Male Pattern Hair Loss (MPHL)

The two main causes of male pattern hair loss (MPHL)

Male Pattern Hair Loss (MPHL) is a common condition affecting half of all men by the time they reach the age of 50. Unfortunately there is no cure  for men at this stage, but if action is taken early enough it can be successfully prevented with medical treatment.

Let’s look at the culprits responsible for men losing their hair.

Genes

Male pattern hair loss only occurs if a man has a specific genetic code in his chromosomes, which is responsible for 95% of all hair loss in men. This code responsible for baldness is carried by a single gene or a group of genes and may be inherited from either mother or father.

However, it is important point to note that not everyone who carries the genes responsible for MPHL will develop baldness.

To be active, the gene for baldness has to be “expressed” in the individual. The expression of a particular gene or genes depends on several factors such as hormones, age, stress level and so on.

Thus, if a person does not develop male pattern baldness, the reason can be either the absence of this gene or lack of its expression.

A family history of MPHL on either side of the family is seen in around 80% while in 20% of cases, there is no family history.

Hormones

Two types of male hormones (androgens) are involved in the mechanism of male pattern hair loss. These are Testosterone and Dihydrotestosterone (DHT). Dihydrotestosterone is a derivative of testosterone.

In the body Testosterone is converted to DHT (Dihydro-testosterone) by an enzyme (5-alpha reductase). DHT acts on different organs in the body including the hair follicles and cells in the prostate. 

Testosterone-to-DHT-1

The relationship of Male Pattern hair loss with testosterone levels was observed by Hippocrates, who noticed that young male eunuchs (castrated male) did not develop hair loss . This is because they had no testosterone to convert to DHT.

Genetics somehow affects the hair follicles making them more “sensitive” to DHT. 

With each phase of the hair cycle the hair follicle gets smaller and smaller as a result of the effect of DHT. The visual effect of this is thinner hair. This term is known as “miniaturisation” of the hair follicle. Eventually the hair follicle closes up and hair stops growing completely.

In addition to the hair follicle miniaturisation that leads to thin hair fibres in MPHL, a reduction in the growth phase (anagen) duration leads to shorter hair length, while an increase in the resting phase (Telogen) duration delays regeneration. 

At the same time the sebaceous gland attached to the follicle remains the same size. As the hair shafts become smaller, the gland continues to pump out about the same amount of oil. So as your hair thins, you will notice that your hair becomes flatter and oilier.

It is this understanding that has resulted in the successful medical treatment of MPHL. Approved medications target the formation of DHT, hence reducing it's effect on the hair follicle  - DHT Blockers (5 Alpha-reductase inhibitors).

Others treatments target the phase of the hair cycle - pushing hair follicles from the resting phase back into the growth phase and keeping them there for longer.

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