Androgenetic alopecia (in men)
Also known as male pattern baldness, male pattern hair loss
What is androgenetic alopecia?
Androgenetic alopecia is the term used to describe a common form of baldness in men that is usually inherited. The condition is slowly progressive and can affect men of any age group after puberty. Approximately 50% of men show signs of cosmetically apparent baldness by the age of 50.
What causes androgenetic alopecia?
The vast majority of affected men have a genetic predisposition to the condition that could be inherited from either or both parents. A few genes such as the androgen receptor gene have been reported to be linked to the condition.
At the scalp level, hair follicles tend to react and shrink with time under the influence of normal levels of male hormone. This does not imply any underlying hormonal abnormalities. However, men who take anabolic steroid supplements may find that this accelerates the progression of their baldness.
What does androgenetic alopecia look like?
The pattern of baldness is easily recognisable. It usually begins with recession of the hairline at the temples and front of the scalp. This slowly advances further backwards. The crown of the scalp also becomes sparser. With time, the areas of baldness join together. The whole scalp may be completely bald except for the back of the scalp (occipital scalp) which is usually protected from the balding process.
In Asian men, the pattern is sometimes less pronounced and hair loss can present in a more diffuse pattern.
What other problems can occur with androgenetic alopecia?
Androgenetic alopecia is predominantly a cosmetic condition. However, it can cause significant psychological and social stress in some affected men and is the main reason for seeking treatment.
Hair functions as insulation for the scalp and helps to regulate body temperature. The lack of hair leads to more heat loss from the scalp, especially in colder months if a hat is not worn.
Hair on the scalp also serves to protect against excessive sun exposure. Men with baldness may develop solar keratoses or skin cancers on their scalp.
How is androgenetic alopecia diagnosed?
This is an easily recognisable condition and the diagnosis can be made purely on clinical grounds.
How is androgenetic alopecia treated?
It is important to have realistic expectations when seeking treatment. Results are variable and it is not possible to predict who may or may not benefit from treatment.
The main aim of treatment is to slow or halt the progression of hair loss and then try to stimulate some hair regrowth. Slowing the progress may be achieved either by the application of minoxidil lotion or by a very small oral dose of minoxidil (previously prescribed for the treatment of high blood pressure). Stimulation may be achieved by taking oral finasteride (also prescribed for the treatment of benign prostate gland enlargement).
There is currently insufficient evidence to recommend laser treatments and platelet-rich plasma injections as standard treatments. The true value of commercially available hair tonics and nutritional supplements claiming to treat the condition is also dubious.
Cosmetic camouflage techniques are often very useful. Caps and hats provide good sun protection to the scalp as well as camouflaging hair loss. Some men find that synthetic keratin hair fibres are cost effective and easy to use to camouflage the sparser scalp areas.
Hair transplant surgery is a common and effective treatment for advanced cases. It involves harvesting hairs from the back of scalp (which is usually resistant to hair loss) and implanting these into the affected area at the front and top of the scalp. The technique has evolved over the years and good long-term cosmetic results may be achieved.
What is the likely outcome of androgenetic alopecia?
Without treatment, the condition is likely to progress gradually. This form of hair loss is considered to be a normal process of advancing age. Most men come to terms with the condition eventually, without the need for treatment.
This information has been written by Dr Leona Yip
Updated 15 January 2016