Male pattern baldness
Male pattern baldness is normally seen in males in their early twenties. This is called male pattern baldness because of the reason that there is a specific pattern in which we see the baldness progression. Male pattern baldness usually starts from sides for from sides and Crown simultaneously. Hairline keeps on getting deeper from the sides and eventually a w shaped hairline is Apparent. There can be associated hair fall from the remaining scalp or there can be no hair fall as such and only hairline keeps on receding from both sides in the front and from a Patch on the crown or top of the head.
Age of presentation.
Normally the age of presentation in male pattern baldness is decided by the genetic makeup of an individual. Depending upon how aggressive the baldness progress in paternal and maternal sides of the individual, the progression of male pattern baldness is decided in a particular individual. The usual age of presentation for male pattern baldness is in the early twenties but in certain cases, male pattern baldness is apparent as soon as 17 to 18 years of age. Even In normal healthy males, there is a continuous recession of the hairline. Of eventually by the age of 60 years, almost 80% of the men show a varying amount of baldness ranging from grade 4 to grade 6.
Cause for male pattern baldness.
Cause for male pattern baldness lies in the body itself. There are small receptors which are present in the scalp around the hair roots. These small receptors are called DHT receptors. DHT stands for dihydrotestosterone. Testosterone is the normal circulating hormone in males and there is another enzyme present in the human body which converts testosterone into dihydrotestosterone. This enzyme is called 5 Alpha reductase.
The actual story starts with the binding of dihydrotestosterone to the DHT receptors which are present in the hair roots. This binding of dihydrotestosterone with the hair roots lead to the weakening of blood vessels which supply the tissue around hair roots. As blood vessels keep on decreasing in volume and number, there is decreased blood supply to the hair follicle. Beyond a certain level if blood supply is decreased there is regression or slow growth of the concerned follicles. Eventually, this weakness keeps on progressing and a terminal thick strong hair gets converted to fine and thin vellus hair. You must have seen people having male pattern baldness with very fine thin feathery hair in their frontal hairlines which confirms the diagnosis of male pattern baldness.
As I have explained the reason behind male pattern baldness in the above paragraph it is clearly evident that if by any means we are able to decrease either testosterone levels or are the dihydrotestosterone receptors, we will be able to save the follicles from destruction. Practically speaking this is not possible either to decrease the male hormone or to reduce the number of dihydrotestosterone for DHT receptors. So we have an option to decrease the circulating level of dihydrotestosterone by blocking the conversion of circulating testosterone to dihydrotestosterone. This can be achieved by blocking the enzyme called 5 Alpha reductase. Usually, available 5 Alpha reductase blockers are finasteride and dutasteride.
Normal dose of finasteride to decrease the level of circulating dihydrotestosterone is 1 milligram per day and for dutasteride is 0.5 milligram per day. These are us FDA recommended drugs and are not available over the counter. These are prescription drugs and id-id be taken only with proper medical guidance.
Side effects of 5 Alpha reductase or finasteride.
The most common and much-hyped side effect of 5 Alpha reductase inhibitor is decrease in libido and sexual drive. This topic is too much controversial and you will find many conflicting data as regarding the use of finasteride or dutasteride on the internet. In my experience of more than 10 years in the field of trichology and hair transplant, I will suggest that one should try finasteride 1-milligram tablet for at least three days of the week. If there is any kind of side effect noticed then the medicine should be discontinued. It should be tried again after a gap of a few weeks and any kind of Regiment can work for individuals depending upon their metabolism and overall circulating level of testosterone. You can take finasteride 1 milligram continuous 3 days of the week or alternate days of the week or even one tablet at a gap of 2 to 3 days. But one should definitely try finasteride to control the progression of male pattern baldness.
Male pattern baldness in females
Female androgenetic alopecia is a well-known entity. Female androgenetic alopecia shows its impact on the female hairline with regression of hairline on both sides just like as seen in the males. Eventually, the crown and most of the top area of the head gets involved and typical male pattern baldness come to the picture. F a g a: is another name given to female androgenetic alopecia. Treatment of female androgenetic alopecia is on the same lines as in the males. We primarily use finasteride or dutasteride to block 5 Alpha reductase and finally decrease the circulating testosterone levels.
Another important reason we find in females for higher levels of circulating testosterone is increased adipose tissue deposited around the abdomen and thighs in females. So lack of exercise and accumulation of more fatty tissue in the body leads to the conversion of circulating estrogen to testosterone in females. Female androgenetic alopecia due to obesity and increased circulating testosterone also shows symptoms of increased acne, libido excessively oily skin and hair fall. Vigorous exercise along with dietary control will help to control the situation in male pattern baldness seen in the females.
Hair transplant and male pattern baldness
As I have explained previously male pattern baldness is diagnosed typically with receding hairline and or hair fall. Initial stages of baldness cure for male pattern baldness and minoxidil and finasteride explain. But what if the male pattern baldness has progressed to an extent that the scalp is clearly visible. Here comes the role of hair transplant. Hair transplant typically involves the relocation of resistant roots from the donor area to the recipient area. We clearly see in cases suffering from male pattern baldness that there is a variable width of scalp starting from above the ear on one side extending to back and then moving to the other side.