Androgenetic alopecia (common male-pattern baldness, or MPB) is responsible for more than 95% of hair loss in males. By the time they reach thirty-five years old, 66% of men in the United States will experience some degree of hair loss. By the time they hit 50, around 85% have significantly thinning hair. And about 25% of men with MPB have symptoms before they’re even old enough to get served at a bar.
We’ve all heard many stories of men having no problem with their hair loss; they’re doing just fine. While this may be true for some, there’s another side to that coin, and it’s a painful, embarrassing one. Losing your hair affects many, many aspects of life. It can affect relationships and it can hurt job performance, eventually leading to different choices of careers by sufferers.
Researching your options through the phone book or commercial sites online is a risky game. There are hundreds of products and services for those searching for answers, but do you know how many FDA-approved products that have actually proven to stop or prevent hair loss? Two. That’s right: two. And good luck finding a good surgeon who can perform up to standard.
Causes of Hair Loss
There are a number of reasons people lose their hair: side-effects related to serious diseases, reaction to medication, stressful events, etc. But usually it’s heredity.
Those with MPB inherit hair follicles with a genetic sensitivity to Dihydrotestosterone (DHT). Hair follicles that are sensitive to DHT miniaturize, shortening their lifespan. These follicles eventually stop producing hair; or at least hair that “passes for hair”.
We’ve all seen receding hairlines and thinning crowns. Hair in these areas – not to mention the temples and the mid-anterior part of the scalp – appear to be the most DHT-sensitive spots. Eventually, these patterns progress into more pronounced baldness throughout the entire top of the scalp, leaving a horseshoe pattern of hair. Even this “last hair standing” is susceptible to onset.
A Closer Look at DHT
Dihydrotestosterone (DHT) is a by-product of testosterone. Testosterone converts to DHT with the help of the enzyme Type II 5-alpha-reductace, which is held in the hair follicles’ oil glands. While the entire process of MPB and how exactly genetics plays a part is still a mystery to an extent, scientists know that DHT can shrink hair follicles. When DHT is suppressed, hair follicles continue with business as usual. But the ones that are DHT-sensitive must be exposed to the hormone for a prolonged period of time for the effected follicle to complete the miniaturization process. Fortunately, with proper treatment, this process can be slowed if caught early enough. Even stopped!
First comes the diagnosis. An experienced dermatologist will look at the hair, see the patterns of hair loss or thinning, and compare that with a patient’s medical history and the history of hair loss in his family. The dermatologist will examine the scalp under magnification (possibly with a densitometer), in order to find out the degree of miniaturization of the follicles. This is crucial to recommending the proper course of treatment.
Some clinics may recommend a hair analysis ($$$!) or a biopsy of the scalp to properly diagnose your hair loss. Hair analyses are for assessing the possibility of poison-induced hair loss. The results may reveal substances such as arsenic or lead, yes. But poison-induced hair loss does not present itself in typical MPB. You should avoid these clinics like The Plague and talk to a board-certified dermatologist who can properly examine and treat you.
Medicine has made huge strides in recent years. With the advent of 5-a-reductase inhibitors like Propecia and the actualization of surgical hair restoration, living with obvious hair loss is inevitable no more. Doctors and medicine are able to stop or slow the progression of hair loss and to replace lost hair through surgery with completely natural results. That being said, the majority of hair-loss treatments today can be classified as “fly-by-night” businesses and products.
We’ve seen the magazine ads, we’ve heard the radio commercials, and we’ve seen the infomercials with their “miracles”. Yeah, sure. The vast majority of these do not work for the prevention and/or treatment of hair loss. Make sure the product is approved by the FDA or recommended by The American Hair Loss Association. Is the FDA flawless? Certainly not, and we all know that. But in this case, the goal of everyone really is to prevent and cure, so chances are they have our backs this time.
As with anything else, remember these two words: EARLY and DETECTION. They sound even better when said in succession. And it’s critical.
So get on with it, right? What are the treatments? Here you go:
Proscar and Propecia are the drugs we’ve heard of, and Finasteride is the generic form of these. It was developed by Merck to treat enlarged prostate glands (Proscar). Oddly enough, during studies, an intriguing side effect of hair growth developed in test cases. Finasteride had already gotten the “thumbs up” from the FDA for its original intent, so Merck and Company pursued the possibility of developing finasteride as the first pill to treat Male Pattern Baldness.
On December 22, 1997 the FDA approved a 1-milligram dose of finasteride for the treatment of MPB. Propecia signed on and became the first drug in history to effectively treat male pattern baldness.
How Propeica/Finasteride Works:
Finasteride inhibits Type II 5-alpha-reductace, the enzyme that converts testosterone into a more potent androgen dihydrotestosterone (DHT). Propecia’s 1-milligram dose of finasteride can lower DHT levels up to 60% if taken on a daily basis. This stopped hair loss in 86% of men during the drug’s clinical trials. 65% of test subjects experienced a substantial increase in hair growth.
DHT levels must be lowered to prevent hair loss; that much is clear. The American Hair Loss Association recommends finasteride for all men wishing to treat MPB.
Minoxidil (loniten) was the first drug approved by the FDA for the treatment of MPB. Similar to finasteride, minoxidill originally had a different use: it was used to treat high blood pressure. And again – just like finasteride – those individuals taking minoxidil were growing hair in, shall we say, odd places: on their cheeks, the back of their hands, and even on their foreheads!
As you may have guessed, researchers took notice. The question was raised: “What if we apply minoxidil directly on places where we want to grow hair?” And it worked. It wasn’t perfect, but it was something.
So yes, minoxidil can slow the progression of hair loss – and sometimes regrow hair – but many experts in the field see it only as a stepping stone to an absolute cure. We need something long-term and stable.