Male androgenetic alopecia
What it is and where it comes from
Male androgenetic alopecia originates from genetic and hormonal factors. Although it is common for men diagnosed with this type of alopecia to have a family history, its absence does not rule out the possibility of developing this condition at some point in life. In fact, it is estimated that 50% of the male population develops androgenetic alopecia.
Although it is more common in men, women can also develop it. It occurs in a smaller percentage of the female population and its development is also different.
In this type of alopecia, hair loss mainly occurs in areas such as the hairline, the top of the head, and the crown due to the increased sensitivity of hair follicles to the action of androgens, male hormones. These trigger a gradual process of miniaturization in the follicles, resulting in progressive thinning and eventually complete hair loss if left untreated.
Generally, male androgenetic alopecia begins around the age of 20-25, although it can occur at earlier ages. It is usually not associated with any concomitant diseases in men.
How male androgenetic alopecia develops
The development usually starts from the temples and progresses gradually towards the crown. It is initially perceived as a gradual loss of hair density.
Although this is the natural onset of alopecia, other patients experience it diffusely. This means that hair is gradually lost over a large part of the head, resulting in decreased density. Greater alopecia will be noticeable under direct light or with wet hair.
There is a scale to determine the alopecia of each patient. It is the Hamilton-Norwood scale. It ranges from grade I to VII, from the mildest to the most advanced. The onset of alopecia does not necessarily lead to the final grade. It may stabilize over time. However, it is more common for it to progress over time. It can be stopped by taking oral medication.
How it is diagnosed
The diagnosis of androgenetic alopecia can be established after a consultation with a doctor specialized in trichology. After obtaining a medical history, a clinical approach will be developed to address the condition.
The doctors at Instituto Médico del Prado will almost certainly propose the intake of oral medication. To adjust the best dose, they may require, in a large number of cases, a hormonal analysis. Based on the values obtained from it, the exact amount of medication will be established to maximize the effects and minimize potential, albeit unlikely, side effects.
In case of doubt, they can also rely on a genetic test. Through a sample, the Fragon Trichotest will provide the most effective medications for each patient.
Treatments available at Instituto Médico del Prado
Treatments for alopecia can be divided into two categories, those aimed at maintaining hair or the only one that serves to reverse it, the hair transplant. Despite all the procedures that promise the return of our former hair, nowadays, it can only be achieved through hair surgery.
To maintain hair, there are various methods, from taking oral medication to intradermal treatments. These will stabilize alopecia, as well as achieve greater thickness and density in the follicles, addressing the problem of miniaturization.
It is important to know that this improvement and stabilization of alopecia depends on medication intake. Our follicles will regain vigor and density as long as the dose is maintained. This does not mean that medication must be taken for the rest of our lives. The dosage or intake may be reduced in the future, once the doctor sees a clear stabilization of alopecia. However, the more medication is taken, the longer the action will remain in our body afterwards.
HAIR TRANSPLANT
The hair transplant surgery, as mentioned, is the ultimate goal to recover lost hair. In this treatment, hair from parts of the head such as the occipital, parietal, or temporal areas is transplanted to where hair has disappeared.
At Instituto Médico del Prado, Dr. Espinosa Custodio is the hair surgeon who leads the intervention. He always uses FUE techniques for extraction and DHI for implantation. These are the most advanced techniques in the field of hair surgery and are the least invasive for the patient.
The surgeries are performed in an operating room fully equipped for the requirements of the intervention. In addition, the doctor’s team does not rotate. The same technicians and doctors, who have been trained by the Medical Director himself, assist him in all interventions.
The surgery is minor outpatient, so no hospitalization is required. Once the session is finished, the patient will return home for recovery. During the first few days, brief discomfort may occur, but it will be alleviated with medication provided by the clinic.
The final results will be seen 12 to 18 months after the intervention, and it will be when the doctor schedules the definitive discharge from the treatment.
ORAL MEDICATION: ANTIANDROGENS
When talking about antiandrogens, we refer to Dutasteride and Finasteride. These medications are non-steroidal anti-hormones whose function is to block 5-alpha reductase. That is, they prevent the conversion of testosterone into DHT (dihydrotestosterone), one of the causes of alopecia.
Both medications are used to treat benign prostatic hyperplasia, and it was through the intake of these medications in patients with this pathology that an improvement in hair density was observed. They help, in hair medicine, to stop and reverse hair loss. They are prescribed at reasonably lower doses, so side effects are almost nil.
The difference between the two antiandrogens lies in their suitability for the patient. Dutasteride is much more selective and is shown to be more effective in the miniaturization of the crown. It will be the specialized doctor who determines the ideal medication for the patient.
ORAL MEDICATION: MINOXIDIL
Minoxidil is the second main component of oral medication. Regarding the mechanism of action of this drug, it is determined by arteriolar vasodilation. It is a treatment for high blood pressure, and as a side effect, thickening of the hair or hypertrichosis was demonstrated due to increased prostaglandin.
Although it can be applied topically, oral intake of the medication shows greater effectiveness in patients. Its excellent safety profile makes it one of the best options against alopecia.
It is the combined action of antiandrogens with Minoxidil the best option against alopecia. At Instituto Médico del Prado, the masterful formulation will be, in a large number of patients, the medication prescribed by the doctors. In a single capsule, both medications are present. Prolonged, continuous, and consistent intake of them will lead to great results.
PLATELET-RICH PLASMA (PRP)
It involves the application of the patient’s own plasma. By extracting and centrifuging blood, plasma is separated from the rest of the elements. It is injected into the scalp, promoting collagen creation and tissue regeneration thanks to an improvement in blood capillarization due to the growth factors and fibroblasts it contains.
Platelet-Rich Plasma (PRP) is a convenient treatment that does not require specific recovery. Normal life can be resumed afterwards. The number of sessions and their periodicity will be determined by the doctor.
MESOTHERAPY
Capillary mesotherapy is a completely natural treatment to stop hair loss and increase the thickness and volume of our existing hair. Several components are injected to help hair growth and stimulation.
Among the benefits of mesotherapy are improved blood circulation, revitalization of the hair follicle, improvement of scalp trophism, and increased hair thickness and volume.
By increasing blood circulation in the scalp, the first of the causes of alopecia is stopped. Helping to recover thin and fine hair will increase hair thickness. For both reasons, mesotherapy is shown to be one of the best therapies against baldness.
Bibliography
The effect of finasteride on the risk of acute urinary retention and the need for surgical treatment among men with benign prostatic hyperplasia. Finasteride Long-Term Efficacy and Safety Study Group. N Engl J Med., 338 (1998), pp. 557-563 J.D. McConnell, R. Bruskewitz, P. Walsh, et al. http://dx.doi.org/10.1056/NEJM199802263380901 | Medline
Efficacy and safety of finasteride therapy for benign prostatic hyperplasia: Results of a 2-year randomized controlled trial (the PROSPECT study). PROscar Safety Plus Efficacy Canadian Two year Study. CMAJ., 155 (1996), pp. 1251-1259J.C. Nickel, Y. Fradet, R.C. Boake, et al. Medline
Incidence and severity of sexual adverse experiences in finasteride and placebo-treated men with benign prostatic hyperplasia. Urology., 61 (2003), pp. 579-584. H. Wessells, J. Roy, J. Bannow, et al. Medline.
Benign prostatic hyperplasia. Lancet., 361 (2003), pp. 1359-1367. A. Thorpe, D. Neal. Recuperado de: http://dx.doi.org/10.1016/S0140-6736(03)13073-5 | Medline
A review of the clinical efficacy and safety of 50alpha-reductase Inhibitors for the enlarged prostate. Clin Ther., 29 (2007), pp. 17-25. M. Naslund, M. Miner. http://dx.doi.org/10.1016/j.clinthera.2007.01.018 | Medline
Effect of 5α-reductase inhibitors on sexual function: A meta-analysis and systematic review of randomized controlled trials. J Sex Med., 13 (2016), pp. 1297-1310L. Liu, S. Zhao, F. Li, et al. http://dx.doi.org/10.1016/j.jsxm.2016.07.006 | Medline
