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What Causes Male Balding, and What Can Be Done About It?

Male pattern baldness will affect up to 70 percent of men sometime during their lives.

If you’re losing the battle to keep your hair, you can probably blame androgenetic alopecia, better known as male — or female — pattern baldness. AGA is the most widespread form of hair loss, affecting up to 70 percent of men and 40 percent of women sometime during their lives, according to Canadian dermatologists K.J. McElwee and J.S. Shapiro.

This most common form of hair loss occurs when the scalp’s follicles shrink to the point that they can no longer support the normal growth of hair. This shrinkage of the follicles is a gradual process. At its outset, hair growing from the targeted follicles becomes progressively thinner. Eventually the follicle becomes so minuscule that no hair can grow at all.

DHT Gets Most of the Blame

Most scientists and medical professionals believe that the culprit behind the shrinking follicles of androgenetic alopecia is dihydrotestosterone. DHT is a derivative of testosterone, which is the primary sex hormone in males but is also present in lesser amounts in females.

According to the American Hair Loss Association, the conversion of testosterone into DHT is triggered by Type II 5-alpha reductase, an enzyme that resides in the oil glands of hair follicles.

Although circulating levels of testosterone vary sharply between males and females, scientists believe that overall testosterone levels are less of a factor in hair loss than the amount of DHT that binds to receptors in the follicles. Once the DHT takes hold in the follicle, the shrinking process begins, ultimately leading to hair loss.

Another Theory Proposed

An alternate theory of what causes male pattern baldness emerged in a study published in the March 2012 issue of “Science Translational Medicine.” If the theory can be proven correct, it may open up an additional avenue of treatment for hair loss.

The research team behind the 2012 study reported that bald men tend to have abnormally high levels of a protein called prostaglandin D2 on their scalps. The team concluded that this protein and its derivatives block hair growth by shrinking hair follicles.

George Cotsarelis, M.D., one of the study’s participants, said, “We have really identified a factor that is way out of whack by actually studying the disorder.” Cotsarelis, chairman and professor of dermatology at the University of Pennsylvania’s Perelman School of Medicine, said that drugs that inhibit the effects of prostaglandin D2 should delay the onset of male pattern baldness. These findings are likely to apply to women as well, according to researchers.

Impact on Follicles

The 2012 study also provided additional insight into the effects of AGA on hair follicles, regardless of what agents — individually or in combination — may be responsible for the process.

Thinning hair is a sure sign that trouble lies ahead.

Thinning hair is a sure sign that trouble lies ahead.

During AGA, large “terminal” hair follicles that form thick hair shafts miniaturize over time into small follicles that generate microscopically thin hairs. At the same time, each follicle’s growing phase, known as anagen, decreases sharply in duration. The follicles’ growing phase, which normally lasts for years, decreases in duration to weeks or even days. This results in an increase in the number of resting hair follicles that support only microscopic hairs.

Protein Inhibits Hair Growth

The research team behind the 2012 study also reported that its laboratory testing confirmed that prostaglandin D2 significantly inhibited the growth of hair from both mouse and human follicles.

While AGA is by far the leading cause of baldness among both men and women, it is not the only reason for hair loss, according to MayoClinic.com.

Just as delicate hormonal imbalances may play a role in triggering AGA, other hormonal changes can trigger temporary hair loss. These are most common among women and may occur in conjunction with pregnancy, childbirth, the onset of menopause, or the discontinuation of birth control pills, all of which involve marked hormonal changes.

Medical Conditions

Hair loss also may occur as a result of certain medical conditions, such as thyroid problems. The thyroid gland helps to regulate hormone levels throughout the body, so when it malfunctions, hormonal changes can cause hair loss. Scalp infections and other skin disorders can lead to temporary — and sometimes permanent — hair loss.

Another cause of hair loss is alopecia areata, a disorder in which your immune system attacks hair follicles. The result is smooth, rounded patches of baldness.

Other Hair Loss Causes

Among other common causes of hair loss — both temporary and permanent — is the use of certain medications, including some drugs used to treat arthritis, cancer, depression, heart problems, and high blood pressure.

Some people experience hair loss after suffering a physical or emotional shock, such as a sudden or excessive loss of weight, a death in the family, or a high fever.

People with the hair-pulling disorder, a form of mental illness, feel compelled to yank hair from their scalp, as well as eyebrows and other areas of the body.

What Can Be Done?

No matter what its cause, men and women suffering the effects of androgenetic alopecia and other forms of hair loss are desperate to find ways of retaining the hair they have left or regrowing hair in areas where it’s been lost.

At present, the primary methods of treatment for hair loss are the medications known generically as finasteride and minoxidil, and through such surgical procedures as transplantation and scalp reduction.

Finasteride, marketed under the trade name Propecia, is widely considered the most effective of the two hair loss medications. The American Hair Loss Association calls it the “first line of attack” in treating male pattern baldness.

Used to Treat BPH

Finasteride originally began life as an oral treatment for benign prostatic hyperplasia, a non-cancerous form of prostate enlargement. Men who were taking the drug to treat BPH experienced unexpected hair growth. This serendipitous discovery prompted Merck, the drug’s manufacturer, to investigate the possibility of marketing the drug as an oral medication to fight hair loss.

Approved by the FDA for use in men only, Propecia combats hair loss at the hormonal level. The oral medication contains 1 milligram of finasteride that inhibits the 5-alpha-reductase enzyme that is known to trigger the conversion of testosterone into DHT, which then targets hair follicles, causing them to shrink until they can no longer support healthy hair growth.

Story of Rogaine

Minoxidil, the other drug marketed to treat hair loss, began life as a high blood pressure medication. When men taking the anti-hypertension drug experienced hair growth, researchers began to study the drug’s potential as a treatment for hair loss. As a result, Rogaine, a topical minoxidil application, came to market in the late 1980s. A lower-strength version of the drug was eventually made available for women.

Rogaine’s precise mechanism of action is unknown, but it is believed that the topical application of minoxidil helps to enlarge hair follicles, in some cases reversing the miniaturization process that leads eventually to balding.

Although it gives its highest recommendation to finasteride — the active ingredient in Propecia — the American Hair Loss Association believes that Rogaine’s minoxidil formulation still has a role to play. Specifically, it suggests that Rogaine can be used by those who have not had satisfactory results from Propecia or who wish to add another medication to their treatment regimen.

Both Propecia and Rogaine are available from eDrugstore.com, which can ship these drugs discreetly to your front door. eDrugstore’s prices are among the lowest available online.

Surgical Procedures

Hair loss due to male pattern baldness is generally confined to the top of the head. Surgical remedies — transplantation and scalp reduction — for this form of hair loss are designed to make the most of the hair that you have left, according to MayoClinic.com. Expensive and often painful, surgical procedures can also run the risk of infections and/or scarring.

In hair transplantation, the surgeon takes tiny plugs of skin — each containing a few hairs — from the back or sides of your scalp. The plugs are then implanted into bald sections of your scalp. Multiple transplant sessions are generally required, depending on the extent of the bald area to be covered.

Scalp reduction involves the surgical removal of some of the bald skin on the top of your head. Once the hairless scalp has been removed, the surgeon stretches sections of hair-bearing scalp upward to cover the surgically removed patch of bald scalp.

Don Amerman is a freelance author who writes extensively about a wide array of nutrition and health-related topics.