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Hair loss is a fairly common problem in men. About 85% of men will have major hair thinning by the time they're 50. Some men start to lose theirs before they turn 21. The most common type of hair loss is a condition called androgenetic alopecia (AA), also known as male pattern hair loss.
BlaiserPascal, CC BY-SA 4.0, via Wikimedia Commons
Fun fact: This type of hair loss can affect both men and women. In women, it is known as female pattern baldness, and they can lose their hair in a different pattern than men.
For many people, losing their hair is a frustrating experience. It may affect their confidence and self-esteem.
Although androgenetic alopecia (AA) is the most common cause of hair loss, there are a number of other conditions that can cause hair loss. If you realise that you start losing hair abnormally, consult a doctor. Your doctor will provide diagnosis by taking your history and examining your scalp.
Typically, a man with AA experiences a gradual onset of hair thinning after puberty. The hair loss most often affects the crown and frontal areas of the scalp. In many men, the hairline around the temples regresses. As it moves back to the mid scalp, an M-shaped hair pattern develops. The hair in areas affected by hair loss may be of various lengths and thickness, and the presence of uneven lengths and texture is a classic sign of AA.
Professor Raimo Suhonen, Creative Commons Attribution-NonCommercial-NoDerivs 3.0 (New Zealand),via DermNetNZ.org
Before we talk about the cause of androgenetic alopecia (AA), let’s look at how our hair grows.
The hair follicle is a structure that encases the lower part of the hair shaft. Each follicle contains blood vessels that nurture new hair growth. All hair follicles are present at birth; throughout the lifetime, each follicle grows and sheds single hairs in a repetitive cycle.
The growth phase for a single new hair lasts two to three years.
At the end of this time, growth ceases and the follicle enters a resting phase.
After three to four months in the resting phase, the hair is shed and the next growth cycle begins.
On a normal scalp, approximately 80 to 90 percent of follicles are growing at any time. Each day, about 75 follicles shed their hair while the same number enter a new growth phase.
In men with AA, hormones related to testosterone (also called androgens) cause hair follicles to have a shorter-than-normal growth phase, resulting in hair shafts that are abnormally short and thin. These follicles are said to be "miniaturized." The reasons why some men develop AA and others do not are not fully understood. It is generally accepted that AA is a heritable disorder. A study of 572 men evaluated in a dermatology clinic for concerns unrelated to AA found that young men with a balding father were more than five times more likely to have AA than young men with fathers without the condition.
Before you start any treatment for androgenetic alopecia (AA), it is important to keep the following in mind so that you keep a realistic expectation:
AA is incurable. No treatment will completely reverse the condition. But there are treatments that can stimulate hair regrowth and control hair loss.
The response to treatment is quite variable. You may not respond to the treatment the same way as other AA patients.
Some AA patients will not respond to particular treatment.
That is why if you suspect you have AA, do not attempt to self-diagnose and start self-treatment. Always see a doctor for more professional insights.
Finasteride inhibits 5-alpha reductase (5AR), the crucial enzyme in the production of testosterone, thereby reducing its level in AA patients. As a result, this can increase the amount of hair covering more of the scalp.
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 1 mg tablet daily for 3 months, but this should not supersede your doctor’s instruction.
Side effects of finasteride may include weakness and dizziness. Higher doses of finasteride (such as those used to treat some prostate conditions) can cause side effects including erectile dysfunction and decreased sex drive. However, such side effects are rarely seen with the 1 mg dose used to treat hair loss.
Important: Finasteride is not safe for use in women who could become pregnant because of concerns regarding the development of abnormal genitalia in the male fetus; these women should not even touch finasteride pills. Finasteride has not been proven to help regrow hair in most women. So if a man is using finasteride for his hair loss treatment, he should not share the medication with a woman with a hair loss problem.
Minoxidil promotes hair growth by lengthening the growth phase of hair follicles and causing more follicles to produce hair. The hairs that are produced tend to be larger and thicker. Minoxidil is available in a 2% and 5% liquid or 5% foam, and is available in a dropper or pump spray device. To apply minoxidil, spray lightly over the affected area of the scalp and followed by massaging with fingers. Follow your doctor’s or pharmacist’s advice on the frequency of usage.
Minoxidil can be used by both men and women with hair loss problems. It must be used for at least six months to determine if it is effective. When it is effective, you usually begin to shed less hair within two months after the start of treatment, and by four to eight months hair begins to grow. The effects of minoxidil usually stabilize after 12 to 18 months of use. It is important to note that treatment with minoxidil must be continued indefinitely. If it is discontinued, any hair that has been maintained or regrown as a result of the medication will be lost.
Surgery. For some patients, surgical treatment of hair loss may be an option. Surgical options include hair transplantation, in which healthy follicles from other parts of the scalp are transplanted to areas affected by baldness. Scalp reduction is another procedure sometimes performed. In scalp reduction, bald patches of the scalp are removed and the remaining skin is sewn together.
Laser comb. Combs that deliver a type of light called low-level laser light to the scalp may help to grow hair in some people with androgenetic alopecia. These combs are typically used approximately three times per week for several minutes. More research is needed to clarify the best way to use low-level laser light therapy and to determine if this treatment has long-lasting benefit.
Long-term treatment for hair loss can be expensive and does not yield the level of results you hope for. The path to restoring self-confidence in hair loss sometimes does not require medicine – maybe all you need is just the use of a hair piece, such as a wig or hair extensions. You should always discuss with your doctor on the most suitable hair loss treatment options.
Surprise, surprise. Study showed that early-onset AA is actually a strong predictor for coronary artery disease (CAD), a type of cardiovascular disease that may lead to heart attack. Men with AA are also known to have increased risk of high blood pressure,obesity, high cholesterol level, and insulin resistance, a condition that usually precedes diabetes.
While you can’t completely cure AA, you may see AA as an early alarm that prompts you to look into your overall health – whether that is doing body check-up, follow doctor’s advice, start adopting a healthy diet and lifestyle or start other treatments early.
UpToDate - Patient education: Hair loss in men and women (androgenetic alopecia) (Beyond the Basics)
UpToDate - Androgenetic alopecia in men: Pathogenesis, clinical features, and diagnosis
Australian Family Physician - Royal Australian College of General Practitioners (RACGP) - Male baldness
U.S. Pharmacist - Treatment Options for Androgenetic Alopecia
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