The opinion of injertocapilar.com on the Hairdx genetic tests
The latest genetic studies provide a tool when it comes to diagnosing and planning treatment. Given that the medicines available to treat AGA (androgenic alopecia) are drugs which manage to maintain hair (in the majority of cases) but not regenerate hair (in the minority of cases), then it is of utmost importance to be able to diagnose this condition early as the prevention of alopecia is crucial. The tests are useful mainly for dermatologists and hair surgeons, but are not used in the same way for each. A dermatologist may gain information from each of the four tests that exist, either to diagnose a possible case of alopecia early or to know if finasteride should be administered (especially in the USA where normally a dermatologist will not prescribe medicine without first having done the test, for legal reasons). For us hair surgeons, with the information which certain tests provide, we can establish a surgical protocol in some cases. Therefore, we consider the diagnostic AGA test to be of fundamental importance in two groups: young men with incipient hair loss and the androgens-AGA sensibility test in female cases. To be able to depend on a genetic test which, by studying the patient’s chromosome X, allows us to predict with some accuracy to what extent their alopecia could progress helps us to make more informed decisions when it comes to the therapeutic strategy: medical treatment or medical-surgical treatment. Therefore the tests do provide precise prognoses but not all of them can be applied to everyone. A more detailed look at the two groups: Young men, less than 26 – 27 years of age and with incipient alopecia: the AGA test is fundamental to determine their genetic predisposition and to know if their hair loss is only the beginning of something more serious or if the possibilities of it progressing are minor. The most typical case is a young man of 21 or 22 years who is beginning to worry about an increasingly high forehead and a receding hair line. If the test says that the alopecia will progress, then the prognosis is medical treatment and no surgery as there isn’t any justification for surgery yet. We wait and see how he responds to the medical treatment but there is NO need for surgery at the moment. In patients who have already developed a pattern of hair loss, either due to age or due to advanced alopecia in the case of a younger man, then the test is of no use as we already know that the alopecia is advanced and doing the test is not going to change the surgical strategy. The androgenic response test in men isn’t justified either (except when in legal terms). We know that in 90% of men finasteride will help to stabilise alopecia but not to re-grow hair. In 30% hair is recovered (66% for hairdx). That said, a negative test indicates that you will not recover hair but knowing that 90% is stabilised, then why do the test? Be it positive or negative the patient doesn’t need to stop taking the medication. Having this data helps us to make a better decision when it comes to treatment (medical and/or surgical). The more information we have then the more informed will be the decision and thus the results will be maximised. More importantly, for women: there is also a test for alopecia for women (also of little importance except if there is a doubt in the diagnosis). But for our surgical protocol, the androgenic response test is mandatory. For women, contrary to men, finasteride only works in 30% of cases and does not increase or maintain hair. A positive test result will justify surgical intervention, the repair and conservation of native hair providing a better result. A negative test indicates that the patient could continue losing hair and the only possibility is surgery. This diagnosis obliges us to re-evaluate the prognosis of surgical intervention. There are doctors who after receiving a negative test decide not to treat (by neither surgical nor medical means). It’s very difficult to say this to a patient, but as doctors, we are giving a very important prognosis and so the clearer things are at the beginning then the better it is for all concerned. So for women the test for androgenic alopecia is of little interest and the test for androgenic response is performed on all female patients who are not taking medicine when they arrive for the consultation. But this test will also confirm the diagnosis of androgenic alopecia and the grade to which the alopecia may progress (incipient or advanced). They are two tests in one; the androgenic response test includes the androgenic alopecia test, therefore making the latter test practically obsolete. In the case of men, a complete test which provides this kind of information is lacking. In summary, the protocol of action based on the tests is as follows:    
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Advanced Hair Transplant Clinic PIONEERS IN SPAIN Year 2003 FUE TECHNIQUE
PROTOCOL FOR MEN
< 27 Years
 27 - 40 Years
Alopecia
Emerging
With Finasteride
Without Finasteride
AGA TEST (MANDATORY)
Response TEST Finasteride (OPTIONAL)
SURGERY
Response TEST Finasteride (OPTIONAL)
RISK
RISK
Medical Treatment
Surgical Treatment +/- Firasteride
Control Treatment in 6 months and surgery
Finasteride to maintain and evaluate surgery
Control Treatment in 6 months and surgery
Finasteride to maintain and evaluate surgery
Alopecia
Established
+
-
+
-
+
-
PROTOCOL FOR WOMEN
THE ONLY POSSIBILITY IS SURGERY. PROGNOSIS IS BAD
Response TEST Finasteride  (MANDATORY)
BEGIN FINASTERIDE (+/-) MINOXIDIL AND PLAN SURGERY. PROGNOSIS IS GOOD