It’s not uncommon to see as many men descend into their middle-age that they start to develop pattern hair loss/ balding as the following:
All image credit to DermNetNZ.org
This is scientifically known as androgenetic alopecia (AA), or otherwise known as male pattern baldness. Hair is lost in a well-defined pattern, beginning above both temples. Over time, the hairline recedes to form a characteristic "M" shape. Hair also thins at the crown (near the top of the head), often progressing to partial or complete baldness.
What causes male pattern baldness?
Male pattern baldness is a genetically inherited condition. The development of baldness stems from increased production of a hormone known as dihydrotestosterone (DHT). It is known that DHT reduces the growth of hair cycle from a usual duration of 3-6 years to just weeks or months. DHT also reduces the size of follicles and progressively produces fewer and finer hairs.
Several genes are involved, accounting for differing age of onset, progression, pattern and severity of hair loss in family members. The susceptibility genes are inherited from both mother and father.
The production of DHT is not possible without another crucial enzyme called 5-alpha reductase (5AR). Many treatments for male pattern baldness target at 5AR. There are three types of 5AR in the body, and type I and type II are significant in the treatment of male pattern baldness. Type I is located in the skin, including the sebaceous glands and hair follicles, and type II is located in the inner root sheath of hair follicles in the scalp, face, chest, genitals, and prostate gland.
Image credit: AK Clinics
Treatment of male pattern baldness
There are several treatments for male pattern baldness, with 5AR inhibitors and minoxidil most commonly used.
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5AR inhibitors - finasteride
Finasteride inhibits 5AR, the crucial enzyme in the production of DHT, thereby reducing its level in male pattern baldness patient. In Malaysia, finasteride is available as a brand called Propecia®. It is available as a 1mg tablet, and you can only buy it with a doctor’s prescription. The common direction of taking finasteride is one 1mg tablet daily for 3 months, but this does not supersede your doctor’s instruction. Side effects of finasteride include low blood pressure, dizziness, erectile dysfunction, ejaculatory dysfunction and decreased libido.
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Minoxidil
Minoxidil can dilate the blood vessels, increase blood flow in the hair scalp, thus stimulating the growth of hair. It is available in 2% and 5% solution and 5% lotion to be applied on the hair scalp. The 5% lotion has been shown to be more effective than the 2% solution. In approximately 50% of men, hair loss is stopped, and a small percentage of men experience some hair regrowth. The minoxidil must be continued indefinitely or hair growth will subside.
Other treatments include:
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Low-level laser therapy
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Microneeding and hair transplantation
Conclusion
So is male pattern baldness an inescapable ‘curse’? Although there’s no effective treatment available currently, medications such as minoxidil and finasteride may help to slow down the hair loss process. We believe as more emerging therapies come into the light, male pattern baldness will one day become curable.
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