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The mechanism by which the androgen receptor triggers Dermal Papilla permanent senescence is not known but may involve IL6, TGFB-1 and oxidative stress.

In women, the diagnosis usually requires more complex diagnostic evaluation.

Further evaluation of the differential requires exclusion of other causes of hair loss, and assessing for the typical progressive hair loss pattern of androgenic alopecia.

As it progresses, a rim of hair at the sides and rear of the head remains.

This has been referred to as a 'Hippocratic wreath', and rarely progresses to complete baldness.

Ketoconazole shampoo has also shown consistent efficacy in improving androgenetic alopecia either by its antiandrogenic effects or by improving seborrheic dermatitis which aggravates androgenetic hair loss.

Finasteride is a medication of the 5α-reductase inhibitors (5-ARIs) class.

Although hair follicles were previously thought to be permanently gone in areas of complete hair loss, they are more likely dormant, as recent studies have shown the scalp contains the stem cell progenitor cells from which the follicles arose.

Transgenic studies have shown that growth and dormancy of hair follicles are related to the activity of insulin-like growth factor (IGF) at the dermal papillae, which is affected by DHT.

The grafts are obtained from either follicular unit transplantation (FUT) or follicular unit extraction (FUE).

In the former, a strip of skin with follicular units is extracted and dissected into individual follicular unit grafts, and in the latter individual hairs are extracted manually or robotically (with the FDA cleared ARTAS system).

Previously, it was believed to be caused by testosterone just as in male baldness, but most women who lose hair have normal testosterone levels.

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