Male pattern hair loss; its progression and treatment
Published on 6th February '19Male pattern hair loss (MPHL) can be just as stressful as any other hair loss, it can begin in men during or after puberty caused by increased androgen activity. Androgens are hormones, they play a major role in male traits, reproductive activity and are responsible for male sexual development. It is not just androgens that cause male pattern hair loss, genetics play a part too. It can be inherited from both maternal and paternal parents therefore it can also be known as andro-genetic alopecia.
For MPHL to occur there has to be normal levels of testosterone, this androgen is then converted to dihydrotestosterone (DHT) by the presence of an enzyme called 5 alpha reductase. Dihydrotestosterone is five times more potent than testosterone. This will then target hair follicles, usually following the Norwood-Hamilton scale. Which is a scale that measures the severity of MPHL.
The hair cycle has three main stages anagen, catagen and telogen, these cycles will differ from person to person. Normal hair growth cycles are as follows; Anagen stage – which is the growth stage and can last anywhere approximately between 2 to 6 years. Usually about 85%-90% of your hair on your head will be in this stage at one time. The longer the anagen stage is the longer your hair will grow.
Catagen stage – this is known as the regression or transitional stage where the hair’s matrix cells stop dividing and the hair stops growing, the papilla detaches its self from the hair cutting the blood supply. The hair will stay in this stage for around 2-3 weeks.
Telogen stage - is the resting stage which last 3-4 months. Telogen hairs can be prematurely shed due to brushing and styling but naturally at the end of this stage the hair is shed and the new hair shaft will begin to emerge, anagen stage will begin all over again completing the cycle.
When testosterone has been converted to dihydrotestosterone the anagen stage is a lot shorter than in a normal cycle producing shorter hairs and there is an increase in shedding hairs (telogen stage). The hair follicles start to go through miniaturisation which then produce weaker shorter hairs thinner in diameter, this hair will usually be less pigmented making the hair loss appear a lot worse. The hair will eventually turn into vellus type hairs before the inevitable hair loss.
There is a scale which has been developed as previously mentioned, known as the Hamilton-Norwood scale which shows the progression and different paths male pattern hair loss can take in seven stages, the typical pattern is starting at stage one where the hair starts to recede at the temples right back then hair sheds at the vertex until they meet (stage seven) where hair is usually only found around the nape and ears. There are alternative routes known as;
Vertex pattern – hair loss at the vertex soon after hair receding at the temples then progresses as a typical pattern.
Anterior pattern – hair receding from the front moving backwards towards the vertex.
Male pattern hair loss can be treated with oral and topical medicines but cannot be cured without surgery. These medicines include DHT blockers which you can speak to your doctor about as these group of medicines are prescription only and come with side effects.
Minoxidil is a topical lotion or foam and has shown to be very effective in both male pattern hair loss and female pattern hair loss. It helps to prevent miniaturisation of the follicle and produce thicker longer hair. Minoxidil will not help sufferers who are already bald, the hair follicle must still be active.
Surgery
Follicular Unit Strip Surgery (FUSS) is where a strip of the scalp is removed from the back of the head an area that is not sensitive or affected by androgens, the scalp is stitched leaving just a small scar usually hidden and covered well by existing hair. The strip of tissue that has been removed is then processed into individual follicular units and repositioned in the affected areas. Follicular Unit Extractions (FUE) are also available the biggest difference being that as a strip is not being removed there will not be a lengthy scar. The follicular units are removed by small biopsies leaving just tiny scars. These methods are very expensive.
Non- surgical treatment
There are many different treatment methods to aid hair loss on every level of severitystarting from hair fibres that can be used to disguise thinning to hair replacementsusing adhesives to attach to the scalp.