Male Pattern Baldness

What is male pattern baldness?
Male pattern baldness (MPB), also termed male androgenetic alopecia (MAGA), is a very common condition affecting up to 50% of men by age 50. In fact, less than 3% of men reach the age of 80 with a full head of hair.

MPB refers to common balding in men, and has a universally recognisable and distinct pattern of hair loss. It usually starts with a receding frontal hairline, that progresses to the development of a bald patch on top of the head, and the fusion of the bald areas ultimately leads to complete loss of hair on top of the head. In most men, hair at the back of the head, termed the occipital area, remains intact. Good hair density in the occipital area forms the prerequisite for successful hair transplantation.

What causes male pattern baldness?
Two things - genetics and androgens. The term "androgenetic alopecia" is derived from "androgens", which is a class of male sex hormones that includes testosterone; "genetic" which implies the role of genetic inheritance; and "alopecia" which means hair loss.

How is male pattern baldness inherited?
For many years, it was thought that sons inherit MPB from their fathers. However, we now know that this is NOT the case - sons can inherit baldness from either parent although the mode of inheritance is yet unclear. Although most people affected by MPB can identify someone in their family affected by the condition, this is not always the case. They could be the first in a long line of premature balding descendants.

There are many genes that contribute to MPB, but only one gene has a proven association with MPB. This gene is called the androgen receptor (AR) gene. The first group of researchers to identify this association is from the University of Melbourne, and this finding has since been confirmed by three other independent groups. Researchers worldwide are currently looking for other genes responsible for MPB.

Is there really a hormonal influence in male pattern baldness?
Yes - it has long been noted that eunuchs and castrated men do not go bald as they do not or have very low levels of androgens (male sex hormones). This observation has helped us understand that androgens are required to trigger the balding process in genetically susceptible men.

The crucial androgen hormone involved is dihydrotestosterone (DHT), which is produced by the hair follicles themselves, and also in the testicles and travel to the scalp hair follicles via the bloodstream. DHT is five times more active than testosterone, from which it is derived. The enzyme that converts testosterone to DHT is called 5-alpha reductase. Finasteride, which is a medication used to treat MPB, blocks the action of this enzyme.

How long would it take for me to go bald?
Hair loss can begin at any age after puberty. Once it starts, it tends to continue through the various stages of hair loss over a 10-20 year period. The hair loss process is not constant, but goes in fits and bursts. It is common for people to go through phases of accelerated hair loss lasting 3-6 months, followed by periods of stability lasting 6-18 months.

Is there a cure for male pattern baldness?
There are treatments available but a cure for MPB is yet unavailable. In most cases, these treatments aim to slow or stop the progress of hair loss rather than hair regrowth. However, there have been people who have had some hair regrowth from these treatments. Results are variable and it is not possible to predict who may or may not benefit from treatment.

Minoxidil lotion (Rogaine), Finasteride (Propecia, Proscar) tablets, and hair transplant surgery are the only treatments medically proven to benefit MPB. It is advisable that you see your doctor before commencing any treatment for MPB to clarify the diagnosis and learn about the side effects of treatment.

You need to be on treatment for at least 6 months before you see the effects of your treatment, and it is important not to stop your medication before this time. Long term medication is usually necessary to sustain any benefits seen.

Where do I go to seek help?
Your first stop would be to see your general practitioner (GP) who can then refer you to a dermatologist if further advice is needed in regards to further management of MPB.

Be careful of the information and advice for treatments of MPB that you obtain especially from the internet. There are many bogus treatments that cost a lot of money and do not work. Always get expert medical advice before you decide on a certain treatment.

Many thanks to the common baldness patient information sheet produced by the Australasian Hair and Wool Research Society.