Androgens and Alopecia

    Keith D. Kaufman
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    TLDR Male hormones, particularly DHT, are linked to male pattern hair loss, and treatments like finasteride can help, but they don't work for postmenopausal women's hair loss, which may have different causes.
    The document from 2002 examines the influence of androgens on androgenetic alopecia (AGA) in both men and women. It identifies dihydrotestosterone (DHT) as a key androgen in the development of male pattern hair loss (MPHL), based on observations of eunuchs and males with 5α-reductase (5αR) deficiency who do not experience hair loss. The effectiveness of finasteride, a 5αR inhibitor, in treating MPHL is supported by three Phase III trials involving 1553 men aged 18-41, where 48% of those treated showed improved scalp hair coverage after 5 years, compared to a 75% worsening in the placebo group. However, finasteride was not effective in postmenopausal women with female pattern hair loss (FPHL), indicating a possible different pathophysiology between MPHL and FPHL. The document concludes that more research is needed to understand the molecular mechanisms of androgen regulation of hair growth and the pathophysiological differences between MPHL and FPHL.
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