult to assess prognostically. Some patients have little to no response to medication. In other men and women, drug therapy approaches lead to a decrease in symptoms. It is only six months after the start of treatment that it is possible to determine whether the form of therapy has been successful or whether the process of hair loss is intensifying again. A complete regeneration of the former hair density is prognostically impossible. Prescription-free treatment attempts certainly lead to visible successes against a progression of hair loss in the long term. However, the positive prognosis depends on regular use as well as tolerance of such tinctures. As with medications, the treatment of the scalp is necessary over the following years, if possible without a break in application. Without treatment, baldness forms sooner or later, mainly in men. This can be eliminated only by a costly hair transplantation and not infrequently leaves visible signs of artificial production. In women, the overall hair fullness can improve again. Nevertheless, the still intact hair remains thinner than before due to the hereditary predisposition. Alleviation of symptoms is quite possible after final entry into menopause. But for this, the hormonal hereditary cause of hair loss should be diagnosed as early as possible at the beginning of menopause.
Prevention
There are no preventive measures against hormonal-hereditary hair loss so far.
Aftercare
The aftercare of hormonal-hereditary hair loss depends on the respective therapy. If the affected person was treated with hormonal medications, these must be controlled in their amount and application as well as their effects again and again, and permanently. The control is important to document the progress or its absence and to change the treatment if necessary. In case of transplantation, it is also advisable to regularly check the scalp and the hair pattern. Also, the transplant sites and sutures must be checked closely immediately after the procedure, and at longer intervals thereafter. If the hair pattern changes in other areas over time, the transplanted areas and the new bald patches no longer match and it is necessary to discuss how to proceed. If, on the other hand, no treatment or therapy has been effective, or if nothing further has been done, the affected person can make do with a wig for the future, whereby first-class wig studios are to be preferred in order to achieve a good appearance. In the case of hereditary hair loss, the patient is entitled to one prescription for a human hair wig per calendar year. This prescription can be issued by the dermatologist or the family doctor. Additional payments may have to be made by the affected person if a higher-priced model is chosen.
What you can do yourself
People with hormonal hereditary hair loss can resort to a variety of measures, home remedies and aids to alleviate or at least conceal the symptoms. First, however, should go with the suffering to the family doctor. The physician can determine beyond doubt whether it is really hormonal hereditary hair loss and then suggest suitable therapeutic measures. In general, a healthy and balanced diet is recommended. Those who eat a lot of fruit and vegetables and drink enough will strengthen the hair roots and prevent hair loss in a natural way. Regular exercise has a similar effect. Sport strengthens the immune system and prevents stress – an essential factor for hair loss. Tried and tested natural remedies include aloe vera and amla oil. A classic alkaline treatment can also reduce hair loss and make the hair on the head thicker. A household remedy: beer. The drink is applied to the scalp as a shampoo and naturally revitalizes the hair roots with its strengthening ingredients.Another home remedy is an infusion of onion cubes and rubbing alcohol. Also massaged into the scalp, the decoction reduces hair loss and also prevents dandruff.
