AGA/FAGA

About AGA and FAGA

AGA (Androgenetic Alopecia) is a progressive hair loss condition in which dihydrotestosterone (DHT), a male hormone, acts on hair follicles to shorten the growth phase of the hair cycle, causing hair to become thin and short. FAGA (Female Androgenetic Alopecia) is a similar condition occurring in women, characterized by overall volume loss in the frontal and vertex regions. Both conditions are primarily caused by genetic predisposition and androgen receptor sensitivity. If left untreated, hair follicles permanently shrink, making early treatment intervention important.

Mechanism of Onset and Scientific Evidence

DHT, the primary causative substance in AGA, is produced when the enzyme 5α-reductase converts testosterone. When DHT binds to androgen receptors in the hair papilla, it increases TGF-β1 production and suppresses IGF-1 production, impairing hair matrix cell proliferation and advancing hair follicle "miniaturization." A systematic review published in the Journal of Cosmetic Dermatology (2021; doi:10.1111/jocd.14537) comprehensively summarizes the efficacy and safety of diverse AGA treatment approaches, including oral medications, topical agents, phototherapy, and surgical treatments, positioning 5α-reductase inhibitors and minoxidil as the current standard-of-care treatments. For the female type (FAGA), estrogen decline and age-related increases in androgen receptor sensitivity are thought to be involved; a recent review in Drugs (2023; doi:10.1007/s40265-023-01880-x) also points to the multifactorial involvement of genetic and environmental factors.

Types of Treatments We Offer

Oral Therapy (5α-reductase inhibitors and oral minoxidil)

Finasteride (1 mg) and dutasteride (0.5 mg) inhibit 5α-reductase and suppress DHT production. Oral minoxidil awakens hair follicles through vasodilation and direct action on the hair papilla, extending the growth phase. A review in Drug Design, Development and Therapy (2019; doi:10.2147/DDDT.S214907) details the mechanism of hair follicle expansion through minoxidil's blood flow promotion and potassium channel opening action. Males are candidates for finasteride and dutasteride; however, females (FAGA) cannot typically use 5α-reductase inhibitors, making oral or topical minoxidil or anti-androgen medications the options.

Topical Therapy (Topical minoxidil)

Topical minoxidil solution and foam can be used by both men and women as a foundation for hair growth promotion and should be continued long-term. Combining oral and topical medications provides additive effects. Adherence to proper dosing (twice daily, applied directly to the scalp) is essential, and evaluation should continue for at least 3–6 months.

Mesotherapy and PRP Therapy

PRP (platelet-rich plasma) is concentrated platelets derived from the patient's own blood. When injected into the scalp, it locally supplies growth factors (PDGF, EGF, VEGF, IGF-1, and others). A 1-year prospective study published in the Journal of Cutaneous and Aesthetic Surgery (2014; doi:10.4103/0974-2077.150743) confirmed significant increases in hair density and hair shaft diameter in AGA patients treated with PRP injection. Additionally, a 2017 study in the International Journal of Molecular Sciences (doi:10.3390/ijms18020408) examined differences in growth factor concentrations between non-activated and activated PRP, demonstrating that both are effective for promoting hair growth.

Low-Level Laser Therapy (LLLT) and Medical Devices

Low-level laser therapy (LLLT) delivers light energy around 650 nm to the scalp, activating mitochondria and enhancing the metabolism of hair follicle cells. A multi-center, double-blind RCT published in the American Journal of Clinical Dermatology (2014; doi:10.1007/s40257-013-0060-6) reported that hair density in both men and women increased significantly compared to sham irradiation, with good tolerability. When combined with microneedling (such as dermapen), the Wnt pathway activation accompanying wound healing and growth factor release provide additive hair growth promotion, as confirmed in a randomized comparative trial in the International Journal of Trichology (2013; doi:10.4103/0974-7753.114700).

Treatment Flow

At the initial consultation, we conduct a detailed assessment of your current hair loss pattern and progression stage (Hamilton-Norwood classification for males with AGA; Ludwig classification for females with FAGA), lifestyle, and medical history. We perform dermoscopy for detailed evaluation of the scalp and hair follicles. When necessary, blood tests (thyroid function, anemia, zinc, DHEA-S, etc.) are performed to rule out other conditions before proposing a personalized plan combining oral medications, topical treatments, and procedures. After treatment begins, we evaluate efficacy at 3 and 6 months and optimize the plan accordingly.

Downtime and Precautions

Oral and topical therapies have virtually no downtime and impose no restrictions on daily activities. After PRP injection, temporary petechiae and mild swelling may occur at the injection site but typically resolve within a few days. After laser treatment, you may be asked to avoid styling on the treatment day. Since AGA re-manifests when treatment is discontinued (due to renewed DHT effects on hair follicles), continued treatment is the standard approach to maintain results. Early in treatment, "initial hair shedding" may occur due to hair cycle reset—a transient phenomenon requiring no concern.