Male pattern hair loss ( androgenetic alopecia) affects our dads, brothers, uncles, husbands, partners, and friends. It is a very common presentation and, to some degree, is more socially and culturally accepted over female pattern hair loss. The frontal hair line starts to recede gradually over time and the forehead starts to look a little more prominent. The frontal scalp hair also starts to become thinner and shorter with a relatively thicker section of hair preserved in the back of the head. Unfortunately, it happens to all men as they age but is quite variable from one man to the next.
Why does this hair loss occur?
Male pattern hair loss is the hair changes that occurs related to aging, changes in sex hormones, and may be associated with a genetic predisposition. Average age of onset is the fourth decade of life or after. Rarely, onset may occur as early as the late teenage years in some men. Familial patterns of androgenetic alopecia have been studied, however, specific genes have not been identified.
As men age, androgen hormones such as dihydrotesterone ( DHT) increase in scalp hair follicles. Testosterone is converted to DHT by the enzyme 5a-reductase, which is very active in hair follicles. There is scientific evidence implicating elevated DHT and 5a-reductase enzyme levels in the pathogenesis of male pattern hair loss.
In men, androgenetic alopecia is typically gradual over time and asymptomatic. It is usually a clinical diagnosis with very characteristic patterns. If there are concerns about other causes of hair loss, a scalp biopsy can be done to evaluate the state of the hair cycles and to determine whether there is miniaturization of hairs microscopically.
Successful treatment of male pattern hair loss involves growing hair in longer growth phases and attempting to halt the hormonal cycles leading to gradual hair loss.
1. Topical minoxidil grows hair by stimulating smaller hairs into active full "terminal" hairs. It also causes the growth phase to be prolonged. It does not address the hormonal changes, however, that result in the eventual loss of thinning hairs. Minoxidil is FDA-approved for androgenetic alopecia and is over-the-counter. Side effects include unwanted facial hair growth and skin irritation.
2. Finasteride is an oral medication FDA-approved for male pattern hair loss and is taken by mouth as 1 mg daily. It is a type II 5a-reductase blocker, which halts the conversion of testosterone to DHT. This allows hairs to remain in the active growth phase longer, halting the transition to a thinner, miniaturizing hair. A prescription is needed for this treatment and side effects should be discussed with a health care provider and include changes in sexual health and lower PSA levels.
3. Viviscal oral vitamin supplement: a recent clinical study did show that marine complex thickened the hair of men with male pattern hair loss. Consider this over-the-counter hair dietary supplement if you want to start with a safe, non-drug alternative.
4. Surgical intervention: numerous cosmetic procedures are available to transplant hair from thicker scalp areas or to implant synthetic to human hair fibers. Consultations are typically needed to evaluate if a person is a candidate for these procedures. Surgery may reset the clock but the process of hair loss many times continues.
If you are interested in an evidence-based approach to treatment of male pattern hair loss, visit a dermatologist and ask more about treatment options, side effects, and what treatments are appropriate for you.
Ablon G. A 6-month, randomized, double-blind, placebo-controlled study evaluating the ability of a marinecomplex supplement to promote hair growth in men with thinning hair. J Cosmet Dermatol. 2016 Aug 9.
Arndt K, et al. Manual of Dermatologic Therapeutics, 8th Edition. Lippincott Wiliams & Wilkins 2014.