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For Men

Hair Loss in Men

Androgenetic alopecia or common male pattern baldness (MPB) accounts for more than 95% of hair loss in men. By the age of thirty-five two-thirds of men will experience some degree of appreciable hair loss, and by the age of fifty approximately 85% of men have significantly thinning hair. Approximately 25% of men who suffer with male pattern baldness begin the painful process before they reach the age of twenty-one.

Contrary to societal belief, most men who suffer from male pattern baldness are extremely unhappy with their situation and would do anything to change it. Hair loss affects every aspect of the hair loss sufferer’s life. It affects interpersonal relationships as well as the professional lives of those suffering. It is not uncommon for men to change their career paths because of their hair loss.

Causes of Hair Loss

Androgenic alopecia or male pattern baldness (MPB) is responsible for the vast majority of hair loss in men. While there are many possible reasons people lose their hair, including serious disease, reaction to certain medications, and in rare cases extremely stressful events, most hair loss in men can be blamed on heredity.

What male pattern baldness sufferers are actually inheriting are hair follicles with a genetic sensitivity to Dihydrotestosterone (DHT). Hair follicles that are sensitive to DHT begin to miniaturize, shortening the lifespan of each hair follicle affected. Eventually, these affected follicles stop producing cosmetically acceptable hair.

Male pattern baldness is generally characterized with the onset of a receding hairline and thinning crown. Hair in these areas including the temples and mid-anterior scalp appear to be the most sensitive to DHT. This pattern eventually progresses into more apparent baldness throughout the entire top of the scalp, leaving only a rim or "horseshoe" pattern of hair remaining in the more advanced stages of MPB. For some men even this remaining rim of hair can be affected by DHT.

Diagnosis

Typical male pattern baldness is usually diagnosed based on the appearance and pattern of the hair loss, along with a detailed medical history, including questions about the prevalence of hair loss in your family. An experienced medical hair loss expert should examine the scalp under magnification (preferably with a device called a densitometer), in order to assess the degree of miniaturization of the hair follicles. This assessment is very important when recommending the proper course of treatment.

Treatment

The following treatments have been clinically proven to successfully treat hair loss in men to varying degrees.

Minoxidil (Rogaine)

Minoxidil is an over-the-counter liquid or foam that you rub into your scalp twice a day to grow hair and to prevent further hair loss. It may be used by men and women. With this treatment, some people experience hair regrowth, a slower rate of hair loss or both. The effect peaks at 16 weeks and you need to keep applying the medication to retain benefits.

Possible side effects include scalp irritation, unwanted hair growth on the adjacent skin of the face and hands, and rapid heart rate (tachycardia).

Finasteride (Propecia)

This prescription drug is available only to men. It’s taken daily in pill form. Many men taking finasteride experience a slowing of hair loss, and some may show some new hair growth. You need to keep taking it to retain benefits.

Rare side effects of finasteride include

  • Diminished sex drive and sexual function
  • Increased risk of prostate cancer
  • Women who are or may be pregnant need to avoid touching crushed or broken tablets

How Propecia/Finasteride Works

Finasteride’s hair-raising success is due to its ability to specifically inhibit Type II 5-alpha-reductace, the enzyme that converts testosterone into a more potent androgen dihydrotestosterone (DHT). Propecia’s 1 mg dose of finasteride can effectively lower DHT levels by as much as 60% when taken daily. It is DHT that shrinks or miniaturizes the hair follicle, which eventually leads to baldness. This 60% reduction in DHT has proven to stop the progression of hair loss in 86% of men taking the drug during clinical trials. 65% of trial participants experienced what was considered a substantial increase in hair growth.

At this point, the only truly effective medically proven way to arrest the hair loss process is to lower DHT levels.

The Norwood Scale

When considering treatment for your hair loss, it is important to understand just how far your hair loss has progressed. There will be times when you will have to relay this information via telephone or the internet to physicians or practitioners you may be trying to receive information from. It is also important to guard yourself against misdiagnoses of your condition.

Note: There are many variants in pattern hair loss; these have been cited as the most typical.

  •  University of Pavia - Dr. Wissam Adada - Hair Transplant Surgeon
  •  Università Degli Studi di Padova - Dr. Wissam Adada - Hair Transplant Surgeon
  • Harvard Medical School - Harvard University - Dr. Wissam Adada - Hair Transplant Surgeon
  • American University of Beirut - Dr. Wissam Adada - Hair Transplant Surgeon