Hair loss in Males

Male androgenic scalp hair thinning (aka male genetic or pattern balding) is the most common form of hair loss in post-pubertal men, however other hair loss and scalp conditions do affect males almost as equally as females.

Male androgenic thinning: At one time it was thought male genetic thinning was not a sex-linked characteristic (i.e.: not transmitted on the X or Y chromosomes) and boys could inherit the problem from either parent. However a 2005 German study found the X-linked androgen receptor (AR) genes – which boys inherit from their mother – to be the major determinant in early-onset male pattern scalp hair thinning (MPT). From which parent you inherit the genetic trait from is essentially academic once it reveals itself.

After puberty the incidence to exhibit MPT in predisposed males is around 20% of young men in their 20’s; 30% in their 30’s and so on.

When a young male has the genetic inheritance to exhibit MPT, it’s a part of the same hormonal changes that gives him his facial & body hair, musculature and 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) suggest the overwhelming percentage 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 MPT. This is an important point as the anxiety these changes cause in some young males is readily preyed upon by some in the hair replacement industry.

Recession is determined by genetics, ethnicity and male hormone levels, and is a process of physical maturing in young males.

How Male Hormones affect the hair: In susceptible males, a percentage of the main male hormone Testosterone (TT) is up-converted to a more potent androgen: 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, un-pigmented 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 (1).

Androgenic thinning usually begins with some perceptible recession of the hairline at the temples and 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 – potentially leading to – but NOT always resulting in total baldness.

Once it presents, MPT 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 treatment options available today, the management of MPT in young males is generally straightforward and uncomplicated.

Diet, lifestyle and medical history should always be reviewed, as well as some preliminary pathology testing to assess nutrient-metabolic status. Any underlying disturbances in these have the potential to adversely affect treatment outcomes and should be corrected before commencing hair loss therapies.

When a male of any age presents with hair loss, it should not be assumed the problem is simply MPT. Other common causes of hair loss in males are:

• Nutrient-metabolic disturbance the result of poor or
  particular dietary habits, or malabsorption due to Gut dysbiosis (2)
•  Alopecia areata or other autoimmune scalp conditions
• Abrupt onset hair shedding (TE) from severe emotional stress, illness/accidents or surgical procedures (especially where significant blood loss has occurred); commencing or ceasing certain prescription medication or illicit drug use (including anabolic steroids)

1. Male hormones are collectively known as androgens. The main ones (including
   Testosterone) are produced in the testis; other weaker ‘adrenal androgens’ are synthesised from within the adrenal cortex of the adrenal glands.
2. ‘Particular’ dietary choices may be due to religious requirements such as lacto-vegetarianism in people of Hindu faith; vegans or vegetarians by choice.

Copyright
– Anthony Pearce 2019