Male pattern hair loss (Androgenetic Alopecia)

Male pattern baldness (also known as androgenetic alopecia) affects all men to some degree as they age. Progressive thinning of the hair on the head can eventually lead to baldness.

Hair loss typically begins at the temples, receding backwards, and sometimes involves the crown to begin with also.

In severe cases the loss progresses leaving only a rim of hair around the edges and at the back.

Why do people develop male pattern hair loss?

This is to do with how testosterone affects the scalp. Testosterone gets converted to dihydrotestosterone (DHT) by an enzyme called 5-alpha reductase. DHT acts on different organs in the body, including the hair follicles and the cells in the prostate.

Some genes can make the hair follicles more sensitive to DHT, which causes the follicles to miniaturize (the hairs growing become thinner and shorter with each cycle of growth) at a younger age than normal.

The process is gradual, and only the scalp is affected.

How common is it?

Significant balding affects about 20% of men in their 20’s, 30% of men in their 30’s and 40% of men in their 40’s.

How is hair loss treated?

There are two main well accepted and proven treatments for managing male pattern hair loss.

5α-reductase inhibitors:

5α-reductase inhibitors are taken in tablet form to prevent the conversion of testosterone to DHT. As such it stops the progression of hair loss. In 2 out of 3 men there is some hair regrowth, while 1 out of three report their hair stops getting thinner.

About 1 in 100 men 5α-reductase inhibitors have no effect at all.

It can take up to 4 months of continual usage to begin to have an effect, and up to 2 years before hair regrowth can be seen. If treatment is stopped the balding process will start again, so ongoing treatment is needed for a long term benefit.

Side- effects are very uncommon, but about 2 in 100 men may experience a lower libido.

High doses of 5α-reductase inhibitors are used for benign prostatic enlargement. There is a concern that high doses of 5α-reductase inhibitors for hair loss can mask the signs of early prostate cancer, but there is no evidence that using the lower doses have any effect on the development of prostate cancer.

Talk to us at GS Health to see if 5α-reductase inhibitors for hair loss is right for you.

Minoxidil:

Minoxidil is a topical lotion that is rubbed into the head.

  • 50% of men using minoxidil have a delay in further balding.
  • 15% have hair regrowth.
  • 30% of men continue to have hair loss.

Minoxidil needs to be used twice a day, and takes about 4 months before results can be seen. Treatment needs to be ongoing and hair that has regrown can fall out about 2 months after treatment is stopped.

Side effects are uncommon, but some people can be sensitive to minoxidil and it may cause a rash.

Discuss with your doctor at GS Health if Minoxidil may be helpful in your situation

Hair transplantation:

Hair transplantation takes small follicles from areas of continued hair growth, and inserts them into areas with hair loss. There is a small risk of scarring and infection, but generally a very successful procedure. With improvements in technology fewer treatments are required than before, and excellent results can be obtained.

Making sure you see a hair transplant surgeon with experience is vital. This is not a procedure we perform at GS Health, though your doctor can refer you to a doctor experienced in this field.

Other treatments:

There are a variety of treatments available on the market, some with promise, lots that are essentially snake oil. There is some growing evidence for the use of PRP (platelet rich plasma) when combined with 5α-reductase inhibitors and minoxidil to increase the chances of hair regrowth.

Topical 5α-reductase inhibitors shows some promise in maintenance therapy, but not in initial treatment. So patients who have taken their 5α-reductase inhibitors for 2 years can then trial a change to topical treatment.

Minoxidil inversely can be used as a tablet for those not wanting to use it topically, but comes with increased side effects of low blood pressure, fast heart rate, hair growth in other unwanted places, and changes on ECG’s. It is seldom used, but only for those who understand the risks and topical minoxidil has proven successful but causes intolerance.

If you are suffering from male pattern hair loss and it concerns you, come see your doctor at GS Health today. Firstly to ensure it’s the right diagnosis, but then to commence the appropriate treatment.

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