How to Treat Androgenetic Alopecia

Androgenetic alopecia—commonly known as male-pattern or female-pattern hair loss—is the most prevalent form of hair loss worldwide. It results from a genetically determined sensitivity of hair follicles to dihydrotestosterone (DHT), a potent metabolite of testosterone. In susceptible individuals, DHT shortens the anagen (growth) phase of the hair cycle and progressively miniaturizes follicles, leading to thinner, shorter, and eventually absent terminal hairs.

First-line pharmacologic treatment for androgenetic alopecia includes topical minoxidil and oral finasteride—both FDA-approved for this indication. Minoxidil, available over-the-counter in 2% and 5% formulations, promotes vasodilation and prolongs anagen; it is effective in both men and women, though higher concentrations are typically recommended for men. Finasteride, a 5-alpha-reductase inhibitor, reduces systemic DHT production by approximately 70% and is approved for use in men only due to teratogenic risk and lack of established safety and efficacy data in women of childbearing potential.

For women with androgenetic alopecia—particularly those with biochemical or clinical signs of hyperandrogenism—off-label antiandrogens such as spironolactone may be considered under specialist supervision. Dutasteride, a more potent dual 5-alpha-reductase inhibitor, shows promise in refractory cases but remains unapproved for hair loss in most jurisdictions and requires careful risk–benefit assessment.

Emerging therapies include low-level laser therapy (LLLT), platelet-rich plasma (PRP) injections, and topical prostaglandin analogs like bimatoprost and latanoprost—though robust clinical trial data supporting routine use remain limited. Hair transplantation remains a durable surgical option for stable, patterned alopecia in appropriately selected candidates.

Early diagnosis and intervention are critical: treatment halts progression and may restore some density, but cannot regenerate fully scarred or fibrosed follicles. Patients should undergo thorough evaluation—including scalp examination, trichoscopy, and, when indicated, hormonal assays—to rule out secondary causes such as thyroid dysfunction, iron deficiency, or telogen effluvium before initiating long-term therapy.