Pattern hair loss, also known as androgenetic alopecia, is a hair loss condition that primarily affects the top and front of the scalp. In male-pattern hair loss, the hair loss typically presents itself as either a receding front hairline, loss of hair on the crown and vertex of the scalp, or a combination of both. Female-pattern hair loss typically presents as a diffuse thinning of the hair across the entire scalp. The condition is caused by a combination of male sex hormones and genetic factors. Some research has found evidence for the role of oxidative stress in hair loss, the microbiome of the scalp, genetics, and circulating androgens; particularly dihydrotestosterone. Men with early onset androgenic alopecia (before the age of 35) have been deemed the male phenotypic equivalent for polyendocrine metabolic ovarian syndrome. The cause of female pattern hair loss remains unclear; androgenetic alopecia for women is associated with an increased risk of polyendocrine metabolic ovarian syndrome. Management of hair loss may include styling the remaining hair in a creative manner to make hair loss less apparent or shaving one's head to improve the aesthetic aspect of the condition. Otherwise, common medical treatments include platelet-rich plasma, low-level laser therapy, minoxidil, finasteride, dutasteride, or hair transplant surgery. Use of finasteride and dutasteride in women is not well-studied and may result in birth defects if taken during pregnancy. By the age of 50, pattern hair loss affects about half of males and a quarter of females. It is the most common cause of hair loss. Both males aged 40–91 and younger male patients of early onset androgenetic alopecia (before the age of 35) had a higher likelihood of metabolic syndrome (MetS) and insulin resistance. In both older and younger populations of men who had early onset androgenic alopecia, metabolic syndrome has been found to occur approximately four times as frequently as in a demographically similar population without androgenic alopecia, which is a clinically significant difference. Abdominal obesity, hypertension, and lowered high-density lipoprotein were also significantly higher for younger groups.
Signs and symptoms
Pattern hair loss is classified as a form of noncicatricial alopecia, i.e. a sort of non-inflammatory non-scarring hair loss. Male-pattern hair loss begins above the temples and at the vertex (calvaria) of the scalp. As it progresses, a rim of hair at the sides and rear of the head remains. This has been referred to as a "Hippocratic wreath" and rarely progresses to complete baldness. Female-pattern hair loss more often causes diffuse thinning without hairline recession; similar to its male counterpart, female androgenic alopecia rarely leads to total hair loss. The Ludwig scale grades severity of female-pattern hair loss. These include Grades 1, 2, 3 of balding in women based on their scalp showing in the front due to thinning of hair. In most cases, receding hairline is the first starting point; the hairline starts moving backwards from the front of the head and the sides.
Causes The cause of pattern hair loss is not yet fully understood. It appears to be the result of genetic changes that make the activity of hair follicles on the scalp become sensitive to the presence of androgenic hormones, cholesterol, and proteins such as insulin-like growth factor.
Hormones and genes KRT37 is the only keratin that is regulated by androgens. This sensitivity to androgens was acquired by Homo sapiens and is not shared with their great ape cousins. Although Winter et al. found that KRT37 is expressed in all the hair follicles of chimpanzees, it was not detected in the head hair of modern humans. As androgens are known to grow hair on the body but decrease it on the scalp, this lack of scalp KRT37 may help explain the paradoxical nature of Androgenic alopecia as well as the fact that head hair anagen cycles are extremely long. Although it is generally accepted that male pattern baldness follows a pattern of autosomal dominant inheritance, more recent research has shown that approximately 80% of bald men have bald fathers. This is greater than would be expected if pattern balding were a purely autosomal trait, and may suggest that there is an important paternal route of inheritance, either through a Y-chromosome gene or a paternal imprinting effect.
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