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Male pattern baldness: Causes, Symptoms & Treatment

Male pattern baldness is the most common type of hair loss. It often starts at the hairline and widens to include more of the scalp. A receding hairline, a widening part, and thinning in front are all signs of this type of baldness. Androgenetic alopecia is the term experts use to describe male pattern baldness. It is also known as pattern baldness, androgenetic alopecia, and hereditary hair loss. Male pattern baldness may affect 5% of men in their lifetime, and 50-80% of men will experience some degree of hair loss in their lifetime.

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Causes:

The cause of male pattern baldness is not entirely known. However, it is largely believed to be hereditary and due to a combination of genes and environment that results in sensitivity to androgens (male sex hormones) in the scalp. The two main hormones that trigger hair loss in men are testosterone and dihydrotestosterone. 

Testosterone affects the rate at which hair grows, whereas dihydrotestosterone or DHT affects the presence of fine structures called vellus hairs (which grow on parts of the body where hair is absent). Because these fine structures are sensitive to DHT, they become thinner when male pattern baldness occurs.

The scalp also contains two types of hair follicles:

1. Terminal follicles – which make thick, long-lasting hair.

2. Vellus follicles – which produce fine and short-lived hair.

Both types of follicles are present in the scalp; however, vellus hair is more abundant than terminal hair in many areas of the body, including the scalp. When male pattern baldness occurs, vellus hairs are lost because they are sensitive to DHT, causing a thinner appearance of the scalp and eventual balding.

The gene that causes male pattern baldness has been found on the X chromosome. 

Symptoms:

As mentioned before, the distinctive signs of male pattern baldness are a receding hairline, a widening part (called a "widening of the vertex") and thinning front hairline. The receding hairline may also include irregular thinning in the temples or behind the ears. Bald patches can appear on other areas of the scalp as well, including at the crown of the head (top), nape (back) and sides.

Furthermore, some patients develop pattern baldness on their head in much more severe and extensive forms. These cases usually involve many more terminal follicles along with other types of hair loss.

The hair on the sides and back of the head may grow, but it becomes very thin, often translucent. When this occurs, it creates a "horseshoe" appearance. 

It is important to note that, even if a man has lost most of his hair, he may not be suffering from male pattern baldness. Male pattern baldness does not occur unless there are changes in structure or function of the hair follicles themselves or signs of hormone sensitivity. Although it is not entirely clear how many strands of hair begin to fall out, many patients suffering from male pattern baldness experience noticeable thinning after a certain number of years (usually 15-25). 

Furthermore, male pattern baldness is not the same as alopecia areata, which is an autoimmune disease. Male pattern baldness occurs when genes and hormones trigger hair loss. At this time, there is no known cause of alopecia areata.

 

Treatments:

1. Hair transplantation:

The best way to repair male pattern baldness is hair transplantation. Hair transplants provide an extended and realistic appearance of a full head of hair with the density, texture and color of natural hair. This procedure requires multiple sessions to ensure complete coverage. Silicone paste applied to the donor area surrounding the bald spots aids in preservation and healing, as does application of allo-hair, which is a mixture of crown or human grafts mixed with 1:3 human scalp (back) pedicle cells. The grafts are harvested from donor areas that are not part of the balding area and then transplanted into the balding areas, or "flanks". Proteins and stem cells from the donor area are also injected into the balding area to restore healthy hair. 

2. Hair with cones:

In some cases, there is a lack of hair follicles which results in the production of excess DHT. The remedy for this type of baldness is wild-type human or animal (typically monkey) hair that has been chemically treated with substances known as alpha hydroxy acids (AHA's). These treatment methods are temporary and not ideal as they essentially prevent new hair growth rather than promoting it. 

3. Finasteride:

Finasteride is an oral drug used to treat male pattern baldness and reduce levels of DHT, the hormone that causes hair loss. Finasteride works by preventing the enzyme 5-alpha reductase from converting testosterone into DHT. It does not change how much DHT you have. Only males can use finasteride to treat hair loss because it can be harmful for women who are or may become pregnant and therefore should not take it. 

4. Minoxidil:

Minoxidil is a topical treatment designed to stimulate hair growth by increasing the blood flow going to the scalp. In most cases, minoxidil is applied directly to the bald spots on the scalp and will show some improvement within 4 months, although continued use may be needed for maximum effect. This medication must be used exactly as prescribed by a doctor or health care professional and should not be used without professional advice or supervision. The medication should not be sold over-the-counter in any country at this time. Side effects include skin irritation, itching, flaking skin and redness of the scalp (erythema), although these side effects are virtually nonexistent with long-term use. 

5. Prescription Strength Minoxidil:

The prescription strength version of minoxidil, sold as Rogaine, or a generic form called lotrisone, worked much better in one study than the standard strength version. However, not all studies have shown this to be true. Also, a long-term study of 2290 men found that minoxidil was ineffective as there was actually an increase in the number of hair-bearing areas after 2 years of treatment with either type. A clinical trial involving 1317 men conducted in the U.S. found that just over one third of patients taking a 2% concentration of minoxidil had moderate hair regrowth or some benefit. A weaker solution, 1% minoxidil, may be better to use than the higher doses available over-the-counter. 

6. Laser treatment:

Laser and similar medical treatments are available for certain cases of male pattern baldness. Photorejuvenation is an effective, non-surgical method for treating male pattern baldness and stimulating hair growth. It involves focusing a high-intensity light beam directly onto the scalp to stimulate the generation of new blood vessels and thereby promote hair growth in affected areas. 

7. Other treatments:

Other treatments for baldness include several hairpieces that attach to the scalp, as well as mini-scalp transplants. These options may be helpful for women, who cannot take finasteride and are interested in not going completely bald. 

As an antiandrogen, finasteride 5 mg can reduce levels of the 5-alpha reductase enzyme (which converts testosterone into DHT) and thereby reduce hair loss. This is consistent with a hypothesis that androgens cause male pattern hair loss by damaging hair follicles.

 

Prevention:

As with most baldness conditions, prevention is the best option to treat male pattern baldness.

The main tips for prevention of male pattern baldness are:

1. Avoid being under stress and keep a healthy lifestyle.

2. Maintain a balanced diet and drink at least 2-3 liters of water per day.

3. Avoid smoking and alcohol consumption as much as possible.

4. Avoid exposure to harmful UV rays from the sun or solariums, because they can cause permanent damages to body tissues like skin and hair follicles which may lead to male pattern baldness or even cancer in worst cases. 

References: 

"Hair Loss Problems" (PDF)- This article is a detailed description, in simple English and in Hindi, of all types of hair loss. 

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