Male pattern baldness is the most common form of hair loss in men. It usually develops very gradually, typically involving the appearance of a bald spot on the crown of the scalp accompanied by thinning at the temples. Although this problem can strike any man at any time, many first become aware of it as they approach their thirties.
What's the risk?
▪Two-thirds of all men will eventually be affected by male pattern baldness -- in the UK, this means that 7.4 million men are losing their hair at any one time.
▪There are racial differences, however, in the incidence of male pattern baldness. The highest rates are found among Caucasians, followed by Afro-Caribbeans. Chinese and Japanese men have the lowest rates.
▪Male pattern baldness runs in the family. If your grandfather, father or brothers went bald early, the chances are that you will too. The strongest influence is on the mother's side: if your maternal grandfather went bald, that's probably a better indicator that you will too than if your father's father lost his hair. However remember it is a genetic lottery!
What causes it?
There is only a tiny grain of truth in the myth that bald men are more virile because they have more of the male sex hormone testosterone.
This idea probably grew from the observation that eunuchs never became bald and, having being castrated, they didn't, of course, produce very much testosterone.
Yes, testosterone is involved in male pattern baldness, but its relationship with hair loss is complicated and not completely understood. Testosterone is naturally converted in the body to a related sex hormone, dihydrotestosterone (DHT). This stimulates the growth of facial and body hair, as well as acting on the prostate gland. There is good evidence that male pattern baldness results from an over-sensitivity of scalp hair follicles to DHT, rather than raised levels of either sex hormone in the blood. As with pretty much everything, there's probably a link to smoking.
How can I prevent it?
You cannot prevent male pattern baldness, although there may be ways of slowing down the process or disguising the problem.
Is it such a big deal?
Since male pattern baldness is related to testosterone production, the only sure fire cure is castration before puberty which curiously enough few men opt for.
But hair loss never killed anyone. If you're really struggling to come to terms with baldness, talk to someone. Hair loss can be the trigger to unhappiness and depression. A regular radio show 'The Bald Truth UK' is a popular outlet for hair loss sufferers to discus and vent their frustrations and anxieties and also get answers to questions. The Bald Truth UK Radio Show
Should I see a doctor?
▪To get advice and treatment for hair loss, you should always start with either your GP or a professionally qualified trichologist.
▪Until very recently, male pattern balding was seen as a natural process and you may find your doctor to be neither sympathetic nor helpful if you consult him/her about it. But things may be changing. An increasing number of doctors realise that hair loss can have psychological consequences that significantly diminish quality of life, especially for younger men, and they may be more willing to take the problem seriously.
If you are lucky enough to have an enlightened GP, by all means seek their advice -- I have referred many patients over the years to a few very well informed GP's I know in the UK so if you need help refer to my website for information.
A trichologist, by the way, is a hair specialist whose training covers both the cosmetic and the medical aspects of the subject. Some trichologists are also trained hairdressers, but they are not usually medically qualified.
Other types of hair loss, such as alopecia areata, are taken seriously as medical conditions and you should seek your GP's advice as you would for any other medical problem.
What are the main treatments?
There is no cure for male pattern baldness, but there are both drug and surgical treatments available which may lead to some improvements.
Minoxidil (sold as Regaine)
▪This is the only topical treatment (one that you rub into the skin) which is actually licensed for the treatment of male pattern baldness in the UK. It was originally developed (in tablet form) as a drug for high blood pressure. Doctors noticed that people on minoxidil sometimes grew new hair, so the drug was reformulated for this purpose.
▪Regaine comes as 2% or 5% lotions which you rub, daily, into your scalp. It is best to start with the 2% lotion and after three months, if you have not seen significant growth of hair, upgrade to the 5% lotion. In the UK, Regaine is a Pharmacy Only medicine, which means you can obtain it from a pharmacy without a prescription, however it's very expensive compared to a few reliable legitimate online UK stores.
▪Regaine cannot work miracles. About one-third of men using it get good hair growth on the bald patches, one-third get a fine, downy regrowth, while the rest will get little or no response. The majority of men using it find that at least they don't lose much more hair -- but as soon as you stop using it, hair loss resumes its course.
▪Expect to wait up to four months before you get any response from Regaine (be patient), but if nothing happens after, say, a year, you may as well give it up.
Finesteride 1mg (marketed as Propecia)
▪This is a treatment for male pattern baldness which is licenced in the UK but only on private prescription, not on the NHS. It is one of a class of drugs called 5-alpha-reductase inhibitors. Since 5-alpha-reductase is the enzyme which causes the conversion of testosterone into DHT, inhibiting this with finesteride should, in theory, stop hair loss. In fact, finesteride was originally developed for the treatment of benign prostatic hyperplasia (BPH), a condition in which the prostate gland becomes enlarged through the action of DHT.
▪Although there have been no clinical studies directly comparing low dose finesteride and Regaine, the data suggests that the two products may be similarly effective as a treatment for hair loss. Finesteride can lead to side effects in up to 2% of users such as impotence, reduced sex drive and reduced semen volume. (These side-effects are reversible when the treatment stops.)
▪Propecia can be obtained from a GP or dermatologist on private prescription. However few GP's are well informed on the drug. I personally get a private prescription from a reliable informed GP in the UK for 5mg 'Proscar' tablets and cut it into 5ths. It's exactly the same then as Propecia but without the heavy price tag. I pay £200 for 14 months supply.
Anti-androgen therapy
▪Another way of tackling male pattern baldness is to directly block the action of DHT using a variety of hormonal drugs. Some of these are similar to oral contraceptives and female hormone replacement therapy. They should only be applied under the supervision of an endocrinologist (hormone specialist) or a dermatologist with expertise in hormone therapy.