Androgenetic Alopecia

What is androgenetic alopecia? Androgenetic alopecia (AGA), commonly known as male pattern baldness (or female pattern hair loss in women), is a chronic, progressive form of hair loss that follows a recognizable pattern.

It is the most common cause of hair loss for guys, affecting up to 50 percent of men by the time they reach age 50.

Male pattern baldness generally involves more than one cause, some of which are out of your control. 

Typically, a combination of genetics and hormonal activity is involved. A particular derivative of testosterone called dihydrotestosterone (DHT) is commonly linked to male pattern baldness. AGA often appears gradually and, without proper treatment, continues to worsen.

The hallmark of AGA in guys is a predictable pattern of hair thinning. Male pattern hair loss typically shows up with the following characteristics: 

• A receding hairline, often forming an "M" shape

• Thinning at the crown (top of the head)

• Partial or complete baldness over time

It’s normal for everyone to shed between 50 and 100 hairs per day as part of the normal hair growth process. This rate of hair loss doesn’t usually result in frontal hairline recession or other significantly noticeable balding patterns. 

But, as hair is affected by AGA, it becomes shorter, finer, and lighter over time. Eventually, due to follicle miniaturization, strands become hard-to-see vellus hairs. 

For some guys, this might eventually evolve into total baldness, while others may just notice thinning around the crown.

Hair loss in general can result from many things, but androgenic alopecia causes are usually pretty specific. AGA is caused by a genetic predisposition and a certain interaction with androgens (male sex hormones), particularly one called DHT, or dihydrotestosterone. 

Your body creates DHT as a byproduct of testosterone, a guy’s dominant sex hormone. DHT is important; you need it to develop the features that make you male, such as your external genitals, facial hair, and prostate gland.

However, as you age, your body’s relationship with DHT changes, and the compound plays a role in the pathogenesis of AGA. 

DHT can damage hair follicles, causing miniaturization. Follicles affected by DHT become thinner and shorter with a more fragile shaft, and ultimately stop producing new hair.

Here’s how it works:

• DHT binds to receptors in hair follicles, especially those located in the scalp.

• In genetically susceptible men, DHT triggers the shrinking of follicles, which are tiny structures in the skin that play a central role in hair growth. 

• Over time, this shortens the hair growth phase (anagen) and lengthens the resting phase (telogen), reducing overall hair density and thickness.

Men with hair loss tend to have higher levels of DHT than their peers and a greater number of androgen receptors in the scalp.

We all experience certain changes in the growth and appearance of our hair as we get older. If you’re concerned about whether male pattern baldness is in your future, there are several factors that can increase your susceptibility:

• Family history. If your parents or grandparents experienced AGA, your risk is significantly higher.

• Age. The likelihood and severity of AGA increase with age, often beginning in the late teens to early 20s, though some guys (with a lower sensitivity to DHT) may not notice changes until later. Up to 80 percent of guys experience AGA by age 70.

• Ethnicity. White men are more likely to experience AGA than men of Asian or African descent, followed by men of Native American or Inuit descent.

When you notice changes in how your hair is growing (or falling out), it can be concerning. It’s always best to consult your dermatologist or other trusted healthcare provider to find out what’s going on. 

Androgenic alopecia is typically diagnosed through: 

• Hair loss evaluation. Your provider will examine the pattern and distribution of hair loss you’re experiencing, including when it started and whether you can identify any triggers. Some dermatology experts use the Norwood scale, a classification system that measures the extent of male pattern baldness.

• Family history. Discussing whether you have a known family history of similar hair loss can give your provider insight into whether there’s a strong genetic predisposition likely at play. While you can’t change your genes, simply knowing this information can be useful.

• Scalp examination. Your provider may use a dermatoscope to look at the health of your hair follicles. In some less common cases, they may perform a scalp biopsy if there’s confusion about what type of hair loss you’re dealing with. 

• Hair pull test. Doing a hair pull test, where a provider tests 20 to 60 hairs close to the base of your scalp, involves gently tugging on your strands. If more than 10 percent of the hair comes loose from your scalp, it’s generally a sign that your hair loss is beyond typical shedding.

• Ruling out other medical conditions. This may involve ordering blood tests to check your thyroid function, iron levels, or autoimmune markers, especially if your pattern of hair loss is atypical for AGA. However, this kind of blood work is more commonly ordered for women experiencing hair loss. Your provider may even take a hair sample to send to a lab or refer to an endocrine specialist if necessary.

While it can be helpful, you don’t necessarily need a formal diagnosis for androgenetic alopecia to start treating hair loss. Even if you get one, this doesn’t mean that your medical insurance is any more likely to cover medical treatments for hair loss.

Is androgenetic alopecia reversible? Not necessarily. However, it can be treatable, especially when caught early. 

While hair regrowth varies, most treatments for androgenic alopecia aim to slow or stop progression and preserve your existing hair.

So, if you’re wondering how to stop androgenic alopecia, here are some of the most common and effective AGA hair loss treatment options. 

Topical Minoxidil (Rogaine)

Topical minoxidil is an FDA-approved hair loss medication for treating androgenetic alopecia in men. It’s available over the counter.

It stimulates hair growth, though its exact mechanism of action isn’t fully understood. It’s thought to work by prolonging the anagen (growth) phase of your hair and stimulating blood flow to your scalp (and to your hair follicles).

In one study, 84.3 percent of men with androgenetic alopecia who were treated with minoxidil for 12 months rated it as either very effective, effective, or moderately effective at stimulating hair regrowth.

Hims offers minoxidil online as a topical solution in two formulations at 5% strength: a topical minoxidil foam and a liquid. Both options work the same way but have unique benefits. 

Some people with longer hair think the liquid solution is easier to apply because it has a dropper. The foam doesn’t drip, which can be more attractive for guys who want a mess-free application.

Our guide to applying minoxidil explains how this medication can help prevent and reverse androgenetic alopecia hair loss.

For people who don’t want to apply it topically, minoxidil has recently become available as an oral medication. However, while the available research shows its comparable effectiveness to topical minoxidil, the oral form is not yet FDA-approved for AGA. Still, some providers may prescribe it off-label. 

If you’re interested in trying oral minoxidil, we offer it as part of our Minoxidil + Supplement Blend daily chew, which contains 3 milligrams of minoxidil.

Oral Finasteride (Propecia)

Another popular and effective FDA-approved option for treating AGA is oral finasteride. 

While you can’t change your genetics, early action may help minimize androgenic alopecia hair loss. As soon as you notice changes in the growth and/or appearance of your hair or you see more hair shedding than normal, it’s a good idea to consult a trusted healthcare professional. 

Depending on what they find during your exam, they may recommend certain treatments to help stop or reverse hair loss. It’s also important to continue practicing gentle, healthy hair care habits to maintain the hair you have. 

To support overall wellness, practice healthy lifestyle habits, such as managing stress and eating a nutrient-dense diet. Regularly monitor your hair and scalp health and always talk through any changes, questions, or concerns with your provider.