Hair loss medication for male pattern balding

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Hair Loss Medication

For men in their thirties, approximately 30% have androgenetic alopecia, for men in their forties, 40% have alopecia and so on until 80% of men are affected when 80 or more years old. This rough rule of thumb is enough to provide you an idea about the proportion of men affected by androgenetic alopecia. About 50-80% of the population of Caucasian males suffer from androgenetic alopecia. Different ethnic backgrounds have different susceptibility levels towards the development of androgenetic alopecia.

Though the Chinese male population has a similar progressive increase in balding with age; total baldness is much less common compared to Caucasian males. The numbers of Chinese males affected by androgenetic alopecia is approximately half that of Caucasian males. American Indians and African Americans also have a lower incidence of androgenetic alopecia compared to Caucasians. The frequency differences among the different populations and its inheritance clearly points towards the involvement of specific genes for the pattern baldness susceptibility.

Inheritance of Male Balding

Medicine has long recognized androgenetic alopecia as an inherited systemic disease associated with sexual development. Ancient Greek doctors realized that male pattern baldness can develop in men of any age after puberty. They recorded that young boys castrated before puberty did not develop androgenetic alopecia regardless of their genetic family history. However, boys castrated during or after puberty could develop androgenetic alopecia.

The earlier finding now can be supported by the scientific reason that the castration done before puberty stops hair follicles from being exposed to androgens or the male sex hormones made by the gonads during adolescence. Castration after puberty is too late. Once hair follicles have been exposed to androgens they are fated to become androgen sensitive and androgenetic alopecia can develop.

Presentation of Androgenetic Alopecia (Male Pattern Balding)

Androgenetic alopecia develops as a gradual reduction of scalp hair follicle size, and reduced time in the anagen active growth phase, leading to more hair follicles in the Telogen Resting Stage of the hair cycle. In men, the hair loss is typically limited to the top of the head and can involve thinning and/or receding hair lines.

Over time, the terminal scalp hair follicles undergo progressively shorter and shorter cycles. This applies regardless of whether the hair follicles are terminal, intermediate, or vellus hairs. While periods of anagen growth are reduced, catagen and telogen time periods remain the same or get longer. The net effect is that androgenetic alopecia is characterized by a gradual increase in the number of resting telogen hair follicles present at any one time.

In unaffected scalp the percentage of hair follicles in telogen is up to 10%. In the early stages of androgenetic alopecia the number of telogen stage hair follicles can be up to 25% of the total. As androgenetic alopecia progresses the total number of hair follicles can be reduced as the hair follicles are irreversibly destroyed.

In androgenetic alopecia the terminal hair follicles reduce size both in length and diameter. The hair bulb moves upwards in the dermis yielding a small vellus hair follicle. These vellus hair follicles can be affected by fibrosis. Eventually the hair follicles may disappear altogether.

Premature Balding

As the genetically predisposed men progress through their twenties, slight frontal-temporal recessions start becoming evident. The hair line has a concave appearance on each side and a lower peak in the middle. Most of the males with androgenetic alopecia have a predictable pattern of hair loss. The degree of hair loss can be represented by Dr. O’Tar Norwood’s Scale, the standard scale is understood and used by all the Hair Transplant Doctors in Hair Transplant Centers the world over.

Chemical Reasons for Balding

Testosterone (Androgen) is a hormone found primarily in males and in reduced amounts in females; though the amount can increase as women approach menopause. Testosterone itself only has limited negative effects on the hair follicles. However, when testosterone reaches the oil glands in the hair follicles, it comes in contact with the enzyme, 5-alpha-reductase. 5-alpha-reductase is directly responsible for the conversion of testosterone into dihydrotestosterone (DHT). The enzyme 5-alpha-reductase, is produced in the prostate, adrenal glands, and scalp skin. Formation of Dihydrotestosterone is a precipitating factor for baldness in both men and women and can be termed as DHT Hair Loss.

So androgenetic alopecia involves more than just androgen production, it is the altered metabolism of androgens in genetically pre-disposed males and females which plays a major role in Androgenetic Alopecia in women and men.

DHT (and perhaps other androgens) causes hair follicles to shrink and enter a permanent dormant state. DHT triggers synthesis of transforming growth factor-beta2 (TGF-beta2) which suppresses epithelial cell proliferation and eventually leads to apoptotic cell death. TGF-beta2 is directly responsible for significant hair loss on a cellular level.

Hair Loss Medications

The mechanism of action in hair loss medications may depend on combating the effects of TGF-Beta2, or some of the hair loss medications act as DHT and androgen inhibitors and are termed as Anti-Andorgens.

Medications that prevent DHT Hair Loss have formulas to either prevent the conversion of testosterone to DHT, inhibiting DHT's ability to bind to cellular receptor sites or increase the breakdown and excretion of DHT. Once DHT levels in the scalp are decreased, the cycle of hair loss experienced by dormant follicles is corrected allowing new hair re-growth to resume.

Hair loss medications broadly can be divided into the following classes:

Anti Androgens
Growth Stimulators
Nutrition Health Supplements