Androgenetic alopecia — commonly called male pattern baldness or female pattern hair loss — is responsible for approximately 95% of all hair loss cases. Understanding what drives it, how it progresses, and what actually works is the foundation of any effective treatment plan.
What Is Androgenetic Alopecia?
Androgenetic alopecia is a genetically determined sensitivity of hair follicles to dihydrotestosterone (DHT), a hormone derived from testosterone. In genetically susceptible individuals, DHT causes follicles on the scalp to miniaturise — producing progressively thinner, shorter hairs until the follicle eventually stops producing hair altogether.
The condition is called "androgenetic" because it requires both androgenic hormones (DHT) and a genetic predisposition. Having high testosterone does not cause it — what matters is whether your follicles are genetically sensitive to DHT.
How It Progresses
Androgenetic alopecia follows a predictable pattern, described by the Norwood Scale in men and the Ludwig Scale in women.
In men, loss typically begins at the temples and crown, expanding outward. The back and sides of the scalp — the "donor safe zone" — remain DHT-resistant throughout life, which is why hair transplants work: donor follicles relocated from this zone retain their DHT resistance permanently.
In women, loss presents as diffuse thinning across the top of the scalp rather than a receding hairline, preserving the frontal hairline in most cases.
Treatment Options
Finasteride (oral)
Finasteride is a prescription medication that inhibits the enzyme converting testosterone to DHT. By reducing DHT levels in the scalp, it slows or halts follicle miniaturisation.
Clinical evidence: finasteride reduces scalp DHT by approximately 60% and prevents further loss in around 85% of users. Around 65% see some regrowth of miniaturised hair. It requires daily use and effects reverse within 6–12 months of stopping.
Side effects — most commonly reduced libido or sexual function — affect approximately 2–5% of users. These resolve in most cases on stopping the medication. Discuss with a physician before starting.
Minoxidil (topical or oral)
Minoxidil prolongs the anagen (growth) phase of the hair cycle and stimulates blood flow to follicles. Applied topically (2% or 5% solution/foam) or taken as a low-dose oral medication.
Topical minoxidil slows loss and produces modest regrowth in miniaturised follicles. It is less effective than finasteride at preventing loss but has fewer systemic side effects. Oral minoxidil (0.25–1.25mg daily) shows stronger results but requires medical supervision.
Both forms require continuous use — stopping causes the maintained hair to shed.
PRP (Platelet-Rich Plasma)
PRP involves extracting a small amount of the patient's blood, concentrating the growth factors, and injecting them into the scalp. Evidence suggests PRP can slow miniaturisation and stimulate some regrowth in early-stage androgenetic alopecia.
PRP is best used as an adjunct to medication, not a standalone treatment. It is not effective at restoring permanently lost hair.
Hair Transplant
A hair transplant permanently relocates DHT-resistant follicles from the donor zone to areas of loss. Transplanted hair grows for life because the follicles retain their genetic DHT resistance regardless of location.
A hair transplant addresses existing loss — it does not stop ongoing miniaturisation in native hair. For this reason, medication (finasteride and/or minoxidil) is usually recommended alongside transplantation to protect remaining native hair.
The Most Effective Approach
For most patients with established androgenetic alopecia, the most effective strategy combines all three:
- Hair transplant to restore areas of permanent loss
- Finasteride to slow or halt ongoing loss in native hair
- Minoxidil to support density in miniaturising areas
This combination maximises results from a single transplant session and minimises the number of future sessions needed.
When to Act
The ideal time to start treatment is early — when miniaturisation is occurring but before permanent loss is established. Early intervention with medication can preserve follicles that would otherwise be lost. Once follicles are permanently gone, only a transplant can restore density.
Free Assessment
At Estetİstanbul, every consultation includes an honest assessment of your androgenetic alopecia stage, a personalised treatment recommendation, and an honest view of what a transplant can and cannot achieve. We will tell you if medication alone is the better starting point.
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