Male Pattern Hair Loss - Causes and Treatment

The tenderest spot of a man can sometimes be his bald head. This hard fact notwithstanding, there is more felicity on the far side of baldness than hairy young men can ever imagine.
Why, because women love a self-confident bald man, whose baldness is often likened to the comb of experience that life gives him after he’s gone bald!

Alopecia

This is the scientific term for all kinds of baldness. However the baldness that most of us know and usually refer to is the “Male Pattern Baldness” or “Male Pattern Hair Loss”, the most common type of alopecia.

Male Pattern Hair Loss

Hair is lost in a well-defined pattern, beginning above both temples and getting thin at the crown of the head. Often a rim of hair around the sides and back of the head is left. Rarely the condition may progress to complete baldness.

Mechanics of the Hair Cycle

Hair grows in a cycle of three phases namely Anagen, Catagen and Telogen. The hair of a given region of the body, are never in the same phase of the cycle.

Anagen

The lengthening phase in which hair grows at a rate of approximately 1cm a month. The ultimate length achieved depends on the duration of this phase which varies with geographic locale and ethnic predisposition.

Catagen

This is a phase of transformation and lasts about three to four weeks

Telogen

The final stage in the hair cycle. Hair is shed toward the end of this resting phase.

Types Of Balding

Alopecia is broadly sub divided into two major varieties, Non Scarring and Scarring.

Non Scarring Alopecia

Non Scarring Alopecia includes
Nutritional – Iron deficiency, Zinc Deficiency
Androgenic- Male pattern baldness or Androgenic Alopecia.
Autoimmune- Antibodies are directed against hair follicle roots; further subdivided into,
Areata- Patches of scalp baldness
Totalis- Total scalp baldness Universalis- Complete loss of all body and scalp hair.

Scarring Type Of Alopecia

Scarring type of alopecia involves fungal infections, trauma, burns and disorders of the skin such as Lichen planus and DLE.
The bewildering array of Alopecia variants should not confuse us. We need to focus only on the most commonest and important variety, which is ‘Male Pattern Hair Loss” or ‘Androgenic Alopecia’

Causes of Male Pattern Hair Loss (Androgenic Alopecia)

Among the causes of Male Baldness are genetic reasons, environmental influences, Chemotherapy and several others.

Genetics

The male hormone testosterone is converted by various tissues in the body including hair, to an active metabolite called DHT (Di Hydro Testosterone). DHT acts on receptors at the molecular level of a hair follicle influencing normal hair growth.
A defect in the gene coding for this receptor leads to an abnormal variant which is susceptible to DHT, leading to hair loss. What is interesting, is the mode of inheritance of this gene. Being an ‘X’-linked recessive disorder, it is carried by females and transmitted to only those male offspring that inherit the defective X chromosome.

Environmental Influence

Environmental factors do not act directly, but do have a role in exacerbating pre existing genetic baldness. These include, High pressure jet showers and bathing in hard water.
Excessive use of chemicals to the hair (dyes, shampoos, gels, gums, make up work), Continuous use of caps/balaclavas and Nutritional deficiency.

Male Pattern Hair Loss Treatment

The treatment of “Male Pattern Hair Loss” is undertaken for cosmetic reasons only. Hair loss will be a continuous process and cannot be reversed unless one can replace the defective gene.
The aim of treatment therefore is to slow down the shedding and delay progression to overt baldness.

Hairstyle Cosmetics - Hair Weaving

This involves intricately interweaving donor hair with the client’s residual hair, using various methods such as bonding, tracking, fusion, netting and tree braiding. Donor hair can be natural or synthetic and may be chemically treated to alter texture.
This is a delicate and costly procedure with imposing constraints regarding handling, showering and combing.

Hair Transplantation

This is surgical procedure wherein portions of lush scalp are removed and transplanted to areas of bald scalp. The earlier method of single Follicle Unit Harvesting/Extraction (FUE) has been superseded by Strip Harvesting which uses the technique of Follicular Unit Transplantation or Direct Implantation.
Drawbacks include extremely high cost of the procedure, shock loss or thinning of hair, itching, swelling of the scalp and scab formation.

Wig

The time tested and simple solution that is affordable and not all that bad.

Medical Management of Hair Loss

Two classes of drugs are used. Anti androgens and Vasodilators.

Anti Androgens

Although agents such as Spironolactone, Cimetidine and Cyproterone have been tried, Finasteride (Propecia) remains the only FDA approved prototype for this group. It is a 5A – Recductase enzyme inhibitor that prevents conversion of testosterone to DHT. It is a drug primarily beneficial in reducing the size of the enlarged male prostate gland. However, Propecia has gainfully been used in ‘male pattern’ hair loss therapy at a much lower daily dose of 1mg. Therefore, it promotes hair growth in ‘Androgenic Alopecia’ and prevents hair loss as long as it is used.
Observable responses are noted with at least 3 months of therapy and benefits accrued are lost or reversed within a year of treatment cessation. Cheap and readily available at any online pharmacy, it is very effective orally and well tolerated by most clients.
In addition to the rare hypersensitivity reactions (skin rashes) that accompany almost any drug nowadays, Propecia does affect libido and can reduce the volume of ejaculation, rarely causing impotence. For more details you can watch the presentation below.

Topical Vasodilator

MINOXIDIL is a drug that is applied locally to the scalp. It acts by increasing the blood flow to the scalp, thereby promoting follicle nourishment and reducing hair loss. It needs careful application as it can lower the Blood Pressure if absorbed through the skin.
Post applicatory hand washing is mandatory to preclude such excess absorption. It is expensive and can cause burning on the scalp or headaches.

Male Hair Loss Treatment -Conclusion

While most prematurely balding young men strive hard to reduce their hair loss, middle aged bald men adjust gracefully to their fate accepting baldness as a gift, and not some unnatural curse of ugliness.
But until that transition is made, man’s obsession with hair loss remedies will forever be fuelled.