Dr. Tariq Jagnarine
Fam Med, Endocrinology/Diabetes
Male pattern baldness refers to a loss of hair on the scalp in males. It is not always possible to prevent it, but various treatments can reduce or reverse some of the hair loss. Male pattern baldness affects half of all men by the age of 50. It occurs as hormone levels change over time, especially as a person gets older.
Although a natural part of the aging process for many, hair loss can be distressing. Sudden hair loss can sometimes indicate a health condition that may need medical attention.
CAUSES OF MALE PATTERN BALDNESS
Many people find they lose their hair fullness as they age. This is because hair growth slows down over time. What leads to male pattern baldness is a combination of this slower growth and genetics. People who inherit certain genes are more susceptible to male pattern hair loss.
Research has linked several genetic changes to this type of hair loss, but, so far, scientists have only confirmed one of them. This gene is known as the androgen receptor (AR) gene. The AR receptor gene controls how sensitive cells are to androgens or male sex hormones. These hormones influence the hair growth cycle.
Male pattern hair loss affects up to half of all white men by the age of 50 years, and up to 80% of men in the same group by the age of 70 years. Male pattern hair loss is less prevalent in other groups, such as among Chinese and Japanese people. If a person has first- and second-degree relatives who lost their hair due to age, they may have a higher likelihood of experiencing male pattern hair loss.
Male pattern hair loss also has associations with some medical conditions, including:
* Hypertension, or high blood pressure
* Obesity
* Diabetes
* Enlarged prostate
* Coronary heart disease
* Prostate cancer
Some of these conditions may result in elevated androgens, which could explain the link.
SYMPTOMS OF MALE PATTERN HAIR LOSS
There are different types of hair loss, and they can manifest themselves in different ways. In male pattern baldness, or androgenic alopecia, hair loss typically begins at the hairline or on top of the head. Slowly, the hairline recedes, and the hair thins. For some, the hair loss stops there, leaving the hair on the sides and back of the head intact. Some people lose more hair, some less. Hair loss that occurs suddenly, in patches, or with additional symptoms could be a sign of a different condition that requires treatment.
TREATMENT FOR MALE PATTERN BALDNESS
For some, male pattern hair loss can be a typical part of growing older. Some people embrace the change and do not perceive a need for treatment. In others, hair loss can trigger negative feelings, such as low self-esteem. For people who do want treatment, there are ways to reduce hair loss, or, in some cases, reverse it.
The available options include topical treatments, medicated shampoos, oral medications, hair transplants, laser or light therapy.
Medication for male pattern baldness
The U.S. Food and Drug Administration (FDA) has approved two types of drug treatment for male pattern baldness.
* Minoxidil
Minoxidil is a topical treatment. It is available over the counter at pharmacies, usually as a lotion or foam. Scientists originally developed minoxidil to treat blood pressure, but some people noticed additional hair growth as a side effect while using it. It is unclear exactly how it works. It can take 6–12 months for results to appear. To maintain the effects, a person must use the medication indefinitely. Potential adverse effects can include itchiness, irritation, and headaches. Rarely, people can have more serious side effects, such as severe allergic reactions.
* Finasteride and dutasteride
Finasteride is an oral medication available only on prescription. It is a 5-alpha reductase inhibitor that works by blocking the formation of dihydrotestosterone (DHT), an androgen that plays a role in male pattern hair loss.
Treatment involves taking a daily pill, which people can use alone or in combination with minoxidil. It can take around 6 months for results to appear. If a person stops the medication, the effects would be reversed.
Finasteride can slow down hair loss in around 80–90% of males who take it. It can also result in some regrowth, particularly when people begin finasteride as soon as they notice signs of hair loss. In some, finasteride causes side effects such as: reduced sex drive,
difficulty maintaining an erection, breast tissue tenderness or enlargement, depression. This could indicate androgen levels are too low.
Shampoo for male pattern hair loss
There is some evidence that certain medicated shampoos can reduce male pattern hair loss. Ketoconazole is an antifungal and antiandrogen medication present in dandruff shampoos such as Nizoral. A 2019 review of past studies found evidence that it can increase hair shaft thickness and improve hair loss.
However, it is worth noting that one of the researchers was on the medical board for Janssen Biotech Inc., which produces Nizoral shampoo. As a result, there may be a conflict of interest.
Hair transplantation
Hair transplantation involves taking hair from elsewhere on the body and grafting it onto the scalp.
Laser treatment for hair loss
Laser therapy may have promise for slowing hair loss, but the evidence supporting this option is not as strong as the evidence for other treatments.
If hair loss is sudden, patchy, or occurs with other symptoms, people should contact a doctor. These symptoms could include:
* Itchiness
* Inflammation
* Dry, flaky scalp
* Tiredness
* Unexplained weight loss or gain
* Persistent stress, anxiety, or low mood
A doctor would be able to check a person’s symptoms and medical history to look for potential explanations. If necessary, they can also perform diagnostic tests.
