Hair Loss in Men
Male pattern hair loss, also known as Androgenetic Alopecia (AGA), is the slow and progressive loss of hair from the scalp causing baldness in a patterned distribution. It is a very common disorder, affects about half of men worldwide, and usually begins before age 40. The incidence rises with age — 10% of 30 year old men show signs of hair loss, while the rate climbs to 50% in those over 50. The incidence is highest in the white population, followed by African Americans and Asians.
What Causes Male Pattern Hair Loss?
Androgenetic alopecia is an inherited condition. It is linked to hair follicle sensitivity to androgens produced by the male reproductive organs. Hair growth on the scalp is progressively slowed by these androgens. This causes a gradual miniaturization and eventual loss of hair follicles. The result is 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 involved 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. Environmental factors like stress, exercise, and even nutrition are also linked to male pattern hair loss, possibly through their effects on hormone levels, but their role is not fully defined.
How Does It Present?
AGA can show up as a receding hairline at the front of the head, a loss of hair at the center of the scalp, or both. It often gives 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. Most men with AGA don't experience "shedding," and the hair loss is not associated with excess scaling, itching, or scarring. The patterns of hair loss are characteristic and are represented by the Norwood Scale. It is very important to be evaluated by a trained professional, particularly with trichoscopy, to diagnose the exact cause of your hair loss.
Treatment Options for Male Pattern Hair Loss
Minoxidil
Used as a topical treatment, Minoxidil increases the growth phase of the hair and boosts blood supply to the hair follicle. It helps the majority of men using it maintain or regrow at least some of their hair. PS Dermatology & Surgery offer unique vehicles and compounded higher concentration forms beyond what is available over the counter.
Finasteride & Dutasteride
These oral anti-androgens are 5-Alpha Reductase inhibitors. They block the formation of DHT in the scalp and slow the progression of hair loss. They are more effective than minoxidil but require prescription and monitoring, and may have some side effects. In general they are well tolerated and affordable.
Ketoconazole Shampoo Combinations
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 — boosting medication penetration and delivering otherwise unavailable medications to the scalp. For example, finasteride may be compounded into a topical formulation to avoid side effects associated with oral use.
