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Androgenetic alopecia in women

Androgenetic alopecia (AGA) is a condition related to the influence of androgen hormones on hair follicles. Androgens may stimulate a slow transformation and finally the "deactivation" of the hair follicle (so-called miniaturization). It is observed in people with genetic predispositions and often runs in the family. In the Caucasian population, androgenetic alopecia is observed in 80% of men and approximately 40% of women. In people of Asian descent and African Americans, the prevalence of AGA is lower.

Androgenetic alopecia in women is often called by the abbreviation FAGA (female androgenetic alopecia) or FHPL (female pattern hair loss).

Female androgenetic alopecia may have different clinical presentations. Often, it is related to hair thinning, with the so-called Christmas tree sign, where the thinning of hair is more visible near the forehead and less visible towards the vertex. Less frequently, diffuse hair thinning is accompanied by the recession of the hairline in temporal areas. All these conditions give a clinical picture of marked variation of hair thickness between the frontal and occipital areas. Moreover, the number of hair units with more than one hair decreases; they are replaced by single-hair units. Androgenetic alopecia may be a symptom of hormonal disorders, such as polycystic ovaries syndrome (PCO), and may accompany such conditions as insulin resistance or metabolic syndrome. Androgenetic alopecia may be accompanied by seborrhea.

Course of disease
The condition is progressive. First symptoms of the androgenetic alopecia may appear before age 20. In females, complete hair loss does not occur.

Beside clinical examination, trichoscopy plays an important in diagnosing AGA. Tricoscopy allows to differentiate the condition from other types of hair loss. It is particularly important due to the fact that androgenetic alopecia may be accompanied by chronic telogen effluvium. Sometimes, laboratory tests are recommended to rule out the possibility of coexistence of hormonal disorders.

The treatment of androgenetic alopecia is the more efficient the faster it is implemented as the miniaturization of hair follicles is only partially reversible. In treatment, preparations of minoxidil and 5-α-reductase inhibitors, finasteride and dutasteride are used. In women, general treatment with androgen suppressants or antagonists, such as spironolactone or cyproterone acetate and estrogen, may be introduced. In AGA therapy, injections of autological platelet-rich plasma may be also used. Reconstruction treatment (hair transplantation) also has some importance in the treatment of androgenetic alopecia.