What is the initial workup and treatment for a patient suspected of having Androgenetic (Androgenetic Alopecia)?

From the Guidelines

The initial workup for androgenetic alopecia (AGA) involves a thorough history and physical examination, focusing on the pattern of hair loss, family history, and potential triggers, as well as laboratory testing including thyroid function tests, complete blood count, iron studies with ferritin, and in women, hormonal evaluation (testosterone, DHEAS, androstenedione, and prolactin) to rule out other causes 1. The diagnosis of AGA is primarily clinical, based on the characteristic pattern of hair loss and a thorough medical history.

• Key points to consider in the initial workup include:
  • Pattern of hair loss: AGA typically presents with a specific pattern of hair loss, including receding hairline, thinning at the vertex, and preservation of the frontal hairline in women.
  • Family history: A positive family history of AGA increases the likelihood of the diagnosis.
  • Potential triggers: Certain medical conditions, such as thyroid disorders, iron deficiency, and hormonal imbalances, can contribute to hair loss and should be ruled out.
• Laboratory testing should include:
  • Thyroid function tests to rule out hypothyroidism or hyperthyroidism.
  • Complete blood count to rule out anemia or other blood disorders.
  • Iron studies with ferritin to assess iron stores and rule out iron deficiency.
  • Hormonal evaluation in women, including testosterone, DHEAS, androstenedione, and prolactin, to rule out hormonal imbalances.
• A scalp biopsy may be considered in unclear cases to rule out other causes of hair loss, such as scarring alopecia or telogen effluvium. First-line treatment for men includes topical minoxidil 5% solution or foam applied twice daily and oral finasteride 1mg daily, while for women, topical minoxidil 2% or 5% solution or foam applied twice daily is the mainstay treatment, with low-dose oral minoxidil (0.25-2.5mg daily) and spironolactone (50-200mg daily) considered in certain cases 1. Treatment response should be assessed after 6-12 months, with maintenance therapy required indefinitely to sustain results.
• These medications work by:
  • Prolonging the anagen phase of hair growth (minoxidil).
  • Blocking dihydrotestosterone production (finasteride), which is responsible for follicular miniaturization in genetically susceptible individuals.
• Platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) are emerging treatments for AGA, with some studies suggesting their efficacy in promoting hair growth and improving hair density 1. However, more research is needed to fully understand their role in the treatment of AGA.

From the Research

Initial Workup for Androgenetic Alopecia

When suspecting Androgenetic Alopecia, the initial workup involves:

• Medical history to identify any underlying conditions that may be contributing to hair loss
• Physical examination to assess the pattern and extent of hair loss
• Diagnostic tests such as hair pull test, scalp biopsy, or trichoscopy to confirm the diagnosis 2, 3

Treatment Options for Androgenetic Alopecia

Treatment options for Androgenetic Alopecia include:

• Medical treatments:
  • Topical minoxidil (2-5%) to promote hair growth and slow down hair loss 4, 5, 6
  • Oral finasteride (1mg) to slow down hair loss and promote hair regrowth 3, 4, 6
  • Oral dutasteride to slow down hair loss and promote hair regrowth 5
• Surgical treatments:
  • Follicular unit transplantation to restore hair growth 3, 4
  • Hair transplantation to restore hair growth 5
• Alternative treatments:
  • Low-level laser therapy to promote hair growth 6
  • Platelet-rich plasma (PRP) therapy to promote hair growth 5
  • Exosome therapy to promote hair growth 5

Considerations for Treatment Selection

When selecting a treatment for Androgenetic Alopecia, considerations include:

• Efficacy of the treatment 2, 3, 6
• Side effect profile of the treatment 2, 3
• Patient compliance and budget 2
• Extent of hair loss and aesthetic goals 2, 3