Male androgenic hair loss
Male androgenic hair loss – what it is, treatment & other considerations
Male androgenic alopecia (male pattern balding) is the most common form of hair loss seen in post-pubertal males and readily identified by its familiar pattern of progression.
It was believed male balding was not a sex-linked characteristic (not transmitted on the X or Y chromosomes) and we could inherit the problem from either parent. However a 2005 German study found the X-linked androgen receptor (AR) genes – which we inherit from our mothers – to be the major determinant in early-onset male pattern hair loss.
The percentages for male balding are around 20% of men in their 20’s; 30% in their 30’s and so on. At this time the condition cannot be “cured” (because there’s nothing wrong with you) but can usually be stabilised (>80%) and a good percentage of hair recovered.
When a male has the genetic inheritance to exhibit androgenic alopecia, it’s a part of the same hormonal changes that gives him his facial & body hair, muscle bulk, & deepening voice. Statistics suggest it’s more common for mature-age males to exhibit some degree of androgenic alopecia than not.
Dawber & Van Neste (2004) suggests 100% of young males will show some changes in the shape of their hairline (termed recession) following puberty – this does not always indicate the onset of androgenic alopecia. Recession is determined by genetics & male hormone levels, & is a process of maturation.
How Male Hormones affect the hair:
In susceptible men, a percentage of the main male hormone Testosterone (TT) is converted to a more potent androgen (male hormones are known as androgens) – Dihydro-testosterone (DHT). DHT progressively exerts a ‘miniaturising’ effect on the hair follicles across the top of the scalp. Within a reduced growing phase affected follicles then produce fine-textured, unpigmented hair (termed vellus) that rarely grow beyond a couple of centimetres in length – thus thinning of the hair density is seen in this androgen-sensitive area.
Male androgenic alopecia usually begins with a receding of the hairline at the temples, and a concomitant thinning of the hair density on the crown. Over time all the hair follicles across the top and sides of the scalp may be affected – leading to – but NOT always – resulting in total baldness.
Once revealed male balding is most vigorous in the late teens through to the early 30’s. Quite simply the reason is hormone levels are at their peak during these years.
Assessment & Treatment options:
With accepted treatments available today, the management of androgenic thinning in young males is generally straightforward and uncomplicated.
Diet, lifestyle, & medical history should always be reviewed as well as a preliminary blood test for nutritional/metabolic pathology. Any underlying disturbances in these have the potential to adversely affect treatment outcomes and should be corrected before commencing hair loss therapies.
Minoxidil topical solution in combination with the oral prescription medication Finesteride or Dutesteride is one approved pharmaceutical treatment regime for male androgenic thinning.
Minoxidil presently remains the only topical lotion medically approved (FDA/TGA) to stimulate follicle hair growth. Under various brand names, Minoxidil is available ‘over the counter’ in 2% and 5% strengths. However these commercial preparations are known to be poorly absorbed and the 30% basic propylene glycol additive is the predominant cause of scalp irritation.
Exclusive ‘next generation’ Minoxidil formulations possess advanced penetration agents; DHT hormone blockers, Minoxidil activators, ‘vellus hair reversal’ properties, and anti-inflammatory agents. They can be ‘tailored ‘to the client’s hair loss problem, their skin sensitivity, skin tone – & even the way it feels on the scalp and hair ***.
**Current update: Australia’s leading Minoxidil formulator (C-Pharmacy) has formulated a quantum leap in Minoxidil topical solution: a hybrid form that incorporates Essential Fatty Acids (EFA’s), Amino Acid and B-group Vitamins in a Minoxidil base to provide the safest, most effective skin penetration, follicle ‘activation’ & DHT-blocking capacity of any compounded Minoxidil presently available.**
An exclusive inclusion to the molecular nutrition supplement (powder) range is the amino acid Taurine. Taurine is an especially effective biologic ‘anti-ageing’ amino acid at therapeutic doses, providing anti-fibrotic properties and aids in the prevention of macular degeneration. In the treatment of ‘pattern’ hair loss in both sexes Taurine is a Transforming Factor Beta 1 (TGF Beta 1) conversion blocker.
Current research identifies a significant catalyst for DHT-induced hair loss is TF Beta 1. TF Beta 1 induces follicle cell apoptosis (cell death) and premature scalp hair balding. At optimised therapeutic dosage, Taurine is a potent inhibitor of TF Beta 1.
According to the research Pharmacist there are some increasing “question marks” over the long-term safety of some early or cruder forms of topical Retinoic Acid. The following two paragraphs are ‘information only’ for those readers who require Minoxidil/Retin A formulations:
Whilst different international studies have found Minoxidil + Retinoic Acid (Retin A) was a potent (skin) penetration enhancer and effective for receding frontal hairline margins/recession in males only, Minoxidil/Retin A is generally NOT recommended for female hair loss because of the HIGH RISK of unwanted facial hair as an adverse reaction.
In all cases Clients should be assessed for their suitability and need for this potent topical treatment****. Highly atopic, skin sensitive, photo (sun) sensitive, asthmatic or those with cardiac issues should NOT use Minoxidil (Retin A) topical solutions without written Doctor’s approval. Minoxidil/Retin A topical solution should NOT be used on inflammatory scalp conditions, those with itching, flaking or scaling scalps OR those living or working in high temperature environments.
The oral medication Finesteride (Propecia/Proscar) and its newer competitor Dutesteride (Avodart) are both inhibitors of the enzyme 5-alpha reductase. 5-Alpha reductase converts testosterone to DHT. Dutesteride is more follicle 5-AR ISO-enzyme specific than Finesteride, and reportedly induce less libido side-effects than Finesteride. Both medications stabilise androgenic alopecia in about 80% of men (manufacturer’s trials).
There is still some studies speculation whether or not these drugs benefit women with androgenic pattern hair loss, and the reader should be wary if any studies have been funded by the manufacturers themselves. These 5-AR inhibiting drugs – ostensibly approved for Prostatic Hypertrophy disease in males – should only be taken under the strict supervision of an experienced medical practitioner, particularly if the woman is pre-menopausal.
For those wanting to accelerate their hair regrowth or have significant hair loss (VI/VII) would be the short-term low-dose use of the blood pressure drug Loniten – from which topical Minoxidil was originally derived. Increased facial/body hair is the commonest visual side effect of Loniten therapy (>80%), so its use in women to accelerate scalp hair regrowth is not advisable.
There is still some debate whether or not herbal supplements such as Saw Palmetto (Serenoa Serrulata/Repens), has an inhibiting effect on the 5-alpha reductase ISO-enzyme that influences the hair follicle.
A research Pharmacist colleague has formulated a Saw Palmetto ‘Complex’ that helps lower the TT-DHT ratio – thus minimizing DHT influence/production on the androgen sensitive hair follicles. It has the multiple benefits of maintaining Prostate and Bladder health; an excellent libido and general men’s health tonic – and aids in stabilising androgenic hair loss in mature men.
Another new product (from Europe) that appears to show promise for adult males and Women of peri/post-menopausal age is a compounded isoflavanoid capsule derived from Soy called Equol; & it’s topical (Nano-particle) equivalent for males – Equol Ultra.
Equol has been shown to help mitigate DHT activity in male androgenic thinning – without the potential adverse side effects of the oral prescription drugs (Finesteride et al) *****
Some practitioners have used saw palmetto 160mg Bid (twice daily) in women to aid in altering TT pathways & decrease the levels of ‘free’ circulating hormone. The Mediherb brand (only) of Tribulus – one herbal supplement commonly used by body builders to enhance Testosterone (TT) levels – can lower endogenous TT and alter androgen pathways in women.
For early-onset androgenic or a telogen effluvium hair loss, the natural nutrient therapy Activance Rhodanide* is often very effective. Rhodanide is the vital ingredient for cellular regeneration of the hair follicle + hair shaft integrity. Activance boosts the hair’s Rhodanide + moisture levels (by up to 50%) and revives hair follicle activity.
Activance Rhodanide would be the ‘non-drug’ topical treatment of choice when Minoxidil sensitivity (heart palpitations, shortness of breath etc) occurs.
At 50mg per day the mineral zinc is an inhibitor of 5-alpha reductase (5-AR), but as it antagonises the absorption of copper & iron it should only be taken at full dosage for an extended time with a review of (pathology) levels – and not in conjunction with copper or iron supplementation**.
Because Zinc is a 5-AR inhibitor, young males can present with an ‘appearance’ of genetic thinning hair loss (i.e.: follicle miniaturisation) which is due to – or exacerbated by – Zinc deficiency (my observational opinion only). A thorough clinical inquiry will reveal the true condition.
UPDATE: Latest research recommends a course of 50mg Zinc Complex for minimum 4-8 months (up to 12 months under supervision) as a potent scalp hair growth accelerator; to more rapidly counter-act any “anti-nutrient” influence of relative Copper dominance to Zinc ratios (Baratosy: 2005) as well as aid in helping to redirect thyroid conversion away from rT3 (together with Selenium).
Laser Light Therapy:
Photo-biotherapy such as ‘soft/cold’ low level laser light (LLLT) is a strong vasodilator and moderates the skin’s immune response. To be therapeutically effective these laser appliances should be classified ‘3A’; be in the red light spectrum + wavelength vicinity of 660-780nm. Bio-available power output should be 60-100mW. Note: some commercially-sold hand held lasers have a power output of 1.5-5mW! I believe they offer little more than placebo effect.
LLLT as a SINGLE ‘stand alone’ therapy will not regrow hair to any aesthetically-satisfying degree in my opinion. This was confirmed by the unpublished research study of eminent Dermatologist Dr. Anthony White (Low energy laser treatment for androgenic alopecia: 1994). So beware the claims of laser hair loss treatment salesmen!!
As a combination therapy however, LLLT can enhance the scalp environment due to its anti-inflammatory & blood perfusion properties – so hair growth potential is maximised. LLLT is consistently effective (in a combined therapy approach) for inflammatory scalp problems, & for settling telogen effluvium hair shed. LLLT is a non-UV light source and considered an adjunct (2nd line additional) treatment******
Follicular Unit Extraction (FUE) appears to be the current preferred form of hair transplantation over ‘strip excision’ surgery. A skilled surgeon will provide an aesthetically-pleasing outcome but a prospective client should be aware of the following:
- Total cost of the procedure/s (which may need to be undertaken in stages)
- Pharmaceutical hair loss treatments such as Minoxidil or Propecia/Avodart may still be required to maintain existing ‘androgen-sensitive’ scalp hair. Activance Rhodanide ultra-hypo-allergenic or Practitioner Formula is an excellent post-surgery leave-in treatment to decrease inflammation, encourage skin repair and transplanted follicle health for (eventual) optimal hair growth.
- Ensure baseline pathology testing is assessed – as well as any current health conditions. Underlying deficiencies or health conditions will significantly influence hair transplantation success or failure.
Hair cleansing products:
There is strong evidence to support the use of sodium lauryl sulphate and paraben-free shampoos for healthy follicle function and optimal hair growth. Shampoos with natural ingredients & mild enough for daily use are the best options. Activance ‘Blue’ treatment shampoo is the scalp + body cleanser of choice for sensitive, irritated, inflamed scalps or dry skin.
As a continuously growing & metabolically-active tissue, hair requires high levels of available nutrients for hair cell DNA synthesis & development. In terms of nutrient supply however, hair is a ‘non-essential’ tissue – receiving its full nutrient supply only after vital tissues have been accommodated. For this reason the taking of a quality multi vitamin/mineral & amino acid supplement is often advised******.
When a male of any age presents with hair loss, it should not be assumed the problem is male genetic thinning. Other general causes of hair loss in males are alopecia areata (or other autoimmune scalp conditions; illness/accidents or surgical procedures (especially where significant blood loss has occurred), certain prescription or illicit drugs (including anabolic steroids), or severe emotional stress.
I regularly see nutritional deficiencies in males through blood/urine pathology which I always request. These problems usually originate from poor dietary habits or gut malabsorption.
*Professional Series only available through Practitioners. Contains a natural anti-microbial-anti-inflammatory herb and >X3 more intense formulation ‘hair growth specific’ (Chan: 2016) than the commercially-sold Activance.
**Other than Zinc Picolinate
*** Exclusively available to Anthony Pearce Trichology Clients
****NOT provided as a standard ‘one lotion suits all’ approach that certain hair loss centers provide.
***** Or Spironolactone in Women
*****LLLT is contraindicated as a hair loss treatment following Radiotherapy or Chemotherapy for brain/head tumor or other malignancy. You should NOT use LLLT IF you have a ‘shunt’ or known cerebro-atherosclerosis.
****** I would recommend ‘one’ of the Vitamin C Amino acid range of ‘all-in-one’ supplement powders from C-Pharmacy – now with added Taurine (amino acid) to suppress TF-Beta 1.
Copyright Anthony Pearce 2009 (August 2017)