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
In men who develop alopecia, the hair loss may begin any time after puberty when blood levels of androgens rise. The first change is usually recession in the temporal areas, which is seen in 96 percent of mature Caucasian males, including those men not destined to progress to further hair loss. Hamilton, and later Norwood, have classified the patterns.
Vito C. Quatela, M.D., FACS
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Hamilton first noted that androgens (testosterone, dihydrotestosterone) are necessary for the development of (MPHL) Male Pattern Hair Loss.
The amount of androgens present does not need to be greater than normal for MPHL to occur.
If androgens are present in normal amounts and the gene for hair loss is present, male pattern hair loss will occur.
Axillary (under arm) and pubic hair are dependent on testosterone for growth.
Beard growth and male pattern hair loss are dependent on dihydrotestosterone (DHT).
Testosterone is converted to DHT by the enzyme, 5¤-reductase. Finasteride (Propecia®) acts by blocking this enzyme and decreasing the amount of DHT.
Receptors exist on cells that bind androgens. These receptors have the greatest affinity for DHT followed by testosterone, estrogen and progesterone.
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.
Ultimately growth of the hair follicle ceases.
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A board-certified facial plastic surgeon and a board-certified otolaryngologist–head and neck surgeon, Dr. Lee is dedicated to improving the lives of adults and children by using her surgical talents. She specializes in procedures of the face and head including facelift, functional and cosmetic nose surgery, blepharoplasty, and injectable treatments.
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.
Other Causes of Hair Loss
There are a variety of hair loss causes in addition to this main cause including alopecia areata, which is an autoimmune disorder. It first appears as small circle bald areas across the scalp. These are a few more hair loss conditions:
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.
While hair loss has been a historical problem for men and women, there hasn’t been any conclusive studies on how to cure the problem. If hair loss is hereditary, there are surgical procedures that can be conducted to transplant hair from the back to sponsor hair growth once more. It’s important to realize that alopecia can be inherited from both mother or father. As more research is conducted into male pattern hair loss, hopefully there will be more ways to reduce the effects of alopecia and find a cure.
These represent only a few of the different types of hair loss. However, androgenetic alopecia represents close to 95% of all hair loss.
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