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Hair Loss in Men

Male pattern hair loss, otherwise known as Androgenetic Alopecia (AGA), refers to the slow and progressive loss of hair from the scalp causing baldness in a patterned distribution. It is a very common disorder and affects about half of men worldwide and usually begins before the age of 40. The incidence increases with age and 10% of 30 year old males exhibiting signs of hair loss, while incidence increases to 50% in those over 50. The incidence is highest in the white population, followed by the African Americans and the Asians. 

What causes male pattern hair baldness?

Androgenetic alopecia is an inherited condition. It is associated with sensitivity of the hair follicles to androgens produced by the male reproductive organs. Hair growth on the scalp is progressively inhibited by these androgens. This causes a gradual miniaturization and eventual loss of hair follicles. This reduction leads to the production of weaker, shorter and thinner strands of hair. With each growth cycle, no new hair is formed, and baldness becomes visible and permanent. The major androgen implicated is called Dihydrotestosterone (DHT). DHT is produced from the conversion of testosterone by an enzyme called 5-alpha reductase which is present in the hair follicle. It is also said that environmental factors like stress, exercise and even nutrition are linked to male pattern hair loss, possibly by their effects on hormonal levels, but their effect is not fully defined.

How does it present?

AGA can present itself in the form of a receding hairline at the front of the head or a loss of hair at the center of the scalp or both. It may often give a characteristic M shape at the top of the head. The hair loss is slow and progressive over time, starting after puberty and slowly advancing over time. Most men with AGA do not experience “shedding” and the hair loss is not associated with excess scaling, itching, or scarring. The patterns of hair loss are characteristic, and they are represented by the Norwood Scale It is very important to be evaluated by a trained professional, particularly with trichoscopy, to diagnose the exact etiology of your hair loss. 

What are some treatment options?

Minoxidil, used as topical treatment , has been shown to increase the growth phase of the hair and also increase blood supply to the hair follicle. It has been shown to be effective in male pattern hair loss and allows the majority of men using it to maintain or regrow at least some of their hair. PS Dermatology & Surgery are experts in the use of Minoxidil and offer unique vehicles as well as compounded higher concentration forms than are available over the counter. 

Anti-androgens: finasteride and dutasteride are available as oral treatments. They are 5-Alpha Reductase inhibitors, thereby blocking the formation of DHT in the scalp, and thereby slowing the progression of hair loss due to DHT. They are more effective than minoxidil, but require prescription and monitoring, and may come with some side effects. In general however, they are well tolerated and inexpensively obtained. 

Shampoo based combinations with ketoconazole have also shown to improve hair growth in androgenetic alopecia, although studies have not been as large or well controlled. 

Compounded topicals: PS Dermatology & Surgery are experts at compounded prescriptions for hair loss to increase medication penetration and deliver otherwise unavailable medications to the scalp surface. For example, finasteride may be compounded into a topical formulation to avoid the side effects associated with oral ingestion.

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