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Health and Wellness Advice

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Male pattern baldness


Thumbnail for Male pattern baldness

Alopecia or hair loss is a situation that a significant number of men will encounter during there lifetime. In fact, it is so common that by the age of 35 approximately 66% of males will experience some degree of alopecia. Losing hair can be a particularly stressful situation for both males and females. The most common form of hair loss is called male pattern baldness and like the name suggests primarily occurs in males.   

There are many different causes that can result in hair loss for both males and females including auto immune disease (alopecia areata), chronic stress or as a side effect from certain medical treatments such as chemotherapy. Today we will be focusing on cause and associated treatments for male pattern baldness. 

Hair loss in patients with male pattern baldness can start to precipitate in males as young as twenty and will likely get worse throughout the aging process. It starts with loss of hair at the front hairline, followed by the top crown and temples – which is a set pattern and hence it is coined male ‘pattern’ baldness.

Male pattern baldness is generally genetic and is due to patient’s hair follicles being particularly sensitive to DHT, a powerful metabolite of testosterone. The DHT molecule binds to receptors in the hair follicle causing them to miniaturise over time resulting in the hair becoming thinner and less dense. Over time the follicle will become so affected by DHT that hair will cease to grow leading to baldness over time. Due to the powerful androgen DHT being the principle cause of the condition is may also be referred to as ‘androgenic alopecia’. 

Often losing hair can cause anxiety and distress and can even lead depression in some patients. Unfortunately, there is no cure for the condition however depending on patient response there are several therapies that can prevent further hair loss or reduce the rate at which the hair is lost. These therapies work by either promoting hair growth or blocking DHT from binding to the hair follicle.   

Pharmacological treatments can include a combination of the following:

  • Minoxidil solution
  • Finasteride oral tablets
  • Ketoconazole hair shampoo

Minoxidil topical solution:

If you are wondering where to start on your treatment journey, topical minoxidil is a good place to begin. Originally in tablet form, it was indicated for the treatment of high blood-pressure, however one of the unwanted side effects was hair growth. Scientists have now formulated a topical application to target hair growth.

Minoxidil comes in a 2% and 5% solution. The 5% is usually more effective but is also likely to be more irritable to some. The following brands are available:

Regaine comes in both solution and foam formulations , we recommend the foam as it is easier to apply and can last longer than the solution.

Generic brands of minoxidil 5% solution such as 'Hair A-gain' and 'Generic Health Minoxidil extra strengh' solution are very cost-effective products compared to the original Regaine.

How to use it: It is recommended to apply once to twice daily with the application and results can often from anywhere from 4 to 8 months to see the full effect. Patients often see an increase in shedding at the start (indicating stimulation of the follicles), however do not be alarmed, this is very common and new hair will grow out subsequently. Treatment must be used on-going, and any cease of treatment will result in the loss of any newly gained hair.

Finasteride:

Low dose finasteride 1mg is a prescription medicine indicated for the treatment of men with male-pattern hair loss (androgenic alopecia) to prevent further hair loss and increase hair growth. Clinical trials have shown it to be effective in at least 8 out of 10 men taking 1mg daily finasteride for mild-to-moderate patterned baldness.

It works by acting on an enzyme called 5-alpha reductase inhibitor. This enzyme is responsible for converting testosterone to DHT. By reducing the conversion of testosterone to DHT to total amount of DHT a patient has in their system is reduced. As a result, it no longer interacts with the hair follicle as much resulting in reduced hair loss.  

How to use it: Finasteride is in an oral tablet to be taken once a day with or without food, at any time during the day. To see an effect, most people need to take it for a minimum of 3 months before seeing any visible effect. As finasteride is a prescription medicine, you must consult with a doctor before starting this treatment to understand the effects of this medicine and to see if it is suitable for you.

Finasteride 1 mg tablets are available in the original Propecia brand in a box of 30 (Click here) or generic brand in a box of 30 (Click here).

Ketoconazole shampoo:

Ketoconazole 2% shampoo (Sebizole 2% or Nizoral 2%) has also been shown to benefit some due to its' anti-androgenic effects and perhaps because it is effective in seborrheic dermatitis and dandruff. Although in Australia it is only indicated for the treatment of seborrheic dermatitis and dandruff it is approved for the use of male pattern hair loss in some countries including the USA. It likely works by the active ingredient ketoconazole blocking DHT receptors in the scalp which prevents DHT from interacting with the hair follicles.  

How to use it:

You should use ketoconazole shampoo according to the product label and or on the advice of your doctor.

For the treatment of the scalp, squeeze a small amount of the shampoo onto your hands and apply to wet hair. Lather it your hair thoroughly, giving it around 3-5 minutes to soak in and rinse off like any other shampoo. Avoid contact with the eyes and do not ingest.

As with all treatments, there may be potential for side effects. Please consult your health professional before starting treatment.

Posted at 09 November 20