Androgenetic alopecia. Part II

Androgenetic alopecia part I here

Therapeutic strategies androgenetic alopecia

Clinical and research progress has helped clarify some of the pathogenic stages leading to androgenic hair loss. In addition to androgens and genetic imbalance, additional pathogenic factors, microbial flora, endogenous and exogenous stresses, microinflammation, and possibly others are expected to participate. And although, obviously, other potential factors will be identified, when considering the biological conditions that contribute to androgenic alopecia, it is necessary to take into account the individual diversity of pathogens, as well as the sequence of events or a combination of factors.

Until now, the effects of oxidative stress, inflammatory component and emerging fibrosis have not been considered in the treatment protocols of androgenic alopecia. A thorough analysis of the molecular controls of physiological degeneration of the hair follicle caused by the immune system through apoptosis-mediated organ death will help to understand how to stop the progression of some forms of permanent baldness, which can only be partially suspended with the use of modern treatment methods. This also applies to further studies of androgenic alopecia with inflammatory processes and fibrosis.

The existing methods of treatment of androgenetic alopecia with proven efficacy are oral finasteride – a type 2 5-alpha-reductase inhibitor – and topical minoxidil – an adenosine triphosphate-sensitive potassium channel activator, which is reported to stimulate the production of VEGF in cultured cells of the dermal papilla. Androgen antagonists, including finasteride, cyproterone acetate, flutamide and spironolactone, are second-line drugs for the treatment of androgenic alopecia in women, but their use is limited due to a number of contraindications and insufficient response to treatment. Hair transplantation for patients with alopecia is an exceptional treatment option. Traditionally, in the complex therapy of patients with hair pathology, metabolic complexes containing amino acids, pantothenic acid, biotin and their combinations, as well as a combination of L-cystine, medicinal yeast and pantothenic acid are used. Implantation of cells of dermal papillae or cells of the dermal membrane of the follicle will be available soon for the treatment of men and women with androgenic alopecia.

Androgen metabolism modifiers: finasteride

The rationale for the use of finasteride for treatment in men is based on the absence of androgenic alopecia in men with congenital deficiency of type 2 5-alpha-reductase and increased activity of 5-alpha-reductase and DHT levels on the balding scalp. The oral form of the drug lowers the level of DHT in the blood serum and on the scalp. Finasteride 1 mg/day was registered for the treatment of AHA in men in 1998. Randomized clinical trials have confirmed that finasteride 1 mg/day can prevent or slow down hair loss in most men, about two-thirds of the study participants showed improvements. During clinical trials, a slight increase in sexual dysfunction was noted, but after discontinuation of finasteride, these side effects disappeared.


Oral antiandrogenic drugs, such as spironolactone and ciproterone acetate, are used in women with signs of hyperandrogenism, since they compete with androgens for androgen receptors. Cyproterone acetate prevents the binding of 5a-DHT to the androgen receptor, and also inhibits the secretion of FSH and LH as a result of its progesterone action. For women with hyperandrogenism, the recommended dosage is 100 mg / day, the drug is taken in the first 10 days of the menstrual cycle, for postmenopausal women, a dosage of 50 mg / day is recommended. Due to the danger of feminization of the male fetus, it is mandatory to take such drugs simultaneously with estrogen (ethinyl estradiol or oral contraceptives). Side effects include loss of libido, mood swings, fatigue, mastodynia, hypertension and weight gain. The drug is contraindicated in patients with liver diseases. Spironolactone is an aldosterone antagonist and an inhibitor of androgen synthesis. The drug in a dosage of 200 mg / day is effective in stimulating hair growth in women.