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The Non-Surgical Management of Men’s Androgenic Hair Thinning

Male androgenic alopecia (male pattern balding) is the ‘natural’, & most common form of hair loss seen in post-pubertal males; readily identified by its familiar pattern of progression.

Until recently 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) – Dihydrotestosterone (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 exhibited, 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.

Assessing & Treating Male Thinning

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 remains the only topical lotion medically approved 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.

The current generation Minoxidil formulations possess advanced penetration agents; DHT hormone blockers, Minoxidil activators, ‘vellus-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 (“sticky” or too drying) ***.

Different international studies have found that Retinoic Acid (Retin A) – combined with Minoxidil – is a potent (skin) penetration enhancer and most 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, 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.

It is always sensible to commence with a low percentage Retin A formulation & incrementally increase as tolerated by the user.

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).

For those wanting to accelerate their hair regrowth or have significant hair loss (VI/VII) would be the short-term use of the blood pressure drug Loniten – from which topical Minoxidil was originally derived. Under medical supervision, one half of a 10mg tablet is taken at bedtime (to minimise any blood pressure lowering effects) for two months only. 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), has an inhibiting effect on the 5-alpha reductase iso-enzyme that influences the hair follicle. My research Pharmacist colleague has formulated a Saw Palmetto ‘Complex’ that lowers 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 – 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 – a 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, but as it antagonises the absorption of copper & iron it should only be taken at full dosage for 3-4 months – and not in conjunction with copper or iron supplementation**.

Laser Light Therapy

Photo-biotherapy such as ‘soft/cold’ low level laser light (LLLT) is a strong vasodilator & 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 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 androgenetic 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******

Shampoos

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. Non-perfumed, anti-inflammatory + >50% stronger than the commercially-sold Activance.

**Other than Zinc Picolinate
*** Exclusively available to National Trichology Clients
****NOT provided as a standard ‘one lotion suits all’ approach that certain hair loss centres 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.

Copyright Anthony Pearce 2009 (fully revised January 2015)