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Feature Article

Androgenetic alopecia in men and women

Rodney Sinclair

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Abstract

All men and women suffer androgenic hair loss as they age. Androgenic alopecia becomes a problem only when the hair loss is perceived as excessive, premature and distressing.

Key Points

  • Some degree of bitemporal recession occurs in 65% of women and 95% of men; however, neither the presence nor severity of bitemporal recession correlates with vertex or midfrontal scalp hair loss. Bitemporal recession does not respond to finasteride or oral antiandrogens.
  • Finasteride will arrest hair loss in 90% of men and stimulate hair regrowth to some degree in over 60%.
  • Oral antiandrogens will arrest hair loss in over 90% of women and stimulate hair regrowth to some degree in over 30%.
  • Topical minoxidil will produce visible hair regrowth in over 50% of men and women within six months, but might not arrest further hair loss.
  • Diagnosis of female pattern hair loss is facilitated by the use of the described clinical grading scale. Women with grade 3, 4 or 5 hair loss have androgenetic alopecia.
  • Up to 60% of women presenting with increased hair loss but who appear to have normal hair density on examination (grade 1 or 2) will have demonstrable androgenetic alopecia on scalp biopsy. Doctors should be wary of too eagerly reassuring women who claim to be losing hair but who have little visible hair loss.

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