MALE PATTERN HAIR LOSS
Causes, Signs & Treatments
Male pattern hair loss, also known as androgenetic alopecia, is a common condition that affects millions of men worldwide. It involves a distinct pattern of hair thinning and loss. This can begin as early as adolescence and progresses with age. Although this condition is not usually entirely reversible, it can be slowed down. In fact, it is even possible to regrow hair. That being said, the earlier you start treatment the better the outcomes. This is why it is important to understand the signs and symptoms of male pattern hair loss in order to diagnose it at its earlier stages. Understanding the causes behind male pattern hair loss is also crucial to find the most effective treatment.
What is Male Pattern Hair Loss & Who Gets it?
Male pattern hair loss is the form of androgenetic alopecia that occurs in men. It is a multi-factorial condition with a genetic underpinning. Male pattern hair loss can start as early as the late teens or early twenties and may affect as much as 50% of men by the age of 50. The main driver is dihydrotestosterone (DHT) which is a derivative of the male hormone testosterone.
The main feature of male pattern hair loss is a distinct pattern of progressive hair thinning and loss on the scalp. It typically begins at the temples and the crown of the head which results in a receding hairline and thinning of the hair on the top of the head. Over time, these areas may continue to expand and eventually merge to create a characteristic “M” shape at the front and a bald spot on the crown. The sides and back of the head usually retain hair for longer which forms a horseshoe pattern around the bald areas.
What Does it Look Like?
The distinct appearance of male pattern hair loss occurs because hair follicles in different parts of the scalp have varying sensitivity to DHT. Common signs and symptoms of male pattern hair loss include:
- A receding hairline (particularly at the temples)
- Thinning of hair on the crown
- Overall reduction in hair density
- Formation of a horseshoe pattern of hair around the sides and back of the head as the top continues to thin
Causes of Male Androgenetic Alopecia
Male pattern hair loss is primarily caused by a combination of genetic predisposition, hormonal factors and the natural aging process. At the core of this condition is the influence of androgens, particularly DHT which is a potent derivative of testosterone. DHT binds to receptors in the hair follicles and causes them to shrink. As the follicles shrink, the hair growth cycle shortens, producing progressively finer and shorter hair. Eventually, the follicles stop producing hair altogether. The main factors that contribute to male pattern hair loss are:
- Genetics: These play a significant role in male pattern hair loss. Men with a family history of this condition are more likely to inherit sensitivity to DHT. The specific genes involved may be inherited from either parent, and the pattern and onset of hair loss can vary widely among individuals.
- Hormonal Changes: Hormonal imbalance of androgens (particularly DHT) also affects hair follicles. Increased levels of DHT or heightened sensitivity of hair follicles to this hormone can lead to hair thinning.
- Aging: As men age, hair follicles may shrink, and hair growth cycles become shorter. This natural aging process can exacerbate hair loss.
- Environmental & Lifestyle Factors: Pollution, smoking, stress and poor diet can negatively affect hair health. This is also the case for certain health conditions and medications. Whilst these do not cause male pattern hair loss, they can accelerate and worsen hair loss.
Diagnosis & Stages of Male Pattern Hair Loss
The most common way to diagnose male pattern hair loss is with a thorough medical history and clinical examination of the presenting signs and symptoms. Healthcare providers may also perform blood tests to check for hormonal imbalance, underlying medical condition or nutritional deficiencies especially if the hair loss is in someone young or it is sudden or severe. Doctors may use tools such as dermoscopy to examine the scalp and hair follicles closely they may even perform a biopsy to rule out other causes of hair loss.
If the diagnosis is male pattern hair loss then doctors will classify it according to stage. This helps to assess the severity of the hair loss, determine the best treatment options and allows for more objective progress monitoring. Generally, male pattern hair progresses through various stages and the most common classification is using the Hamilton-Norwood scale:
- Stage 1: Minimal or no hairline recession.
- Stage 2: Noticeable hairline recession at the temples.
- Stage 3: Deepening hairline recession and thinning at the crown.
- Stage 4: Significant hair loss at the crown and a more pronounced receding hairline.
- Stage 5: The gap between the crown and hairline narrows.
- Stage 6: Bald areas at the temples and crown meet, leaving a horseshoe-shaped ring of hair.
- Stage 7: Only a narrow band of hair remains around the sides and back of the scalp.
Male Pattern Hair Loss Treatment
Whilst its not usually possible to fully reverse male pattern hair loss, there are a number of treatment options that can stop shedding and stimulate growth of lost hairs. The aim of treatment is to simultaneously slow down hair loss, stimulate regrowth and increase hair density. For this reason, successful treatment of male pattern hair loss often requires a multi-pronged approach. The main treatment options include:
- Minoxidil: This topical medication is available over-the-counter in lower strengths or by prescription for higher or bespoke compounded treatments. It is applied directly to the scalp and works by prolonging the growth phase of hair follicles and enhancing blood flow to the affected areas. This stimulates hair growth and slows down hair loss.
- Hormone Blocking Medications: Both Finasteride and Dutasteride, are prescription only drugs that inhibit the enzyme 5-alpha reductase, which converts testosterone to DHT. By reducing DHT levels, these medications can help prevent further hair follicle miniaturisation and promote regrowth. They may be available either as an oral or topical treatment and usually used in combination with minoxidil and other hair loss medicines.
- Low-Level Laser Therapy (LLLT): This is a non-invasive treatment that uses laser devices to stimulate hair follicles and increase hair density.
- Platelet-Rich Plasma Therapy: This treatment involves injecting a patient’s own platelets into the scalp to stimulate hair follicles and promote growth.
- Hair Transplant Surgery: Not usually first line, this procedure involves harvesting hair follicles from denser areas of the scalp, typically the back and sides, and transplanting them to the thinning or balding areas. It is a relatovely expensive procedure with traditionally variable results. However, more modern techniques like Follicular Unit Extraction and Follicular Unit Transplantation have improved the success of these transplants.
Living with Hair Loss
Alongside the the above treatment options for male pattern hair loss, you can support hair health and promote regrowth by adopting a healthier lifestyle. Here are some of the health and well-being measures that can help:
- Balanced Diet: Adequate intake of vitamins and minerals like biotin, iron and zinc is essential for healthy hair.
- Gentle Hair Care: Avoid harsh treatments, excessive heat and tight hairstyles. These can all cause damage to the hair and scalp.
- Stress Management: Chronic stress can exacerbate hair loss. Yoga, meditation and regular exercise can also be effective in helping reduce stress levels.
- Support: Dealing with male pattern hair loss can be emotionally difficult. It can help to seek support from friends, family and even professional therapists. Many also find joining support groups or forums helpful to share their experiences with other similarly affected men.
Male pattern hair loss is a common but manageable condition. Understanding the causes, signs and symptoms as well as progression of male pattern hair loss is essential for early diagnosis and finding the best treatment. Although it is not usually possible to fully reverse male pattern hair loss, there are a number of solutions that can slow down progress and even regrow hair. With the right approach, including medical treatments, lifestyle adjustments and support, men can achieve significant improvements in hair density and quality of life.
SOURCES
https://cityskinclinic.com/hair-loss-men-treatments/
https://cityskinclinic.com/hair-scalp-treatments/hair-loss-treatment-men/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4135103
https://cityskinclinic.com/minoxidil-hair-growth/
https://cityskinclinic.com/our-ingredients/minoxidil/
Authored by:
Aesthetic Doctor & Medical Director BSC (HONS) MBBS MRCS PHD
Founder City Skin Clinic
Member of the Royal College of Surgeons of England
Associate Member of British Association of Body Sculpting GMC Registered - 7049611