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Androgenic Alopecia

Androgenic Alopecia is a common form of hair loss in both men and women. In men, this condition is also known as male-pattern baldness. Hair is lost in a well-defined pattern, beginning above both temples. Over time, the hairline recedes to form a characteristic "M" shape. Hair also thins at the crown (near the top of the head), often progressing to partial or complete baldness.

The pattern of hair loss in women differs from male-pattern baldness. In women, the hair becomes thinner all over the head, and the hairline does not recede. Androgenic Alopecia in women rarely leads to total baldness. Androgenic Alopecia in men has been associated with several other medical conditions including coronary heart disease and enlargement of the prostate, a walnut-sized gland in males that is located below the bladder. Additionaly, prostate cancer, disorders of insulin resistance (such as diabetes and obesity), and high blood pressure (hypertension) have been related to androgenic alopecia. In women, androgenic alopecia is associated with an increased risk of polycystic ovary syndrome (PCOS). PCOS is characterised by a hormonal imbalance that can lead to irregular menstration, acne, excess body hair (hirsutism), and weight gain.

Currently there is no cure for the disease. Only 2 drugs currently have US Food and Drug Administration (FDA) approval for the treatment of androgenic alopecia: minoxidil and finasteride.

Minoxidil's method of action is essentially unknown., minoxidil appears to lengthen the duration of the anagen phase, and it may increase the blood supply to the follicle. Regrowth is more pronounced at the vertex than in the frontal areas and is not noted for atleast 4 months. Continuing topical treatment with the drug is necessary indefinately because discontinuation of treatment produces a rapid reversion to the pretreatment balding pattern. Patients who respond best to this drug are those who have a recent onset of androgenic alopecia and small areas of hair loss.

Finasteride is given orally and is a 5-alpha-reductase type 2 inhibitor. It is not an antiandrogen. The drug can be used only in men because it can produce ambiguous genitalia in a developing fetus. Finasteride has been shown to diminish the progression of androgenic alopecia in males who are treated, and, in many patients, it has stimulated new regrowth.

Although it affects vertex balding more than frontal hair loss, the medication has been shown to increase regrowth in the frontal areas as well. Finasteride must be continued indefinitely because discontinuation results in gradual progression of the disorder. A study in postmenopausal women indicated no beneficial effect of the medication in treating female androgenic alopecia.

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