Seventy percent of adult males will experience some degree of balding, and advanced male pattern baldness affects well over one half of the adult male population. It is so common that some degree of hair loss is considered normal in adult males. Once male pattern baldness begins, it does not stop.
Fig 1 Male pattern baldness is dependent on the interaction of three factors: age, a genetic pre- disposition, and male hormones. This hair loss may begin as early as the teenage years and gradually worsens with time. (1) The male hormone, testosterone, is converted to another male hormone, 5-DHT, in the hair follicles. In genetically susceptible men, the hair on the front and top of their scalps tends to miniaturize (become more fine and not grow as long) over the years under the influence of 5-DHT. Eventually, this hair will completely disappear, leaving a balding pattern behind.
Figure 1-2. The incidence of cosmetically significant male pattern hair loss (types III, IV, V, VI, and VII) increases steadily with age and is represented by a solid line. The incidence of hair loss characterized by only a remaining horseshoe fringe of hair (types V, VI, and VII) is depicted by the dotted line. The significance of this is that once hair loss begins, it does not stop. It progresses through life.
Figure 1-3. During male pattern baldness, the original hair slowly miniaturizes, moving slowly through progressive cycles becoming more fine and unable to grow as long until it eventually disappears.
It is critical for patients to be certain that they are dealing with male pattern baldness if they are losing hair. A visit to the dermatologist is warranted if they are not absolutely certain.
Alopecia areata is a fairly common form of hair loss in which the hair falls out in small coin-sized spots anywhere on the scalp. Severe forms rarely progress to complete hair loss. This is a medical, not a surgical problem, and it should not be treated with transplants unless it has remained stable for many years. Even then, the transplanted hair will likely fall out if the disease is reactivated.
Various primary dermatologic diseases can affect the scalp, leading to hair loss due to scar formation. Treatment is aimed at medical control of the disease. If the disease remains under control for years, transplants can be considered for the scarred areas, but just like with alopecia areata, if the disease returns, that transplanted hair could be lost.
Rarely, patients will actually pull out their own hair. This condition is known as trichotillomania. In adults, it is usually seen in the setting of psychological problems such as anxiety, depression, or frank psychosis. Again, this can be treated with transplants, but it is not uncommon for patients to relapse and begin pulling out the hair again.
The Norwood Scale
A flash based Norwood scale for male hair loss pattern.
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