Laboratory Studies

The most important aspects are the history and the physical examination. In the case of a woman, if virilization is evident, laboratory analysis of dehydroepiandrosterone (DHEA)-sulfate and testosterone may need to be obtained. Some authors have suggested that total testosterone level alone may be adequate to screen for a virilizing tumor. If a thyroid disorder is suspected, obtaining a thyrotropin level is indicated.

If telogen effluvium is present, laboratory analysis of serum iron levels or a biopsy to note an underlying papulosquamous disorder may be indicated. Telogen effluvium may accelerate the course of pattern alopecia. Iron deficiency is a common and reversible cause of telogen effluvium. A normal CBC count does not exclude iron deficiency as a cause of hair loss. While a low ferritin level is always a sign of iron deficiency, ferritin behaves as an acute phase reactant, and levels may be normal despite iron deficiency. Iron, total iron-binding capacity, and transferrin saturation are inexpensive and sensitive tests for iron deficiency.

Diffuse alopecia areata may mimic pattern alopecia. The presence of exclamation point hairs, pitted nails, or a history of periodic regrowth or tapered fractures noted on hair counts suggests the diagnosis of diffuse alopecia areata.

Schmidt et al used dermoscopy to study androgenetic alopecia. They noted brown peripilar casts and miniaturized hairs.^[27]

Köse and Güleç examined the value of dermoscopy in the study of alopecias, finding that hair diameter diversity was seen in every patient with androgenetic alopecia. This was an essential but not specific finding of this alopecia because it was also present in alopecia areata, chronic telogen effluvium, and primary cicatricial alopecia. However, peripilar signs and empty follicles were indicative of androgenetic alopecia, as they were confined to this patient group.^[28]

Procedures

A biopsy is rarely necessary to make the diagnosis of androgenetic alopecia. If a single biopsy specimen is obtained, it should generally be sectioned transversely if pattern alopecia is suspected. Some dermatopathologists recommend that if a biopsy is to be performed, a sample should be obtained from 2 sites: one for horizontal sectioning and one for vertical sectioning of the hair follicles. Other dermatopathologists point out that one may commonly obtain sufficient information from serial vertical sections to diagnose the condition.

Histologic Findings

In pattern alopecia, hairs are miniaturized. In evolving-pattern alopecia, the diameter of hair shafts varies. Fibrous tract remnants (so-called streamers) can be found below miniaturized follicles. Although androgenetic alopecia is considered a noninflammatory form of hair loss, at times, a superficial, perifollicular, inflammatory infiltrate is noted. A mildly increased telogen-to-anagen ratio is often observed.

Treatment & Management

Manabu Ohyama. Hair Follicle Stem Cells-New Insights & Clinical Relevance. AccessMedicine. Available at http://www.accessmedicine.com/updatesContent.aspx?aID=1001537. Accessed: December 3 2009.
Luderer HF, Demay MB. The vitamin D receptor, the skin and stem cells. J Steroid Biochem Mol Biol. 2010 Feb 6. [QxMD MEDLINE Link].
Magro CM, Rossi A, Poe J, Manhas-Bhutani S, Sadick N. The role of inflammation and immunity in the pathogenesis of androgenetic alopecia. J Drugs Dermatol. 2011 Dec. 10(12):1404-11. [QxMD MEDLINE Link].
Brockschmidt FF, Heilmann S, Ellis JA, et al. Susceptibility variants on chromosome 7p21.1 suggest HDAC9 as a new candidate gene for male-pattern baldness. Br J Dermatol. 2011 Dec. 165(6):1293-302. [QxMD MEDLINE Link].
Kure K, Isago T, Hirayama T. Changes in the sebaceous gland in patients with male pattern hair loss (androgenic alopecia). J Cosmet Dermatol. 2015 Sep. 14 (3):178-84. [QxMD MEDLINE Link].
Kaya Erdogan H, Bulur I, Kocaturk E, Yildiz B, Saracoglu ZN, Alatas O. The role of oxidative stress in early-onset androgenetic alopecia. J Cosmet Dermatol. 2016 Dec 16. [QxMD MEDLINE Link].
Kim MW, Shin IS, Yoon HS, Cho S, Park HS. Lipid profile in patients with androgenetic alopecia: a meta-analysis. J Eur Acad Dermatol Venereol. 2016 Oct 7. [QxMD MEDLINE Link].
Patil VB, Lunge SB. A Study of Correlation of Angiographic Evaluation of Coronary Artery Disease with Androgenetic Alopecia - TricoHeart Study. Int J Trichology. 2019 Nov-Dec. 11 (6):227-31. [QxMD MEDLINE Link]. [Full Text].
Henne SK, Hochfeld LM, Maj C, Nothen MM, Heilmann-Heimbach S. Systematic investigation of a potential epidemiological and genetic association between male androgenetic alopecia and COVID-19. Skin Health Dis. 2021 Dec. 1 (4):e72. [QxMD MEDLINE Link]. [Full Text].
Wang TL, Zhou C, Shen YW, et al. Prevalence of androgenetic alopecia in China: a community-based study in six cities. Br J Dermatol. 2010 Jan 22. [QxMD MEDLINE Link].
Stough D, Stenn K, Haber R, et al. Psychological effect, pathophysiology, and management of androgenetic alopecia in men. Mayo Clin Proc. 2005 Oct. 80(10):1316-22. [QxMD MEDLINE Link].
Lesko SM, Rosenberg L, Shapiro S. A case-control study of baldness in relation to myocardial infarction in men. JAMA. 1993 Feb 24. 269(8):998-1003. [QxMD MEDLINE Link].
Oh BR, Kim SJ, Moon JD, et al. Association of benign prostatic hyperplasia with male pattern baldness. Urology. 1998 May. 51(5):744-8. [QxMD MEDLINE Link].
Arias-Santiago S, Arrabal-Polo MA, Buendía-Eisman A, et al. Androgenetic alopecia as an early marker of benign prostatic hyperplasia. J Am Acad Dermatol. 2012 Mar. 66(3):401-8. [QxMD MEDLINE Link].
Sanke S, Chander R, Jain A, Garg T, Yadav P. A Comparison of the Hormonal Profile of Early Androgenetic Alopecia in Men With the Phenotypic Equivalent of Polycystic Ovarian Syndrome in Women. JAMA Dermatol. 2016 Jun 15. [QxMD MEDLINE Link].
Polat EC, Ozcan L, Otunctemur A, Ozbek E. Relation of urinary stone disease with androgenetic alopecia and serum testosterone levels. Urolithiasis. 2016 May 7. [QxMD MEDLINE Link].
Ludwig E. Classification of the types of androgenetic alopecia (common baldness) occurring in the female sex. Br J Dermatol. 1977 Sep. 97(3):247-54. [QxMD MEDLINE Link].
Hillmer AM, Flaquer A, Hanneken S, et al. Genome-wide scan and fine-mapping linkage study of androgenetic alopecia reveals a locus on chromosome 3q26. Am J Hum Genet. 2008 Mar. 82(3):737-43. [QxMD MEDLINE Link]. [Full Text].
Alsantali A, Shapiro J. Androgens and hair loss. Curr Opin Endocrinol Diabetes Obes. 2009 Jun. 16(3):246-53. [QxMD MEDLINE Link].
Krajcik RA, Vogelman JH, Malloy VL, Orentreich N. Transplants from balding and hairy androgenetic alopecia scalp regrow hair comparably well on immunodeficient mice. J Am Acad Dermatol. 2003 May. 48(5):752-9. [QxMD MEDLINE Link].
Cousen P, Messenger A. Female pattern hair loss in complete androgen insensitivity syndrome. Br J Dermatol. 2010 Feb 1. [QxMD MEDLINE Link].
Paladini RD, Saleh J, Qian C, Xu GX, Rubin LL. Modulation of hair growth with small molecule agonists of the hedgehog signaling pathway. J Invest Dermatol. 2005 Oct. 125(4):638-46. [QxMD MEDLINE Link].
Olsen EA, Reed KB, Cacchio PB, Caudill L. Iron deficiency in female pattern hair loss, chronic telogen effluvium, and control groups. J Am Acad Dermatol. 2010 Dec. 63(6):991-9. [QxMD MEDLINE Link].
Lattouf C, Miteva M, Tosti A. Connubial androgenetic alopecia. Arch Dermatol. 2011 Nov. 147(11):1329-30. [QxMD MEDLINE Link].
Ahouansou S, Le Toumelin P, Crickx B, Descamps V. Association of androgenetic alopecia and hypertension. Eur J Dermatol. 2007 May-Jun. 17(3):220-2. [QxMD MEDLINE Link].
Su LH, Chen TH. Association of androgenetic alopecia with smoking and its prevalence among Asian men: a community-based survey. Arch Dermatol. 2007 Nov. 143(11):1401-6. [QxMD MEDLINE Link].
Schmidt, AN, Taylor BR, King LE, and Tourjee SM. The ProScope HR: A promising diagnostic tool. J Am Acad Dermatol. March, 2010. 62:AB64.
Karadag Köse O, Güleç AT. Clinical evaluation of alopecias using a handheld dermatoscope. J Am Acad Dermatol. 2012 Aug. 67(2):206-14. [QxMD MEDLINE Link].
Headington JT, Novak E. Clinical and histological studies of male pattern baldness treated with topical minoxidil. Curr Ther Res Clin Exp. 1984. 36:1098-106.
Olsen EA, Dunlap FE, Funicella T, et al. A randomized clinical trial of 5% topical minoxidil versus 2% topical minoxidil and placebo in the treatment of androgenetic alopecia in men. J Am Acad Dermatol. 2002 Sep. 47(3):377-85. [QxMD MEDLINE Link].
Scarinci F, Mezzana P, Pasquini P, Colletti M, Cacciamani A. Central chorioretinopathy associated with topical use of minoxidil 2% for treatment of baldness. Cutan Ocul Toxicol. 2011 Sep 23. [QxMD MEDLINE Link].
Rittmaster RS. Finasteride. N Engl J Med. 1994 Jan 13. 330(2):120-5. [QxMD MEDLINE Link].
Rossi A, Cantisani C, Scarnò M, Trucchia A, Fortuna MC, Calvieri S. Finasteride, 1 mg daily administration on male androgenetic alopecia in different age groups: 10-year follow-up. Dermatol Ther. 2011 Jul. 24(4):455-61. [QxMD MEDLINE Link].
Sato A, Takeda A. Evaluation of efficacy and safety of finasteride 1 mg in 3177 Japanese men with androgenetic alopecia. J Dermatol. 2012 Jan. 39(1):27-32. [QxMD MEDLINE Link].
Pallotti F, Senofonte G, Pelloni M, et al. Androgenetic alopecia: effects of oral finasteride on hormone profile, reproduction and sexual function. Endocrine. 2020 Feb 12. [QxMD MEDLINE Link].
Rogers NE, Avram MR. Medical treatments for male and female pattern hair loss. J Am Acad Dermatol. 2008 Oct. 59(4):547-66; quiz 567-8. [QxMD MEDLINE Link].
Fields JR, Vonu PM, Monir RL, Schoch JJ. Topical ketoconazole for the treatment of androgenetic alopecia: A systematic review. Dermatol Ther. 2020 Jan. 33 (1):e13202. [QxMD MEDLINE Link].
Motofei IG, Rowland DL, Baconi DL, et al. Androgenetic alopecia; drug safety and therapeutic strategies. Expert Opin Drug Saf. 2018 Jan 24. [QxMD MEDLINE Link].
Singh S, Neema S, Vasudevan B. A Pilot Study to Evaluate Effectiveness of Botulinum Toxin in Treatment of Androgenetic Alopecia in Males. J Cutan Aesthet Surg. 2017 Jul-Sep. 10 (3):163-7. [QxMD MEDLINE Link]. [Full Text].
Leavitt M, Charles G, Heyman E, Michaels D. HairMax LaserComb laser phototherapy device in the treatment of male androgenetic alopecia: A randomized, double-blind, sham device-controlled, multicentre trial. Clin Drug Investig. 2009. 29(5):283-92. [QxMD MEDLINE Link].
Blume-Peytavi U, Lönnfors S, Hillmann K, Garcia Bartels N. A randomized double-blind placebo-controlled pilot study to assess the efficacy of a 24-week topical treatment by latanoprost 0.1% on hair growth and pigmentation in healthy volunteers with androgenetic alopecia. J Am Acad Dermatol. 2011 Aug 27. [QxMD MEDLINE Link].
Sinclair R, Patel M, Dawson TL Jr, et al. Hair loss in women: medical and cosmetic approaches to increase scalp hair fullness. Br J Dermatol. 2011 Dec. 165 Suppl 3:12-8. [QxMD MEDLINE Link].
Zimber MP, Ziering C, Zeigler F, et al. Hair regrowth following a Wnt- and follistatin containing treatment: safety and efficacy in a first-in-man phase 1 clinical trial. J Drugs Dermatol. 2011 Nov. 10(11):1308-12. [QxMD MEDLINE Link].
Navarro MR, Asin M, Martinez AM, Molina C, Navarro V, Pino A, et al. Plasma rich in growth factors (PGRF) for the treatment of androgenetic alopecia. European Journal of Plastic Surgery. June 21, 2015; Accessed: June 25, 2015.
Wessagowit V, Tangjaturonrusamee C, Kootiratrakarn T, Bunnag T, Pimonrat T, Muangdang N, et al. Treatment of male androgenetic alopecia with topical products containing Serenoa repens extract. Australas J Dermatol. 2015 May 25. (HTML)(/doi/10.1111/adj.12352/full). [QxMD MEDLINE Link].
Fukuoka H, Suga H. Hair Regeneration Treatment Using Adipose-Derived Stem Cell Conditioned Medium: Follow-up With Trichograms. Eplasty. 2015. 15:e10. [QxMD MEDLINE Link].
Lee GY, Lee SJ, Kim WS. The effect of a 1550 nm fractional erbium-glass laser in female pattern hair loss. J Eur Acad Dermatol Venereol. 2011 Dec. 25(12):1450-4. [QxMD MEDLINE Link].