Male Pattern Hair Loss - Jerry Shapiro, MD

Male pattern hair loss (MPHL) scientifically known as androgenetic alopecia, is the most common form of hair loss in men. MPHL represents close to 95% of all hair loss experienced by men. This progressive loss of hair eventually results in the thinning and/or loss of hair at the front or top of the scalp. Hairs tend to miniaturize or downsize in these areas.

As many as 50% of men are affected by MPHL by age 50. Hair loss can begin anytime after puberty, but most commonly begins among men in their mid-twenties.

Hair loss in MPHL is progressive and follows a predictable pattern. During the first stage of hair loss, hair usually recedes from the forehead, eventually forming an "M" shape. Other areas such as the crown may subsequently thin out. There is a classification system which illustrates the standard assessment scale used to determine the stages of hair loss. (Norwood-Hamilton scale)

Male pattern hair loss is caused by genetic and hormonal factors. The genetics can be inherited from either the maternal or paternal sides of the family. Male hormones, known as androgens, also play an important role. Specifically, the male hormone dihydrotestosterone (DHT), can cause progressive miniaturization of the hairs on site - specific areas of the scalp.

Treatments available for MPHL are topical minoxidil solution (Rogaine®), oral finasteride (Propecia®) and hair transplantation.

Rogaine® is a topical agent available without prescription in a 2% or a 5% solution. The 5% solution is known as Rogaine® Extra Strength. Rogaine® works by stimulating specific growth factors within the hair follicle that prevent hair from shedding, maintain the growing phase of the hair cycle and thicken the hair shaft. With Rogaine®2% solution, 26% of men showed moderate to dense regrowth and 33% showed minimal regrowth after 4 months of use. Studies also show that hair counts increase with the 2% solution and even more with the 5% solution. Studies also show a 45% increase in hair weight when using the 5% solution compared to the 2%. In those who respond to minoxidil, regrowth can occur as early as two months following the first application. Men who respond to treatment can expect their hair loss condition to stabilize within one year. Continued use of the medication is necessary to sustain any benefit.

Propecia®is the only prescription medication available for MPHL. It is given in tablet form at a dose of 1 mg daily. It acts by inhibiting DHT, the hormone related to the development of MPHL. It cannot be prescribed for women. Clinical studies show that it is well tolerated, stops hair loss in 90% of men for at least 5 years and can regrow hair in 65% of men. In those who respond to Propecia®, continued use of the product is necessary to sustain benefits. As is the case with minoxidil, halting the medication will continue the hair loss.

Surgical hair replacement, specifically hair transplantation and scalp reduction, is another alternative for MPHL. Hair transplants involve taking hair from an area not susceptible to hair loss and transplanting this hair where hair loss has occurred. The transplanted hair will continue to grow as if it were in its original location. Scalp reduction is a surgical procedure where an area of the bald scalp is removed and the hair bearing scalp rejoined together.

Frequently, medical and surgical therapies are combined to maximize results.

For a proper diagnosis and to best deal with male pattern hair loss, contact your physician.


References:

• Need reference.
  

The following are frequently asked questions on male pattern baldness. The information provided is not meant to be a substitute for the information obtained at an evaluation and by discussion with a physician but merely to encourage understanding of this condition. No questions regarding individual scenarios will be answered by the NAHRS. No changes in treatment should be undertaken by a patient without discussion first with the patient's physician.

• How is this condition inherited?
• I've heard that if you use Rogaine, you have to use it for the rest of your life or your hair will fall out.
• I am 22 years old and am losing hair in my frontal hairline: My father is bald. Am I likely to go bald too? Can I prevent it? (Link to Merck end?)
• What about all the nonprescription products that say they can help hair growth, do they work?
• I am 28 years old, single and have lost a lot of hair on the top of my head. I've seen ads for hair transplants and the results look great. What should I know about hair transplants before I go for a consultation with one of the groups in the yellow pages?

1. How is this condition inherited?
   Contrary to popular belief, male pattern baldness (MPB) is not inherited only from the mother's side. The exact inheritance pattern of MPB is still debated. It is believed to be most likely a dominant trait, involving more than one gene, and inherited from either parent.
   
   
2. I've heard that if you use Rogaine, you have to use it for the rest of your life or your hair will fall out.
   There is no cure for MPB. As a result, all medical treatments need to be used indefinitely.
   If the treatment has been discontinued, all the benefits will be lost. Upon discontinuation, you do not lose "all your hair", but simply will resume the state of hair loss, you would have attained if you had never used the product.
   
   (Go to Pharmacia.com for further information on Rogaine)
   
   
   
3. I am 22 years old and am losing hair in my frontal hairline: My father is bald. Am I likely to go bald too? Can I prevent it? (Link to Merck end?)
   Your hair loss in the frontal hairline is most likely due to MPB. However, there are other causes for hair loss in the frontal area and it is important your physician confirm the diagnosis.
   
   The fact that your father is bald increases the likelihood you will also express the trait. The degree of how severe the problem will be is unpredictable. Your father may be very bald, but you may only develop some thinning on the crown and frontal hairline area. Nobody can predict with certainty how "bald" and individual will become.
   
   You can prevent it my considering two medical options. Propecia is a pill you can take once daily. Rogaine is a lotion you can rub on your scalp twice daily. Both have been scientifically proven to prevent further hair loss in the majority of men with early MPB.
   
   
4. What about all the nonprescription products that say they can help hair growth, do they work?
   There are only two medical treatments that are approved by the US FDA for the treatment of MPB. These are Propecia(finasteride) and Rogaine (topical minoxidil solution). Propecia is a prescription. Rogaine is non-prescription/over the counter. Both these medical treatments have undergone rigorous medical testing to prove without doubt that they have a positive effect on MPB. This is called "evidence-based" medicine. All other treatments have not yet gone through this degree of rigorous testing and have not been approved by the US FDA for the treatment of MPB. Most physicians and scientists will not agree that a product "works" on MPB until it has gone through all the appropriate scientific tests to prove that it can prevent hair loss or grow more hair.
   
   
5. I am 28 years old, single and have lost a lot of hair on the top of my head. I've seen ads for hair transplants and the results look great. What should I know about hair transplants before I go for a consultation with one of the groups in the yellow pages?
   It is always best to have some information before a consultation. It is wise to read up on the procedure so you know what questions to ask the hair transplant surgeon. A good website is the International Society for Hair Restoration Surgery (www.ishrs.org). At the consultation, the hair transplant surgeon will go over the procedure with you at length. He/she should be able to show you lots of before and after photos of their work. After learning about the procedure and the seeing the surgeon's results, you will be able to make an informed decision as to whether you wish to proceed with this popular procedure.