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Health Library - Hair Loss

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What is male hair loss (male pattern baldness/androgenic alopecia)?

Male pattern baldness is the common type of hair loss that develops in most men at some stage. It usually takes 15-25 years to go bald. However, some men go bald in less than 5 years. Typically, at first the hair begins to recede (thin) at the front. At the same time, the hair usually becomes thin on the top of the head. A bald patch gradually develops in the middle of the scalp. The receding front, and the bald patch on the top gradually enlarge and join together. A rim of hair is often left around the back and sides of the scalp. In some men, this rim of hair also thins and goes to leave a completely bald scalp.

What causes male hair loss?

Some men have areas on the scalp that are very sensitive to the male sex hormones that circulate in men's blood. The hormones make the hair follicles - from which hair grows - shrink. Eventually, they become so small that they cannot replace lost hairs. The follicles are still alive, but are no longer able to perform their task. The condition usually starts in men aged 20 to 30 and follows a typical pattern. First, a receding hairline develops, and gradually the hair on top of the head also begins to thin. Eventually, the two balding areas meet to form a typical U-shape around the back and sides of the head. The hair that remains is often finer, and does not grow as quickly as it used to.

What are the treatment options for male pattern baldness?

Treatment with medication

1. Finasteride (Propecia) was launched in the UK in 2002, although it has been available in the US since 1997. It works by blocking the conversion of testosterone to dihydrotestosterone. The hair follicles are then not affected by this hormone, and can enlarge back to normal. Some hair re-growth occurs in about 2 in 3 men who take a finasteride tablet each day. In about 1 in 3 men there there is no hair re-growth, but most do not have any further hair loss whilst taking finasteride. It has no effect in about 1 in 100 men. So, if you take finasteride, you have a good chance that hair will re-grow, or at least stop any further hair loss. Some points about finasteride include the following:

  • It takes about 4 months for any effect to be noticed, and up to 1-2 years for full hair growth. 
  • The balding process returns if treatment is stopped. Therefore, if successful, you need to carry on treatment to maintain the effect.
  • Side-effects are uncommon. The most common is that about 2 in 100 treated men report loss of sex drive (libido).
  • It does not work in women with male pattern baldness.
  • You need a private prescription to get it from a pharmacy.

2. Minoxidil lotion (Regaine regular strength or Regaine extra strength) is applied twice daily to the scalp. Minoxidil was originally invented as a treatment for high blood pressure; the hair growth is a side effect that, in this case, has proved useful. It is not available on NHS prescription, but can be purchased over-the-counter. About 60 per cent of patients benefit from it to varying degrees but its effects start to wear off as soon as it is stopped.

Plastic surgery

Techniques such as hair transplantation, scalp flaps, and other procedures have been used for a number of years. Success rates vary and a specialist opinion is needed if surgery is considered. It is expensive and not available on the NHS.

Do nothing

To become gradually bald is a normal part of the ageing process for most men. No treatment is wanted or needed by affected men. For some men, baldness can be distressing, particularly if it is excessive or occurs early in life. Treatment may then help.


Hair loss in women
Women can also suffer hair loss, especially those with many relatives who are also prone to losing their hair. The female pattern sets in at a later age than in men and is usually limited to the top of the head. Total baldness is rarely seen in women. The only treatment licensed for hair loss in women is Regaine for women.

References

Dr Flemming Andersen, Professor James Ferguson, NetDoctor, Patient UK

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