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Male pattern baldness (MPB), medically known as androgenetic alopecia, is the most common type of hair loss in men. It affects approximately 50% of men by the age of 50 and up to 80% of men by age 70, making it one of the most prevalent conditions seen in dermatology clinics worldwide.
The condition is characterised by a distinctive pattern of hair loss that typically begins with a receding hairline at the temples and thinning at the crown (vertex) of the scalp. Over time, these areas of hair loss often expand and merge, leaving a horseshoe-shaped rim of hair around the sides and back of the head.
Unlike other forms of hair loss that may be temporary or reversible, male pattern baldness is a progressive condition. However, early intervention can significantly slow progression and, in many cases, restore lost hair density through treatments such as PRP therapy, medications, or surgical options.
Male pattern baldness results from a complex interplay of genetic predisposition and hormonal factors, primarily involving dihydrotestosterone (DHT). Understanding these mechanisms is crucial for selecting effective treatments.
DHT is a potent androgen hormone derived from testosterone through the action of the enzyme 5-alpha reductase. In individuals genetically predisposed to MPB, DHT binds to androgen receptors in hair follicles, triggering a process called follicular miniaturisation. This causes affected follicles to progressively shrink, producing finer, shorter, and lighter hairs with each growth cycle until they eventually stop producing visible hair altogether.
Research has identified several genes associated with male pattern baldness, with the androgen receptor (AR) gene on the X chromosome being particularly significant. However, contrary to popular belief, baldness can be inherited from either parent, as multiple genes across different chromosomes contribute to hair loss susceptibility.
Recognising the early signs of male pattern baldness is crucial, as treatments are most effective when started early in the progression of the condition. The pattern of hair loss in MPB is distinctive and predictable, which helps differentiate it from other types of alopecia.
Hair loss typically begins subtly and may go unnoticed for months or even years. Many men first notice increased hair shedding during washing or brushing, though it is important to note that losing 50-100 hairs daily is normal. In MPB, the concern is not necessarily the amount of shedding but the failure of lost hairs to regrow at their original thickness.
The Norwood-Hamilton scale is the standard classification system used by dermatologists and hair restoration specialists to assess the severity of male pattern baldness. Originally developed by Dr. James Hamilton in the 1950s and later revised by Dr. O’Tar Norwood in the 1970s, this scale helps in treatment planning and prognosis.
Understanding where you fall on the Norwood scale can help you and your clinician determine the most appropriate treatment approach. Generally, earlier stages (1-3) respond better to medical treatments, while advanced stages (5-7) may require surgical intervention for significant restoration.
Diagnosis of male pattern baldness is typically straightforward for experienced clinicians and is usually made through clinical examination and patient history. However, additional tests may be ordered to rule out other conditions or contributing factors.
During your consultation, your clinician will examine your scalp and the pattern of hair loss, take a detailed medical history including family history of hair loss, and may perform a ‘pull test’ to assess active shedding. In some cases, dermoscopy (using a magnifying device to examine the scalp) can help identify the miniaturised hairs characteristic of androgenetic alopecia.
While male pattern baldness cannot be completely prevented if you are genetically predisposed, early intervention and lifestyle modifications can significantly slow its progression and maintain hair density for longer.
The key to ‘prevention’ in MPB is really about early treatment. Starting treatments like finasteride or minoxidil at the first signs of hair loss is far more effective than waiting until significant loss has occurred. Once follicles have been dormant for several years, they become much more difficult to revive.
Several effective treatments are available. The best approach depends on your specific situation, stage of hair loss, and goals.
This is a common myth. While the androgen receptor gene located on the X chromosome (inherited from your mother) plays a significant role, research has identified multiple genes on different chromosomes that contribute to hair loss. You can inherit baldness genes from either or both parents. Looking at both sides of your family can give you an indication of your risk.
Written By
Owner, Plasma Therapy
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