Male pattern hair loss or Androgenetic Alopecia

Men begin to lose hair in several different ways. The most common of which involve receding at the temples, centralized loss on the top back of the head (vertex), and something known as diffuse thinning, where hair over larger areas begins to thin without any specific change in the shape of the hair line. Naturally, combinations of these types of thinning is also very common.
You may wish to familiarize yourself with the "Norwood Scale". It is one of the most commonly used methods of identifying exactly which class of hair loss you fit in, and to what extent your loss has progressed. It is also a good way to see how things may continue if your situation is left untreated.

By far the most common form of hair loss is determined by our genes and hormones: Also known as androgen-dependent, androgenic, or genetic hair loss. It is the largest single type of recognizable alopecia to affect both men and women. It is estimated that around 30% of Caucasian females are affected before menopause. Other commonly used names for genetic hair loss include common baldness, diffuse hair loss, male or female pattern baldness.

1. Male Pattern Baldness (MPB)
    Signs and Symptoms
    Receding hairline
    Moderate to extensive loss of hair, especially on the crown

2. Female pattern Baldness (FPB)
    Signs and Symptoms
    General thinning of hair all over the head
    Moderate loss of hair on the crown or at hairline

MPB is the hair loss most frequently encountered. It usually starts with the hair at the temples, which gradually recedes to form an "M" shape. You also may find your hair is finer and does not grow as long as it once did. The hair on the crown of your head begins to thin out and eventually at the top points of the "M" meet the thinned spot on your crown. Over time, you are left with a horse-shoe pattern of hair around the sides of your head. Any remaining hair in the balding areas usually manifests some miniaturization - it is thinner and grows at a below-normal rate, changing from long, thick, coarse, pigmented hair into fine, unpigmented sprouts.

Female pattern baldness usually begins about age 30, becomes noticeable around age 40, and may be even more noticeable after menopause. Female hair loss is usually an overall thinning -- two hairs where five used to be--rather than a bald area on top of the head, though women may have a receding hairline, too. It's thought that about 20 million American women have such hair loss. As in males, hair follicles simply shut down, with hormones playing some role in the process.

A receding hairline reflects age, but not necessarily great age, since some men start balding quite young. With the spurt in androgen secretion at puberty, the hairline moves back a little in 96 per cent of boys and 80 per cent of girls. Most boys continue to shed hair as they mature and, if baldness runs in the family, lose increasing amounts. By age 35 to 40, two thirds of Caucasian men are noticeably bald. The loss may begin at age 20, then stop, only to start up again a few years later. Since this type of baldness is largely hereditary, a man can usually, although not always, predict the extent of his future baldness by examining family portraits. About 50 per cent of children with a balding parent of either sex will inherit the dominant baldness gene.

Dating as far back as history will take us, baldness has been a part of the aging   process that many men fear the most. Before Rogaine, hair transplants and hair additions, men coped in various ways from magic ointments to the styling of their hair. Julius Caesar grew his hair long in the back and combed it all forward. Napoleon did the same thing. Somehow we often disregard history and the fact that this has been an age old condition. We can't imagine or accept the fact that there is not a cure.

Understanding the cause of male pattern hair loss may better indicate exactly why it presently has no cure.

ANDROGENETIC ALOPECIA

The modem medical term for either male or female pattern hair loss - can be broken down in two parts.

First, Androgenetic, consisting of ANDROGEN (Any of the various hormones that control the appearance and development of masculine characteristics such as testosterone). And GENETIC--the inheritance of genes from either the mother or the father's side of the family. Add AGE, which when coupled with genetics, represents a time clock that will signal the hair follicle to produce an enzyme named 5 alpha reductase. When the testosterone present in the follicle combines with the enzyme 5 alpha reductase, it produces dihydrotestosterone (DHT). Hair follicle receptors are sensitive to DHT and thereby start the process of male or female pattern hair loss.

Second, ALOPECIA meaning hair loss, of which there are many types.

Put simply, scientists are working against aging, hormones and genetics. This is no easy task. Add the fact that male or female pattern hair loss is not life threatening, and it is easy to see why many physicians do not view hair loss as a priority in scientific research.

What is working for you in terms of research is that large pharmaceutical firms now know that a cure for hair loss could mean a fortune in revenue for their companies and stockholders. This is fuel enough and the race HAS begun.

Although we may not see a cure in our lifetime, it is possible. Science is closer to understanding hair loss due to many recent advancements. To say the cure is around the corner would only be speculation but hope certainly is alive.

Dynamics and mechanism of balding

The rate of hair shedding in androgenic alopecia is speeded up by three forces: advancing age, an inherited tendency to bald early, and an over-abundance of the male hormone dihydrotestosterone (DHT) within the hair follicle. DHT is a highly active form of testosterone, which influences many aspects of manly behaviour, from sex drive to aggression.

The conversion from testosterone to DHT is driven by an enzyme called 5-alpha reductase, which is produced in the prostate, various adrenal glands, and the scalp. Over time, the action of DHT causes the hair follicle to degrade and shortens the anagen phase. Thought the follicle is technically still alive and connected to a good blood supply--it can successfully nurture a transplanted follicle which is immune to the effects of DHT--it will grow smaller and smaller (figure 3). Some follicles will gradually die, but most will simply shrink to the size they were when you were born which produce weaker hairs. With a steadily shorter anagen growing cycle, more hairs are shed, the hairs becoming thinner and thinner until they are too fine to survive daily wear and tear. Balding hair gradually changes from long, thick, coarse, pigmented hair into fine, unpigmented vellus sprouts.

However, the sebaceous gland attached to it remains the same size. As the hair shafts become smaller, the gland continues to pump out about the same amount of oil. So as your hair thins, you will notice that your hair becomes flatter and oilier.

But the hormonal link in balding is complex. Eunuchs, who produce no testosterone, never go bald -- even if carrying a baldness gene. However, if castrated men with a family history of baldness are given testosterone, they lose hair in the classic horseshoe-shaped pattern.

Studies show that while balding men don't have higher than average circulating testosterone levels, they do possess above-average amounts of a powerful testosterone derivative, dihydrotestosterone in the scalp follicles. In male balding, genetically primed follicles convert circulating testosterone to dihydrotestosterone, which successively diminishes or miniaturizes follicle size, producing ever weaker hairs. With a steadily shorter anagen growing cycle, more hairs are shed, the hairs becoming thinner and thinner until they are too fine to survive daily wear and tear. Balding hair gradually changes from long, thick, coarse, pigmented hair into fine, depigmented vellus sprouts.

Other physiological factors might cause hair loss. Recently, a group of Japanese researcher reported a correlation between excessive sebum in the scalp and hair loss. Excessive sebum often accompanying thinning hair is attributed to an enlargement of the sebaceous gland. They believed excessive sebum causes an high level of 5-alpha reductase and pore clogging, thus malnutrition of the hair root.

Although this condition could be hereditary, they believe diet is a more prominent cause. The researchers note that Japanese hair was thick and healthy, with a small gland and little scalp oil, until the occidental habit of consuming animal fat crept into their diet after World War II. This change has led to a significant height increase in the Japanese population, but it has also resulted in more Japanese men losing hair. To some extent, their observation makes sense since problems with greasy hair have often been noted as much as six months to a year prior to when thinning hair becomes noticeable, but this might be just one of the symptoms, not underlying cause, more research is needed. Most doctors agree that if you have a oily scalp with thinning hair, frequent shampooing is advised. shampooing can reduce surface sebum, which contains high levels of testosterone and DHT that may re-enter the skin and affect the hair follicle.

Other causes of hair loss and male baldness

Alopecia areata: Generally thought to be an autoimmune disorder. Causes "patchy" hair loss, often in small circular areas in different areas of the scalp.

Alopecia totalis: Total hair loss of the scalp, (an advanced form of alopecia areata).

Alopecia universalis: Hair loss of the entire body, (also an advanced form of alopecia areata).

Traction alopecia: Hair loss caused by physical stress and tension on the hair such as prolonged use of hair weaving, corn rows etc. Done too tightly on weak hair these can cause permanent hair loss.

Telogen effiuvium: (usually temporary hair loss) Caused by Physical stress, emotional stress, thyroid abnormalities, medications and hormonal causes normally associated with females.

Anagen effiuvium: Generally due to internally administered medications, such as chemotherapy agents, that poison the growing hair follicle.

All of these represent only a few of the different types of hair loss. Androgenetic alopecia represents close to 95% of all hair loss however.

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