No need to despair over a loss of hair

Men unhappy with their male pattern baldness should know that lost hair isn’t a lost cause. Depending on his goal, a man can correct male pattern baldness with medication, hair transplantation, or cosmetic aids.

Androgenetic alopecia—better known as male pattern baldness—generally begins when a man is in his mid-20s. Hair recedes from his forehead and is lost from the crown of his head. In the most severe form of male pattern baldness, the only hair that remains forms a half-ring that runs across the back of the head from temple to temple.

Behind the fall

Male pattern baldness appears to be inherited, although it’s not clear how. The man can have a family history of the condition on either his mother’s or his father’s side...or neither.

But scientists do know that androgenetic alopecia depends on androgens. These hormones are present in both men and women, but at much higher levels in men. The specific culprit is the androgen dihydrotestosterone, or DHT. Two particular cell enzymes convert the male sex hormone testosterone to DHT. Here again, the exact mechanism of change is not yet understood, but the hair follicle (the “root” that nourishes hair growth) begins to shrink. Thick, pigmented (colored) hairs known as terminus hairs are more frequently replaced by short, fine hairs with no pigment (vellus hairs). Eventually, the vellus hairs don’t even make it to the skin’s surface.

In addition, the usual 2- to 7-year growth phase for a hair strand is shortened and the “resting phase,” when old hairs are shed, lengthens.

As a result of these changes, the total number of hairs decreases.

Drugs can slow, stop, or reverse hair loss

Two drugs are approved for male pattern baldness.

• Minoxidil (available as Rogaine) is a blood pressure medication when taken in pill form. As a topical solution, however, it is rubbed directly onto the scalp to slow hair loss and increase hair density. It works, in part, by reversing the shrinking of the hair follicles. Hair growth peaks about 4 months after minoxidil treatment begins, but if the person stops using it at any point, hair loss returns to pretreatment levels.
• Finasteride (available as Propecia or Proscar) is an oral medication originally approved for the treatment of non-cancerous enlargement of the prostate gland. Finasteride prevents the conversion of testosterone to DHT. Like minoxidil, finasteride stops the shrinking of hair follicles, slowing hair loss and increasing hair density. Hair growth levels off approximately 1 to 2 years after a man begins finasteride treatment.

Both minoxidil and finasteride are effective if taken daily on a long-term basis. Some men use both treatments. Candidates for hair-restoration surgery often use minoxidil and/or finasteride so that less hair needs to be transplanted. That way their hair doesn’t look drastically different after the operation.

Another enlarged-prostate medication, dutasteride (e.g., Avodart), may eventually be added to the stable of androgenetic alopecia treatments. Like finasteride, dutasteride stops testosterone from being converted to DHT.

Surgical solutions

Hair-restoration surgery techniques have improved markedly since they were introduced nearly 50 years ago—particularly in the past 2 decades. Hair follicles are transferred from the back or side of the head, where hair grows without androgens, to areas losing hair. Approximately 70% improvement is visible within 5 or 6 months after surgery. Commonly, repeat surgery is needed, especially for the crown of the head.

A lesser-used technique is scalp reduction, in which small areas of bald scalp are removed to bring areas with hair closer together.

In the future, transplantation may be performed using hair follicles from a donor rather than from the man having the treatment.

Cosmetic alternatives

Today’s wigs and hair systems look more natural and weigh less than hairpieces of years past. Although they do not treat the condition of male pattern baldness, colored powders, lotions, and hair sprays can be used to camouflage hair loss.

First, ask yourself...

If you choose to seek treatment for male pattern baldness, you should first define your goals. What bothers you the most about your hair loss? What level of replacement will best fulfill your expectations? Discussing these matters with your healthcare provider will help you make the best treatment choice.

From the Mayo Clinic Proceedings