male pattern hair loss Archives -

February QoM

questiontext \

I heard that if I have Male Pattern Hair Loss and if I start using Rogaine (Minoxidil), I will have to use it forever? Is that true, and why?

answertext

Yes this is true. The main reason for this is that there is no cure for Pattern Hair Loss. The underlying cause is a genetic disorder, and as such would require gene therapy, which does not exist. The medical therapies that exist, including Minoxidil, only reverse the effects of the genes and not the gene itself. Therefore, if you do not continue using the Minoxidil, you will lose the benefits of keeping the regrown hair.

September’s QOM- What is Aminexil?

questiontext

Hi Doc,

Could you give me some information on Aminexil Force R capsules? What is aminexil?

answertext

Hiya!

Aminexil Force R is a relatively new topical hair loss product produced under the L’Oreal group. Aminexil,, 2,4-Diamino pyrimidine-3-oxide, is a derivative of Minoxidil.

Minoxidil

minoxidil

Amenixil

kopexil

It has been marketed as having the same positive effects as Minoxidil, i.e. hair growth, without the side effects. It is also claimed to help prevent fibrosis or scarring around the hair follicles which can be seen in late stage Androgenetic Alopecia. There has only been a few studies done on the efficacy of this molecule. Therefore, it has not been rigorously examined when compared to Minoxidil.

Is it worth trying? Only if you have already exhausted available topical and oral options.

Treatment of Male Pattern Hair Loss

Treatment options for Male Pattern Hair Loss are quite limited. With more men seeking treatment, and plenty start suffering from hair loss at quite young ages, more research is being placed on reversing or slowing this frustrating condition.

Treatment of Male Pattern Hair Loss are mainly divided in to three: Topical, Oral, and Surgical

Topical Treatment of Male pattern Hair Loss

Topical Minoxidil

This is the mainstay of treatment for Male Pattern Hair Loss. Studies have shown that 5% Minoxidil prolongs the anagen phase and thickens the hair fibre. The exact mechanism by which it does this is still unknown. It takes 4-6 months before results can be seen. It is up to 60-70 % effective in the crown and 30-40% effective in the front of the scalp. The brand is Rogaine and it comes in 2 forms- solution and foam. There are many generic brands available and quite a few countries that provide it OTC.

In Europe, OTC caffeine based products are available in shampoo and lotion form. Caffeine has been shown to increase the anagen phase. The studies have been found to be encouraging.

Oral Treatment of Male Pattern Hair Loss

The two main medications used are Finasteride and Dutasteride. Both are used off-label from their intended use, which is for the treatment of Benign Prostatic Hypertension.

Finasteride (Propecia or Proscar) help to stop the conversion of Testosterone to Dihydrotestosterone by the enzyme 5 alpha reductase. Fiansteride takes up 4 months before results can also be seen. It has a slightly greater efficacy compared to Rogaine. Together with Minoxidil, there is increased benefit to the patient. Most persons can start off with Minoxidil and Finasteride added to see if there is any more improvement.

Dutasteride (Avodart) is a more potent form of Finasteride because it acts on the many forms of the enzyme. It is 95% effective compared to the 50-70% seen with Finasteride. However, it has 5 times more the effects of side effects compared to Finasteride. The main concerns for both Finasteride and Dutasteride include: decreased libido, decreased power of orgasm/ejaculation, erectile dysfunction, and depression. For Finasteride, this is quite low, but much higher in Avodart. The side effects usually go away after cessation of the medication, however, it should note that many men who start this medication are already at risk of having these issues.

Surgical Treatment of Male Pattern Hair Loss

The ultimate treatment of this condition is Hair Transplantation. It involves permanent removal of hair from the back of the scalp, which is less likely to be affected by the condition. These are then transplanted to the front of the scalp and will take and grow keeping their inherent properties from where they are coming from. There are two main types: Follicular Transplant (strip harvesting that leaves a visible scar) and Follicular Unit Extraction (individual harvesting of hair follicles). Hair growth is not immediate. It takes about 4-6 for the transplanted hairs to start growing, and up to a year for it to be noticeable.

Surgical treatment is limited to how much hair is present in the donor site. There are many factors that can cause decreased hair growth. However, up to 99% of the hairs transplanted usually grow.

Treatment of Male Pattern Hair Loss is limited but promising as there are many new treatment therapies such as Stem Cell Therapy are actively being investigated.

Male Pattern Hair Loss

Male Pattern Hair Loss or Androgenetic Alopecia is the most common type of hair loss found in men. Up to 80% of men will experience some level of hair loss by their 70s. Most will discover their hair loss in their 30s and 40s however, quite a number may start long before in their teens.

So what causes Male Pattern Hair Loss?

Male Pattern Hair Loss is due to the activity of a hormone Dihydrotestosterone, a potent androgen (male hormone). The hair follicle in affected men is more sensitive to this hormone. There are several genes responsible for the condition and they can be inherited from either the mother, father, or both. This hormone is made from Testosterone under the action of the enzyme, 5-alpha reductase. Dihydrotestosterone latches onto the receptors in the hair follicle and causes a decreased anagen (hair growth) along with reduction in the size of the hair follicle. The hairs become progressively thinner and more vellus-like.

Stages of Male Pattern Hair Loss

There are several stages of Male Pattern Hair Loss. The main staging system used is the Norwood Hamilton Scale for Hair Loss in men.

norwood-hamilton

Which stage do you fall under?

Next month: Treatment options

Pattern Hair Loss

First in our series on non-scarring hair loss is the ever pervasive Pattern Hair Loss or Androgenetic Alopecia. It is mostly an inherited condition affecting up to 40% of women by menopause, and up to twice that amount in men by age 50.

Pattern Hair Loss presents differently between men and women. Women tend to have generalised thinning to the top and sides, whilst men start off with thinning at the temples eventually ending with the “horse shoe” shape that is often dreaded.

The cause of Pattern Hair Loss, though largely known, is still being determined. In men it is due to excessive sensitivity to the male hormone dihydrotesterone. In women, male hormones are not seen as a major factor, however, the exact mechanism is yet to be determined. In fact, it has been postulated that there are other non-hormonal factors which may contribute to Pattern Hair Loss in both men and women.

As it is a genetic disorder, there is no permanent cure for Pattern Hair Loss. Gene therapy, ideally the perfect treatment, has not been developed for the condition. The best that is available today is hair transplantation. In the near future, stem cell therapy will likely lead the way. For most, topical Minoxidil is the best option in addition to oral therapy with Finasteride and other anti-androgen medications are useful.

Next month: Male Pattern Hair Loss- Cause and Staging