How common is male pattern hair loss?
80% of men develop a degree of male pattern hair loss by the time they are 80 years old. The process can start as early as in the late teens, though for most men it begins in their twenties or thirties. The pattern of hair loss usually (but not always) follows the Hamilton-Norwood staging system.
Hamilton Norwood staging of male pattern hair loss
Either the frontal and temporal areas, or crown, or both are affected. Even in advanced cases, a rim of hair over the temples and back of the scalp remains unaffected. This area can safely be used as a donor site for hair transplantation procedures.
Progression of male pattern hair loss
The rate at which hair loss advances varies a lot between men. For some, hair loss can advance as quickly as two stages a decade. For others it can take 20 years to advance a stage. Studies have shown that the earlier the process starts, the faster it may progress.
Genetics of male pattern hair loss
There is a strong hereditary tendency to develop male pattern hair loss, though no single gene is responsible. In fact, multiple genes are likely to be responsible, each with a variable contribution. This means that hair loss can be inherited from either parent, and that the disorder may skip generations.
Miniaturisation
This is the process by which thick terminal hairs become thinner and shorter with time. Hair loss becomes visible when 50% of hair in an area has become miniaturised. Miniaturisation occurs under the influence of dihydrotestosterone. The process does not occur without testosterone, explaining why eunuchs never became bald.
Treatment
Three treatments have been medically tested and shown to be safe and effective. These are minoxidil, finasteride and hair transplantation. Several other treatments including herbal supplements, nutritional supplements, mesotherapy and laser, are touted as being helpful but do not carry any supporting scientific evidence.Minoxidil. This lotion or foam can be obtained at any pharmacy and has been shown to slow down the process of male pattern hair loss in about 50% of users, and increase hair density in 15%. Effects can take 6 or more months to become visible. Minoxidil needs to be continued indefinitely for the effect to be maintained. Our clinic also provides oral minoxidil treatment.Finasteride. Finasteride drug blocks the conversion of testosterone to dihydrotestosterone, thereby reducing miniaturisation. This is more effective than Minoxidil, and can lead to 60% increase in hair counts after 2 years of use.Hair transplantation. This is a surgical procedure that takes advantage of the fact that hair on the back of the scalp is spared from male pattern hair loss. Hair from here is redistributed to areas of low density over one or more surgical procedures.
