What are the causes and treatments of androgenetic alopecia (hormonal hair loss)?

From the Guidelines

Hormonal hair loss can be effectively managed with a combination of medications and lifestyle changes, prioritizing treatments that reduce morbidity, mortality, and improve quality of life. For women, minoxidil 5% foam or 2% solution applied twice daily to the scalp is the first-line treatment, often showing results within 3-6 months of consistent use 1. Spironolactone (50-200mg daily) may be prescribed to block androgens that contribute to hair loss. For men, finasteride 1mg daily is effective by inhibiting DHT production, while minoxidil can also be used concurrently. Both sexes should consider low-level laser therapy devices for home use, with treatments 3 times weekly for 20-30 minutes. Blood tests to check hormone levels, iron, thyroid function, and vitamin D are important to identify underlying causes, as vitamin D deficiency has been associated with alopecia areata 1. Nutritional support through a balanced diet rich in protein, iron, zinc, and vitamins (particularly biotin supplements at 2,500-5,000mcg daily) can improve hair health. These treatments work by either stimulating hair follicles directly (minoxidil), reducing hormonal factors that shrink follicles (anti-androgens), or providing essential nutrients for hair growth. Consistency is crucial, as most treatments require 3-6 months before visible improvement and must be continued long-term to maintain results. It is essential to note that the provided evidence primarily focuses on alopecia areata, but the question pertains to androgenetic alopecia (hormonal hair loss), thus the recommended treatments are based on the most relevant and recent guidelines for androgenetic alopecia, prioritizing patient outcomes in terms of morbidity, mortality, and quality of life.

Some key points to consider:

• The role of micronutrients, such as vitamin D and iron, in hair loss has been explored, with some studies suggesting a link between deficiencies and alopecia areata 1.
• The use of low-level laser therapy devices has shown promise in promoting hair growth.
• A balanced diet rich in essential nutrients is crucial for maintaining healthy hair.
• Regular blood tests can help identify underlying causes of hair loss, such as hormonal imbalances or nutrient deficiencies.
• Consistency and patience are key when undergoing treatment for hormonal hair loss, as results may take several months to become apparent.

Overall, a comprehensive approach that incorporates medical treatment, lifestyle changes, and nutritional support can help effectively manage hormonal hair loss and improve patient outcomes.

From the FDA Drug Label

Minoxidil topical solution 5% is for men with hair loss or thinning hair that begins on the vertex of the scalp. Many of those experiencing hair loss have other family members with gradual thinning hair or of gradual hair loss Minoxidil topical solution 5% will not prevent or improve hair loss which may occur with the use of some prescription and non-prescription medications, certain severe nutritional problems (very low body iron; too much vitamin A intake), low thyroid states (hypothyroidism), chemotherapy, or diseases which cause scarring of the scalp Also, minoxidil topical solution 5% will not improve hair loss due to: • damage from the use of hair care products which cause scarring or deep burns of the scalp. • hair grooming methods such as cornrowing or ponytails which require pulling the hair tightly back from the scalp.

The causes of androgenetic alopecia (hormonal hair loss) include:

• Genetics: Family history of gradual thinning hair or hair loss
• Hormonal imbalance: Not explicitly stated in the label, but implied as "hormonal hair loss"
• Other medical conditions: Certain severe nutritional problems, low thyroid states, chemotherapy, or diseases which cause scarring of the scalp
• Hair care practices: Damage from hair care products, hair grooming methods such as cornrowing or ponytails

The treatments for androgenetic alopecia (hormonal hair loss) include:

• Minoxidil topical solution 5%: For men with hair loss or thinning hair that begins on the vertex of the scalp
• Usage: Apply 1 mL with applicator 2 times a day directly onto the scalp in the hair loss area 2 Note: The label does not provide a comprehensive list of treatments, and minoxidil topical solution 5% may not work for all men 2

From the Research

Causes of Androgenetic Alopecia

• Androgenetic alopecia is a common type of hair loss, generally influenced by genetic factors and systemic androgens resulting in follicular miniaturization 3
• It is the most common form of alopecia, typically genetic 4
• The condition is androgen-dependent, at least in the majority of cases 5

Treatments for Androgenetic Alopecia

• First-line treatment is minoxidil, with oral finasteride available for male patients 4
• Other effective standard medical treatments include oral dutasteride and hair transplantation 3
• Novel treatments have been developed, including new medications, regenerative medicines (autologous platelet-rich plasma, adipose-derived stem cells, micrograft generation, and exosome), and low-level laser therapy 3
• Subcutaneous injections of autologous platelet-rich plasma into the scalp represent an interesting alternative treatment for androgenetic alopecia, as monotherapy or as an adjuvant treatment 6
• Combination therapies have been tested to assess whether there may be a synergistic relationship between multiple modalities 7

Treatment Efficacy and Considerations

• While many women using oral antiandrogens and topical minoxidil will regrow some hair, early diagnosis and initiation of treatment is desirable as these treatments are more effective at arresting progression of hair loss than stimulating regrowth 5
• The quality of evidence varies greatly and there is still a great need for randomized double blinded clinical trials to adequately assess the clinical efficacy of some treatments 7
• Patients with moderate to severe hair loss are more likely to have accompanying anxiety, depression, and lower work productivity and quality-of-life scores, making comprehensive treatment and patient education important 4