Male pattern baldness is the common type of hair loss that develops in most men at some stage. It usually takes 15-25 years to go bald. However, some men go bald in fewer than five years. Typically, at first the hair begins to recede (thin) at the front. At the same time, the hair usually becomes thin on the top of the head. A bald patch gradually develops in the middle of the scalp. The receding front and the bald patch on the top (the crown) gradually enlarge and join together.
Who gets male pattern baldness?
Nearly all men have some baldness by the time they are in their 60s. However, the age the hair loss starts is variable.
What causes male pattern baldness?
Hair is made in hair follicles which are like tiny pouches just under the skin surface. A hair normally grows from each follicle for about three years. It is then shed, and a new hair grows from the follicle.
Baldness occurs when:
- Affected hair follicles on the scalp gradually become smaller than normal.
- As the follicle shrinks, each new hair is thinner than the previous one.
- Before falling out, each new hair grows for much less time than the normal three years or so.
- Eventually, all that remains is a much smaller hair follicle and a thin stump of hair that does not grow out to the skin surface.
Male hormones are involved in causing these changes. The level of testosterone, the main male hormone, is normal in men with baldness. Hair follicles convert testosterone into another hormone called dihydrotestosterone. For reasons that are not clear, affected hair follicles become more sensitive to dihydrotestosterone, which causes the hair follicles to shrink.
The condition is genetic (hereditary).
What are the treatment options for male pattern baldness?
To become gradually bald is a normal part of the ageing process for most men. No treatment is wanted or needed by most affected men. For some baldness can be distressing, particularly if it is excessive or occurs early in life. Treatment may then help.
Currently there are two medicines that help - finasteride and minoxidil.
Finasteride works by blocking the conversion of testosterone to dihydrotestosterone. The hair follicles are then not affected by this hormone, and can enlarge back to normal. Some hair regrowth occurs in about 2 in 3 men who take a finasteride tablet each day.
Some points about finasteride include the following.
- It takes about four months for any effect to be noticed, and up to 1-2 years for full hair growth.
- The balding process returns if treatment is stopped.
- The most common side effect is that about 2 in 100 treated men report loss of sex drive (libido).
Minoxidil lotion is a rub-on treatment that you can buy at pharmacies without a prescription. It is not clear how it works. The higher-strength solution (5%) is more effective than the 2% strength.
Some points about minoxidil include the following.
- It needs to be rubbed on the scalp every day.
- It usually takes four months or more for any effect to be noticed.
- Treatment needs to be continued indefinitely. Any new hair that does regrow falls out two months after treatment is stopped.
- It is quite expensive.
A wig is the traditional option for baldness.
Techniques such as hair transplantation, scalp flaps, and other procedures have been used for a number of years. Success rates vary and a specialist opinion is needed if surgery is considered.
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