Hair Loss 101 – The Doctor’s Diagnosis

Male pattern baldness (MPB) also known as androgenetic alopecia, is the commonest cause of hair loss in men. It accounts for over 90% of cases and it becomes more common with age. Approximately 30% of men by the age of 30 and 70% by the age of 70 are affected by MPB but it can appear as early as teenage years, particularly if there is a strong family history of early baldness.

Of course, hair loss is not life threatening – but it is a very personal experience. It affects people differently. Just because your friend or brother is reacting differently to you about losing his hair, doesn’t mean that your concerns and anxiety around your hair loss aren’t valid.

Of course, hair loss is not life threatening – but it is a very personal experience. It affects people differently. Just because your friend or brother is reacting differently to you about losing his hair, doesn’t mean that your concerns and anxiety around your hair loss aren’t valid.

Hair loss is a very personal experience and it affects everyone differently. Some men embrace the prospect of losing their hair – as a sign of wisdom and maturity – while for others the psychosocial impact of hair loss can be far reaching. For some men, feelings of low self esteem and poor confidence levels, anxiety and depression can accompany losing their hair.

This can create difficulties across many aspects of a man’s life – from forming and maintaining relationships to their performance at work. The effects of hair loss can be far-reaching.

Hair has always been more than just a beauty asset. It is a deeply personal and emotive physical trait that has, throughout history, been closely linked to a person’s identity. Consequently, many people who lose their hair often describe a feeling of being stripped of their identity.

In my observation as a doctor, men experience greater difficulty in speaking openly about hair loss compared to women. There remains a stigma associated with a man being seen to openly care about losing his hair. Many of my patients fear that their peers would make fun and tease them about being vain for seeking hair loss treatments.

Furthermore, there is a general attitude that hair loss has less impact on a man compared to a woman, as they can simply ‘shave it all off’. Internalisation of this narrative unfortunately contributes to the delay in some patients seeking help for their hair loss.

The bottom line is there is absolutely no shame in showing self care and that includes caring about your hair. If hair loss is having a negative impact on you or your quality of life, it’s time to speak to a reputable specialist about your treatment options.

The bottom line is there is absolutely no shame in showing self care and that includes caring about your hair. If hair loss is having a negative impact on you or your quality of life, it’s time to speak to a reputable specialist about your treatment options.

Interestingly and unfortunately, a significant proportion of men are not aware of any treatments for male pattern baldness (MPB).

As MPB is progressive and worsens over time, the best outcomes result from starting treatments early in order to:

1. Stabilise the condition and prevent further hair loss/thinning.
2. Potentially improve hair growth/density with continued treatment.
3. Delay the need for more invasive treatments such as hair transplants.
4. Improve the prospects for future hair transplantation by minimising the area that requires transplanting into.

As male pattern baldness is progressive and worsens over time, the best outcomes result from starting treatments early.

I am seeing a definite trend in my clinical practice of men taking a more proactive and preventative approach. This means starting treatments at the early stages of MPB.

This is usually in the form of the anti-androgen prescription tablet Finasteride or the topical solution Minoxidil; the two licensed products for treating MPB. The “anti-androgen” tablet Finasteride is the most effective of the two licensed treatments for treating MPB. However, remember that treatments will need to be continued long term to maintain the effect. Of course, many men also stop taking the treatments when the prospect of hair loss is no longer of concern to them personally.

As continuous treatments are required, it’s very important to discuss potential risks and side effects of treatment with your doctor.

If you don’t want to take Minoxidil or Finasteride, additional treatments for MPB may include other anti-androgen tablets, injection therapies and hair transplantation – as well as more cosmetic approaches such as scalp micropigmentation (scalp tattoo) and bespoke hair systems. You can discuss these with your doctor.

I am seeing a definite trend in my clinical practice of men taking a more proactive and preventative approach. This means starting treatments at the early stages of MPB. The “anti-androgen” tablet Finasteride is the most effective of the two licensed treatments for treating MPB.

MPB appears when there is a deepening recession of the hairline over the temples (adopting a more M-shaped pattern) and/or a progressive thinning on the crown. The extent of hair loss varies enormously between individuals. The most common grading system used to assess the severity of hair loss is the Hamilton-Norwood scale.

As MPB is a progressive condition, the earlier in age it starts, the more severe the hair loss becomes over subsequent years if no treatment is taken. While there are many myths and misconceptions around genetic hair loss, MPB is due to a combination of many genetic, hormonal and environmental factors and not all of these are fully understood. What is clear is that MPB is related to the effect of male hormones (collectively known as androgens) on the growth cycle of the hair follicle – in particular the androgen called DHT (dihydrotestosterone), which is the active form of testosterone.

MPB is due to a combination of many genetic, hormonal and environmental factors and not all of these are fully understood. What is clear is that MPB is related to the effect of male hormones (collectively known as androgens) on the growth cycle of the hair follicle – in particular the androgen called DHT (dihydrotestosterone), which is the active form of testosterone.

To understand hair loss, you need to understand how normal, healthy hair grows. In healthy hair, each hair follicle undergoes three phases of the growth cycle: anagen (growing phase), which lasts up to seven years, then catagen (regression phase when the hair follicle stops growing), which lasts three weeks. Finally each follicle goes through telogen (resting phase), which lasts on average three months.

After telogen the old hair is expelled and replaced with a new hair in the anagen phase. Androgens trigger the balding process by gradually shortening the anagen phase. With time the hairs become shorter and finer (so called miniaturised or vellus hairs). This leads to visible thinning on the scalp.

Androgen hormones ‘communicate’ to hair follicles through specific androgen receptors located at the root of the hair follicle. Interestingly, these receptors are only present on hair follicles located at the front and crown of the scalp. They are not present on the back and sides – which is why these areas are not normally affected by the process of MPB.

The inheritance pattern of MPB is complex –  but certainly having a close relative with early onset baldness (from either side of the family) is a risk factor.

Genetic factors determine how active these receptors are and therefore how sensitive the hair follicles are to the effect of androgens.The gene that codes for the androgen receptor (AR) has been confirmed to play a role in MPB.

The androgen receptor (AR) gene is located on the X chromosome, which in men is inherited from the mother. This explains the common belief that MPB is inherited from the maternal side of the family. But is your mother really to blame? Possibly not, as this theory does not explain the similarity in baldness patterns commonly seen between fathers and sons.

New research supports that there are far more genetic factors, which can come from one or both parents that contribute to the overall risk of MPB –  than simply the AR gene alone. As a result, the inheritance pattern of MPB is complex – but certainly having a close relative with early onset baldness (from either side of the family) is a risk factor.

Interestingly, some studies have shown a possible link between lifestyle/environmental factors and early baldness in those who are genetically susceptible. These include smoking¹ and use of anabolic steroids.² Equally, early onset MPB has been independently linked to the metabolic syndrome and other risk factors for heart disease³ Go and see your GP if you’re concerned about any of the above.