Reviewed by Dr Epameinondas Bonaros
Male pattern baldness, also known as male androgenetic alopecia (AGA), is one of the most common conditions affecting men. This article looks at the causes and characteristics of alopecia in men and discusses how to prevent and treat male pattern hair loss in Glasgow.
Male pattern baldness or androgenic alopecia is one of the most common hair disorders. It is estimated that around 40% of men will have noticeable hairline recession and hair loss by age 35. This rate increases with age, with approximately 50% of men over 50 having noticeable hair loss, 65% by the age of 60 and 80% by the age of 80.
Male pattern hair loss results in low self-esteem, reduced confidence and distress in affected men, irrespective of age or stage of baldness. As an androgen-dependent condition, male pattern baldness can present soon after puberty. Early onset hair loss in men can cause significant psychological distress.
Male pattern hair loss is characterised by androgen-related progressive male hair thinning in a defined pattern across the scalp. The hair follicle shrinks in size over time, eventually leaving a bald scalp.
Genetic factors and androgens are critical role players in male pattern hair loss. Male sex hormones, such as testosterone metabolite DHT, and the genes for hair loss must be present for AGA to occur. Male pattern baldness or alopecia could also be triggered by medical conditions.
Male pattern hair loss is associated with many genes. A novel study revealed more than 250 genetic locations associated with severe hair loss. Some of these genes provide instructions for making androgen receptors, allowing the body to respond appropriately to DHT and other androgens.
Studies suggest that this excessive activation of the androgen receptor in hair follicles leads to follicular miniaturisation through a progressively shorter anagen phase, resulting in hair that grows thinner and shorter hair follicles that may not penetrate the epidermis.
Early onset male pattern baldness could start from the late teenage years or early twenties, but most men begin to lose hair during their 30s.
Typically, hair loss begins with thinning on the top of the head and a hairline that gradually recedes into an “M” shape. Once you start noticing signs of male pattern baldness, seeking a medical professional before your hair loss progresses is important.
The progression rate of male pattern baldness differs from individual to individual, and variation is also observed in affected family members.
The temporal regions are usually the first places males experience hair loss, or androgenic alopecia. In some men, the hair loss stops there and never progresses. In other men, hair loss continues over other areas of the scalp.
While almost all Caucasian men will eventually face some degree of male pattern baldness, Asian men, East Asians in particular, have historically experienced the lowest incidence of hair loss in the world.
Hair thinning at the crown and temporal regions and a receding hairline are the first signs of pattern baldness.
Once you notice signs of excessive hair fallout, thinning or slow hair growth, seeking a professional to diagnose male pattern baldness is important. Receiving a diagnosis and early treatment can prevent complete baldness and shift the focus on growing healthy new hair.
Getting specialised medical advice is essential when dealing with and treating hair loss. While androgenetic alopecia in men is the most common cause of hair loss, other conditions can contribute. These conditions may only be recognised once a physician or hair restoration specialist studies your medical history and diagnoses them.
Many types of male pattern baldness exist, and not all can be treated the same way. A complete medical evaluation ensures that each patient achieves the best long-term outcome.
Androgenetic alopecia is usually diagnosed clinically with a history of gradual onset after puberty and often a family history of baldness. Unless the diagnosis is unclear, a biopsy is generally unnecessary to find the right male pattern baldness treatment for you.
Dermoscopy shows miniaturised hair and a few other signs of male pattern baldness. Dermoscopy can help differentiate if the hair loss comes from alopecia areata. A dermoscopy can help your specialist decide which male hair restoration options will be best for your needs and aesthetic goals.
Male pattern hair loss occurs in various patterns illustrated in the Norwood-Hamilton Scale. Norwood classification is one of the most detailed classification systems for male patterned hair loss.
Men who struggle with hair loss often ask our team of hair loss specialists how to prevent male pattern baldness or how to stop male pattern baldness. Although prevention is better than a cure, hair loss is genetic.
That being said, early male pattern baldness has medical treatment options that slow down hair loss and hair breakage and help regrow hair that’s already lost. Taking oral hair loss medications and applying topical treatments like minoxidil on scalp hairs during the early stages of balding may help to lessen further hair loss. However, it may not be enough in some patients to prevent a bald spot from forming.
Every patient needs a personalised treatment plan, which is why you’ll need to get the advice of a hair loss specialist who can help you find the best solution for your male pattern baldness.
Androgenetic alopecia, or male pattern baldness more specifically, progresses over time. Although medical treatments like finasteride and minoxidil are effective in arresting the progression of the disease, they allow only partial hair restoration for men.
Some progress has been made in the medical management of androgenic alopecia and hair regrowth. That being said, the best treatment for male pattern baldness in the advanced stages remains hair transplantation, a minimally invasive hair loss solution for men.
Today, many promising male hair loss treatment options are available. There are safe and effective ways to restore your hair, whether your hairline is receding, your crown is losing thickness, or you have thinning hair all over your scalp.
When using hair loss medicine for a man, the earlier therapy starts, the more optimal the long-term outcome.
The overall goal of men’s hair loss treatment in AGA is to:
Here are the topical and oral medications and surgical options that slow down hair loss and help with regulating hair growth:
Topical minoxidil is an over-the-counter alopecia treatment for men. Minoxidil is available in various strengths up to a 5% solution. Minoxidil has been shown to prevent hair loss and stimulate hair growth in 2 out of 3 men.
Minoxidil works by prolonging the anagen phase of the hair follicle and transforming the miniaturised follicles into terminal hair follicles. Several meta-analysis studies have confirmed the high quality of evidence for using minoxidil to treat male pattern hair loss.
The most common adverse effects are pruritus and local irritation with resulting flaking. The latter is usually due to propylene glycol or alcohol in the formulation of the drug.
Finasteride, when taken at a 1mg dose daily, is FDA-approved as a male pattern baldness medication. It is one of the most effective ways to prevent hair loss in men. Finasteride slows hair loss while enhancing hair calibre. The influence of finasteride on hair count is most significant on the vertex scalp. It can improve new hair density on the frontal scalp to a lesser degree and is least effective in the temporal regions.
Finasteride needs to be continued indefinitely to maintain hair regrowth efficaciousness. Patients whose male pattern balding fails to respond in the first year are likely to be non-responders in the long term. The next step would be other treatments, such as minoxidil or dutasteride. In the current market, topical minoxidil and finasteride are often combined in a variety of formulations.
Side effects of finasteride include lowered libido, erectile dysfunction, reduced ejaculatory volume, temporary reduction in sperm count, testicular pain, depression and gynecomastia.
Topical finasteride may be a good alternative for men who are uncomfortable with the side effects of oral finasteride. The topical administration of finasteride can reduce systemic effects associated with its mechanism of action by inhibiting 2-α reductase in the scalp. Compared to oral finasteride, it has a markedly lower systemic exposure and less impact on serum DHT levels.
Topical finasteride has only been studied as a topical treatment for male pattern androgenetic alopecia in a small number of randomised controlled trials. These studies, however, show promising results and non-inferiority to systemic delivery.
Dutasteride is an effective medicine for male pattern baldness, as shown by various studies and meta-analyses. In most of these studies, dutasteride was found to be more effective than finasteride, with similar adverse effects.
This medication still needs to be approved in the UK as a hair loss treatment, so it is prescribed off-label. However, it may become a treatment of choice for AGA in the future.
Low-level laser therapy and micro-needling may also help ward off male pattern baldness, especially in combination with pharmacologic therapies. Additional studies are required to define and validate optimal treatment protocols that slow hair loss.
During a male hair transplant, a hair specialist removes healthy hair follicles from a donor region and implants them in balding areas on the patient’s scalp to increase hair density with natural-looking results.
While hair transplants have high success rates for male and female pattern baldness, they are highly specialised surgical procedures requiring the right doctor and medical team. Dr Bonaros performs the entire procedure as the lead surgeon with the use of advanced hair transplant technology and techniques.
Dr Bonaros is a member of the International Society of Hair Restoration Surgery (ISHRS), the world’s leading medical authority on hair loss and restoration.
Dr Bonaros and his team are male pattern baldness specialists committed to providing the best possible guidance, care and hair loss treatment for men. Book your consultation today and discover the most effective male pattern hair loss treatment for you at our hair loss clinic in Glasgow.
Contact us if you are concerned with hair loss and live in Glasgow, Edinburgh or anywhere in Scotland. We’d love to discuss how we can help you regain your hair and confidence.
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