Hair Loss In Man - What is male pattern baldness?

With every lost strand of hair goes a sizable chunk of self-esteem. You may not get all of them back, but you can certainly try.

Is your top gone? A man may not admit that hair is his crowning glory but baldness deals a heavy blow to his confidence. Genetic hair loss, the most common type of alopecia (baldness), affects not just older men but yuppies and teenagers as well.

But don't fret. Medicine and cosmetics can work wonders in restoring a withering self-esteem. Top-of-the-line wigs are nothing like the dark, stiff mop your great-grandfather used to wear; oral and topical medications are potent; and surgically restored hair doesn't resemble a doll's anymore.

The bald truth
Androgenetic alopecia is not the type of hair loss caused by medical conditions, medications, stress or salon hair treatments. As its name implies, it is triggered by androgens or male hormones, and is greatly influenced by genetics: your inherited genes determine the speed, age of onset and degree of alopecia. In fact, in men, balding among first-degree male relatives is a good indicator for genetic predisposition to androgenetic alopecia.

Females can also develop this condition, but androgenetic alopecia in men (male pattern baldness or MPB) is localized and usually more severe. "[Male] androgenetic alopecia is patterned, progressive and gradual, with stepwise miniaturization of hair follicles," says Dr. Rica Mallari, head of the Hair Unit of St. Luke's Hospital's Dermatology Center.

"Testosterone, in the presence of the enzyme 5-alpha-reductase, is converted to dihydrotestosterone, or DHT," Mallari explains. DHT, the hormone responsible for MPB, causes hair follicles to become smaller and finer with every hair growth cycle. Thus, each new batch of hair that grows is shorter, weaker, less deeply rooted and less pigmented, until the hair on the frontal and vertex portions of the scalp virtually disappear and shiny bald areas appear.

"The hair usually grows out for three to five years, then just sits [on the scalp] for three to four months until a new hair grows out and slowly pushes the old hair out. In pattern baldness, instead of growing three to five years for the next hair cycle, hair will first just grow for two years, then probably just for nine months in the next cycle," Mallari explains further. Eventually, hair growth stops.

Half of men over age 50 experience some degree of androgenetic alopecia. "As we enter puberty, all of us experience gradual thinning of our hair, [but] there are some [whose hair] thins out faster and earlier," Mallari says. Although MPB cannot be prevented, poor lifestyle choices can accelerate it. "Any form of stress (including major depression) and lack of nutrients, especially zinc and iron, can aggravate the condition," Mallari points out.

Gone today, back tomorrow
Hair loss comes naturally with the aging process in some men, and no treatment is necessary. However, baldness, if excessive or occurs early in life, is very distressing. Mallari advises young patients to do something about baldness as early as possible, as MPB is progressive and it would take a longer time to fill in bald spaces at a later stage. "It is important that patients see a dermatologist first for initial assessment and information regarding treatment options available to suit their needs," she adds. These options include:

Wigs
Donning a wig or toupee is the traditional and least expensive option for baldness. Good quality, more natural-looking wigs are available.

Finasteride
Finasteride inhibits 5-alpha-reductase, preventing the miniaturization of follicles due to DHT. According to Mallari, studies done on male patients 18 years old and above show that 99 percent of the patients experienced cessation of hair loss and 66 percent had regrowth with finasteride treatment.

Daily finasteride at 1-milligram dosages is recommended to prevent further hair loss and increase hair growth in men with MPB. "The tablet has to be taken daily for as long as the patient wants his hair. It usually takes about 3 to 6 months before hair loss slows down and 6 to 12 months before hair growth is noticed," says Mallari. "Since this will be a long-term treatment, it is necessary that the patient consult a dermatologist prior to starting this medication. It is important that all other causes of hair loss be ruled out," she continues. The downside of finasteride is that once the medication is stopped, the balding process gradually resumes. Women and children should not use or handle finasteride.

Minoxidil
"The exact mechanism of action of minoxidil in MPB is still unknown but numerous studies have shown that it is effective for pattern baldness. As a lotion, cosmetically acceptable results are attained with a minimum concentration of 1 percent, optimal results with 2 percent and more immediate effects with 5 percent," Mallari says.

People of all ages can use the lotion, which is applied twice a day. Some patients, however, may develop itching, prickling and headaches. "It also takes several months for hair to regrow and usually the hair that grows is thinner. Once minoxidil is stopped, the balding process immediately resumes," says Mallari.

Hair transplants
Hair transplant is the option for those who want a more significant, immediate and permanent hair-loss solution. "Here, the patient's hair on androgen-insensitive areas, like the parietal and occipital areas, are relocated to the balding areas," Mallari explains. "Sometimes, it takes several months for the new grafts to grow, but once they grow, they will look and grow like the normal hair."

Not all patients are candidates for hair transplant, though. Mallari notes: "Usually, patients in the middle-age group are the ones who undergo the procedure, as their hair loss is advanced and difficult to treat with medications alone. It is sometimes difficult to do transplant on the elderly as their hair loss is too extensive--they have a very large area needed to be covered but usually don't have good donor sites.

"[Hair transplant] is a very tedious and expensive procedure. Scalp care is very important after the procedure to prevent the grafts from popping out. The patient can not shampoo normally for the first three weeks."

Furthermore, since the hair-transplant procedure requires surgery, risks include bleeding, swelling, infection, bruising, scarring and numbness. Only board-certified dermatologists, plastic or cosmetic surgeons should perform transplants.

Scalp reduction
Surgical removal of balding scalp areas is called scalp reduction. "This involves the excision of an elliptical piece of bald skin so that the balding area looks smaller," says Mallari. The remaining parts of the scalp with hair growth are stretched and expanded, giving the appearance of more hair. But according to the American Medical Association, the effectiveness of scalp reduction depends on the degree of hair loss and the elasticity of the scalp. "Sometimes, after surgery, the bald area enlarges again as the skin becomes lax," Mallari states.

Counseling
Counseling can also help men cope with baldness. "Usually, patients bothered by MPB are young and single. Most of my patients are in their 20s and 30s, who do not want to go to school or the office [because of alopecia]. They get depressed, lose their self-confidence and develop a psychological problem," Mallari relates. Such shattered self-esteem may improve with a visit to a therapist, but more so from acceptance, affirmation and support from family members