It is well known that men with MPB have an increased rate of balding in the presence of androgens. Despite the suggestion that androgens are the cause, there is a limited number of androgen-dependent genes in balding scalp compared to a hairy scalp. This indicates that androgens are only part of the cause, and alterations in the levels of androgens, the androgen receptor, and the genes to which androgens affect may be a part of the process. The hormone prolactin is also associated with MPB. This hormone is said to cause inhibition of hair growth in the scalp and appears to play a role in the oversensitivity of hair follicles to androgens in the development of MPB. High levels of sebum are also a cause of increased DHT and the rate of balding.
For many years, there have been a number of biological and environmental factors that cause male pattern baldness (MPB). However, it has not been until recently that there has been significant progress in determining the exact causes and understanding how these causes impact treatment options. Pattern hair loss in both males and females is a result of a genetic predisposition to higher sensitivity to the thinning effects of male and female hormones on hair follicles. It follows a specific pattern of progressive hair loss, which varies from one individual to another. The exact cause of male pattern baldness is unknown. Its incidence increases with age, and it is suggested to affect 4% of men by age 30, 28% of men by age 40, and 49% of men by age 50.
Causes of Male Pattern Baldness
Male pattern baldness is inherited from our parents. The genes can come from either our mother’s or father’s side of the family, and they affect how the hormones work in the hair follicle. Pattern baldness is caused by genetic programming of hair follicles to be oversensitive to the sex hormone dihydrotestosterone and testosterone. When testosterone from the bloodstream gets to the hair follicle, it changes to DHT on contact with an enzyme called 5 alpha reductase. This process is part of the normal metabolism in men. DHT binds to hormone receptors at the hair follicle. This process causes the hair follicles to shrink (miniaturize) and become finer. Finally, the affected follicles gradually produce shorter and finer hair until they stop producing hair completely. The genetic process of hair follicles reacting to DHT in a predictable pattern means that hair loss can be passed down from one generation to another. The onset, rate, and severity of pattern baldness can vary greatly in one person compared to another because it depends on the influence of androgens hormone. The more the hormone works on the hair follicle, the more hair loss will occur.
Male pattern baldness (androgenetic alopecia) is a genetic condition caused by the effects of male hormones over the scalp. Male pattern baldness is the most common cause of hair loss in men. Men who begin losing their hair at an early age tend to develop more extensive baldness. In male pattern baldness, hair loss occurs in a well-defined pattern, beginning above both temples. Over time, the hairline recedes to form a characteristic “M” shape. Hair also thins at the crown (near the top of the head), often progressing to partial or complete baldness.
Genetic Factors
The X chromosome is passed from both the mother and father of a child. The androgen receptor gene is located on the X chromosome. Therefore, sons tend to inherit this gene from their mothers, which determines whether they develop MPB. This is not a 100% cause for MPB, but it allows males to inherit the gene from their mother and therefore are twice as likely to receive it. This pattern is slowly changing as slight mutations in the androgen receptor gene are occurring. These mutations are producing a variant of the androgen receptor. One of these mutations has actually started to have a preventative measure for hair loss, as the receptor has a lowered affinity for the androgen hormone testosterone. However, this gene will not be passed down through generations to show any real effect. As the androgen receptor gene is the most prevalent contributor to MPB, it is still the target of many studies today to try to understand in more detail how the genetic component of androgen hormones directly causes hair loss.
The androgen receptor gene is a gene that is associated with male pattern baldness (MPB). However, it hasn’t been proven to be a cause. But when bonded with the male hormone DHT and the location in which hair loss occurs, it relates to the sensitivity in the androgen hormones, increasing the likelihood of men developing MPB. In recent years, medical professionals have noted that men who have a higher level of DHT located in the scalp often experience a high level of hair loss. This proves that, to some degree, the development of male pattern baldness is related to the androgen hormone. Studies of twins have shown that male pattern baldness is primarily caused by genetics, specifically the inherited sensitivity of the androgen hormone in which the hair loss occurs.
Hormonal Imbalance
Male pattern baldness is a genetically predetermined trait and hormonal event. The individual genetic makeup determines the reactions of the hair follicles to the male hormone testosterone. This reaction is called Androgenetic Alopecia. The hormone testosterone has many functions, one of which is to build protein. A group of these proteins are enzymes. Testosterone acts on the enzymes in the highly regulated process called metabolic hormone. In the scalp, there are special enzymes called Type II 5-alpha reductase. This enzyme is created in large amounts in the parietal area. The parietal area is the very front of the scalp above the forehead. Pattern hair loss is caused by the action of an enzyme called 5-alpha reductase on testosterone. This process results in the production of the by-product DHT. DHT is a powerful substance and is very problematic because it can accumulate in the hair follicles and oil glands in the skin. DHT can cause the hair follicles to regress and deprive the hair of nutrients. Usually, it is associated with increasing age and hormonal changes. This explains why it occurs more frequently in men than women and in Asians compared to Native Americans. DHT is a major factor, with Asians having proportionally more DHT than Caucasians, causing more hair loss. DHT is a primary cause in the factor of hair loss, mainly in the front and the higher degree of androgen cases. DHT also interferes with the growth of hair and results in the easier loss of hair. From all of the findings, this provides hope in the development of a cure for hair loss by blocking the actions of DHT. By knowing the causes and how it occurs, we can trace the necessary action for prevention and recovery.
Symptoms and Progression
Most men afflicted with this unfortunate process are often unsuspecting of the cause. In other words, they do nothing to cause their hair loss. The affected individuals may begin to notice the hair on the top of the head starting to thin – either a widening part or significant thinning around the crown. Although men are rarely left with a completely bare scalp, the hair loss may reveal more scalp than usual. This makes the identification of a thinning crown paramount to prevent further hair loss. The key to halting further progression of hair loss is to identify the process early. Although male pattern baldness presents with many variations, the most common progression begins with thinning at the temples and the frontal scalp, which is usually followed by increased shedding and a thinning crown. By the age of 30, 25% of men in North America will have the onset of male pattern baldness, and by the age of 50, up to 50% will show some signs of hair loss. Inactive follicles slowly produce smaller and thinner hairs and eventually die. Although hair on the back and sides of the scalp never falls out, this process can result in complete baldness. Around 80% of men are affected with general thinning of the hair by the age of 70. High levels of dihydrotestosterone are indicative of more severe cases and are generally associated with a genetic predisposition of hair follicle sensitivity to the hormone.
Receding Hairline
Losing hair at any age can have dramatic effects on the overall psychological health of an individual. The popularity, cheap cost, and overall ease of access of hair restoration products wrongly imply that changing the loss of hair image is doable. An American review of a number of studies exposing the psychosocial effects of balding detailed the vulnerability of many who are feeling distressed with the appearance of a receding hairline. As hair loss advances, there are few men who don’t have some level of concern.
A study, “Male Pattern Baldness: A Mixture of Genetic and Environmental Risk Factors,” revealed there was probably a genetic predisposition to going bald at an early age. Using recollection and comparison to family members, it is likely that someone with a receding hairline will see it continue for a while, finally leading to more noticeable hair loss. The acceptability of hair loss in males is a side of the study of male pattern baldness that has an effect on the overall mental health of a young male.
The first sign of male pattern baldness is the appearance of a receding hairline. This process normally starts in the late twenties and is often ignored as an indication of thinning hair. A receding hairline will begin above the temples with the edges taking after a letter M. The hair at the vertex and temples may also start to thin, taking after a prevalent feature of male pattern baldness.
Thinning Hair on the Crown
Thinning hair on the crown, or the top of the head, is one of the early signs of male pattern baldness. In this area, hair thins out and men may progress to extensive hair loss. Although this is not a classically receded hairline, it is the most common pattern of hair loss in male pattern baldness. This process can occur in conjunction with a receding hairline or it can occur by itself. It is rare that only the frontal hairline is lost. Normally, men who have identified a receding hairline will go on to experience further hair loss. In a study of white males, between the ages of 18 to 49, conducted over a 25-year period, the highest progression of hair loss was found in men who first experienced hair loss when they were aged between 30-39. The least progression was found in the men who first experienced hair loss after the age of 40. This simply demonstrates that hair loss increases with age and if no action is taken, it will get worse.
Complete Baldness
Consider the man with the receding hairline who has very little hair on the top of his head and is a NW pattern sufferer compared to the man with a slight thinning over the entire scalp. The latter will have less noticeability, and the psychological effects of the hair loss are less likely to be as severe as in the former. Nevertheless, the complete baldness sufferer has reached the same stage as the man with a receding hairline or a thinning crown. There is just a higher degree of hair loss, and it is, in fact, these individuals who have been affected the most by MPB.
Complete baldness is the endpoint of a process that has affected various individuals in different ways. Generally, a slick or partially shiny scalp is exposed, and this is the most common shape of the scalp for bald men. The rest of the scalp may show many signs of hair which has stopped growing. The hairline, mid-scalp, and crown areas may have lost hair but still have follicles present, vellus hairs may be in abundance, or there may be no hair at all. This last statement may give the false impression that hair loss is different for those who experience a general thinning of hair compared to a receding hairline.
While the process of male pattern baldness truly culminates in 2.3, the preceding section plays a crucial role in the progress to 2.3 and provides a useful context for the man that is either bald or in the throes of becoming bald. For men that are now experiencing complete baldness, the progression demonstrated in this essay can jog their memories and bring them to the realization that there was actually a specific point at which their hair loss began and a pattern which the loss followed.
Treatment Options
The only two drugs that are approved by the MHRA in UK and the Food and Drug Administration in America are called Finasteride and Minoxidil. Both work by either reducing the effect of the hormone on hair follicles or by stimulating hair growth. Finasteride is a tablet. It works by reducing the amount of dihydrotestosterone (DHT) in the body. DHT is a hormone that causes male pattern baldness, so reducing the amount of it in the body will lead to an increased hair growth and prevention of further hair loss. Although it is not licensed by the FDA for the treatment in male pattern baldness, it has been shown to be effective in preventing further hair loss for men. However, this drug has known to cause negative sexual side effects in men, and may also affect female partners if they come into contact with the drug. Therefore, there are implications that need to be taken into consideration. Minoxidil is a lotion which is rubbed onto the scalp. It can be used by both men and women. Minoxidil is not fully understood how it works, but it is thought that it works by increasing the blood supply to the hair follicles, and increasing the follicles size, which prevents further hair loss and triggers hair regrowth in some cases. Studies have shown that 2 out of 3 men who use Minoxidil at a strength of 5% have a hair regrowth of varying degrees. It is often used in combination with finasteride for the most effective results of hair regrowth. However, like all medications, Minoxidil has its side effects. The most common is an irritation to the scalp in the form of dry, flaky skin, and a non-allergic contact dermatitis. This can be treated by changing the strength of Minoxidil to 2%, which is less likely to cause skin irritations. Due to the fact that the Minoxidil will lose its effectiveness and hair will be lost as soon as it is stopped being used, it is a lifelong treatment. This may not be a viable option for some people.
Medications
Medications can be used to treat male pattern baldness. The most widely used drug is finasteride, which decreases the production of DHT in the scalp. The second medication is called minoxidil, which works by increasing the blood flow to the hair follicles, which in turn strengthens hair and prevents it from falling out. While these medications show positive results in helping to prevent further hair loss, results can take upwards of 6 months to become visible so it is important to remain patient. A newer drug on the market called Dutasteride has been suggested to be even more effective than finasteride although the supporting evidence is minimal at this stage. These drugs must be taken continuously to maintain any positive results and discontinuation of usage may lead to the progression of hair loss. Medications are a useful option for the treatment of male pattern baldness as they are generally easy to obtain and apply and results can be seen after using the drugs consistently for a time period. They are generally the cheaper option in comparison to hair transplantation surgery with the cost of the drugs dependent on how much is paid for by the consumer and how much is subsidized by the government. However, it is a common scenario that people become frustrated with medications after a period due to the time it takes to see some visible results and the maintenance of the positive effects.
Hair Transplantation
There are two main techniques for hair transplantation: 1. Follicular Unit Transplantation (FUT) – this is the more modern and more effective technique. A strip of hair is taken from the back of the scalp. This is then cut up under a microscope to produce individual hair grafts. Small incisions are then made in the bald area and the individual grafts are placed in them. A scar will be left at the back of the scalp, but this will be covered by hair and is no longer than 1-2 cm. 2. Follicular Unit Extraction (FUE) – this is where individual hair grafts are taken directly from the back and sides of the scalp and then placed in the bald areas. This means there will be no linear scar at the back of the scalp. However, this is a time-consuming procedure and is much more expensive than FUT.
Hair transplantation is a relatively simple outpatient procedure. It involves taking hair from the back and sides of the scalp and transplanting it to the top and front. The reason hair from the back and sides is permanent is that it is not affected by the same genetics that cause hair loss. The transplanted hair is also permanent.
For persons who are bothered by the appearance of their hair and are willing to pay for the improvement, hair transplantation is the treatment of choice. It is most appropriate for men with male pattern baldness. In women with female pattern baldness, the thinning is diffuse. Therefore, the procedure is less certain for them.
Laser Therapy
Scalp microneedling has been suggested as a relatively new and cheap treatment modality. This is based on the idea that microtrauma caused by needles to the skin of the scalp will cause activation of the skin’s natural wound healing response, and this will also stimulate the hair follicles and promote hair growth. This would be more convenient for patients if it were effective, as it could be performed at home with relatively lower costs compared to laser therapy. However, no concrete evidence has been demonstrated regarding this form of therapy.
Laser therapy has been suggested as a treatment for male pattern baldness. This is based on the idea that the weak electromagnetic radiation applied to the scalp could promote hair growth. The mechanism of action is not entirely understood, however it is felt that laser light may cause hair follicles in the telogen phase to prematurely enter the anagen phase of hair growth, thus reversing the process of male pattern baldness. Alternatively, it has been postulated that the laser therapy improves the blood and oxygen flow to the scalp and therefore improves the overall condition of the scalp. Treatment protocols for the various different types of laser therapy vary, and it seems that the most effective treatment being studied is the use of the so-called “soft” lasers, of which an example is the “erchonia”. This is a low-level laser that has been the subject of various studies, one of the most well-known being placed on a specific website of which the author is familiar. The treatment times using these lasers are much longer than the high-level therapy, sometimes being administered over a prolonged period (e.g. one hour per session). The efficacy of this form of treatment is still debatable, with some studies showing signs of improvement and others showing no strong evidence of growth. A recent study did show some positive results in using a combination therapy of the “erchonia” laser phototherapy with finasteride.
Lifestyle Changes
Another lifestyle change is to exercise regularly and have a balanced diet. Now, have they told you something you didn’t know? This one becomes an overwhelming no. But eating well and keeping fit can never be a bad suggestion and to be fair it’s keep fit and healthy hair, rather than the keep fit having hair for which a balding man may strive. But this change will at least keep a man away from the guilt that it is his misspent years of staying up late watching TV and eating junk food that caused this hairy travesty to occur.
“Get a hairpiece” – first off is a suggestion of a hairpiece because that would presumably solve the quandary of people having to come to terms with baldness on a level more visual than is possible by adopting a hat. But a hairpiece is steeped in negative connotations and one can only assume this is for comb-over revival rather than acceptance.
This section of the essay really makes you think about how people with male pattern baldness may cope with the condition. It is a strange array of statements combined with lifestyle changes that on first glance appear to have little to do with hair. It’s an atypical section on an atypical type of hair loss with atypical expectations and results, worth reading. But take a trip first to your pair of male pattern astro-turf slippers.
Coping with Male Pattern Baldness
Due to the unpredictability of how far male pattern baldness will progress and which pattern a man will have, hairstyling can be quite difficult. It is very important that during the difficult times of hair loss, men must avoid hairstyles that draw more attention to their hair loss. This may involve growing hair longer to comb over bald spots or using gels and hair creams to create a certain style. Unfortunately, these methods will make hair loss more noticeable, and shorter hair is generally easier to manage and less conspicuous. For those not ready to shave their heads to a uniform length, it may be beneficial to visit a hairstylist who is experienced in working with thinning hair. A good stylist will be able to suggest a style that makes thinning hair less noticeable and teach their client ways to do so on their own. The goal is to make the hair look thicker and draw less attention to any bald spot.
One of the first steps to coping with male pattern baldness is to accept the problem and learn to live with it. As previously mentioned, most men will face hair loss at some point in their lives, and many will inevitably have patchy hair. Those who can accept that hair loss is just a natural part of life will be better off in the long run, both emotionally and physically. Self-confidence does not have to dissipate when it does not come from one’s looks, but rather from how they feel about their appearance. Because balding is an appearance that will be constant for the remainder of their lives, men with male pattern baldness are often unlikely to see positive changes in their appearance and should learn to adjust their feelings of self-worth to their changing hairline. “If the hair loss is natural and unpreventable, it is better to focus on acceptance and a positive attitude,” says Richard. “It is far better than to spend a great deal of effort, time, and money attempting to change appearance in search of an elusive fountain of youth.” This ultimately fruitless search has left many men feeling much worse about their hair loss due to attempts to hide it with treatments like hair plugs, which can actually worsen the hair loss. Acceptance does not mean giving up all hope for hair regrowth, and men may still find it comforting to undergo less aggressive treatments like minoxidil or propecia.
Acceptance and Self-Confidence
Changing Faces offers a UK-wide Skin Camouflage Service for people who have visible disfigurements. Camouflage can help disguise and improve the appearance of hair loss and give an individual a better sense of confidence in their appearance.
Some people will find it helpful to talk about their feelings regarding hair loss. This could be to a close friend or family member. Alternatively, some people find it more beneficial to speak with others who are experiencing the same thing. If this is the case, hair loss support groups can be an excellent source of social and emotional support. They can help people adjust to their hair loss by hearing the stories of others and learning how they cope.
Accepting hair loss of any degree can be a difficult and often traumatic experience. It is therefore important to respect your feelings and give yourself time to adjust. The disfigurement service at Changing Faces suggests practical ways to help, such as concealing your head with a hat, scarf, or alternative headwear until you are comfortable and ready to reveal your new look. It is important to remember that you are not alone and there are positive steps you can take to boost your self-esteem and come to terms with your condition.
Hairstyling Tips
You also need to factor in the use of a decent shampoo and conditioner to keep your scalp in good condition and free from dandruff. Choosing the right shampoo can provide your remaining hair the look of additional thickness while improving the health of the scalp. Step 1 Herbalife Males Shampoo was a private recommendation, as well as Nizoral and T-Gel for dandruff control. On the topic of cleanliness, a shaved head is the cleanest and easiest to maintain compared to many styles that involve ongoing manipulation.
A common mistake for men with male pattern baldness is to cover up the hairless area with a hairdo that is basically a bad solution to a significant issue. Having accepted your current situation, the following step is to decide on a hairstyle that not just covers up the bald areas but also adds a component of class to your look. There are a variety of possibilities open to men in this position; however, the general rule is to avoid the comb over. This alternative simply exposes the hairless area and is an insult to anyone who happens to spot you using it! Both shaving the head and a better option is a very close cropped cut. This is low-maintenance, looks professional, and the cause is a recognized one due to an increase of military-style haircuts in men with male pattern baldness!
Wearing Hairpieces or Wigs
Now that a man knows the cause of his hair loss, he would be interested in knowing what options are available to him. On the market today, there are a great deal of hair pieces and wigs available that are of good quality and natural looking. There are several advantages to wearing a hairpiece. For the man who has a desire to have hair in order to feel good about himself, he can get immediate satisfaction in his appearance. This can be done by selecting a natural looking hair piece that is similar to the style he once had. Resulting in a hair piece could act as a ‘temporary fix’ over the years for the man who is interested in Hair Transplantation. In other words, when he uses the proper hair piece it can serve as a disguise for hair loss that may be in the early stages, so he can go back to the look of having a head full of hair. Hair pieces and wigs are relatively low maintenance, easy to apply and remove, and after some getting used to, a man can look natural in one. There is no perfect solution for wearing a hair piece. The main disadvantage is that high quality, natural looking pieces are very expensive. Often times they need to be custom made to ensure proper fit and comfort. This could cost several thousands of dollars, which makes this option unrealistic for some men. Besides the high price, a man must practice caution when wearing a hairpiece as it can easily be noticed if it doesn’t fit right or the style does not look natural. This can cause embarrassment and a loss of self-esteem if it is noticed his artificial hair. For these reasons, there are men who will opt to having a few good wigs as it is a cheaper alternative and a wig can be an easier way to change styles.
Support Groups and Counseling
There is some indication from the authors that people who are or feel undesirable may seek aid or counseling services. These actions will often have been prompted by a significant event or personal crisis caused by the conditions or the negative societal attitudes towards a particular physical feature. The significance of impact has not been entirely proven and it is still unclear as to whether hair loss would be classed as a stigmatized or undesirable condition. It is not unreasonable to assume that support groups specifically for hair loss sufferers would exist but these will typically be small localized groups and pamphlets or booklets offering advice and information may be more readily available through dermatologists and GPs. The impact that hair loss has on an individual’s mental health and well-being will vary. For those who have a strong emotional attachment to their hair or invest much of their personal image in their hairstyle, the psychological effects may be quite damaging. Such people may experience loss of confidence and self-esteem and altered self-image and perception. In more extreme cases, hair loss may lead to depression and or social phobia. At this point, it is possible that a person will seek professional counseling services, though again the extent and the likelihood of this happening have not been quantified. A phenomenon occurs where the inability to accept a condition may actually exacerbate it or cause further conditions, this has been indicated in studies of stress-related hair loss and may be an area where further research is needed. It would seem hair loss services would be difficult to give a universal recommendation for seeking counseling. It will vary between individuals based on their personality type, underlying emotional attachment to their hair, and the impact of the hair loss on their life. A cost-benefit analysis would also need to be considered as the individual’s assessment of the severity of their condition and the potential effectiveness of counseling services will influence whether the resources required are deemed cost-effective. This is something that I would personally be very happy to see further work done on, as I feel that there are many hair loss sufferers, particularly those in the early stages of hair loss or in younger age groups who may be struggling to deal with an altered self-image but are unsure of how to tackle this issue.