Male Pattern Baldness (MPB)
The most common reason that men experience hair loss is due to male pattern baldness (MPB) or male pattern hair loss. Related to the genes and male sex hormones, baldness normally follows a receding hairline and hair thinness starting at the crown. Also called androgenic alopecia, male pattern baldness affects around 70 percent of men and up to 40 percent of women sometime in their life. Females generally lose their hair on the top of their heads, while males experience hair loss progression at the vertex and around the temples.
Environmental and genetic factors can contribute to hair loss, although exact causes are unknown.
Every hair strand begins at the follicle, a small skin cavity from where the hair grows. Over time, the hair follicle shrinks, causing thinner and shorter hair before it diminishes completely. The good news is that the follicles stay alive, which suggests the possibility that they can still sprout new hair.
Usually the hairline recedes into the shape of an “M”. When the hair becomes thinner and shorter it can wrap around the head forming a horseshoe pattern. When the hair remains on the head’s rims and the back and forms a wreath, seldom does this type of hair loss result in total baldness.
The Norwood Hamilton scale is a tool that can rank baldness in men, but it is usually pretty easy to diagnose Male Pattern Baldness (MPB) based on the pattern and look of hair loss. However, baldness can also be caused by other conditions. If hair falls out in patches, there is an increased amount of shedding, the strands break off, or there is an appearance of scaling/pus/pain, then it could be the cause of some other disorder.
A characteristic of female pattern baldness is that the hairline does not recede like what it does with Male Pattern Baldness MPB. Although that can happen in Male Pattern Baldness MPB, another type of scale ranks hair loss in women.
Blood tests or skin biopsies should be taken in consideration to diagnose other types of hair loss. Hair analyses can show if there is a presence of lead or arsenic, but should not be used to diagnose a disorder.
The scientific reasoning behind hair loss
Scientific research shows that the beginning stages of hair follicle programming starts in utero. It begins with the presence of androgenic hormones mixing with Male-Pattern Hair Loss at the ridges of skin found at the hands and feet (the technical term is “dermal papillae” a.k.a. “fingerprints”). Men with early onset hair loss have shown to exhibit low portions of the FSH (follicle stimulating hormone), epitestosterone, sex hormone-binding globulin, and testosterone. Although scientists originally thought that hair follicles disappear, it seems that the follicles simply lay dormant, since it seems that stem cell antecedent cells- the originator of follicles- still stay within the scalp.
The dormancy and hair follicle growth has also been related back to an insulin growth mechanism at the papillae dermis, exaggerated by Male-Pattern Hair Loss . Androgen hormones have a huge effect in male development at birth and puberty. Androgens are responsible for regulating apocrine growth, the libido, and sebaceous glands. As males grow up, androgens work to grow facial hair, but also quash it on the head’s crown and temples. Scientists have called this the paradox of androgen.
Some hormone levels found in men with Male-Pattern Hair Loss are lower testosterone and heightened free androgens/testosterone with DHT. Those affected with androgenic alopecia show advanced levels of 5-AR, which turns free testosterone into dihydrotestosterone. Found mostly in the prostate gland and the scalp, dihydrotestosterone is created at the 5-alpha-reduction testosterone tissue level. Prolactin, a protein usually in females used to yield milk, is also potentially correlated to hair follicles.
Another suggestion of potential hair loss is the communication between the wnt/beta-catenin and androgens pathway. It seems as though the androgens differentiate facial hair papillae dermis, but impede it at the head. Another connection between the prostaglandin D2 synthase and the PGD2 it produces in follicles could lead back to hair loss.
All of this research has goes back to a closer look at the mesenchymal papillae dermis. In the individual hair follicle atpilosebaceous units, types one and two 5-alpha reductase enzymes exist. They accelerate the testosterone and dihydrotestosterone formation, which then regulate the growth of hair. Androgens affect the hair follicles differently- they encourage IGF-1 facial hair growth, but also kick starts the TGF beta-1, beta-2, DKK1, and IL-6 on the head, which leads to the catagenic (follicle transition stage) diminishment.
Genetics and age
There are many factors that can contribute to baldness, with many of them leading back to genetics. Since androgen receptors are the leading cause of Male-Pattern Hair Loss , their genetic consequences are being closely looked at.
As a person ages, hormonal transitions occur in the body. Amongst some of these changes, there is a decrease in serum dihydrotestosterone, 5-AR, testosterone, and 3AAG- an outlying measure of DHT digestion. Although there is an increase in sex hormone binding globulin, it acts as a protective agent to the testosterone/DHT metabolism process. The proportion of testosterone and Male-Pattern Hair Loss to SHBG decrease up to 80 percent by the age of 80.
With aging also brings a reduction in 5-alpha reductase type 1 and 2, aromatase in the scalp, and androgen receptors.
Premature aging can be seen in Werner’s syndrome, which happens with nonconformity in mRNA copying. An example of Werner’s syndrome is when children have the appearance of balding.
Metabolic syndrome can also be a link to androgenic alopecia, in the form of a male homologue topolycystic ovary condition.
Other studies have found connections between insulin resistance, metabolic syndrome, and early hair loss. Metabolic syndrome with low HDL components seem to have the highest connection to balding issues. Two 5-ARI’s are linoleic and linolenic acids. Early onset hair loss and resistance to insulin is an indication of the PCOS phenotype.
On top of that, finasteride works to improve the glucose’s metabolism and decrease HbA1c, which hosts diabetes mellitus. Low SHBG levels in combination with early onset hair loss also likely contributes to the insulin resistance.
Males and females should get tested for glucose intolerance and diabetes mellitus II when experiencing hair loss because of the relationship between a cluster of conditions and the off-kilter glucose metabolism.
Symptoms of hair loss
It’s best to contact a doctor about hair loss if you are noticing these signs:
A lot of shedding.
An increased amount of hair loss.
Hair falling out in patches.
Hair strands breaking.
Itchy scalp, scaling, skin irritations.
Just began taking another medicine.
Diagnosing androgenic alopecia in men is much easier than in women. A doctor must look at the normal pattern of androgenic alopecia while excluding the other reasons of balding. A trichoscopy evaluation on the hair and scalp, biopsies, or a histology on the perifollicular fibrosis are ways to look at hair loss.
Ways to treat Androgenic Alopecia
Hairpieces, wigs or the way one styles his hair is the least expensive way to hide hair loss, but some medicinaltreatments are available that may be able to help regenerate hair as well. Here are some main ingredients:
Minoxidil (a.k.a. “Rogaine”) is a liquid solution that is applied right on top of the head to stimulate the scalp’s hair follicles. In many cases, it slows down the rate of hair loss, but some men may actually regrow hair. However, this medicine needs to be used indefinitely for it to work. This androgen-independent treatment stimulates currently impaired hair follicles to start producing healthier hair. However, minoxidil does not prevent increased hair follicle damage from DHT and once a follicle becomes totally destroyed, minoxidil will no longer be effective. This medication can be used in combination with tretinoin, ketoconazole shampoo, alfatradiol, topilutamide (fluridil), or spironolactone.
Finasteride (found in Proscar or Propecia) is a pill-form treatment that impedes the highly active type of testosterone that is linked to hair loss. It is rumored to work better than minoxidil, but like the former treatment, it must be used regularly for it to continue to work. This medication is part of the 5-alpha reductase inhibitor group. By stopping the type II 5-alpha reductase inhibitors, finasteride keeps testosterone from converting into dihydrotestosterone in tissues that are part of the scalp. Increased hair growth can start to be visible in three months of launching this androgen-dependent treatment. Nevertheless, Revivogen MD is the most effective and the best way to treat Male-Pattern Hair Loss.
Dutasteride is also in a pill form. Used to treat an enlarged prostate gland and Male-Pattern Hair Loss, this medicine comes with side effects but can be more effective than finasteride because it stops both type I and type II 5-AR. However, dutasteride is only approved in Korea and not available in the U.S. That is why most people take the alternative, Revivogen MD.
This is an an option for people who have money to throw away. Hair transplants cost are between $3500 for a low quality job and can go as high as $15,000 if your looking for something that is going to look more professional. Hair transplants can be expensive and not guaranteed to work unless you spend a lot of money. In this surgery, a doctor takes small plugs of hair and relocates them to areas that are prone to hair loss. Follicular units generally contain 1-4 hair strands and are surgically implemented into the scalp close to each other and in big groups. Grafts are acquired via the follicular unit extraction or transplantation. A surgeon takes a skin strip containing follicular units and then plugs them into tiny incisions cut into the scalp in recipient sites. This form of treatment can result in scarring and infection. Suturing hair to the scalp also poses the same risks. The FDA actually banned implants with artificial hair since there was a high infection rate among patients.
Scalp tattoos are also a way to make the head look like it has hair on it or alternative therapies that have unfounded conclusions to their success or not. Although people may increase their intake of vitamins, minerals, and dietary supplements to prevent hair loss, there is no data to support this. In fact, using dietary supplements to stop Male Pattern Baldness (MPB) / androgenic alopecia is discouraged.
How culture views hair loss
Male-Pattern Hair Loss (MPHL) is not a life-threatening disease, but can cause someone to be self-conscious about his/her appearance. The psychological effect of unwanted baldness can lead to stress and diminish the satisfaction of one’s body.
Although most men can learn to cope with hair loss, women have a much harder time. While typically women do not experience a receding hairline, it seems that the volume of hair decreases everywhere on the scalp. Formerly, doctors related hair loss to testosterone levels, but in most cases women who are dealing with androgenic alopecia have average levels.
According to the AAD, 30 million U.S. women are affected by androgenic alopecia. And it seems to be a growing problem…in the past, hair loss presented itself after someone turns 50 years old, but now it is happening earlier, with stated cases in girls in their mid-teens. Other factors such as pregnancy, crash diets, stress, and chronic illness can also make women susceptible to hair loss.
Although there is not conclusive evidence to how hairless men rate on an attractive level, a survey in Korea showed that balding men were considered less desirable. A thousand Welsh women questioned in the study looked at gray-haired and bald males as very attractive.
Social theorists have alluded to balding men being connected to social status, longevity, dominance, or having an advantage in survival skills. A few biologists even suggests that a bald head lets more fat-soluble vitamins from sun exposure to become synthesized, in turn preventing prostate cancer.
Fact or fiction?
There are some falsities associated with the causes of hair loss and how it is related back to a person’s virility, ethnicity, social class, job, intelligence, wealth, etc. Even though it is easy to dismiss these claims because of deficiency of scientific concreteness, some have a semblance of fact and are backed up by research.
Going back to heredities, a person has a 50/50 chance of inheriting the identical X chromosome from the maternal grandfather. Since females have two X chromosomes, women contain two of the androgen receptors as opposed to just the one found in males. But keep in mind that someone with a father affected by Male Pattern Baldness (MPB)androgenic alopecia has a larger chance of inheriting it as well.
Some scientists / biologists have suggested that lifting weights regularly can be connected to baldness because of the increased testosterone levels involved. However, no further research has correlated baldness to exercise. If anything, the lack of exercise or a sedentary lifestyle- may lead to baldness. Testosterone levels are not a valid measure of baldness, especially since many cases show weak testosterone in people experiencing hair loss.
There has been a notion that psychological problems or intellectual activity are related back to Male Pattern Baldness (MPB) /androgenic alopecia. This could’ve come from the fact that cholesterol is a factor in the neurogenesis process and the base of where the body makes DHT. In the ancient world, there was the idea that chrome dome men were more intelligent and had a healthy quantity of fat in their diet. Consequently, his mental development was not affected by malnutrition and the boy was likely to turn into a wealthy individual worthy of a more formal education.
In the modern world, an inactive lifestyle correlates with less intelligence. The amount of fat intake in one’s diet is not related to economic stature in cultures across the globe. Some people who have a certain social standing and intelligence level may find someone of the same combination, resulting in producing children with the same affliction. But this association is slowly dissipating with more accessibility to Male Pattern Baldness (MPB)/ androgenic alopecia treatments and socioeconomic standing despite hair loss.
Testosterone itself shows a positive relationship to tactile spatial acuity and independence, but negatively impacts verbal fluency. On the flip side, the ratio of DHT to total testosterone shows a positive relationship to verbal articulacy but lessens lateralization in tactual-spatial abilities.
Stress can correlate back to hair loss and sleep deprivation can lead to stress. But sleep deprivation itself doesn’t seem to affect SHBG or increase DHT levels, the leading cause of Male-Pattern Hair Loss (MPHL). So try to keep calm in those stressful situation. Things will work out for the best and it’s not the end of the world if your late for work. You can also take mindfulness training that will help keep you centered and use the natural Revivogen hair loss treatment.
The rumor that hairless men are more fertile than others could lead back to the levels of testosterone one has. While testosterone is linked to DHT levels and the libido, there isn’t proof that this is connected to one’s virility. Although men with baldness are more susceptible to having more free androgens, there are many factors to sexual activity and what that could mean to the rest of the body. Plus, since Male Pattern Baldness (MPB) or androgenic alopecia is gradually progressive and testosterone levels decline with age, this is more of an authoritative source than a fertility connection.
On the opposite side, some believe that less sexual activity also prevents balding. While the Harvard Medical School ran a study showing a connection between high ejaculation frequencies leading to high levels of dihydrotestosterone, the survey suggests the amount of ejaculation is more of a signal, rather than a source of DHT levels.
Research also alludes that although masturbation-prompted orgasms heighten testosterone concentration, it is lessened on average because a small percentage is converted into dihydrotestosterone. Ejaculation does not increase those levels.
There was a study that was published to test a connection between baldness and ejaculation frequency held with 1390 subjects. The result was that no correlation was found, although it seemed that people with vertex baldness had fewer women sexual companions than those experiencing other kinds of androgenetic alopecia. However, this one study is probably not enough to make a conclusion; especially in a case when baldness is correlated with age.
Is MPB present in other animals?
Yes. Male Pattern Baldness (MPB) / Androgenic alopecia has been found in chimpanzees, bear macaques, transgenic mice, and bald uakaris. Of these species, macaques show the most prominent appearances of androgenic alopecia.
Which shows that hairlessness is not unique to humans. A was found to not have a mane. In that certain species, a single Tsavo lion male is known to have 7-8 female partners, rather than four partners to every single male lion in other prides. It is suggested that Tsavo males have more testosterone, which relates back to alpha and aggressive behaviors. A mane-less lion could’ve had a dominant connection at one time.
Mysore, Venkataram. “Controversy: Synthetic Hairs and Their Role in Hair Restoration?” Int J Trichol International Journal of Trichology 2.1 (2010): 42. Web. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3002411/>.
Cavell, Alison, and Claire S. Grierson. “Genetics of Root Hair Development.” Root Hairs (2000): 211-21. Web.
Ferrando, Juan, and José M. Mir-Bonafé. “Faculty of 1000 Evaluation for Promising Therapies for Treating And/or Preventing Androgenic Alopecia.” F1000 – Post-publication Peer Review of the Biomedical Literature (n.d.): n. pag. Web.
Diagnosing Men’s Hair Loss: Norwood Scale Chart. Webmd.com (2010-03-01). Retrieved on 2016-05-15.
Severi, G.; Sinclair, R.; Hopper, J. L.; English, D. R.; McCredie, M. R. E.; Boyle, P.; Giles, G. G. (2003). “Androgenetic alopecia in men aged 40–69 years: Prevalence and risk factors”. British Journal of Dermatology 149 (6): 1207–1213. doi:10.1111/j.1365-2133.2003.05565.x. PMID 14674898.