Male pattern baldness, also known as androgenic alopecia, is one of the most common causes of hair loss, with at least 50% of men experiencing hair loss by the age of 50. Male pattern baldness predominantly occurs at the temples, vertex and mid frontal scalp. Some men can get an individual bald spot or experience their hairline receding in the shape of an M with the hair loss progressively increasing. It is well recognised that hereditary predisposition accounts for 80% of male pattern baldness sufferers.
What causes male pattern baldness?
In order to understand why male pattern balding occurs, let’s first understand the Hair Growth Cycle and it’s 4 stages:
HAIR GROWTH CYCLE
1. ANAGEN
The growth phase of the hair cycle, where healthy hair grows roughly half an inch (1.27cm) per month, this usually lasts between 3-5 years.
2. CATAGEN
The transition phase of the hair cycle, this is at the tail end of the anagen phase and lasts an average of 10 days.
3. TELOGEN
The resting phase of the hair cycle, this is where the follicle remains inactive for up to 3 months as new hairs begin to grow.
4. EXOGEN
The new hair phase of the hair cycle, this is where the old inactive hairs from the telogen phase fall out as the new hairs continue to grow.
The key pathophysiological features of male pattern baldness is:
- Alteration of the hair growth cycle (mentioned above)
- Miniaturisation of the hair follicle
- Inflammation
When it comes to the hair growth cycle, the anagen (growth) phase begins to shorten with each cycle and the telogen (resting) phase remains or in some cases becomes prolonged. After a number of cycles, the anagen phase becomes so short that the hair doesn’t even grow long enough to reach the surface of the skin.
Dihydrotestosterone (DHT) is a sex hormone that provides the development of ‘male’ characteristics such as body hair, also known as an androgen. DHT is a byproduct of testosterone which binds to the scalp hair follicle androgen receptors, leading to male pattern baldness. This is where finasteride comes into play.
What Is Finasteride?
There are only two drugs approved by the Food and Drug Administration (FDA) for the treatment of hair loss: Minoxidil and Finasteride. Finasteride is an inhibitor of the isoenzyme 5-alpha-reductase, in simpler terms, finasteride inhibits the conversion of testosterone into dihydrotestosterone (DHT). Jerry Shapiro conducted a study on the use of the recommended 1 mg oral dosage of finasteride to treat male pattern baldness (androgenic alopecia) showed a 71% decrease in scalp DHT levels compared to a 1% increase with a placebo.
Side Effects of Finasteride
The following are a list of possible side effects associated with the use of finasteride:
- Loss of libido
- Erectile dysfunction
- Decreased ejaculatory volume
- Gynecomastia (condition that makes breast tissue in boys and men)
- Orthostatic hypotension (decrease in blood pressure)
- Dizziness
- General weakness
- Dyspnea (medical term for shortness of breath)
- Rhinitis (also known as coryza, is the condition where the inside of the nose becomes inflamed)
- Skin rash
- The continuation of adverse effects post treatment has also been witnessed.
It is important to note that studies relating to the negative side effects of finasteride are somewhat limited. During the studies conducted, side effects occur in 10% of individuals however only 1% suffer from adverse effects having discontinued use of finasteride.
What To Do If You Suffer From Hair Loss
Whilst it may be frustrating to suffer from hair loss, ensure you do your own thorough research before opting for treatments such as finasteride, consult a clinician to determine what the best course of action may be for you.
It may be time to implement the following to help slow down the process of hair loss.
Decrease stress
Stress can push the hairs into the telogen (resting) phase of the hair cycle and prevent the production of new hairs and speed up the male pattern baldness. Ensure you manage your stress levels, this may differ from person to person dependent upon your lifestyle but the most important tool when battling stress would be exercise. Following a consistent exercise routine or meditation/yoga is greatly beneficial for controlling stress levels along with sufficient rest.
Haircare
Make sure you are using a shampoo and that it is suitable for you, using the proper product can allow you to maintain a healthy scalp and in turn look after your hair. Using the wrong product may be too harsh for your scalp and begin to irritate follicle and lead to shedding. Whilst not shampooing often enough can be bad, shampooing too often can damage hair too. It is recommended that you shampoo your hair twice a week with specialised shampoo for thinning hair and conditioning your hair daily.
Healthy diet
Ensure that you are getting a well balanced diet rich in essential vitamins and minerals to allow for the body to function well. A poor diet e.g. low protein levels can begin to damage healthy hair and inhibit the body’s ability to develop new hair follicles.
References
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5817427/
[2] https://www.ncbi.nlm.nih.gov/books/NBK278957/
[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3115771/
[4] https://www.ncbi.nlm.nih.gov/books/NBK513329/
[5] https://www.sciencedirect.com/science/article/pii/S0022202X15529357