Male Pattern Hair Loss (Androgenetic Alopecia)


Male Pattern Hair Loss Is Very Common

Male pattern hair loss, a medical condition also known as androgenetic alopecia, affects more than 40% of white men by the age of 40. I’m sure you’ve noticed the receding hairlines and patchy spots starting to form on the back of most men’s heads by this age. We’ve all heard the men in our lives complain about that one spot of hair that used to be thicker. Think hair loss is no big deal? Although this may be easy for women or those lucky men who have managed to keep their hair, hair loss can be a very distressing condition for a man. It affects your physical appearance and can lead to low self-esteem. Youth is tied to having abundant hair in men; hair loss can make you look and feel older.

I’ve discussed other types of hair loss including telogen effluvium and alopecia areata in the past.

Why do men develop hair loss?

The reason men develop hair loss more often than women is due to high levels of dihydrotestosterone (commonly referred to as DHT). DHT is a more potent androgen than testosterone (meaning it binds the testosterone receptor for longer and more tightly). In men, DHT causes hair loss in the scalp. Paradoxically, DHT also causes hair growth on the face.

How is male pattern hair loss treated?

As far as prescription medications go, there are only two FDA approved treatments for male pattern hair loss. These are minoxidil (aka Rogaine) and finasteride.

Minoxidil (Rogaine)

Minoxidil (rogaine) is available over the counter without a prescription. It comes in different formulations including: foam or topical serum. This is an advantage over the other FDA approved drug in that there is little to no systemic absorption. This means less possibility of side effects.

You should be warned that during the first 2 weeks of minoxidil use you might actually shed more hairs. This is due to the mechanism of action of minoxidil. It is theorized that minoxidil works by increasing the delivery of blood, oxygen, and nutrients to the hair follicles. This causes the hairs in telogen (the inactive hairs) to be shed. These shed hairs can be replaced by the thicker, active hairs of anagen. Instead of generating new hairs, the hairs appear thicker.

The patent on this drug has long since expired therefore Rogaine is not the only manufacturer of minoxidil. A quick Google search revealed that Walgreens and Equate, among others, all sell their own generic minoxidil.

5 alpha-reductase Inhibitors

Finasteride, on the other hand, is an oral medication taken once a day for hair loss. Finasteride was originally approved for benign prostatic hyperplasia (aka BPH). BPH which is a condition that occurs in elderly men where they develop enlarged prostates that can interfere with being able to urinate. Finasteride works by blocking an enzyme called 5α-reductase. This is the enzyme that converts testosterone to DHT.

Dutasteride, a medication in the same class of drugs as finasteride, is also commonly used to treat male balding. However, they do not have the official FDA indication. You may also hear dutasteride referred to as Avodart. Finasteride can be referred to as Propecia when used for male pattern balding or Proscar when used for benign prostastic hyperplasia.

These medications are usually not covered by insurance when used for male pattern hair loss. Finasteride, being the older drug, is much cheaper. You can obtain discounts on goodrx.com for different pharmacies and obtain it for around $10 per month. Dutasteride will run you about $60 per month if you use the goodrx.com discount.

Why pay more for dutasteride?

Studies have shown that dutasteride is more effective at reducing hair loss than finasteride. This is because dutasteride is able to decrease circulating DHT levels by about 99%. Dutasteride can inhibit all three isozymes of 5α-reductase that are present in the body. Finasteride can only inhibit 2 of the 3 isozymes of 5α-reductase.

Men can be hesitant to begin using a DHT blocker for male pattern hair loss. This is because the main side effect of using a drug that decreases your DHT levels is sexual side effects. This will go away if you stop the medication but most men are wary of trying a medication that may cause erectile dysfunction or decrease libido.

If you want to be really proactive, you can use both minoxidil and a 5α-reductase inhibitor to combat male pattern hair loss. They have different mechanisms of action and thus can work synergistically to stop hair loss.

Future Directions in Hair Loss

Other non-invasive avenues for treating hair loss include increasing certain prostaglandins. Latisse, the medication used to increase the growth of eyelashes, is a prostaglandin. Studies for these medications are currently in the works. Low-level light therapy is another device that may help with hair loss. However, clinical trials are still pending.

If you don’t mind going obtaining injections to the scalp you can also pursue platelet rich plasma (PRP) treatments. There is evidence that PRP can induce hair regrowth and induce hairs to go from telogen to anagen phase.

Platelet Rich Plasma for Alopecia

PRP is exactly what it says in the name. Your blood is made up of cells and plasma. One type of cell, the platelet, has many granules filled with growth factors within it. When blood is drawn, a special machine can separate the platelets from all the other cells and concentrate them in the plasma. The addition of certain chemicals causes the platelets to become activated and release their growth factors. This is then injected into the scalp. The growth factors interact with the hair follicles to increase the number of hair follicles in anagen and inhibit the death of hair follicles. PRP has also been shown to help increase the yield rates in conjunction with hair transplantation.

Hair Restoration (The Hair Transplant)

The final option for men who will go to any length to regain the hair they’ve lost is a hair transplant. Technically, it shouldn’t be called a hair transplant, but that’s the way many of us refer to this procedure. This procedure should be called hair restoration. There are 2 ways to do a hair restoration procedure. You can either have the Follicular Unit strip surgery (FUSS) or the Follicular Unit extraction (FUE).

In the FUSS, a 6-10 inch linear strip of hair is removed from the bottom back of the scalp. The scalp is then sewn back together. The hair surgeon will then harvest the hair follicles from this strip and place them back on the areas of balding. The harvested hair follicles are punched back into the balding areas. Unfortunately, removing the long strip of hair and skin from the scalp results in a linear scar.

In the FUE technique, individual follicular units are removed from the donor area (wherever there is abundant hair) at random by punching out small holes. These harvested hair follicles can then be transplanted to the balding areas just like in FUSS. The advantage of the FUE is that there is no long linear scar in the back of the head.

However, FUE results can be very dependent on the hair surgeon’s ability. The harvesting of the hair follicles must be done at a certain angle so that they are not transected. This requires a certain level of expertise. The invention of a robotic device called Artas that can harvest the hair follicles has revolutionized FUE. Look for hair surgeons that offer this device if you want the best results.


male pattern hair loss treatment-rogaine-finasteride-hair-transplant-featured-image

 

Did you know about the many treatment options available for male pattern hair loss before? What did you learn from reading this article?

 

References:

  1. Keaney, T. “Emerging Therapies for Androgenetic Alopecia.” Journal of drugs in dermatology: JDD9 (2015): 1036-1040.
  2. Harcha, Walter Gubelin, et al. “A randomized, active-and placebo-controlled study of the efficacy and safety of different doses of dutasteride versus placebo and finasteride in the treatment of male subjects with androgenetic alopecia.” Journal of the American Academy of Dermatology3 (2014): 489-498.
  3. https://en.wikipedia.org/wiki/Finasteride
  4. https://en.wikipedia.org/wiki/Dihydrotestosterone
  5. https://en.wikipedia.org/wiki/Minoxidil 
  6. http://www.telegraph.co.uk/content/dam/men/2015/12/08/bald_2526587b-large_trans++pJliwavx4coWFCaEkEsb3kvxIt-lGGWCWqwLa_RXJU8.jpg

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