What Is Male Baldness/ Male Androgenetic Alopecia?

Male pattern baldness or correctly termed as Male androgenetic alopecia (MAA) is a common cause of progressive hair loss in men.

How Common Is It?

Around 30-50% of men develop MAA by the age of 50.

Types of Hair:

There are 2 types of hair we have on our body, vellus and terminal. Vellus is derived from the Latin language which means wool and refers to the thinner, not longer than 2mm hair that we have on our body, while terminal hair refers to the hair on our scalp.

In MAA, a gradual conversion of terminal hair to vellus hair takes place which completely denudes the scalp leading to baldness ¹. It’s one thing to lose some of your hair due to androgens after puberty, which happens to almost everyone. But losing hair to alopecia another thing

Each hair on your head has a growth cycle. However, with male pattern baldness, the growth cycle of hair weakens and the hair follicle reduces in size, giving rise to shorter, weaker, and finer hair. Eventually, the growth cycle ends and the only thing that grows is baldness.

Stages of Baldness/Alopecia | Hamilton-Norwood Scale

According to the Hamilton-Norwood Scale or simply the Norwood Scale, there are 7 stages of the progression of male pattern baldness ³:

1. Stage 1

There is no significant hair loss

2. Stage 2

Slight recession of the hairline around the temples is observed. This stage is also termed as an adult or mature hairline.

3. Stage 3

Signs of clinically significant baldness are shown. The hairline is greatly recessed. There is hardly any hair left at the recessed spots. They are either completely bare or sligthly covered in hair.

4. Stage 4 (Vertex)

The hairline is at stage 2, but there is a significant hair loss on the top of the scalp, known as the vertex.

5. Stage 5

The hairless area is larger in stage 5. Although they are still separated, the band of hair between them is narrower and dispersed.

6. Stage 6

The balding areas at the temples join with the balding area at the vertex.

7. Stage 7

This is the most severe stage of all. Only a band of hair going around the sides of the head is what remains. This hair is not dense and is a lot thinner than the normal hair.

Treatment of baldness

There are a bunch of treatment options available for male baldness ³.

Minoxidil

This is a pharmacological agent which is applied directly to your scalp. Minoxidil stops your hair from getting thinner. In fact, it can also stimulate hair growth on the top of the scalp.

Laser Devices

The goal of such devices (for example, brushes and combs) is to stimulate hair growth. It is important to mention that till date the effectiveness of these devices has not been proven within a clinical context.

Prescription Drugs

Drugs used to treat male pattern baldness include finasteride ³. Finasteride is approved by the U.S. Food and Drug Administration to treat men with characteristic hair loss. Studies show that it slows hair loss in about 88% of men and stimulates regrowth in about 66%.

Medical Procedures Includes:

Medical procedures can also be performed to combat MAA. Some of the procedural modalities used are ³:

Hair Transplantation

In this procedure, potentially healthy hair is removed and the hair follicles are then transplanted to the balding areas, ensuring growth in the balding areas.

Scalp Reduction

Some parts of the bald scalp are surgically removed, and the parts of the scalp which have good hair growth are brought nearer. This procedure can also be paired with a hair transplant to maximize results.

Scalp Expansion

Scalp expansion is a procedure in which devices are inserted under your scalp for about 3-4 weeks in order to stretch the skin. This is done right before a scalp reduction. It could be used as an independent treatment as well.

Scalp Micropigmentation

Essentially, small tattoos are applied to the scalp in order to create an illusion of a shaved head.

Mental Health And Hair Loss

In one study, 1,717 men with various degrees of male pattern baldness reported feeling very distressed about their hair loss. It was concluded that, in comparison to those without alopecia, those experiencing it felt more anxious and powerless.
Furthermore, in a Korean study, over 90% of non-bald men and women instinctively thought that balding males were older and less attractive.
Some individuals have stated that their hair loss causes them great emotional distress 2. Men who claim to spend hours a day obsessively inspecting their scalp in the mirror are a clear indication of this. They spend a great deal of time brushing and re-brushing their hair, which contributes to their social anxiety and sadness.

Reference:

1. Cranwell W, Sinclair R. Male Androgenetic Alopecia. [Updated 2016 Feb 29]. In: Feingold KR, Anawalt B, Boyce A, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK278957/
2. Aronson, J. K., & Ramachandran, M. (2009). The diagnosis of art: Van Gogh and male pattern baldness. Journal of the Royal Society of Medicine, 102(1), 32–33.
   https://doi.org/10.1258/jrsm.2008.08k023
3. https://www.healthline.com/health/norwood-scale#causes
4. https://www.theguardian.com/lifeandstyle/2019/sep/07/new-hair-loss-research-balding-medical-treatments