The Work-Up for Androgenetic Alopecia and the Best Trending Treatments.

To understand the true cause of your hair loss, it’s important to see a dermatology clinician who knows what to look for and how to treat it properly. Certain skin or hair signs may point to more severe types of loss caused from autoimmune disorders, while many will be due to mere androgenetic alopecia, which is discussed below.

Diagnostic Tests

Hair Pull Test

This is an easy procedure in which your clinician will place steady pull forces on a bundle of up to 100 hairs, to ascertain detachment and extent of hair loss. A finding of greater than 3 hairs is considered abnormal, and 6 excessive.

Scalp Biopsy

If alopecia appears to be more than just androgenetic, your provider may take a plug of skin and hair, close to pencil eraser size, to send for pathology. The pathologist will examine this specimen under a microscope to see if there is inflammation, other skin changes, scarring, miniaturized hairs, or other hair abnormalities.

Densitometry

This hand-held instrument can be used on short, clipped hair (about 1 mm [1/16 inch] in length) to view the scalp hair with magnification. However, I have not seen these often in dermatology offices, but rather general magnifying glasses or goggles.

Blood Work

Your clinician may order blood work to look for conditions which may cause hair loss such as; anemia (iron, ferritin, TIBC), thyroid disorder (T3, T4, TSH), abnormal hormone levels causing androgenic effects (testosterone, androstenedione, DHEAS, prolactin, follicular stimulating hormone [FSH], and leutinizing hormone [LH]), and autoimmune disorders (ANA). However, such panels may be expensive (insurance may not cover in full), so should be used judiciously if cause of hair loss is suspected as non-androgenic alopecia. Nonetheless, many of my patients request this anyways, as in the panic of the moment, it is hard to conceptualize that aging and genetics can be the only cause for thinning. Nonetheless, there are several treatments for androgenetic alopecia as discussed below.

Prescription Drugs for Androgenetic Alopecia

Aldactone (spironolactone) [for women only]

This medication was originally used as a water-pill for edema (swelling) and high blood pressure. However, it has been found to have anti-androgenic properties by blocking receptors and slowing down production of androgens.

Propecia (Finasteride)

This medication which inhibits 5-alpha-reductase, was originally approved for enlarged prostate in men, but is cautiously used in women, only who are proven post-menopausal. Due to possibility of birth defects in people of child-bearing age, many clinicians can be hesitant to use this medication in women.

Antiandrogen Medications [for women only]

Oral contraceptive pills (OCP’s) may help or hinder hair loss, dependent on their affect on androgen production and circulation. Low androgen OCP’s are recommended for those suffering with alopecia; such as Ortho-Tri-Cyclen, Desogen, Ovcon, Yaz, Yasmin, Mircette, Tri-Sprintec, etc (discuss with your provider). Norplant, Depo-Provera, Mirena, Progesterone only pills, and most “Lo-“ meds, like Lo-Estrin, can have worsening effects on hair loss. For those who are post-menopausal, use of estrogen or progesterone therapy may also be used to balance hormones.

Surgical Procedures

Hair Transplants

Surgical transfer of healthy hair follicle units from androgenic resistant scalp areas (lower posterior scalp) to areas of hair loss, is a physical way to create natural looking fullness. FUT (strip of donor hair) or FUE (precise units of donor hair) can been done as a cosmetic procedure. Its effects are more long lasting, with possibility of shedding in the 10-30 year post transplant range. Find out more about this procedure at http://www.zieringmedical.com/.

Innovations in Hair Loss Treatments

Bimatoprost

This is a synthetic prostaglandin which is used in the lash growing prescription called “Latisse.” It is currently in clinical trials with a hopeful FDA approval within the next few years. On the heels of such trials, a few compound pharmacies are offering a bio-similar topical called Latanoprost, which is also experimental in use.

PRP Injections

Platelet Rich Plasma (PRP) scalp injections are a cosmetic treatment with inconclusive results for use in alopecia. However, it is a trending procedure originally used to stimulate healing in wounds, it is thought to also stimulate hair growth. PRP is still an emerging non-surgical therapy, which some clinicians are offering.

Conclusion

These are some of the initial steps your provider may take in ensuring a mere androgenetic alopecia and providing treatment. For those who appear to have alopecia due to other disease, it may take an examination, and/or the results of diagnostic tests to support such. Other alopecias are treated based on their causative factors and clinically based standards of care. Many of the topical or oral methods used can take at least 3-6 months or longer to see full results.

*The information provided above or in any blogs on this site is for educational purposes only. I does not replace advice or necessary examination and diagnosis from your healthcare clinician. Please see your healthcare provider for any and all concerns with changes in your health or treatment of disease.

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