minoxidil

Disorders of Hair: Androgenetic Alopecia

by admin on November 8, 2007

Disorders of Hair: Androgenetic AlopeciaI came across this article today while doing some hair loss research on the internet, and I thought it covered a lot of questions that women have about hair loss. The article is about both male and female pattern hair loss and provides a good overview. It was published on medscape from ACP Medicine Online. Here it is:

David A. Whiting, M.D.

Androgenetic alopecia is the common type of nonscarring hair loss affecting the crown. It results from a genetically determined end-organ sensitivity to androgens. It is often referred to as common baldness, male-pattern alopecia, and female-pattern alopecia.

Epidemiology and Pathogenesis

Androgenetic alopecia affects at least 50% of men by 50 years of age and 50% of women by 60 years of age.6,7 Males have more androgen than females and therefore are usually affected earlier and more severely. Male-pattern alopecia often starts between 15 and 25 years of age. Male-pattern alopecia has two characteristic components, bitemporal recession and vertex balding [see Figure 1 — omitted], which in pronounced cases can progress to complete balding of the crown.6,7 Female-pattern alopecia is more likely to start between 25 and 30 years of age (or sometimes later, after menopause). It is characterized by an intact frontal hairline and an oval area of diffuse thinning over the crown [see Figure 2 — omitted]. Bitemporal recession in women is much less obvious than it typically is in men, or it can be nonexistent. In general, androgenetic alopecia in women progresses to mild, moderate, or severe thinning but not to complete baldness. The best predictor of outcome is the degree of progression in affected relatives.

Androgenetic alopecia is an autosomal dominant disorder with variable penetrance. Susceptible hairs on the crown are predisposed to miniaturize under the influence of androgens, notably dihydrotestosterone. In both sexes, miniaturization results from a shortening of the anagen cycle, from years to months or weeks. Miniaturized hairs are characterized by reduced length and diameter; this accounts for the appearance of hair loss.8 Androgenetic alopecia largely spares the back and sides of the scalp.

Diagnosis

The diagnosis of androgenetic alopecia is usually obvious from the clinical pattern of hair loss from the top of the head.9 In some men, a female pattern of alopecia (see above) causes diagnostic confusion but has no other significance. In women, a male pattern of alopecia (i.e., bitemporal recession and vertex balding) occurring with menstrual irregularities, acne, hirsutism, and a deep voice is significant. The virilism indicates significant hyperandrogenism, the cause of which must be identified and treated [see 3:IV The Adrenal — omitted].

Scalp biopsies are rarely necessary to diagnose androgenetic alopecia. Biopsies cut horizontally are sometimes useful, however, in differentiating female-pattern alopecia from chronic telogen effluvium (see below). [click to continue…]

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Treatment of Female Pattern Hair Loss With A Combination of Spironolactone and Minoxidil I want to thank Kate for emailing me this Case Report about the use of spironolactone and minoxidil in treating female pattern hair loss. The Case Report appeared in the Australasian Journal of Dermatology Volume 48 Issue 1 Page 43-45, February 2007

CASE REPORT

Treatment of female pattern hair loss with a combination of spironolactone and minoxidil

Carlijn Hoedemaker, Sylvia van Egmond and Rodney Sinclair

Department of Dermatology, St Vincent’s Hospital, University of Melbourne, and Department of Medicine and Skin and Cancer Foundation, Melbourne, Victoria, Australia

Summary

A 53-year-old woman with clinical evidence of female pattern hair loss and histological evidence of androgenetic alopecia was initially treated with the oral antiandrogen spironolactone 200 mg daily. Serial scalp photography documented hair regrowth at 12 months; however, the hair regrowth plateaued, and at 24 months there had been no further improvement in hair density. Twice daily therapy with topical minoxidil 5% solution was then introduced and further regrowth documented, confirming the additive effect of combination therapy.

Introduction

Female pattern hair loss is a common, psychologically distressing, age-related, androgen-mediated condition that presents with increased hair shedding and reduction in hair volume over the mid-frontal scalp.1

Binding of dihydrotestosterone to cellular androgen receptors induces susceptible scalp hairs to undergo a progressive and orderly transition from terminal to vellus hairs to produce patterned baldness. Antiandrogen therapy with either spironolactone or cyproterone acetate is commonly used to treat FPHL, as is topical minoxidil.2 The mechanism of action of minoxidil is unknown, but does not involve androgen pathways.3 The use of topical minoxidil together with an oral antiandrogen might have an additive effect; however, combination therapy has not been previously reported. [click to continue…]

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Debra asked this question on the “calling all thickening shampoo” thread, but I decided to repost it here so that other women can have the opportunity to find it easier and perhaps comment as well.

She Wrote:

I love reading these comments. I started loosing my hair about 3 months ago. My family doctor recommended I go see a dermatology. Dermatology told me to use Rogaine for women. I had to stop after a few weeks as I noticed i was loosing more hair. Than I had the biopsy done. Now he is telling me to use Rogaine for men! holy cow. What to do? Need your help please?

Hi Debra-

Welcome to the site!

I am not a doctor so I can’t give medical advice, but I’ll give you the information I’ve found out over the course of the last 8 years losing my own hair.

Did you recently go on or off birth control pills or any other medication? I don’t think I a personally agree that the dermatologist you saw should have advised you to go on Rogaine after only 3 months of hair loss. 3 months is a very short amount of time and you could have just been experiencing shedding caused by any number of factors.

It is not uncommon at all to start shedding more hair after beginning any hair loss treatment such as Rogaine. The hair shedding should be temporary. After a 1-2 months if the treatment works, new hair should begin to grow, hair growth works in cycles. When Rogaine causes hair shedding it may induce the hair shaft to fall off, the follicle would then enter a dormant phase in the cycle (temporarily) while the matrix is restructured for future growth, hopefully with a thicker and stronger hair shaft. In the meantime through you may lose more hair, but after waiting for several months you may have thicker and stronger hair with any new hair growth, assuming the Rogaine works. [click to continue…]

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My Hair Loss Story – How Did I Get Here?

by admin on August 30, 2007

So how did I get here? I find myself asking myself that very same question on a daily basis. The year 1999 was the year that forever changed my life. My hair loss began after having stopped taking the birth control pill Loestrin FE. Later I found out that it is or at least was, an extremely high androgen index pill. Who knew? Certainly not me and certainly not my gynecologist who prescribed it to me.

So the following months after I stopped the pill my hair began to shed and shed like crazy. It was all over the place and coming out what seemed to be by the handfuls. I tried to find answers online, but I found nothing. I went to so-called “hair experts” also known as dermatologists who aren’t any wiser than the other dermatologists, but just know how to capitalize on the vulnerability of women. They were of no help either. Blood work… within normal levels. I felt frustrated that I couldn’t point to it on a paper and say “ah ha that’s it, my estrogen is low” or “there it is, I need more iron.” There simply was no explanation. I should point out that I also saw very expensive “hair experts” who told me I wasn’t losing my hair. What? Like they would know better than me, I’ve only live in this body… umm forever. Of course if I revisited those same doctors today they wouldn’t be telling me that now. This certainly isn’t one of those instances where you want to be right and say “I told you so.”
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