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Male Pattern Hair Loss (MPHL)

What is male pattern hair loss?

Male pattern baldness is the common type of hair loss that develops in most men at some stage in their lives; the condition is sometimes called androgenetic alopecia.. It is mostly the result of a genetic event that causes dihydrotestosterone (DHT), a male hormone, to cause the hair follicles to atrophy. The hair produced becomes progressively smaller, until it is practically invisible or may even disappear completely. It usually takes 15-25 years for people to go bald, however, some men go bald in less than five years.

Usually, the hair begins to recede at the front to start off with and at the same time, it usually becomes thin on the top(crown) of the head. A bald patch gradually develops in the middle of the scalp and the receding front, until the bald patch on the top eventually enlarges and joins together.

A rim of hair is frequently left around the back and sides of the scalp. In some men, this rim of hair also thins and goes on to leave a completely bald scalp.

Who gets male pattern baldness?

Nearly all men have some baldness by the time they are in their 60s. However, the age the hair loss starts varies. About three in ten 30 year-olds, and half of 50 year-olds are fairly bald. Some women also develop a similar type of hair loss, mainly at the crown. Baldness in women is much more common after the menopause- about 13 in a 100 women have some baldness prior to the menopause, increasing to 75 in a 100 above age 65.

What causes male pattern baldness?

Hair grows about an inch every couple of months. Each hair grows for 2 to 6 years, remains at that length for a short period, then falls out. A new hair soon begins growing in its place. At any one time, about 85% of the hair on your head is in the growing phase and 15% is not.

Each hair sits in a cavity in the skin called a follicle. Baldness in men occurs when the follicle shrinks over time, resulting in shorter and finer hair. The end result is a very small follicle with no hair inside.

The following usually happens to men as they slowly become bald:

  • Affected hair follicles on the scalp gradually become smaller than normal.
  • Each new hair becomes thinner than the previous one, as the follicle shrinks.
  • Each new hair grows for much less time than the normal three years, before falling out.
  • All that stays eventually is a much smaller hair follicle and a thin stump of hair that does not grow out to the skin surface.

Ordinarily, hair should grow back. However, in men who are balding, the follicle fails to grow a new hair. It is not well understood why this occurs, but it is related to your genes and male sex hormones.

Symptoms

The typical pattern of male baldness begins at the hairline. The hairline gradually recedes to form an "M" shape. The existing hair may become finer and shorter. The hair at the crown also begins to thin. Eventually the top of the hairline meets the thinned crown, leaving a horseshoe pattern of hair around the sides of the head.

Hair loss in patches, diffuse shedding of hair, breaking of hair shafts, or hair loss associated with redness, scaling, pain, or rapid progression could be caused by other conditions.

Usually, the hair begins to recede at the front to start off with and at the same time, it usually becomes thin on the top(crown) of the head. A bald patch gradually develops in the middle of the scalp and the receding front, until the bald patch on the top eventually enlarges and joins together.

A rim of hair is frequently left around the back and sides of the scalp. In some men, this rim of hair also thins and goes on to leave a completely bald scalp.

See pictures of twin A and B here for contrasts in hair loss due to Dutasteride.

Are there any complications from male pattern baldness?

Although male pattern baldness is a common and harmless condition, it can be linked to heart disease. One study compared 45 year old men who had baldness with men of the same age who had a full head of hair. The study found that men who had frontal hair loss at the crown were at a slightly increased risk of heart disease (an extra nine for every 100 men with a full head of hair) whilst those who had severe hair loss at the crown had a significant risk of heart disease (an extra 32 for every 100 men with a full head of hair). The risk for men with hair loss at the crown is further increased if they have high cholesterol or a raised blood pressure.

Women with male pattern baldness should be checked for causes of raised male hormone levels, such as polycystic ovary syndrome (a condition in which cysts develop in the ovaries).

What are the treatment options for male pattern baldness?

No treatment

Becoming gradually bald is a normal part of the ageing process for most men. No treatment is wanted or needed by most affected men. Although, for some men, baldness can be distressing, particularly if it is excessive or occurs early in life. Treatment may then help.

male pattern hair loss Above you can see the difference in hair count between me (right) and my twin brother (left), my twin has been using Dutasteride since late 2004 to block DHT from forming in his scalp, I only started using it in January 2010 - more photos.

Medication

There are currently three medicines that help - Dutasteride (already covered here) Finasteride, (trade name Propecia®) and Minoxidil (trade name Regaine®). Dutesteride is only available on prescription to treat prostate cancer. Finasteride and minoxidil can be purchased for hair loss treatment in many drug and chemist stores.

Finasteride was launched in the UK in 2002, although it has been available in the USA since 1997. It works by blocking the conversion of testosterone to dihydrotestosterone. The hair follicles can enlarge back to normal because they are then not affected by this hormone.

Some hair regrowth occurs in about 2 in 3 men who take a finasteride tablet each day. In about 1 in 3 men there is no hair regrowth, nonetheless, most do not have any further hair loss whilst taking finasteride. It has no effect in about 1 in 100 men. So, if you take finasteride, you have a good chance that hair will regrow, or at least stop any further hair loss.

Some points about finasteride include the following.

  • It takes about four months for any effect to be noticed, and up to 1-2 years for full hair growth.
  • The balding process returns if treatment is stopped. Therefore, if successful, you need to carry on treatment to maintain the effect.
  • Side-effects are uncommon. The most common is that about 2 in 100 treated men report loss of sex drive (libido).
  • It does not work in women with male pattern baldness.
  • It is expensive, costing around £34 per month (June 2010). You need a private prescription to get it from a pharmacy.

Minoxidil lotion is a rub-on treatment that you can buy at pharmacies without a prescription. It is not clear how it works. The higher-strength solution (5%) is more effective than the 2% strength.

It's effectiveness is still debatable. Further delay in balding probably occurs in about 50% of men who use minoxidil. About 15 in 100 users have good hair regrowth. There is continued hair loss in about a third of users. However, some reports claim much higher success rates. It seems that it is best used to prevent further hair loss, and hair regrowth occurs in some users.

Some points about minoxidil include the following.

  • It needs to be rubbed on the scalp every day.
  • It usually takes four months or more for any effect to be noticed.
  • Treatment needs to be continued indefinitely. Any new hair that does regrow falls out two months after treatment is stopped.
  • It is quite expensive.
  • It may work in some women who have male pattern baldness.
  • Side-effects are uncommon. For example, skin irritation or a rash sometimes occurs.

Other Treatment options:

Hair transplant

Hair transplants involve removing tiny plugs of hair from areas where the hair is continuing to grow and placing them in areas that are balding. This can cause minor scarring in the donor areas and carries a modest risk for skin infection. The procedure usually requires multiple transplantation sessions and may be expensive.

Suturing

Suturing hair pieces to the scalp is not recommended. It can result in scars, infections, and abscess of the scalp. The use of hair implants made of artificial fibers was banned by the FDA because of the high rate of infection.

Prognosis

Male pattern baldness does not indicate a medical disorder, but it may affect self-esteem or cause anxiety. The hair loss is usually permanent.

Possible Complications

  • Psychological stress
  • Loss of self-esteem due to change in appearance

When to Contact a Medical Professional

Call your doctor if:

  • Your hair loss occurs in an atypical pattern -- rapid hair loss, diffuse shedding, hair loss in patches, or breaking of hair shafts.
  • Your hair loss is accompanied by itching, skin irritation, redness, scaling, pain, or other symptoms.
  • Your hair loss begins after starting a medication.
  • You want to attempt to treat your hair loss.

Prevention

There is no known permanent prevention for male pattern baldness. There is however a supplementary prevention through a dht blocker as previously covered.

If you would like to see some prime examples of how male pattern hair loss can affect the hair line on a man's head you can check out my hair loss photos that show my twin brother's well treated full head of hair that has suffered minimal loss from MPHL and my receding hair line which hadn't been treated up until January 2010. The contrast is quite dramatic.