Hair Loss In Men

By the age of 40, some degree of hair loss is evident in nearly 50% of all men, and it’s what brings men from Syracuse, Buffalo, and throughout the region to our Rochester, NY, clinic. Although hair loss is socially acceptable, it is not desirable. Dating far back in history, baldness has been a part of the aging process that many men fear. Before Rogaine, hair transplants and hair additions, men coped in various ways by using ointments or styling their hair in different ways. Hair loss is an age-old condition, but understanding the cause of the male pattern hair loss may better indicate exactly why it presently has no cure.

Androgenic Alopecia — It is estimated that 35 million men in the United States are affected by androgenic alopecia. The term “androgenic” can be broken down into two parts:

• “Andro” refers to the androgens (testosterone, dihydrotestosterone) necessary to produce male-pattern hair loss.
• “Genetic” refers to the inherited gene necessary for male pattern hair loss to occur.

Classifications of Male Pattern Hair Loss

1. The amount of androgens present does not need to be greater than normal for MPHL to occur.
2. If androgens are present in normal amounts and the gene for hair loss is present, male pattern hair loss will occur.
3. Axillary (under arm) and pubic hair are dependent on testosterone for growth.
4. Beard growth and male pattern hair loss are dependent on dihydrotestosterone (DHT).
5. Testosterone is converted to DHT by the enzyme, 5¤-reductase. Finasteride (Propecia®) acts by blocking this enzyme and decreasing the amount of DHT.
6. Receptors exist on cells that bind androgens. These receptors have the greatest affinity for DHT followed by testosterone, estrogen and progesterone.
7. After binding to the receptor, DHT goes into the cell and interacts with the nucleus of the cell altering the production of protein by the DNA in the nucleus of the cell.
8. Ultimately growth of the hair follicle ceases.

• The percentage of hairs in the growth phase (anagen) and the duration of the growth phase diminish resulting in shorter hairs.
• More hairs are in the resting state (telogen) and these hairs are much more subject to loss with the daily trauma of combing and washing.
• The hair shafts in MPHL become progressively miniaturized (see illustration of “Miniaturization”) smaller in diameter and length.
• In men with MPHL all the hairs in an affected area may eventually (but not necessarily) become involved in the process and may with time cover the region with fine (vellus) hair. Pigment (color) production is also terminated with miniaturization so the fine hair becomes lighter in color. The lighter color, miniaturized hairs cause the area to first appear thin.
• Alopecia is an inherited condition and the gene can be inherited from either the mother or father’s side.

• Alopecia Areata — Generally thought to be an autoimmune disorder. “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 Effluvium — Usually temporary hair loss. Causes: Physical or emotional stress, thyroid abnormalities, medications and hormonal causes normally associated with females.

• Anagen Effluvium — Generally due to internally administered medications, such as chemotherapy agents, that poison the growing hair follicle.