Androgenic alopecia, also known as common baldness, is the most frequent form of hair loss. It is genetically determined, meaning that inheritance is crucial for the affection to appear and is basically caused by the action of a hormone called dihydrotestosterone which acts at the level of the hair follicle causing a decrease in cellular activity which is reflected in a reduction of the hair growth and the size of it. The hormone dihydrotestosterone comes from testosterone thanks to an enzyme responsible for this conversion and which is called alpha reductase II.
Baldness mainly affects men; however, women may also be affected. It usually begins after 25 years of age but can also occur after the onset of puberty and when it men occurs before 20 years of age can be a marker of prostate problems in adult life. Baldness plays an important role in the self-perception of each individual so it can affect the quality of life, leading patients to seek various treatments which often do not offer a benefit so they end up being a waste of time and money. Medical treatment for baldness consists of two steps.
The first one is common for men and women and consists in the application of a lotion with minoxidil, which should be applied morning and night with an assessment of the response after 6 months of use, finding good response in up to 40% of male patients. In male patients in whom this treatment is ineffective we then go on to systemic treatments with finasteride which is an inhibitor of the enzyme alpha reductase II so it helps to lower the levels of dihydrotestosterone, hormone as we mentioned responsible for hair loss .
This medication is usually very effective however it is important to mention that it can be accompanied by adverse effects like any other medication, so the start of this treatment should be done in selected patients. In the case of women, systemic treatment consists of the use of antiandrogens, which are drugs capable of inhibiting the action of male hormones in women. When there is good response to either topical or systemic treatment it is important to know that this response will only be maintained while under treatment, so we always emphasize that the treatment is of continuous use, since there is currently no definitive treatment for baldness.
In addition to medical treatment, in selected patients a surgical modality consisting of hair transplantation can be offered which shows very satisfactory permanent results. Hair transplant is a minimally invasive procedure which is performed under local anesthesia and consists in the separation and extraction of hair from the back of the head and its subsequent implantation in the affected areas where they will continue with normal growth allowing the reverse of the degree of alopecia. The hair is taken from the nape of the neck because these hairs are more resistant to falling and have the characteristic of staying throughout life.
