Androgenetic alopecia (male pattern)

What is male androgenetic alopecia?

Male androgenetic alopecia is a type of non-scarring alopecia characterised by progressive hair thinning, particularly at the temples (frontotemporal regions) and the crown (vertex), as described in the Hamilton–Norwood classification. It is the most common form of alopecia in men, and it is estimated that more than 50% will develop this type of alopecia from around age 30, with its frequency increasing with age.  

Signs and symptoms of male androgenetic alopecia

The signs of male androgenetic alopecia include progressive recession of the frontal hairline, hair thinning and reduced density in the upper scalp and crown. In more advanced stages, areas of marked hair loss appear in the frontal and superior regions, while hair is generally preserved on the sides and at the nape of the neck.

Causes of male androgenetic alopecia

Male androgenetic alopecia is caused by the action of male hormones (androgens—particularly dihydrotestosterone) on hair follicles in individuals with a genetic predisposition.
A family history is one of the main risk factors.  

Diagnosis of male androgenetic alopecia

Male androgenetic alopecia is diagnosed through clinical examination by a specialist, based on observation of the scalp. Trichoscopy is used to confirm the diagnosis. This test allows assessment of variability in hair shaft thickness, an increased number of miniaturised follicles, reduced hair density and the presence of follicular units containing fewer hairs. 

Although this type of alopecia is associated with hair ageing, its accelerated progression and its functional and aesthetic impact on the patient justify treatment. 

Treatment of male androgenetic alopecia

Treatment includes topical or oral therapies that help slow hair loss and strengthen the hair (e.g. topical or oral minoxidil); medications that reduce the action of certain hormones (topical and systemic antiandrogens such as finasteride and dutasteride); as well as complementary therapies aimed at improving follicular quality (e.g., mesotherapy and platelet-rich plasma). In selected cases, hair transplantation may also be considered as a reconstructive option.