Male Pattern Baldness

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What is male pattern baldness?

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.

Nearly all men have some baldness by the time they are in their 60s. However, the age the hair loss starts is variable. About three in ten 30 year olds, and half of 50 year olds are quite bald. Some women also develop a similar pattern of hair loss.

Hair is made in hair follicles which are like tiny pouches just under the skin surface. A hair normally grows from each follicle for about 3 years. It is then shed, and a new hair grows from the follicle. This cycle of hair growth, shedding, and new growth goes on throughout life. The following is thought to occur in men as they gradually become bald.

• Affected hair follicles on the scalp gradually become smaller than normal.
• As the follicle shrinks, each new hair is thinner than the previous one.
• Before falling out, each new hair grows for much less time than the normal 3 years or so.
• Eventually, all that remains is a much smaller hair follicle and a thin stump of hair that does not grow out to the skin surface.

Male hormones are involved in causing these changes. The level of testosterone, the main male hormone, is normal in men with baldness. Hair follicles convert testosterone into another hormone called dihydrotestosterone. For reasons that are not clear, affected hair follicles become more sensitive to dihydrotestosterone, which causes the hair follicles to shrink. It is also not clear why different hair follicles are affected at different times to make the balding process gradual.

There is some genetic (hereditary) factor involved.

It is also not clear why only scalp hairs are affected, and not other areas such as the beard or armpits.

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

Medication
Currently there are two medicines that help - finasteride (trade name Propecia) and minoxidil (trade name Regaine). Neither are available on the NHS, so you need to pay the full price for them.

Finasteride 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 finisteride 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.
• It is expensive, costing around £30 per month (December 2003). You need a private prescription to get it from a pharmacy.

Minoxidil lotion is a rub-on treatment that you can buy at pharmacies without a prescription. It is not clear how it works. The higher strength solution (5%) is more effective than the 2% strength.

There is debate as to how effective it is. Probably about half of men who use minoxidil delay further balding. About 15 in 100 users have good hair re-growth. There is continued hair loss in about a third of users. However, some reports claim much higher success rates. It seems that it is best used to prevent further hair loss, but hair re-growth occurs in some users. Some points about minoxidil include the following.

• It needs to be rubbed on the scalp every day.
• It usually takes 4 months or more for any effect to be noticed.
• Treatment needs to be continued indefinitely. Any new hair that does re-grow falls out two months after treatment is stopped
• It is quite expensive.
• It may work in some women who have male pattern baldness.
• Side-effects are uncommon. For example, skin irritation or a rash sometimes occurs.

Scalp 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.

© EMIS and PIP 2004   Updated: December 2003   CHIQ Accredited