General information and goals of treatment of androgenetic alopecia

Androgenetic alopecia does not need to be treated unless the patient requests treatment for cosmetic reasons. The appearance of androgenetic alopecia can cause significant psychosocial effects, particularly in people with early onset or severe hair loss. Discuss the possible harms, benefits and regimens of available therapies, so the patient can make an informed choice about whether or not to undergo treatment.

An important part of managing androgenetic alopecia is counselling patients so they have realistic expectations of therapy. The main aim of treatment is to slow down further hair loss, and the secondary aim is to stimulate regrowth. Clinical response to treatment is best assessed with regular clinical photography; take a baseline photo for comparison. Photographic monitoring is particularly useful in females treated with spironolactone, which is more likely to achieve hair regrowth. The visible effects of most androgenetic alopecia treatments are not immediate; topical minoxidil takes 3 to 6 months, and oral finasteride and spironolactone take 6 to 12 months.

Treatment differs between males and females, and the choice of specific therapy is based on severity of the condition, patient preference, adverse effects, cost and likely adherence to therapy; see Approach to treatment of male androgenetic alopecia and Approach to treatment of female pattern hair loss.

Advise patients to wear a hat or scarf outdoors to prevent sun damage to the scalp where hair is sparse. Cosmetic camouflage (eg natural keratin fibres) is useful and inexpensive. Evidence for laser treatments, commercially available hair tonics and nutritional supplements to treat hair loss is lacking.

Platelet-rich plasma injections are increasingly used to stimulate hair regrowth in selected patients; however, they are unregulated in Australia. Platelet-rich plasma in androgenetic alopecia may be effective when used as an adjunct to more established medical treatments in selected patientsGirijala, 2018. If a patient is considering platelet-rich plasma therapy, advise them to consult a clinician who is also experienced in the medical treatment of androgenetic alopecia.