The Cause of Hair Loss in MenBy Natasha Mehra of Bigplanners.com
By far the most common cause of loss in men is androgenetic alopecia, also
referred to as “male pattern” or “common” baldness. It is caused by the effects of the male
hormone dihydrotestosterone (DHT) on genetically susceptible scalp follicles.
This sensitivity to DHT is present mainly in follicles that reside in the front, top, and
crown of the scalp (rather than the back and sides) producing a characteristic and easily
identifiable pattern described by Norwood (see Norwood Classification).
It is frequently stated that “hair loss comes from the mother’s side of the family.” The truth
is that the condition can be inherited from either parent. However, recent research suggests
that the situation may be a bit more complex than was originally thought.
Factors on the x-chromosome have been shown to influence loss, making the inheritance from
the maternal side of the family slightly more important than the paternal one (Markus Nothen,
2005).
The identification of an androgen receptor gene (AR) on the x-chromosome helps to explain why
the loss pattern of a man resembles his maternal grandfather more often than his father.
However, this is clearly not the whole story since a direct inheritance from the father is
observed as well. An autosomal (non-sex) linked gene would explain this type of transmission –
but this gene has not yet been found.
DHT is formed by the action of the enzyme 5-alpha reductase on testosterone, the hormone that
causes sex characteristics in men. DHT causes male loss by shortening the growth, or
anagen, phase of the cycle, causing miniaturization (decreased size) of the follicles, and
producing progressively shorter, finer hairs. Eventually these hairs totally disappear.
In the patient below, we see a close-up of the side of his scalp where the is not affected
by DHT. We see mostly groups of full thickness hairs (called terminal hairs) and a few scattered
fine, vellus hairs. This is normal.
In the area of thinning (see circle below), we see that most of the has been miniaturized,
although all of the is still present.
In the region that is bald (second circle in the center) , there is extensive miniaturization
and some, but not all of the has disappeared.
What this shows is that the initial appearance of balding is due to the progressive decrease in
hair shaft size, rather than the actual loss of – in early loss, all the is still
present.
This is the reason why medications, such as finasteride (Propecia) work in early
loss (since they are able to partly reverse the miniaturization process) but don’t work in areas
that are totally bald.
It is also the reason why surgery, if not planned properly, can result in loss due to the
shedding of surrounding miniaturized hair
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