Alopecia (Hair Loss): Androgenetic & Alopecia Areata

At a glance
Alopecia means pathological hair loss. The most common forms are:

  • Androgenetic alopecia (AGA) — hereditary hair miniaturization in men and women.

  • Alopecia areata (AA) — sudden round/oval patches of hair loss caused by an autoimmune process.

Early evaluation by a dermatologist–trichologist is key to distinguish these from telogen effluvium, fungal infection, traction, or scarring alopecias.

How they present

Androgenetic alopecia (AGA)

  • Men: bitemporal recession, crown thinning (Norwood–Hamilton scale).

  • Women: diffuse thinning over the crown with a preserved frontal hairline (Ludwig pattern).

  • Progressive miniaturization: hairs become thinner/shorter; scalp usually non-inflamed.

Alopecia areata (AA)

  • One or more smooth, sharply bordered patches without scarring.

  • “Exclamation mark” hairs at the border; may involve eyebrows/eyelashes or beard.

  • Relapsing–remitting course; can progress to total scalp loss (totalis) in some cases.

Red flags: pain/itch with redness or crusts, scarring, rapid complete shedding, broken hairs with scaling in children (possible tinea capitis). Seek prompt care.

Why it happens

  • AGA: genetic predisposition and follicle sensitivity to dihydrotestosterone (DHT).

  • AA: autoimmune attack on hair follicles; often associated with stress, infections, or other autoimmune diseases.

  • Contributors to evaluate: iron deficiency (low ferritin), thyroid disease, protein deficiency, medications, pregnancy/menopause shifts, tight hairstyles/chemical overprocessing.

Diagnosis

  • Specialist scalp exam and trichoscopy (dermatoscopy of scalp).

  • Labs as indicated: CBC, ferritin/iron, TSH (thyroid), vitamin D/B12; selective hormonal workup in women.

  • Rule out tinea capitis and scarring dermatoses.

  • Baseline photos/trichogram for monitoring.

Treatment

Results require consistency; meaningful changes are usually seen after 3–6 months and need maintenance.

AGA — evidence-based options

  • Topical minoxidil (5% foam/solution) — first line for men and women.

  • Oral finasteride/dutasteride for men (prescription; discuss adverse effects and contraception for partners of women who may become pregnant).

  • Antiandrogens for women (e.g., spironolactone) when appropriate and monitored by a specialist.

  • Adjuncts: PRP (platelet-rich plasma), microneedling, low-level laser therapy.

  • Hair transplantation (FUE/FUT) once disease is stable and donor supply is adequate.

  • Supportive care: gentle shampoos, UV scalp protection, correction of nutrient deficiencies.

AA — immunomodulatory approach

  • Intralesional corticosteroid injections (first-line for limited patches).

  • Topical corticosteroids or contact immunotherapy (e.g., DPCP) per protocol.

  • JAK inhibitors for moderate–severe disease under specialist supervision.

  • Topical minoxidil as an adjunct for regrowth.

  • Psychosocial support; cosmetic camouflage (fibers, micro-pigmentation) when desired.

What to expect

  • AGA: aim to slow progression and partially thicken hair; treatment is long-term/ongoing.

  • AA: spontaneous regrowth is possible, but relapses are common; plan regular follow-ups.

At-home care & lifestyle

  • Ensure adequate protein and iron intake; correct deficiencies.

  • Avoid tight hairstyles, harsh chemical treatments, and excessive heat styling.

  • Manage stress; prioritize sleep.

  • Protect the scalp from sun (hats, UV sprays).

When to seek urgent/early evaluation

  • Sudden clumps of shedding, children with scaly patches/broken hairs, signs of infection/scarring, intense itch/pain, rapid loss of brows/lashes.

  • Systemic clues: fatigue, pallor, cold extremities (possible iron deficiency), weight or heart-rate changes (thyroid).

Which specialist to see

Start with a dermatologist–trichologist. As needed: endocrinologist, gynecologist/andrologist, psychologist. Children: pediatrician + dermatologist.

Services & care in Yerevan

Typical pathway: consultation, trichoscopy, targeted labs; as indicated — PRP/microneedling, intralesional therapy, laser, or transplant planning. On Doctor911.am you can compare clinics, packages, and current offers, and book a visit.

FAQ

Do vitamins stop hair loss?
Only if you have a proven deficiency. Routine “hair vitamins” without deficits rarely help.

Do I need minoxidil forever?
For AGA, yes — stopping usually returns hair to its genetic trajectory over months.

Can home remedies replace treatment?
Scalp massage or mild tonics may improve comfort/circulation but do not replace evidence-based therapy.

Is there a single “AGA test”?
No. Diagnosis is clinical with trichoscopy and by excluding other causes.

Will a transplant fix it permanently?
Transplant redistributes hair; AGA continues in non-transplanted areas, so maintenance therapy remains important.

This article is informational and does not replace medical advice. If you notice rapid hair loss, scaly patches in a child, signs of infection, or scarring, arrange an in-person evaluation.