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General Description

Male pattern baldness is a hereditary disorder that first becomes apparent in late adolescence or early adulthood. Progressive hair loss is noted in the front and center of the scalp and is due to the slow shrinkage and subsequent death of hair follicles.

Causes

The majority of men are predisposed to male pattern baldness. The culprit is the male hormone, testosterone, which is converted to dihydrotestosterone (DHT).  DHT has a negative effect on the hair follicle leading to slower hair growth, thinner hair, and eventual hair depletion.

Medical Treatments

Millions of dollars’ worth of quack tonics and megavitamin pills “guaranteed” to reverse the hair-loss process and grow hair are sold annually. Advertised in popular journals or on late-night TV shows, many of these products prey on men’s vanity and as a rule disappear following state or federal investigations. Some meld science with pseudoscience, referencing DHT (dihydrotestosterone, a known causative factor of male pattern baldness) and concoctions of poorly studied herbal remedies.

To date, only two products are FDA approved to retard or reverse male pattern alopecia: minoxidil (Rogaine) and finasteride (Propecia). Minoxidil (in pill form) was first marketed as an oral treatment for high blood pressure. Problems soon became evident when the drug was administered to women and children: they began to sprout beards and mustaches!    A true genius got the bright idea of rubbing the stuff on the shiny scalps of bald men, and—lo and behold—new hairs indeed began to grow. This was indeed a monumental accomplishment, the first time in history that something grew new hairs. It is known that minoxidil dilates blood vessels, but the mechanism of action on scalp hairs is still unclear. Minoxidil does not work on everyone. People with the least hair loss, and those balding for the shortest time period, appear to do best. For many of these individuals, minoxidil really does produce cosmetically acceptable hair. For the majority, minoxidil will help prevent or delay further thinning of the hair. By starting minoxidil treatment early, male pattern baldness may be placed on hold. The trade name for minoxidil is Rogaine, now available in an elegant foam formulation.

Finasteride (Propecia) is used in higher doses to treat an enlarged prostate. This oral medication was approved in 1997 as a treatment for male pattern baldness. The drug inhibits the breakdown of the male hormone, testosterone, to DHT. Clinical studies demonstrate that finasteride can induce new hair growth in about 50 percent of men and can also increase the weight and diameter of existing hair. As is the case with minoxidil, therapy with finasteride is for life; once discontinued, the natural process of hair loss will proceed. Finasteride’s long-term effect on general health is unknown; however, data indicates that chronic use may actually decrease the risk of prostate cancer, a very significant finding. Dutasteride (Avodart) acts in a similar manner to finasteride but has a longer half-life. In other words, one or two pills per week may well keep a guy’s hair intact. And, on another positive note, a study published in 2009 concluded that Avodart lowered the risk of prostate cancer by 23 percent.

For those unaided by, or deciding against use of either minoxidil or oral agents, depleted hair may be covered up by a toupee or hair weave, or partially rectified by hair transplantation. Hair transplant traditionally involved the transfer of quarter-inch round plugs from the back of the scalp to thinned areas in the front of the scalp. The technique was analogous to placing sod down on a depleted lawn and results in permanent replacement. The cosmetic endpoint varied from natural to comical, with many individual heads resembling cobblestone roads. Nowadays, follicular unit transplantation has supplanted plugs; it involves removing thin strips of hair from the posterior scalp, which are then dissected into thousands of micro-grafts prior to transplantation. The results are much more natural and, in many people, virtually imperceptible.

Some physicians are utilizing lasers in attempts to slow down hair loss and stimulate new hair growth. Indeed, units are now available for home use. Until adequate clinical studies are published, laser and light use for baldness should be viewed with a healthy degree of skepticism.

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