Baldness (Androgenetic Alopecia): Causes, Treatments, and Future Directions

There is currently no cure for androgenetic alopecia (AGA), but multiple treatments can slow progression and stimulate regrowth.

Pathophysiology

• Genetic susceptibility + androgen (DHT) sensitivity → follicular miniaturization (terminal → vellus hairs).
• Polygenic; AR/EDA2R loci implicated.
• Men: bitemporal + vertex; Women: diffuse central thinning (Ludwig pattern).

FDA-Approved Treatments

• Minoxidil (topical 2%/5%, oral low-dose): Vasodilation, ↑ anagen phase. Lifelong use needed.
• Finasteride 1 mg/day (men): 5α-reductase type II inhibitor → ↓ DHT. Sexual side effects ~2–4%.
• Dutasteride (off-label): Inhibits type I + II; more potent.

Emerging / Adjunctive

• Low-level laser therapy (LLLT): Devices (combs, caps) — modest evidence.
• PRP (platelet-rich plasma): Growth factors → follicular stimulation; protocols vary.
• Microneedling + minoxidil: Enhanced delivery.
• Stem cell / exosome therapy: Preclinical/early clinical — not standard.
• JAK inhibitors (baricitinib, ritlecitinib): For alopecia areata; being studied for AGA.

Surgical

• FUE/FUT hair transplantation — permanent redistribution of DHT-resistant follicles (occipital).

Realistic Expectations

Early treatment preserves more follicles. Regrowth is partial. Maintenance is lifelong. Consult a dermatologist or hair restoration surgeon for personalized plan.