Male Pattern Baldness: Women and men, their relationship with hair is sacred. When it comes to hair, age is the biggest factor. You all know that, with age, eventually there is loss of hair. Hair fall is a gradual process. Strands of hair on your pillow or a few clumps of hair on the bathroom floor while bathing. Anyone who experiences that, goes to panic mode and wonder what exactly is the problem. 
Contrary to popular belief, women are the not the only ones who experience hair fall and are frightened of it. Men do as well. To a great extent. Unless and until you are absolutely comfortable with sporting a bald look, even if strands of hair fall, men are affected by it. Am I going bald? Do I look good being bald? How do I stop this? These are the general questions constantly summing up the thinking process when there is some sort of hair fall.
What is Male Pattern Baldness?
The most common type of hair loss for men is a condition called androgenic alopecia which is commonly called male pattern baldness.
This condition of male pattern baldness is characterised by hair loss in a distinctive and reproducible pattern from the scalp.
What causes Male Pattern Baldness?
Male pattern baldness includes both genetic and hormonal factors.
One of the main causes of male pattern baldness is genetics, or having someone in the family or a family history of baldness.
Research has proven that male pattern baldness is mainly associated with androgens which are the male sex hormones. The functions of androgens are many including regulating hair growth.
Every strand of hair on your head has a particular growth cycle. With male pattern baldness, this growth cycle weakens and the hair follicles shrink, eventually producing finer and shorter strands of hair. Gradually, the growth cycle for each hair ends and there is no growth of new hair.
There are no side effects if you have inherited male pattern baldness. Male pattern baldness can have a significant negative impact on the quality of life of the affected persons. One of the most important psychological aspects related to male pattern baldness is related to the true or imagined perceptions of others.
Is It Hereditary?
As mentioned before, male pattern balding is often caused due to hereditary causes. If anyone in your family, has male pattern baldness, there is a high chance of you having the condition as well.
Genetics determine the density and location of androgen (hormonal) sensitive hair on the site specific areas of scalp. The exact inheritance pattern is still debated and believed to be polygenic and inherited from either parent. Polygenic factors play a significant role in modifying the age of onset of hair loss, pattern of hair loss and rate of progression of male pattern baldness.
What is DHT?
DHT or dihydrotestosterone is a male sex hormone which contributes to the overall hormonal causes of male pattern baldness.
DHT is recognised as a sex steroid, which means it is produced in the gonads. It is also an androgen hormone. Androgens are mainly responsible for the various biological characteristics of males, including a deeper voice, body hair, and increased muscle mass. 
When it comes to the connection between DHT and male pattern baldness. DHT has been a major hormonal factor. Increased levels of dihydrotestosterone have been found in balding scalp compared to non balding scalp. This hormone binds to androgenic
receptors in the hair follicle and the specific bond triggers
cellular processes which reduce the anagen phase
of the hair cycle. For this reason gradually, over
succeeding cycles terminal hair converts into thinner
and shorter vellus hair and the hair follicle becomes minute
Pattern of Hair Loss in Men
In men there is frontal hairline recession associated with thinning or balding on the crown or vertex. It is estimated that 30 percent men develop male pattern baldness by age of 30 ,50 precent by age of 50. Early onset of male pattern baldness progress more rapidly, where as men with late onset may take two decades to progress a single stage.
Does Diet play a role in Male Pattern Baldness?
The role of diet when it comes to male pattern baldness, is more towards the prevention rather than being a cause. Diet is not a cause of male pattern baldness but inculcating some healthy dietary habits can often prevent hair loss. If hair is thinning, becoming brittle, growing slowly and breaking off easily, it may be that the body is not getting the right nutrients.
Food which needs to be avoided
Fried foods and red meat are avoided to reduce the overall activity of oil and sebum glands, as these are the sites for 5-AR enzyme activity, and hyperactive glands may lead to more conversion of DHT.
High carbohydrate or fatty diet, in turn, causes release of testosterone from its binding protein and makes it available for conversion to DHT.
Chinese food made with aginomoto may adversely affect the hair.
Avoidance of smoking can be beneficial in hair loss, as nicotine is known to decrease blood flow to the hair follicles by causing vasoconstriction and also leads to accumulation of free radicals in the hair roots thus damaging hair roots.
Food which help in hair growth
- Proteins, especially sulphur containing amino-acids such as cysteine and methionine, are beneficial as they are precursors to keratin hair protein synthesis.
- Foods rich in iron , omega 3 fatty acids vitamins C, A, D, and B.
- Minerals that influence hair growth are: Zn, Fe, Cu, Se, Mg and Ca.
Treatments for Male Pattern Baldness
Male pattern baldness is diagnosed mostly clinically or by a trichoscan. The choice of treatment for male pattern baldness depends on various factors including efficacy, practicability, risks and costs.
Medical management
Minoxidil
The exact mechanism of action of minoxidil has not been elucidated. Minoxidil leads to a vasodilatory effect, increased expression of growth factors that stimulates hair growth. Topical 2% and 5% minoxidil solution, applied twice daily is effective to prevent progression. The response to treatment should be assessed ideally at the end of six months. The most common side effect of topical minoxidil is hypertrichosis, irritant and allergic contact dermatitis.
5 alpha reductase inhibitors
The enzyme 5-alpha-reductase converts testosterone to its active form dihydrotestosterone (DHT).
Two drugs inhibiting the 5-alpha-reductase used in male pattern baldness are finasteride and dutasteride.
Mesotherapy
Mesotherapy is a minimally invasive techniques in which medications, mixtures of natural plant extracts, pharmaceuticals, vitamins, enzymes, hormones and other bioactive substances in microscopic quantities are directly injected into the scalp in order to improve hair growth. Hair mesotherapy is a non-surgical, relatively painless injection technique. Despite the fact that there is very little scientific evidence sustaining its widespread use, the field of hair mesotherapy have grown enormously in the past few years, becoming a common method
in cosmetic medicine. However, more studies are needed to establish protocols and to evaluate long- term efficacy.
Platelet Rich Plasma Therapy
Platelet-rich plasma (PRP) has become a newer method for the treatment male pattern baldness. PRP contains high concentrations of over 20 growth factors which stimulate hair growth. 15 ml of blood of is collected from the vein of the patient and centrifuged. The obtained platelet rich plasma is injected into scalp at amount of 0.5-1ml /cm2. A minimum of four sessions are suggested at an interval of one month.
Male Pattern Baldness Surgery
Hair restoration surgery for male pattern baldness essentially involves various forms of hair transplantation. Scalp reduction surgeries are not used frequently at present. Hair is harvested from the donor site using either strip method, follicular unit extraction or a combination of the two.
The side-effects of hair transplantation surgery are relatively minor consisting of mild pain in the operated areas, swelling which may move down onto the eyes and the formation of scabs over the grafts which take approximately two weeks to resolve. Serious problems of bleeding, scarring, and infection are rare.
Male Pattern Baldness Other treatment modalities
Though not evidence based, a number of other treatment modalities have been tried in male pattern baldness. Some of the mechanisms by which these alternative treatment modalities work include:
Promotion of hair regrowth (Iron supplements, millet seeds, Ginkgo Biloba, aloe vera, hibiscus, retinoids, cyclosporine), improving the perifollicular vascularization (prostaglandin analogues like latanoprost, aminexil, mesotherapy, benzyl nicotinate, beta-sitosterol), hormonal effects like inhibition of 5-alpha-reductase (polysorbate, green tea, ketoconazole, saw palmetto extract), anti-inflammatory activity (zinc pyrithione, corticosteroids) and improvement of hair follicle nutrition (vitamin supplements, trace elements).
Hair extensions, hair fibres and wigs are commonly used to improve cosmetic appearance in baldness.
Laser and Lights
Paradoxical hair growth after using lasers and lights for hair removal has triggered interest in using these devices as a treatment modality. The level of evidence for these devices remains poor. Light of 650-900 nm wavelengths at 5 mw has been suggested as an effective option for male pattern baldness.
Counselling
Considering the psychological impact of male pattern baldness, proper patient counseling is an essential aspect of treatment. Important points to keep in mind are to explain the need for life-long treatment in the case of medical treatment and proper selection of patients for surgical intervention. The relatively slow improvement that is expected in the case of medical management should be highlighted. It is important that the patient is given realistic expectations, especially for hair transplantation.
About The Doctor:
Dr. Sindhuri Reddy specializes in clinical and cosmetic dermatology and dermatosurgery. Her continuous thrive to be updated in recent advances of skincare gives her a unique insight and approach to skincare. She has an MBBS and MD from NTR University of Health sciences and has done observership at Mayo clinic , USA . She has several academic publications to her credit. Her areas of special interest are acne scars, hair transplantations and lasers.
