Male androgenetic alopecia also known as male pattern hair loss or male balding is a common condition faced by many men. The proportion of men experiencing hair loss increases with age. Rough estimates have shown about 16% for men between the age of 18-29 and up to 53% for men aged 40-50. Male pattern baldness is characterized by the progressive loss of terminal hairs on the scalp in a characteristic distribution. The common distribution of hair loss is at the anterior scalp, mid-scalp, temporal scalp, and vertex of the scalp. The most common tool used to describe this condition is the Hamilton-Norwood scale.
So what makes you prone to hair loss? 3 main factors influencing this condition are age, genetics and hormones compared to other minor factors. These factors contribute to the gradual shrinkage of scalp hair follicles resulting in follicular miniaturization.
The hair growth cycle consists of 3 phases.
1. Anagen (growth) lasting 3-5 years for hairs on our head
2. Catagen (transition) lasts around 10 days, growth stops and hair follicle starts to shrink
3. Telogen (resting) lasting around 3 months, during which hair sheds
The perception of hair “loss” we see in androgenetic alopecia is the result of the shortening of the anagen (growth) phase of hair follicles, rather than the complete cessation of hair growth in affected areas.
The shortened anagen phase leads to the production of shorter, thinner vellus hair shafts, resulting in follicular miniaturization thus making hair coverage of the scalp progressively decrease.
Other possible causes are:
2. Iron deficiency
3. Severe chronic illness, such as lupus
5. Side effects of medical treatment
When to see your doctor?
Some men see hair loss as a natural part of growing older, and they do not perceive the need for immediate treatment. However, hair loss can trigger negative psychological effects, such as low self-esteem due to cosmetic appearance. In some, it can contribute to depression. Here are some treatments that may help reduce hair loss.
The 2 commonly used medications to treat male pattern baldness are minoxidil solution or foam and finasteride/dutasteride.
- Minoxidil solution or foam
Minoxidil is a topical treatment applied to the scalp. It is available over the counter (OTC) at pharmacies, usually as a lotion or foam. 5% or 2% variant minoxidil applied at 1ml/day over the scalp has proven to help with the prevention of hair loss and stimulation of hair growth. It may take up to 3-6 months for the treatment to start producing results and the medication should be used indefinitely to preserve effects. Some adverse side effects include scalp irritation, contact dermatitis, other rare side effects include headache, lightheadedness and irregular heartbeat.
- Finasteride and dutasteride
Finasteride, or Propecia, is an oral treatment available only on prescription by your doctor.Finasteride is a 5-Alpha Reductase Inhibitor. It prevents the conversion of testosterone to dihydrotestosterone (DHT), a male hormone that plays a significant role in miniaturization of the scalp hair follicles. Dutasteride is similar to Finasteride. It is also a 5-Alpha Reductase Inhibitor. The drug blocks the formation of this hormone in the scalp, slowing the progression of baldness related to DHT.
The effects can take more than 6 months to appear. The 1 milligram (mg) tablet must usually be taken once a day for at least 3 months. If the medication is stopped, the effects will be reversed. The rare side effect of finasteride is it can cause sexual dysfunction. This may include reduced libido, difficulty achieving an erection, and ejaculation disorders.
Other adverse effects include:
- Breast tissue tenderness or enlargement (Gynecomastia)
- Swelling of the lips, tongue, or face
- Abdominal pain
- Back pain
Shampoo treatments used together with medical therapy for male pattern baldness have promising results. The combinant therapy has superior results compared to monotherapy
Ketoconazole 2 percent, also known as Nizoral can be purchased OTC.
Hair transplantation involves taking hair follicles from elsewhere and grafting them onto the scalp.
Hairs in the lower part of the back of the scalp are more resistant to androgens, thus they are more commonly used in surgical transplants. The hair donated to balding areas remains resistant to the male hormones. The surgical transplantation involves taking a strip of skin from another part of the head, complete with hair, to graft it onto the bald area transplanting individual hairs, which avoids scarring
The transplantation procedures are expensive.
As male pattern baldness occurs over time, the faster we act to prevent hair loss the better the results are. Speak to your doctor before starting any treatment, to find the best option of treatment for you.