How Is Androgenetic Alopecia Treated?

Androgenetic alopecia—commonly known as male-pattern or female-pattern hair loss—is the most prevalent form of hair thinning and balding worldwide. It is a genetically influenced, hormone-dependent condition driven primarily by dihydrotestosterone (DHT), a potent metabolite of testosterone that shortens the anagen (growth) phase of the hair cycle and progressively miniaturizes susceptible follicles.

First-line pharmacologic treatment for men includes oral finasteride (1 mg daily), a 5-alpha-reductase inhibitor that reduces systemic DHT levels by approximately 70%. Clinical trials demonstrate that finasteride halts progression in over 80% of patients and promotes measurable regrowth in about 65% after one year of consistent use. For women of childbearing potential, topical minoxidil (2% or 5%) remains the cornerstone therapy; it is a vasodilator with direct mitogenic effects on dermal papilla cells, prolonging anagen and increasing hair shaft diameter. In postmenopausal women or those with hyperandrogenism, off-label low-dose oral antiandrogens—such as spironolactone (25–200 mg/day)—may be considered under endocrinologic supervision.

Emerging evidence supports adjunctive approaches: low-level laser therapy (LLLT) devices—FDA-cleared for both sexes—show modest but statistically significant improvements in hair density when used consistently over 6–12 months. Platelet-rich plasma (PRP) injections, administered every 4–6 weeks for three to six sessions, have demonstrated efficacy in randomized controlled trials, particularly in early-stage disease. Surgical options—including follicular unit transplantation (FUT) and follicular unit extraction (FUE)—are reserved for stable, refractory cases with adequate donor hair reserves and realistic expectations.

Early intervention is critical: treatment outcomes correlate strongly with baseline hair density and duration of active shedding. Patients should undergo comprehensive evaluation—including scalp examination, trichoscopy, and, when indicated, hormonal profiling—to rule out secondary contributors such as thyroid dysfunction, iron deficiency, or telogen effluvium. Long-term adherence and shared decision-making are essential, as androgenetic alopecia is chronic and requires sustained management rather than curative intervention.