More common in men than in women, hair loss can be psychologically devastating. According to a U. S. National Library of Medicine publication, more than 50% of men over age 50 have some degree of hair loss. Androgenic, or androgenetic, alopecia, also referred to as male pattern baldness, is the leading cause of hair loss in men of all ages.
The Mechanism of Hair Loss in Androgenic Alopecia
The pattern of loss in androgenic alopecia begins in the front of the scalp towards the temples, then the hairline recedes over the top and crown of the head. The hair loss can progress further down the sides and back of the head leaving just a rim of hair, or nothing at all. The mechanism of hair loss in androgenic alopecia is likely a combination of environment, genes, and hormones. Environmental factors might trigger early start of the process in a man with the genetic predisposition. Hair loss occurs as follows:
- Affected men inherit a genetic increased sensitivity to the more potent testosterone byproduct, dihydrotestosterone (DHT), at the level of the hair follicle.
- Because of this, the male hormone (androgen) receptor in the hair follicle binds DHT more effectively.
- The increased response to DHT shrinks hair follicles and cause them to produce thinner hair after prolonged exposure.
- Eventually the hairs from the affected follicles fall out and hair production stops.
Other, less common causes of male hair loss, according to MedlinePlus, include:
- Systemic illnesses: Medical problems which can lead to diffuse thinning or loss of hair, or loss of hair in patches (alopecia areata) include:
- Diseases of the immune system such as systemic lupus erythematosis, an autoimmune disease in which the body attacks itself
- Thyroid disease, or other hormone problems
- High fever or surgery, especially with use of anesthesia agents
- Chronic stress, which leads to sustained, systemic levels of stress hormones can affect hair growth
- Medications: Some medicines that can cause hair to fall out, according to DermNet New Zealand, include:
- Heart and anti-high blood pressure drugs
- Drugs used to treat epilepsy
- Retinoids, such as Acutane, used for the treatment acne
- Androgens, mainly the anabolic-androgenic steroids, misused by some athletes
- Skin diseases: These diseases, which can affect the scalp and cause profound itching, inflammation, scarring of the scalp, and localized, patchy hair loss include:
- Psoriasis, which causes lesions with thick, itchy scales and damage to hair follicles
- Lichens planus, a skin disease of unknown cause
- Scalp infections, such as tinea capitis (scalp ring worm), yeast and other fungi
- Seborrheic dermatitis, which is an itchy, scaly, waxy condition of the skin that can affect the scalp
- Trauma: Although more common in women, male hair loss can happen from any hair treatment that cause trauma and lead to inflammation or scarring of the scalp and follicles, including:
- Braided hair styles and tight ponytails that put traction on hair follicles, especially used by people of African descent
- Chemical treatments such as hair dyes and hair relaxers
- Circulation problems: Cardiovascular disease and inflammation in blood vessels to the scalp can potentially affect blood and nutrient supply to hair follicles and cause hair loss.
- Nutritional Deficiencies: Certain vitamins and minerals (especially the B vitamins, iron, and calcium) are essential for healthy hair growth. A strict, low calorie diet that is limited in vitamins and minerals can cause hair to fall out.
- Aging: It is an inevitable fact for most people that hair thins and falls out with age as the hair follicles shrink. The pattern of loss is unique to each person.
Diagnosis and Treatment
Before you can decide how to deal with your hair loss, it is best to look for the cause. Talk to your doctor or a dermatologist about an evaluation and diagnosis, Treatment options depends on the cause of the loss.
Men with hair loss due to causes other than androgenic alopecia can get regrowth of their hair by treating the underlying cause. Likewise, with inherited male pattern balding there are medications that can slow the hair loss and allow your hair to regrow. The earlier you start treatment the more effective it will be.
Approved Drug Options
According to the Skin Therapy Letter, there are two approved drug options for treating male pattern hair loss:
- Finasteride is the generic name for the brands Propecia and Proscar. It is approved by the Food and Drug Administration (FDA) as the first line drug for the treatment of androgenic alopecia. Finasteride features include:
- Is taken as a one milligram oral daily dose
- Starts regrowth of hair in about six weeks and treatment has to continue indefinitely otherwise the hair falls out
- Stops further hair loss in 86% of men and cause "substantial" hair growth in 65% of men who take the drug, according to the American Hair Loss Association
- Lowers DHT levels at the hair follicle by inhibiting the enzyme, 5-alpha-reductase, that converts testosterone to DHT
- You apply the liquid or foam option to your scalp twice a day
- It slows hair loss and starts regrowth in about one to six months, but the effect is temporary as the hair will fall out if you stop the treatment.
- The drug is not as effective as finasteride - it is considered a second line option if finasteride or other options are not effective or available.
- It does not alter the levels of DHT and therefore has no effect on the underlying process in androgenic alopecia.
Researchers are investigating other drugs to treat hair loss, including dutasteride (Avodart), which is similar to finasteride, and prostaglandin-like drugs, which grow eyelashes.
To treat other causes of hair loss, you can use medicines your doctor can prescribe, or over-the-counter treatments. They help clear up the scalp conditions mentioned above that stunt hair follicles and hair growth. They also control the itching (which leads to the scratching that causes breakage of the hair shaft). These products include:
- triamcinolone is used as a topical application or by scalp injections. Steroids decrease inflammation and scarring.
- Oral or topical antifungal prescription-strength agents, including shampoos, such as ketaconozole (Nizoral), which is also available as a 2% over-the-counter (OTC) shampoo in a lower concentration.
- Other OTC preparations contain ingredients that can also help to clear up dandruff, and other scalp conditions. Products which are widely available include:
- Neutrogena T-Sal Therapeutic Shampoo has active ingredient 3% salicylic acid, which is a potent exfoliating agent that cleanses the scalp.
- Neutrogena T-Gel Therapeutic Shampoo has 2% tar as the active ingredient, which suppresses dandruff, seborrhea and other problems and relieves itching.
- Glover's Medicated Shampoo also contains tar which relieves itchy scalp problems.
- Scalpicin Max Strength Scalp Itch Treatment, applied to the scalp as a leave-on lotion, combines 1% hydrocortisone to decrease itching with 3% salicylic to decrease scalp debris. Use as directed on the label or as your doctor advises.
Although there is no scientific evidence for effectiveness, you can also try safe, natural hair loss treatments such as aloe vera gel, for additional help. An Indian herbal recipe is also said to help restore hair growth. These natural options might help to clear up scalp conditions and decrease inflammation and build up of dead cells, fungus and oils in the follicles.
There are numerous hair products sold over-the-counter and online that claim to be effective for treating hair loss. They are highly marketed with unsubstantiated claims and may contain unknown ingredients. They may also contain known ingredients whose safety is uncertain, such as black cohosh, dong quai, and false unicorn. Be wary of false claims and check with your doctor before using any of these concoctions.
Hair Transplant Surgery
Instead of medicines, you can consider doing hair transplant surgery, which is most frequently used to treat androgenic alopecia. According to the Bernstein Medical Center for Hair Restoration, the procedure restores hair to thin or bald areas on the front and top of the head using healthy, DHT-resistant follicles from the back of the head.
In the most current technique, doctors transplant units of one follicle each, with hair and skin, to the donor site under local anesthesia. This is a highly skilled procedure that can take five to ten hours and should be done by a doctor with the appropriate training.
Other procedures include scalp reduction surgery. A complete or partial area of bald scalp skin is removed and the remaining scalp edges are sewn together, which reduces or removes the bald area.
Hairpieces or toupees, or wigs cover the bald areas of scalp. These can be an option if you cannot afford or don't want to go the route of medical or surgical options. It is important to find a reputable business so you don't waste your time or money.
Consult Your Doctor
When you are dealing with hair loss, it is best to consult your doctor or a dermatologist specializing in hair loss to diagnose the underlying cause. This will lead to the best treatment options for your problem.