Hormonal treatments

The role of androgenic hormones has long been recognized in the development of baldness, whether in men or women going through menopause.

Testosterone is converted into dihydrotestosterone, DHT, by 5-alpha reductase enzymes, of which there are 2 types (type 1 and type 2). The transformation can be blocked by inhibitors of these enzymes, finasteride or dutasteride which blocks the 2 types of these enzymes (finasteride blocks only one, type 2).

Dutasteride (trade name AVODART®) does not have FDA approval for alopecia, but it does have approval for the treatment of benign prostatic hyperplasia. Its elimination takes much longer than finasteride.

Studies have shown that in women going through menopause, the secretion of androgens by the ovaries and adrenal glands is no longer compensated for by the secretion of oestrogen and progesterone.

Alopecia can then occur, and replacement therapy (HRT) is not always possible, especially if there is a history of breast cancer or vascular problems, phlebitis, or pulmonary embolism.

For younger people, certain ethinyl oestradiol-based birth control pills, which have anti-androgenic properties, can be of great help.

Anti-androgens, such as cyproterone acetate (ANDROCUR®) are no longer administered because they can promote the development of brain tumours (meningioma).

Some treatments are still possible with topical lotions containing oestradiol and / or progesterone.

In some situations, multidisciplinary investigations must be carried out so as not to miss ovarian pathology (polycystic ovaries).

In all these situations of androgenetic alopecia in women, the genome analysis is an important tool and allows a better assessment of the therapeutic objective.

Since the introduction of genetic testing, hormone dysregulation, although frequently found, is not always the main factor. Many other elements of a vascular, inflammatory or allergic nature can be determining factors.