Symptoms:

• Receding hairline (M shaped pattern)

• Thinning crown
• Tight scalp
• Scalp itch (could also be psoriasis or unhealthy scalp)
• Hair fall (with minituarized bulbs)

Diagnosis:

• Androgenetic alopecia (AGA), commonly known as male or female pattern baldness, is a prevalent form of hair loss characterized by:
  • Increased telogen:anagen ratio
  • Hair follicle miniaturization
  • Dermal sheath thickening and perifollicular fibrosis in balding areas
• Causes and contributing factors:
  • Genetics and androgens play a significant role
  • Elevated androgen receptor density, type II 5α-reductase activity, and DHT in balding scalps
  • Recent research suggests non-androgenic factors (e.g., retinoid receptors, PPAR pathways) may also contribute
• Key points:
  • Affects both men and women, with potentially different patterns
  • The "DHT genetic sensitivity" theory is incomplete, as evidenced by observations in women without androgen production
  • Chronic and progressive nature may be partly explained by structural changes in the scalp

There are many alternative theories on the true cause of the issue:

Tension Theory:

• AGA is caused by chronic scalp tension transmitted from the galea aponeurotica (a dense fibrous membrane on the scalp).
• This tension leads to inflammation and the development of fibrosis (scarring) and calcification in scalp tissues.
• These tissue changes restrict growth space and blood flow to hair follicles, leading to their miniaturization and eventual hair loss.
• Androgens (like testosterone) and a signaling molecule called TGF-beta1 play a role in this process, but they are not the initial cause.
• https://www.sciencedirect.com/science/article/pii/S0306987717310411