Androgenetic alopecia is the most common type of hair loss in both men and women. It develops as a result of follicular miniaturization driven by the interaction between genetic predisposition and androgen hormones. Graded according to the Norwood-Hamilton classification, this condition can be brought under control with early diagnosis and appropriate treatment.
Genetic Basis and Pathophysiology
The central mediator of androgenetic alopecia is dihydrotestosterone (DHT). Testosterone is converted to DHT by the enzyme 5-alpha reductase. DHT binds to receptors in genetically susceptible hair follicles, shortening the anagen (growth) phase and leading to follicular miniaturization.
This process is most pronounced in the frontal and vertex regions; occipital follicles, by contrast, are resistant to DHT. This characteristic forms the biological foundation of hair transplant surgery.
Classification Systems
The Norwood-Hamilton scale is used in men, while the Ludwig classification is applied in women. Male pattern hair loss begins with temporal recession and progresses to vertex thinning, whereas women typically present with a diffuse thinning pattern.
- Norwood I–II: Minimal frontal recession, early stage
- Norwood III–IV: Pronounced temporal and vertex thinning
- Norwood V–VII: Advanced stage with extensive alopecic area
- Ludwig I–III: Diffuse thinning in women ranging from mild to severe
Medical Treatment Options
Minoxidil is an FDA-approved topical treatment. Through its vasodilatory effect, it increases follicular blood flow and prolongs the anagen phase. A 5% concentration is the standard recommendation for men and 2% for women. Finasteride inhibits the type II 5-alpha reductase enzyme, lowering DHT levels and slowing hair loss progression.
PRP and Mesotherapy
PRP (Platelet-Rich Plasma) therapy involves injecting platelet-rich plasma derived from the patient's own blood into the scalp. Growth factors support follicular regeneration. Mesotherapy encompasses intradermal injection of cocktails containing vitamins, minerals, and peptides.
These treatments demonstrate a synergistic effect when combined with medical therapy. Treatment begins with monthly sessions, after which patients transition to a maintenance protocol.
Hair Transplant Surgery and Advanced Treatments
In advanced cases that do not respond to medical therapy, hair transplant surgery offers the most permanent solution. Using FUE and FUT techniques, grafts harvested from the occipital region are transplanted into alopecic areas. Exosome therapy and low-level laser therapy (LLLT) are considered complementary approaches.
This article is for informational purposes only. Please consult a qualified physician for treatment decisions.