Male pattern hair loss is a form of hair loss that typically appears at the front, midscalp and/or the crown/vertex of the scalp. These areas are collectively known as the non-permanent areas. The back and sides of the scalp, where hair usually grows for life, is known as the ‘permanent’ area or the donor area.
Male pattern hair loss is brought on by the presence of hormone receptors in the hair roots of the non-permanent areas. These receptors do not exist in the so-called permanent area of the scalp. The receptors are stimulated by the male hormone dihydrotestosterone (DHT), and when this happens, the hair loss process begins. The areas affected would undergo a process of miniaturization, whereby each follicle would appear thinner and weaker, before it completely stops cycling and sheds. The number and location of these susceptible hairs is determined by an inherited genetic pattern from one or both parents. It is important to be aware, that male pattern hair loss is not an evolutionary process. Men inherit a certain pattern from birth and grow into it at various ages. We don’t progressively bald the older we get.
Hair is lost because of a change in the lifecycle of the hair root, caused by DHT. Before hair loss sets in, the growing phase lasts up to six or seven years, while the resting phase lasts about 100 days. Genetic hair loss is a result of the hair life-cycles going into reverse i.e. the growing phase becomes shorter and shorter and the resting phase longer. Eventually, the hair grows very little or not at all.
Norwood Hair Loss scale of male pattern baldness.
Type I: Adolescent or juvenile hairline. This hairline usually rests just above the upper forehead crease. This pattern doesn’t represent balding.
Type II: This type shows progression to the adult hairline. It usually sits about 1.5cm above the upper forehead crease. Some temporal recession may also be seen. This pattern doesn’t represent balding.
Type III: The earliest stage of male pattern balding. This pattern warrants investigating, and is charactarized by deepening temporal recessions.
Type III vertex: Represents early hair loss at the crown (Vertex) area, with or without the temples.
Type IV: Further frontal hair loss and enlargement of the vertex. Nevertheless, a solid band of hair across the top (Mid-scalp) would still exist, separating the front from the vertex.
Type V: The bald area in the front and in the crown (vertex) continues to enlarge. The bridge of hair separating the two areas (mid-scalp) begins to break down.
Type VI: The connecting bridge of hair at the mid-scalp disappears completely. This leaves a single large bald area on the front and top of the scalp. The hair on the sides and back remains relatively high. (Permanent area)
Type VII: Extensive hair loss. The hair on the sides and back of the scalp (permanent area) is a thinner band. (Lower in height than type VI above).
Other causes of male hair loss
Traction Alopecia
This is caused by tight braiding or pulling on the hair (e.g. tight ponytail hairstyle) and is temporary if the traction is short-term, but becomes permanent with prolonged pulling. One male example of this is seen in some Sikh men after years of tying up their long hair. It is most usually seen as a bald area at the very front of the hairline. Hair transplant surgery can restore hair permanently, as long as the cause of the problem stops.
The use of electric hair straighteners – particularly if over-used and pulled too hard – can bring on traction alopecia.
Chemical Scarring and Burns
Chemicals used in hairdressing – dyes, bleaches, perms, straighteners and relaxers – may cause hair breakage, rather than true hair loss. However, if the substances are used incorrectly, then they can actually cause damage to the skin and to the hair follicles, causing permanent hair loss. Similarly, burns to the skin can destroy the hair follicles and cause a balding patch. In both of these cases, hair transplantation might be a treatment option, but this depends on the amount of scar tissue present.
In some cases of less severe damage, a gentle shampoo followed by a vitamin E containing is sufficient to relieve the damage.
Physical and emotional Stress
Severe illness, surgery, medical conditions (such as thyroid abnormalities or low blood counts), rapid weight change or emotional stress can cause or accelerate hair loss. Once the source of the stress stops, hair usually grows back within few months.
Plastic surgery
Face or brow lifts, or surgeries involving excessive puling on the face, may cause hair loss around the frontal hairline can occur. This can be effectively treated with hair transplantation. Hair loss following facial cosmetic surgery can be temporary and will grow back after time. Neverthless, it may be permanent in certain cases. A consultation with us can identify your particular condition and advise you on the best action to take.
Alopecia Areata (AA)
This is believed to be an auto-immune condition, whereby the body produces antibodies against hair, ultimately leading to hair loss. The condition typically appears as one or more isolated patches of complete baldness. In more severe forms, there might be a total baldness of the scalp (alopecia totalis) or even total loss of all body hair (alopecia universalis). Sometimes, medical treatment can be successful in treating the mild forms of AA. In many cases, the condition clears up by itself, but may recur at a later stage. Contrary to some beliefs, AA is not associated with pain and is not an inherited condition.
Medications
There are hundreds of drugs known to cause hair loss – these include some forms of blood thinning drugs, thyroid medications, chemotherapy for cancer and contraceptive pills. Again, the effects should be reversible once the drug is changed or stopped. Your primary doctor or pharmacist can help assess any adverse reaction related to your medications. It is also important to bring a list of your medications with you, should you schedule a consultaton with us.
Skin conditions and Cicatricial alopecias
Skin problems such as eczema, psoriasis, scarring conditions and infections can cause temporary or permanent hair loss. If the hair loss is permanent, we offer a choice of surgical treatments to restore hair to the area, but only when the underlying skin condition has been successfully treated or has become inactive. Many of these conditions tend to be chronic, or at least flare up now and again. Surgery should only be considered when the skin condition is definitely inactive. In some cases, a thorough evaluation and biopsy of the scalp is necessary to diagnose and quantify the underlying skin pathology.
Chemotherapy and Radiotherapy
Many of the drugs used in chemotherapy act through attacking the cancer cells and disrupting their growth. Unfortunately, they can also affect the normally dividing cells in the body – including hair follicles. A potentially effective way to reduce hair loss during chemotherapy is to wear a ‘cool cap’ that inhibits the amount of chemotherapy-related drugs reaching the scalp. Fortunately -in most cases- hair will grow back following the completion of the course.
Similarly, rays used in radiotherapy treatment of cancer will cause hair loss in the area exposed to the treatment.
In cases where hair fails to regrow, or is not satisfactory-following chemo or radiotherapy-we can certainly assist you to alleviate your hair loss problem. We will certainly liaise with the medical team looking after you prior to any form of treatment. While we do understand the anxiety associated with hair loss and the impact it might have on your overall quality of life, we do take your safety and your ultimate goal in fighting cancer as a priority.
Trichotillomania
Trichotillomania is a compulsion disorder whereby a person uncontrollably pulls their hair out. They may do so from their scalp, eyebrows or even eyelashes. It is a psychological condition where the person is simply unable to stop themselves from carrying out this action. Usually there is an intense urge to pull the hair out and an immense relief after pulling it out. Pulling out hair on the scalp or other areas can ultimately leave bald patches. Sufferers may experience guilt, embarrassment, shame or other negative feelings.
The first line treatment should be counselling and psychological therapy. Treatments such as hair transplant surgery may only be considered if it’s assured that the urge to pull hair has stopped completely.
