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ALOPECIA: ANDROGEN-DEPENDENT - MALE BALDING

What is Alopecia ?

Androgenic alopecia is the name given to hair loss caused by male hormones. It occurs naturally in most men and, to a lesser extent, in women. It should not be regarded as a disease or as being abnormal. In men it can occur from the late teens onwards, but tends to be commonest from the 40s onwards. In women it is most marked after the menopause. The first sign of balding is increased hair loss. It is normal to lose up to 100 hairs a day. In those affected with androgenic alopecia, the hair loss is greater. Eventually the hair becomes noticeably thinner, with a receding hair-line over the temples. With time, the hair-line recedes further and a bald patch may develop over the crown. In some cases, the bald patch merges with the receding hair-line to give complete baldness.

How does Alopecia occur ?

Androgenic hair loss is due to the action of the male hormone (testosterone) on susceptible scalp hairs. The level of blood testosterone is usually normal, but the hairs are more susceptible to its action. This eventually leads to the loss of those hairs. In men, it occurs after puberty. In young women, female hormones protect their hair from this effect. Only mild hair loss is usually seen. After menopause, however, female hormone levels fall but male hormones continue to be produced. Therefore hair loss is more obvious. When a young woman gets severe androgenic alopecia, increased levels of testosterone are sometimes found in the blood. This may suggest to the doctor that you have a condition called polycystic ovarian disease.

Why does Alopecia occur ?

Androgenic hair loss is partly due to an inherited factor. However, a person from an unaffected family may still develop this problem which can be passed on to offspring. The onset of hair loss is quite variable. Around 1 in 20 men show evidence of androgenic alopecia before the age of 20. The age at which the hair loss begins does not seem to be inherited. Caucasians are more prone to this form of hair loss than Afro-Caribbeans: in turn, Afro-Caribbeans are more often affected than Orientals. Itching of the scalp and dandruff may be present, but are not the cause of androgenic alopecia. Wearing of hats and certain hair-styles also have no influence on this form of hair loss.

Treatment Involved for Alopecia

The only sure way to prevent androgenic alopecia is to stop male hormone production. This can be done with drugs or by surgical castration. However, this is radical treatment and is not advised! Shampoos, scalp rubs, hair tonics and over-the-counter hair restorers are generally of very little value and can be very costly. The only safe and effective medical treatment is a lotion containing 2% or 5% minoxidil which is rubbed into the scalp twice daily. Another drug called finesteride, which counteracts the male hormone effect on the hair is also used. In some men using topical minoxidil, the hair loss is reduced and some regrowth does occur. Good responses with dense regrowth are seen in up to one-third of the men treated. Another one in three derive some benefit. The remaining one-third have no response. The earlier the hair loss is treated, the better the chances of success.

The exact response rate in women is not known, but many do well on it. Minoxidil lotion is available over the counter in most chemists. It is generally recommended that individuals should start with the 2% preparation and if after 3 months the response is not as good as you expect, to increase to the 5% lotion. Finesteride tablets are only available on prescription. It is a drug normally used in men who have enlargement of the prostate gland. At low doses of 1mg/day it has been shown to be effective in androgenic hair loss. The response rates seem to be similar to those seen with minoxidil lotion but different individuals may respond to finesteride when they did not respond to minoxidil. The only other approach to androgenic hair loss is surgical, with hair transplants. In this procedure, small pieces of scalp from areas with normal hair are transplanted into the bald area. These must come from the patient and cannot be donated by another person. It is important not to have a hair transplant too early, as progressive baldness may leave the transplanted area as an obvious patch of hair in an expanding sea of baldness. Hair transplantation is expensive and if not properly done may lead to infection, scarring and a much worse cosmetic result.

During Treatment for Alopecia

When minoxidil lotion or finesteride are used, there is usually a reduction in the number of hairs lost each day. Fine downy hair may appear in a bald area. Over a period of several months, the fine hair thickens to become normal hair. Treatment should be continued for at least 3 months before abandoning it as a failure. Very few side-effects have been reported with minoxidil lotion, but some people do experience mild irritation. Finesteride tablets cause some sexual problems in up to 10% of men who try them. These include impotence of failure to maintain an erection, premature ejaculation and loss of libido. Men using finesteride must use barrier methods of contraception as the drug could affect the unborn baby of a female sexual partner.

After Treatment for Alopecia

If a response is achieved with minoxidil lotion or finesteride tablets, treatment must be continued. The hair will start to fall again when the treatment is withdrawn.

If Alopecia is Left Untreated

Androgenic hair loss tends to be a progressive condition. It is impossible to predict how quickly the hair will be lost and how much will be ultimately lost. Some indication may be gained by looking at the father and grandfather's hair pattern. The fact that an individual loses hair early, gives no indication of the speed of hair loss. Someone who starts to lose hair at the age of 19 may have more hair at 30 than someone who begins losing hair at 25.

Effects on Family of Alopecia

Androgenic alopecia tends to be inherited, so that brothers and children may be similarly affected. However, this is impossible to predict.