Hair Thinning and Hair Loss in Men

 Male pattern hair loss also known as male balding or androgenetic alopecia is the most common type of hair loss in healthy men. The condition is characterized by the gradual thinning and loss of the thick and shiny hairs on the scalp following a characteristic pattern.

Male pattern hair loss is considered an inheritable disorder. Young men with a balding father were more than five times more likely to have androgenetic alopecia than young men with fathers without the condition of balding. It is a common disorder that occurs worldwide starting after puberty in approximately 48% of men.

Dihydrotestosterone (DHT) is the key male hormone involved in male pattern hair loss and a potent metabolite of testosterone. DHT has a very strong affinity for male hormone receptors of the genetically predisposed hair follicles. The 5-alpha reductase enzymes located on these hair follicles mediates the conversion of testosterone to DHT. The DHT causes the hair follicles to reduce in size, disrupting their hair growth cycle producing finer and less hair growing. It is common for men with male pattern baldness to experience an itchy scalp and dandruff related to inflammation and scarring around the hair follicles.

Finasteride and Dutasteride are medications that are used in the treatment of male pattern hair loss by blocking the conversion of Testosterone to DHT reducing the exposure of the hair follicles to DHT. DHT blockers have deleterious effects on sexual function in 1.5% of men. These include erectile dysfunction, decreased libido, and ejaculatory dysfunction. The risk for sexual side effects increases with age and there is a small risk for permanency after discontinuation of the medication. Sexual side effect risks can be reduced by introducing the medications slowly and at lower doses. Sperm count reduction may occur while taking Finasteride or Dutasteride. Women who are pregnant should not be exposed to it due to interference with baby’s development. Rare side effects include breast tissue enlargement and testicular pain. The connection with depression and anxiety is unclear.

Minoxidil is another medication used in combination with finasteride or dutasteride for male pattern hair loss. Minoxidil affects the hair growth cycle positively, enlarges the hair follicles and improves the blood flow to the scalp. Temporary hair shedding may occur following introduction of the medication and usually resolves within 2 months.

Balding may have negative psychosocial effects and reduced quality of life and has been linked to cardiovascular disease.

Male pattern hair loss should be distinguished from other causes of hair loss. Consulting a medical professional with training and experience in the field of hair loss is recommended.

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