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Monday, 28 August 2017

Hair Thinning? Could it be androgenetic alopecia?

Losing hair and it seems to run in the family? It could be androgenetic alopecia.

What is this?

This is a type of hair loss that is genetically determined.

The basic

Hair are produced from the hair follicles. And it has a few phases.
Anagen: growth phase
Catagen: involution phase
Telogen: resting phase

What happens in androgenetic alopecia is that there is
1. Increased hair shedding
2. Miniaturisation of hair (thick large pigmented terminal hair --> thinner and shorter indeterminate hairs --> short and non-pigmented vellus hair)

Generally people with this condition tends to have gradual hair loss.
For men,  it usually start with recession of frontal hair lone and gradual thinning at the sides.
For women, it usually start over the crown. Luckily usually there isn't an area of marked baldness.

Why should you see a doctor?

There are many other causes of hair loss. Some people have temporary hair thinning due to stress, drugs or nutritional deficiency. Diffuse alopecia areata may look like androgenetic alopecia too.

Again, I must stress that effective treatment comes after an accurate diagnosis. What works for others who stand out to be the testimonials of certain products may not be what works for you. An accurate diagnosis to begin with will save you a lot of unnecessary money spent.

Investigations and treatment of androgenetic alopecia is not that cheap, but how many times we have encounter patients who have spent up to 5 figures buying packages of hair growth treatment at "hair specialist" saloon or spa trying to "treat Demodex infection that eats up the hair" or "clear the clogged hair follicles" etc.?

While majority of people with this condition can be otherwise quite normal, some people may have abnormal thyroid function, sex hormone etc. Others can have hair thinning as part of polycyctic ovarian syndrome where they might have acne, irregular menses, excessive body hair or even difficulty to get pregnant.

What are the treatments for me?

The treatment for androgenetic alopecia needs to be individualised. But before we talk about treatment, you must understand that the main aim of treatment is to slow or stop the progression of hair loss. While some people can get their hair regrowth, some may not. And it is difficult to predict who may response and who may not.

Main treatments available includes:
1. Topical solutions e.g. minoxidil
2. Oral tablets e.g. finasteride (for men only), spironolactone etc.
3. Low level laser therapy
4. Platelet rich plasma
5. Hair filler
6. Hair transplant

The list above is definitely not exhaustive. And don't forget cosmetic dermatology with hair thickening, hair camouflage, hair prosthesis and wigs.

At the moment,  hair implants are NOT recommended because these synthetic fiber implants are not only expensive, they are also dangerous and leading to a whole lots of complications.

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