Hair,  Hair loss

“Male Pattern Hair Loss” Doesn’t Just Affect Men and It’s Treatable

There comes a time for every man when he realizes that his hairline is… slowly back back backing it up.  If you’re a man, and you haven’t realized this, I bet you will now.  How can I be so sure?  Most men’s frontal hairlines start to recede as soon as they hit puberty.  Our hair’s proclivity to react to changing hormone levels means that we will all lose hair as we get older, though it will happen at varying speeds and to varying degrees of baldness.  That’s why male pattern hair loss is considered a natural process – more of a trait than a true disorder.  It’s just one flavor of a diagnosis called androgenic alopecia (AGA) which can also affect women (in that case called female pattern hair loss).  Though this process is common, that doesn’t mean we have to part with our hair so quickly.  Here’s what you need to know about androgenic alopecia.

What is it?

AGA, in most cases, isn’t a true loss of hair, but rather a shrinking of the hair follicles.  We all have two type of hair: terminal hair which is the thick lengthy hair we tend to grow on our scalps, underarms, groin, eyebrows etc. and vellus hair which is the peach fuzz type stuff you may notice on other parts of the body.  Most of our body surfaces are actually covered in lots of tiny lil vellus hairs.  All terminal hairs start out as vellus hairs and develop to become thicker and darker.  Our current understanding of AGA states that receptors for androgens (male-type sex hormones) are present in the hair follicle, and that exposure to these androgens results in the miniaturization of hairs back to the vellus stage.  There are various genes implicated in the activity of these receptors which is why not everyone seems to exhibit this process in quite the same way and why AGA tends to run in families.

What does it look like?

While the presentation of AGA varies, it has some classic characteristics.  Men would expect to see thinning at the vertex (the top/back of the skull) and front of the scalp with leading edges toward the temples, while women tend to see widening of the part or thinning focused around the crown of the scalp.  While one may notice increased hair shedding, it should be noted that this process is asymptomatic.  Itching, redness, flaking or tenderness of the scalp or hair coming out in clumps or discreet patches could be a sign of inflammatory hair loss which should be worked up by a dermatologist.

What can I do about it?

If you know that your hair loss is due to AGA, I have some good news for you: there are plenty of treatments out there. However, time is of the essence.  Treatment of AGA is usually targeted at helping you keep the hair you have.  It’s like I always tell my patients: consider any new hair growth a bonus.  The simplest and easiest way to treat AGA is with topical minoxidil which has been available over the counter for decades. It’s one of my favorite solutions for hair loss.  Other treatment options address hormonal effects on the hair follicle and include oral medications like finasteride and dutasteride (which prevent the transformation of testosterone to the more potent DHT). There’s also some data showing the efficacy of ketoconazole shampoo in AGA.  Additionally, at-home laser and light devices such as special combs and hats have shown some efficacy in regrowing hair.

Procedural management is also an option and has classically consisted of hair transplants.  Hair transplant technology has become more elegant over the years, though it’s still a serious surgical procedure.   The hot new thing in hair loss is platelet rich plasma injection, in which your own blood is drawn and special growth factors are extracted and then injected into the scalp.  Reports are showing promising results, though no miracles yet.

The Takeaway

While AGA is common and benign, it can have a big impact on your life.  The good news is that there’s plenty you can do about it.  However, the best approach to treating AGA doesn’t rely on just one method, so consultation with a board-certified dermatologist is your best bet for maintaining those luscious locks.

Follow @dermangelo on Instagram for more hair tips!

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  • Dustin

    Hey Dr. Angelo!

    Loved the article, nice summary of the options out there. As someone ‘afflicted’ by AA from a very early age, and with genetics not on my side, I’ve done it all, and still do various things to keep whatever hair I have left.

    I wanted to hone in on a particular aspect of the article — minoxidil. You say it’s your favorite, which is interesting. It’s an old drug, with a decent safety history, and I’m assuming you like it bc the data shows it’s efficacy. The fda backs you up on this and along with finadteride it’s the only thing approved for AA.

    I’ve used it off and on for YEARS. I think it helped overall, but sometimes I really don’t what to do think (especially if you’re using multiple modalities to combat hair loss. The primary issue for me, is that ifs greasy, oily etc. it’s not so practical— weird for dating life, having hair covered in it before bed. I had one derm make me a customized mix containing more potent Minox 7% mixed with Tretenoin.

    One doc inskNnhAh

  • Dustin

    To finish my point …

    I’ve had a diff derm tell me that mouse was less effective. So many different opinions.

    I think something innovative you could teach the world would be on ‘tips and tricks’ to really use this medication in an easy and less bothersome way. How to capitalize on it. Ya, know live yo lyfe but also consistently use the medication. For me, I just got so tired of it.

    Finateride def worked but caused me to have a lot of unacceptable side effects. minoxidil has potential but it’s just so annoying and hard to use consistently.

    • angelo

      Thanks for reading and for your comment! The reason I say minoxidil is one of my favorite treatments for hair loss is because of its ease of use and different approach it takes to hair loss : it makes vellus hairs into terminal hairs. That makes it extremely versatile, but also well-suited to treating AGA. I absolutely agree with you about the cosmesis of the OTC minoxidil preparations. I always say that the vehicle is more suitable to people with less hair because of its greasy character — great for sliding across a scalp but not great for the hair itself. I’m planning on writing a full article about minoxidil because I have so much to say about it. To your point about compounding: I actually heard about the mutlidrug minoxidil compounds recently and want to learn more since I hear many patients like them a lot.

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