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.
It’s believed male balding was nota 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. From which parent you inherit the genetic trait from is essentially academic once it reveals itself.
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 commonfor mature-age males to exhibit some degree of androgenic alopecia than not.
Dawber & Van Neste (2004) suggests almost 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 physical maturing.
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 – potentially leading to – but NOT always resulting in total baldness.
Once it presents, 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 historyshould 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 incombination withthe oral prescription medication Finasteride or Dutesteride is one approved pharmaceutical treatment regime for male androgenic thinning.
Minoxidil remains the only topical lotion medically FDA/FGA 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 and anti-inflammatory agents. They can be tailored to the client’s hair loss problem, skin sensitivity and skin tone (dark skinned people).
**Current update: C-Pharmacy Minoxidil formulations are ‘cutting edge’ anti-irritant with a unique sustained follicle stimulator absorption vehicle. 6% or 10% strengths available for private health rebate where applicable. The 10% formulation is a ‘once daily’ solution/gel.
These formulations are unique Minoxidil ‘hybrids’ with Essential Fatty Acids (EFA), Amino Acid and B-group Vitamins combined in a Minoxidil base to provide the safest, most effective skin penetration, follicle ‘activation’ & DHT-blocking capacity of any compounded Minoxidil presently available.**
According to the research Pharmacist there are some increasing “question marks” over the long-term safety of some early or cruder forms oftopical Retinoic Acid (such as Tretinoin).
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, 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 Finasteride (Propecia/Proscar) or 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 Finasteride, and reportedly induce less libido side-effects than Finasteride. Both medications stabilise androgenic alopecia in about 80% of men (manufacturer’s trials).
NOTE: There is increasing evidence medication such as Finasteride, Roaccutane & (possibly) Dutesteride can adversely influence mood to cause anxiety or depression.
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 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 oral Minoxidil under medical supervision and on prescription. Increased facial/body hair is the commonest visual side effect of oral Minoxidil therapy, so its use in women to accelerate scalp hair regrowth is not advisable.
The use of a combined oral AND topical Minoxidil therapy is NOT advocated due to potential cardiovascular complications (heart & blood pressure).
There is still 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.
My 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 older males.
EQUOL is a product (from Europe) that appears to show real promise in stabilising androgenic thinning in younger adult males or females of peri/post-menopausal age. Equol is a compounded isoflavanoid capsule derived from Soy, requiring gender-titrated co-factors (Zinc + Selenium) to be scalp hair follicle-specific (Equol ‘PLUS’)
Equol ‘PLUS’ binds with free DHT, thereby inhibiting DHT-induced follicle miniaturisation and ‘pattern’ hair loss. There are NO known adverse side effects with Equol ‘PLUS’ as there are with the oral prescription drugs (Finasteride et al or Spironolactone) *****
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.
Advantages of Zinc supplementation:
- At 50-80 mg per day the mineral zinc isa known inhibitor of 5-alpha reductase (5-AR) and potent scalp hair growth accelerator.
- Zinc is critical to Keratin formation (the outer layer of the hair shaft).
- Zinc rapidly counter-acts any “anti-nutrient” influence of relative Copper dominance to Zinc ratios (Baratosy: 2005) as well as facilitating redirection (together with Selenium) of thyroid conversion away from rT3 and back to T3.
Zinc antagonises the absorption of copper & iron, and should be monitored by the treating Practitioner with a review of (pathology) levels. Zinc must be taken 2-3 hours AWAY from any 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) but due to Zinc deficiency (my observational opinion only). A thorough clinical inquiry will reveal the true condition.
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 ‘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 androgenetic alopecia: 1994). 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******
Hair transplantation:
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 pre + 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.
Protein-Rich Plasma Procedure/s (PRP):
This is a summary of PRP use and efficacy from Dr. Sahar Nadimi MD – a US Plastic Surgeon (http://www.chicagohairinstitute.com) I would concur with Dr. Nadimi’s appraisal for the current indications & efficacy of PRP:
‘PRP therapy has been used in other specialties for years– including dermatology, orthopaedics, dentistry, cardiac and plastic surgery–to enhance tissue healing.
More recently, PRP has been postulated as a new therapy for female and male androgenic alopecia, and to aid in wound healing after hair transplant.
For hair loss, PRP is injected in the tissue where hair growth is desired and may require a series of treatments, depending on patient response. Although some studies have shown hair growth after PRP therapy, other studies have not shown a significant improvement in hair loss.
Currently, there are no large studies regarding the optimal protocol for treating hair loss with PRP. Use of PRP to promote hair growth is currently not an FDA-approved indication and is prescribed off-label. It is important to understand that PRP for hair loss should be considered a complementary treatment, rather than a stand-alone replacement.
Studies have shown that patients tend to obtain better and longer-lasting results when using medical therapy (Minoxidil and Finasteride), in addition to PRP injection. I recommend following up with a hair specialist to further discuss hair loss and potential treatment options’.
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 Pro Balancing shampoo containing seven natural plant extracts with Zinc PCA, this Activance range gently cleanses the hair & scalp whilst stabilising overactive sebaceous glands & calming irritated scalps. The preferred hair cleanser for oily scalps, or those with Androgenic scalp hair thinning, Seborrhoeic dermatitis or scalp acne.
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 + >X3 stronger than the commercially-sold Activance.
**50-80 mg for initial 6 months – then 25 mg maintenance dosage. 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 centres provide.
***** Or Spironolactone in Women. Some information on the original Equol product as sold in Europe can be found at www.menopau.com .
*****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 (Revised March 2019)