Androgenetic Alopecia: A Systemic Disease Beyond Androgenic Influence

Androgenetic alopecia (AGA) has traditionally been treated as a dermatological condition caused by the impact of androgens on hair follicles. However, new evidence points to a much more complex model, in which AGA should be considered a manifestation of a multifactorial systemic disorder, going beyond the isolated action of dihydrotestosterone (DHT).

According to Leite Júnior (2024), there is a growing understanding that androgenetic alopecia is strongly associated with chronic inflammatory processes, metabolic dysregulation, and oxidative stress. The progression of AGA occurs concomitantly with systemic factors such as insulin resistance, increased peripheral inflammation, alterations in gut microbiota, and continuous exposure to endocrine disruptors. These elements not only aggravate alopecia but are also part of a broader picture of metabolic and inflammatory disorders that impact the overall health of the individual.

Another relevant factor is the increasing inefficacy of therapies exclusively based on androgen blockade. Although finasteride, dutasteride, and other antiandrogens have shown efficacy in many cases, a significant number of patients do not respond to these approaches, suggesting that AGA cannot be explained solely by androgen action. Leite Júnior (2024) argues that the excessive emphasis on the androgenic pathway may have limited the advancement of new therapies, delaying the development of more comprehensive approaches that consider the underlying inflammatory and metabolic processes.

The reduction of sex hormone-binding globulin (SHBG), frequently observed in individuals with insulin resistance and chronic inflammation, may lead to greater bioavailability of free testosterone and its conversion to DHT. However, this alteration does not occur in isolation; it is embedded within a broader context of metabolic dysregulation, suggesting that the biological environment of the patient may be more determinant than absolute androgen levels.

Given this new perspective, it is essential to redefine AGA as a systemic disease, where metabolic, inflammatory, and environmental factors play a central role. The future treatment of androgenetic alopecia should not be limited to hormonal blockade but should integrate strategies that address the multiple underlying triggers of the disease, promoting a broader and more effective approach to both hair and systemic health

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