Male Pattern Baldness (MPB) is a form of balding characterized by initial hair loss at the hairline (receding hairline) which then spreads backwards to the rest of the scalp. Genetic predisposition is key in whether one develops MPB or not, while other factors such as hormone levels, nutrition, smoking or stress, play an important role in the progressing of MPB.
As the name indicates, this form of baldness affects men primarily and, according to the American Academy of Dermatology, it affects approximately 50 million men in the United States. By age 50, about half of us are/will be balding and the proportion of balding men rises dramatically beyond this age. It is a disorder which can cause much distress to the person suffering from it which explains why the US market for hair loss products is valued at a huge one billion USD per year. Currently, there are only two FDA-approved products for the treatment of male pattern baldness: minoxidil and finasteride.
How does male pattern baldness occur?
Well, it is in the genes, as it is also known as androgenetic alopecia. As outlined by Genetics Home Reference, the way MPB is inherited remains unclear although researchers have identified a genetic variance on the X chromosome that is linked to MPB, hence the initial theory stating that baldness was inherited from the mother’s side. However, after some time, scientist started to discover other variants on the non-sex-linked chromosomes that led to male baldness; what this means, in layman’s terms, is that baldness can be inherited by either the mother’s or the father’s side. This genetic predisposition when combined with the actions of dihydrotestosterone (DHT), an endogenous sex hormone derived from testosterone and found in relevant amounts in males, causes the hair follicles to die. The mechanism of action for androgenetic alopecia is also unclear, but several suggested theories point to the hair follicles being starved from blood flow and thus nutrients; another theory is that DHT causes increased inflammation at the follicle level which causes some form of immune attack to the follicles.
Genetics and physiology aside, MPB can strike at any age, being the ages between 18 to 40 the most common. As mentioned before, 50% of men by age 50 are balding, which really puts into perspective the need for making the most out of our curls while they are still up there! MPB follows a predictable pattern (most of the time) in which thinning (less hair) is initially noticed at the temples, with the thinning and eventual loss of complete hairs progressing back to the vertex (crown or top back of head). The progression of androgenetic hair loss is classified in stages although the transition from stage to stage does not follow a set time per se, rather, some men experience rapid transition as opposed to others maintaining themselves at a given stage for long periods. Said classification of stages is known as the Norwood Scale, published in 1975 by Dr. O’tar Norwood and originally introduced by Dr. James Hammilton in the 50’s. The Norwood Scale is comprised of seven stages, I to VII, with Stage I being the non-balding stage and Stage VII being terminal MPB (almost no hair on scalp save some at the sides and back).
The Norwood scale
Norwood Scale (stages)
As you can see above, the first tell-tale sign of male pattern baldness is recession at the hairline, specifically the temples (Stage I to II). From there onwards, each stage follows the progression of the receding temple in a backward manner with the vertex also losing hair in a circular fashion. Hair loss at the vertex can be experienced at Stage III or still remain unnoticeable yet by Stage IV both temples and vertex are visibly losing hair. By stage VI, the recession which started at the temples meets the expanding vertex area, leading to almost no hair covering the top of the scalp. End-stage MPB (VII) leaves the scalp with minimal hair at the sides and back.
Hair loss products or options to fight male pattern baldness
Currently, as we stand, there are only two FDA-approved medications used to treat MPB, these being minoxidil and finasteride. These medications stop the progression of hair loss and may also regrow new hair. Minoxidil is a topical vasodilator that is thought to increase blood flow to the follicle thus yielding hair maintenance and regrowth, although any regrowth is lost upon cessation of the medication so it needs to be applied daily and long-term. Finasteride, on the other hand, works via inhibiting an enzyme that converts testosterone into DHT, thus lowering DHT levels and reducing the negative impact of this hormone on the hair follicle. Finasteride also needs to be taken chronically to maintain any regrowth and once the medication is stopped, the hair gained or maintained is lost within a space of six to twelve months. Both these medications have been empirically demonstrated to treat hair loss so they are the only proven products available to hair loss sufferers at present.
Another option is surgery, which is performed in the form of hair transplantation and transfers healthy hair follicles from one area of the body into the targeted area of the scalp suffering hair loss. Results differ depending on the type of procedure, age of the patient, number of follicles to transplant and skill of the surgeon, to name a few. A hair transplant can be very costly depending on the amount of hair follicles to transplant yet it offers a good alternative for those who have the time, energy and monetary resources to do it.
Lifestyle factors affecting the progression of male pattern baldness
It must be said that paying attention to risk factors can go a long way in slowing the progress of MPB. Eating a balanced diet, exercising, and not smoking have been proven anecdotically to slow down MPB by either providing more nutrients to hair follicles or improving blood flow. Learning how to manage stress can also impact male pattern baldness as chronically-high levels of stress are associated with hormonal disruption, including the disruption of cortisol, testosterone and insulin (hormones influencing MPB). The use of dietary supplements has been in vogue for many years but remains experimental and, while satisfying all your daily nutrient requirements is an excellent way to manage male pattern baldness, taking megadoses of nutrients or supplements has yet to be solidly proven by research to work on the treatment of male pattern baldness, hence its experimental status.
The lowdown on male pattern baldness
With male pattern baldness, there really isn’t anything you can do to avoid it. As we have seen, genetic make-up is the deciding factor in being affected by MPB but that does not mean you cannot do anything about it. The use of the aforementioned medications plus a healthy lifestyle will, without a doubt, give you additional years up there. For those motivated to make use of modern-day medical advancements, hair transplants can be a valuable addition that is not exempt of drastic consideration. Alternatively, going with a buzz cut or shaving your hair offers a polished and low-maintenance look that is never out of place.
If we take into account that curly hair is, by default, brittler than straight hair, and also consider the high prevalence of MPB in men, it then becomes clear that taking care of your curly hair is a must, whether you already suffer from MPB or are still keeping lucky (touch wood in any case!). It is never too late to sport a great head of curls as a male, and, if you take care of those curls with a good grooming routine and take active measures, the results will be more years of manly curls atop your head.
All the best.