Androgenic alopecia (AGA) is a partial or complete loss of hair that occurs in a progressive pattern in genetically predisposed individuals.  The basis of androgenic alopecia is a progressive decrease in the density of terminal hairs and concurrent increase in density of vellus hairs.

In effect, terminal hairs are turned off and are transformed into vellus hairs, and this effect is due to hair follicle miniaturization, which is associated with substantial reduction in hair diameter. Although the mechanisms of these changes have not been established definitively, male pattern baldness is known to depend on androgens, in particular the dihydrotestosterone DHT. DHT is synthesized from testosterone by 5α-reductase enzyme and is the most potent androgen in AGA.

Ketoconazole (KCZ) is an antifungal agent. Long term use of 2% KCZ shampoo was reported to be effective against androgenic alopecia in patients without seborrheic dermatitis and dandruff. The efficacy of 2% KCZ shampoo in androgenic alopecia patients is conected to its antiandrogenic properties.

Dr Elena Arsova, reccomends Ketoconazole shampoo to many of her patients regardless of the presence of dandruff or seborrheic dermatitis.