Condition Guide
Androgenetic Alopecia
The most common cause of hair loss in both men and women. A direct 1-sentence answer: androgenetic alopecia is a genetically-driven progressive miniaturization of hair follicles caused by sensitivity to dihydrotestosterone (DHT), resulting in characteristic patterned hair loss over years to decades.
Reviewed by the Hair Scripts Medical Review Board · Last updated July 2026
Causes and mechanism
The DHT mechanism
Testosterone is converted to dihydrotestosterone (DHT) by the enzyme 5-alpha reductase. In genetically susceptible individuals, DHT binds to androgen receptors in scalp follicles — triggering a progressive shortening of the hair growth cycle (anagen phase) and miniaturization of the follicle shaft diameter over successive cycles.
Why it's genetic
The primary genetic determinant is the androgen receptor (AR) gene on the X chromosome, which explains the strong maternal inheritance pattern. Additional autosomal variants also contribute. Family history on either parent's side meaningfully increases lifetime risk.1
Pattern and staging
Male pattern (Norwood Scale I–VII)
I–II: Minimal temporal recession. Often invisible without comparison.
III–IV: Visible recession and early crown thinning. Most patients seek treatment here.
V–VI: Bridge of hair connecting temporal and crown areas thinning.
VII: Only a horseshoe band of hair remains at the sides and back.
Female pattern (Ludwig Scale I–III)
I: Widening of the central part. Often first noticed with styling or bright light.
II: Pronounced diffuse thinning across the crown. Volume noticeably reduced.
III: Severe thinning with near-complete loss of density at the crown. Hairline typically preserved.
Female pattern often coexists with telogen effluvium or hormonal triggers (PCOS, perimenopause).
Evidence-based treatments
| Treatment | Mechanism | Best for | Hair Scripts offers |
|---|---|---|---|
| Topical minoxidil (custom 8–10%) | Vasodilation, anagen extension | Grade 2–4 SULT1A1 | ✓ |
| Oral minoxidil (1–2.5 mg) | Systemic vasodilation | All patients, esp. Grade 1 | ✓ |
| Finasteride (oral) | 5-alpha reductase inhibitor — blocks DHT | Males (AMAB) primarily | Via provider |
| Topical finasteride | Local DHT inhibition, lower systemic absorption | Side-effect-sensitive patients | Via provider |
| Anti-gray complex (Grayversal) | Catalase support, melanin preservation | Patients concerned with graying | ✓ Add-on |
Frequently asked questions
Can androgenetic alopecia be reversed?
Early-stage androgenetic alopecia can often be halted and partially reversed. Minoxidil prolongs the growth phase and can increase density. The earlier treatment begins, the better the outcome — follicles that have been dormant too long cannot always be reactivated.
Is androgenetic alopecia the same as male pattern baldness?
Yes. 'Male pattern baldness' and 'female pattern hair loss' are the colloquial terms. Androgenetic alopecia is the clinical term used in research and medical literature.
Does custom compounded minoxidil work better than Rogaine?
Custom compounded minoxidil allows for higher concentrations (8–10% vs standard 2–5%) and vehicle bases tailored for scalp tolerance. For confirmed high-SULT1A1 patients, this can meaningfully outperform OTC formulations.
How long does treatment take to work?
Minoxidil typically shows early results (reduced shedding) at 2–3 months. Visible density improvement usually begins around month 4–6 and continues through month 12. Finasteride results are often slower — meaningful change by month 6–12.
Treating androgenetic alopecia with Hair Scripts
Complete the intake quiz. Your provider reviews your answers, photos, and SULT1A1 grade — then prescribes the right formulation for you.
This page is for informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a licensed healthcare provider before beginning any treatment.