Androgenetic alopecia — Clinical SAQ · MBBS SAQ

Question

10 marks10 min

Stem

A 34-year-old Caucasian man presents to the dermatology clinic with progressive thinning at the temples and crown over the past three years. His maternal grandfather was reportedly "completely bald by the age of 30." On examination he has bitemporal recession extending approximately 2 cm above the coronal suture and a 3 × 3 cm area of vertex thinning, with a band of hair separating the two regions. Trichoscopy shows hair diameter diversity greater than 20%, scattered peripilar halos, and preserved follicular ostia. His blood pressure is 128/82 mmHg, BMI 26 kg/m², and examination is otherwise unremarkable. He is a non-smoker with no significant medical history. He is concerned about progression and asks about treatment options.

Questions

a) What is the most likely diagnosis and what clinical and trichoscopic features support it? (2 marks) [1]

b) Outline a stepwise management plan with first-line and second-line options, including counselling points about adherence and teratogenicity. (4 marks) [1]

c) What is the mechanism of action of finasteride, and what baseline investigations should be performed before starting it? Why does finasteride influence serum PSA testing? (2 marks) [1]

d) What features would make you reconsider the diagnosis or refer for scalp biopsy? List three red flags. (2 marks) [1]

References

[1]Devjani S, Ezemma O, Kelley KJ, et al. Androgenetic Alopecia: Therapy Update Drugs, 2023.PMID 37166619
[2]Oiwoh SO, Enitan AO, Adegbosin OT, et al. Androgenetic Alopecia: A Review Niger Postgrad Med J, 2024.PMID 38826011
[3]Nestor MS, Ablon G, Gade A, et al. Treatment options for androgenetic alopecia: Efficacy, side effects, compliance, financial considerations, and ethics J Cosmet Dermatol, 2021.PMID 34741573
[4]Wang R, Lin J, Liu Q, et al. Micronutrients and Androgenetic Alopecia: A Systematic Review Mol Nutr Food Res, 2024.PMID 39440586
[5]Gupta AK, Talukder M, Williams G. Comparison of oral minoxidil, finasteride, and dutasteride for treating androgenetic alopecia J Dermatolog Treat, 2022.PMID 35920739
[6]Gupta AK, Talukder M, Venkataraman M, et al. Minoxidil: a comprehensive review J Dermatolog Treat, 2022.PMID 34159872
[7]Kearney CA, Brinks AL, Lawrence CN, et al. Androgenetic Alopecia in Women: A Narrative Review of Pathophysiology, Clinical Evaluation, and Treatments Am J Clin Dermatol, 2026.PMID 41714473
[8]Li H, Li W, Zhang J, et al. Risk factors for androgenetic alopecia: a systematic review and meta-analysis BMC Public Health, 2026.PMID 41606541
[9]Ramos-Rodriguez D, Sanchez-Baez D, Cabrera-Garcia P, et al. Characterization and Management of Androgenetic Alopecia in Transgender and Gender-Diverse Individuals: A Narrative Review Dermatol Ther (Heidelb), 2026.PMID 41920277
[10]Gupta AK, Talukder M, Williams G, et al. Low-dose oral minoxidil (LDOM) and topical minoxidil: consensus recommendations for managing male and female pattern hair loss in hair transplant patients using a modified Delphi process Expert Opin Pharmacother, 2026.PMID 41782304
[11]Spindler A, Maas D, Adler R, et al. No increased cardiovascular hazard with oral 5-alpha-reductase inhibitors in treatment of androgenetic alopecia: A TriNetX retrospective cohort study J Am Acad Dermatol, 2026.PMID 42036027
[12]Husseinali M, Engineer N, Asempa O, et al. Cardiometabolic comorbidities associated with androgenetic alopecia: Findings from a sex-stratified, propensity-matched national cohort Dermatol Online J, 2026.PMID 42246337
[13]He J, He M, Zhang D, et al. Early androgenetic alopecia as a possible indicator of diabetes mellitus and its link to cardiovascular risks: A cross-sectional study J Am Acad Dermatol, 2026.PMID 41785995