Androgenetic alopecia (AGA)
Hereditary, hormone-mediated hair loss — the common “male pattern” and “female pattern” baldness. It is progressive, driven by follicular sensitivity to DHT, and is the main indication for hair transplantation.
Androgenetic alopecia is hereditary, hormone-mediated hair loss — the common “male pattern” and “female pattern” baldness that accounts for the overwhelming majority of hair loss presenting to clinics, and the primary indication for hair transplantation. It is progressive by nature: untreated, the pattern advances over years to decades.
The mechanism runs through androgens. In genetically susceptible follicles, dihydrotestosterone (DHT) drives miniaturisation: each growth cycle produces a slightly shorter, finer hair, growth phases shorten, and terminal hairs regress toward invisible vellus hairs until follicles fall silent. Susceptibility is regional — frontal and crown follicles carry it, occipital donor follicles largely do not — which is the asymmetry that makes transplantation possible.
Diagnosis is more than recognising a receding line. History and examination distinguish AGA from mimics — telogen effluvium’s diffuse shedding after stressors, patchy autoimmune loss, scarring alopecias that contraindicate transplant — and trichoscopy quantifies miniaturisation and maps zones that still look covered but are already thinning. Getting this step right is why “hair loss consultation” is a medical act, not a sales meeting.
Management is a ladder, not a single rung. Pharmacology addresses the process — 5α-reductase inhibition to lower DHT, minoxidil to support growth phases — and adjuncts such as PRP sit alongside. Surgery redistributes resistant follicles but treats nothing: it must be planned against a progressing background, which is why stabilising loss first, and modelling future stages before designing today’s hairline, separates durable results from transplants that strand an island of hair as native loss advances behind it.
AGA is the most common form of hair loss by a wide margin, affecting a large share of men and a substantial share of women across a lifetime — which is why it anchors every hair clinic’s case mix and why its emotional weight deserves clinical respect. The consultation that treats distress seriously, sets expectations against the progression curve, and offers the full ladder rather than jumping to surgery is both better medicine and, over the years, a better business.
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