Male pattern baldness (MPB) also known as Androgenic Alopecia typically appears as either receding front hairline, loss of hair on the vertex, or a combination of both. It seems to be due to genetic causes or body androgenic hormones. It has varying severity and age of onset with marked psychological distress.
Why is it called Pattern baldness?
Male pattern baldness either begins as receding hairline which continues to a remarkable extent or originates from the vertex of the scalp and proceeds to leave only a rim of hair at the sides and back of the head known as “Hippocratic wreath”. But complete baldness is rare. i.e. in MPB baldness proceeds in a particular pattern or fashion.
Why male pattern baldness a problem?
We generally have a perception that the men around us are quite unconcerned about their looks so MPB is not a big deal for them. But here are some statistics that will compel you to reframe your above statement:
- A South Korean survey claims that in 2021, about 38.4% of men have experienced alopecia this year and about 20.8% of them were “very worried” about it.
- In 2019, approximately 503000 males used anti-hair fall shampoo or treatment in Spain.
- According to the US NHCS survey, 12.42 million Americans used follicles regrowth products in 2020. This figure is expected to increase to 12.94 million in 2024.
- Among Asian men, 45% claimed that baldness was a concern for them.
Hence, MPB is not only a genuine problem for males but is also very distressing for them.
What is behind male pattern baldness?
- Genetics:
MPB is strongly linked to the AR gene found on the X-chromosome. People having this gene are at twice greater risk of developing MPB. However it is not the only gene responsible, research has found that 63 genes may play roles in MPB; out of these 6 are located on the X- chromosome.
- Inheritance:
Like genetics, heredity (family history) also acts as a cause where individuals inherit baldness from their ancestors. According to studies, more than 80% of patients of MPB had a father or a forefather who also suffered from it.
- Hormonal imbalance:
Male sex hormones called androgens particularly dihydrotestosterones (DHT) are found to be one of the causes of the given condition. Androgens regulate hair growth. Hormonal imbalance of thyroid hormone affects in the same way.
- Hair growth cycle:
These patients show a weakened follicle growth cycle which initially leads to the shrinkage of follicles producing shorter and finer strands of hair and eventually, re-growth becomes impossible.
- Alopecia areata:
It is an immune condition (auto-immune disorder) that results in hair loss in patches.
- Trichotillomania:
Trichotillomania is a psychological condition marked by an urge to pull out one’s hair.
- Infection or Trauma:
Medical conditions such as ringworm infection and traumatic events may also cause MPB (traumatic alopecia).
- Tight hairstyles that put stress on your follicles can lead to traction alopecia which can be permanent or temporary.
- Drugs or medications used to treat depression, heart diseases, hypertension, inflammatory arthritis, etc and radiation therapy or chemotherapy of cancer patients also show alopecia as a side effect.
- Prolonged and excessive stress affects hormones and mental health and results in baldness.
- Nutritional deficiencies like diet lacking protein, essential minerals e.g. zinc harm hair health.
Diagnosis of male pattern baldness
Diagnosis is made after clinical presentation of AGA (androgenic alopecia) or MPHL/ MPB in males that is the appearance and pattern of balding. Women require more complex diagnostic assessments. Diagnosis methods include:
- Trichoscopy (dermatoscopy-simple and invasive imaging technique to identify scalp disorders).
- Biopsy to check other causes of baldness.
- Histology for the evaluation of perifollicular fibrosis.
- A scale is used to grade or rate the severity of androgenic alopecia in males. It is called the Hamilton Norwood scale (by James Hamilton in the 1950s and updated by O’Tar Norwood in the 1970s). This scale also classifies baldness in its stages between 1 and 7.
Treatment
Treatment of male pattern baldness depends upon its cause and it varies from person to person.
- Androgenic alopecia is treated by administering synthetic androgens and by medications that stimulate the production of adrenal androgens, for example, Finasteride, Dutasteride, etc. As the main cause of androgenic alopecia is the low level of circulating androgens (cortical hormone) due to the malfunctioning of the adrenal cortex
- Androgen-independent alopecia or MPB due to causes other than androgens is treated medically by Minoxidil which is a drug primarily for blood pressure regulation but also causes follicle regrowth.
- Surgical transplantations: Three basic surgical transplantation techniques are:
- Traditional FUT (Follicular Unit Transplantation) or FUSS (Follicular Unit Strip Surgery)involves removal of a strip or patch of scalp covered with hair from the donor site and grafting it to the recipient site.
- Modern FUE (Follicular Unit Extraction)is removing individual follicles from the donor site and embedding them to the recipient site.
- An updated version of FUE is FIT (Follicular Isolation Technique).
FUE replaced FUT because it is simple, less invasive, and does not give the “hair-plug look” like FUT. The sole purpose of these transplantation surgeries is to recreate or repopulate the areas of hair thinning or balding but you can only undergo transplantation if you have enough healthy and rich hair on the donor’s site that can be grafted to the recipient site.
- Modern techniques provided some other non-surgical treatments that include:
Low-level laser light therapy (LLLT).
Platelet-rich plasma (PRP).
Adenosine ketoconazole.
Scalp Micropigmentation (SMP).
- Vitamins, minerals, and other dietary supplements intake. Follicles re-growth depends upon our body’s metabolites. But these are not typically recommended until and unless baldness is solely due to nutritional causes.
Socio-cultural perspective
The effect of baldness on men of our society exhibits some socio-cultural influences. For example, in 2001 South Koreans rated balding men as “less attractive” but in 2002, a survey on Welsh women rated bald and grey-haired men as “quite attractive”.
This may be due to the social perception that men who shave their heads completely have a high social status and endurance as the dominance in their personality. So the question of social acceptance of baldness still needs clarity and objectivity.
Myths about male pattern baldness
Here we list some of the myths that have no basis in reality (not proven by any research):
- Weight training causes baldness (it may increase testosterone levels but no study claims its relation with hair loss).
- Baldness and its relationship with one’s virility, IQ, social class, ethnicity, etc.
- Baldness is associated with testosterone secretion.
What are the possible reasons for hair becoming thinner and less thick?
Conclusion
MPB or alopecia is not only a problem of males but of every gender and age group worldwide. It is a serious global concern as more than 50% of all males above the age of 50 years are at risk of male pattern baldness to some extent as stated by the U.S National Library of Medicine (NLM). Similarly, according to a JWT intelligence survey published in June 2013, 26% of men feel anxiety about baldness. This is because hair is considered to be a prominent criterion of “beauty” both genders try their best to solve this problem and therefore are facilitated by both science and technology which are working on all the innovative and easy methods to either replace or treat alopecia.