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There’s a reason many men feel insecure as they begin to bald. Hair is a powerful symbol that can reflect your overall state of health.

Male pattern hair loss and male balding describe the medical condition called androgenic alopecia. Although typically occurring in men, it can also occur in women (sometimes called “female pattern” hair loss). But since it is Father’s Day, I’ll specifically be addressing the treatment options for men. As pharmacists, we’re most comfortable discussing the medications used for androgenic alopecia, but we’ll also address several non-drug choices, including hair transplant and cosmetic aids.

How common is male pattern hair loss?

The prevalence of androgenic alopecia increases with age and it is estimated that in Caucasians, about 50% of men will experience male pattern hair loss by the age of 50.  While in Asians, the prevalence is lower. A recent study in six cities in China found that about 30% of men aged 50-59 years old had male balding. Of the men included in this study, 30% had a positive family history of male pattern baldness.

What is the role of androgens?

Genetics does seem to play a role in the risk of male pattern hair loss. In addition to genetics, it is thought that hormones also play a role in causing hair loss. One such hormone is called dihydrotestosterone (DHT), which is a metabolite of testosterone. Both of these substances are androgens, the hormones that give men their manly characteristics, such as facial and armpit hair growth, deeper voices, and increased muscle mass.

Interestingly, excessive androgens can also cause hair loss in specific areas of the head that are sensitive to to the hormones. These hair follicles are stimulated by DHT, and begin to shrink, or miniaturize over time. Although the conventional thinking implicates DHT as the main culprit in male hair loss, others have argued that male pattern hair loss is primarily due to a hardening of tissue of the scalp leading to inflammation and decreased blood flow. This reduced flow of blood cutes of the supply of nutrients which contributes to the shortening and thinning of hair.

You probably know someone with the typical pattern of hair loss: first it begins near the temples, and then gradually moves to the top (vertex) of the head. This gives the hair an “M” shape pattern and spares the hair along the side of the head. Looks almost like a half circular donut!

What health conditions are associated with male pattern hair loss?

Potential risk factors that are linked to male hair loss include cardiovascular disease, prostate cancer, and decreased insulin sensitivity. A person who is obese, has type 2 diabetes mellitus, or has high blood pressure may have reduced sensitivity to insulin and trouble breaking down sugars. If you haven’t been to the doctor recently, then it would be a good idea to measure you weight, blood pressure, blood sugar and screen for prostate cancer (if appropriate). That way you can address any risk factors that may contribute to your baldness.

Generally no blood tests are needed to diagnose male pattern hair loss. However, it is worthwhile to see a doctor so that they can order some basic lab tests to rule out other causes of hair loss. For example, iron deficiency and low thyroid hormone can cause hair loss.

What drugs can cause hair loss?

Sometimes medications cause hair loss. If you regularly take medicines, check with your pharmacist or doctor to see if a drug could be causing your hair loss. The most common drugs that may cause hair loss include blood thinners (anticoagulants), hormone therapy (thyroid drugs, androgens), psychotropic drugs (antidepressants, antipsychotics, lithium), and cancer chemotherapy. Depending on your circumstances it may be possible to adjust your medications to solve your hair loss problem.

Male pattern hair loss treatments

Several treatment options are available. Many men begin with conventional drug treatments.

Minoxidil

Minoxidil is an old drug that was originally studied to treat high blood pressure. Patients began to notice the surprising side effect of hair growth so now it is mostly used on the scalp to manage hair loss.

In Hong Kong, there are about two dozen products containing minoxidil. The most common brand name is Regaine 倍健. Minoxidil comes as either a liquid or foam and it can be easily purchased from a pharmacy without a prescription.

Use it twice a day on the area of hair loss. Make sure the the skin is dry and not irritated. You’ll want to avoid swimming or showering for at least 30 minutes after applying the medicine in order to allow it to be absorbed into your skin. Generally you need to continue using it for at least a year to make a meaningful decision about the drug’s effectiveness. It is available in concentrations of 2-5%. The extra strength (5% concentration) may be more effective and cause hair to regrow sooner.

You’ll want to monitor for any itchiness, skin irritation (allergy), flushing, and excessive hair growth (hypertrichosis). Follow the product directions for full details on how to apply the medicine.

Finasteride

Finasteride is a strong blocker of an enzyme called 5-alpha-reductase. Pharmacologically it causes a dramatic drop in the levels of DHT in your blood. However, similar to minoxidil, it doesn’t work very quickly and needs to be taken on a daily basis for usually at least a year to see an effect.

The typical starting dose of finasteride is 1 mg per day. It is a prescription drug. The 1 mg strength product is called Propecia 保康絲, while the 5 mg product strength (used to treat enlarged prostate) is called Proscar 保列治. To save on medication cost, it is perfectly reasonable to use a tablet cutter and split a 5 mg tablet. Take one quarter of the 5 mg tablet on a daily basis. Because finasteride drastically reduces androgen levels, split or crushed tablets should not be handled by pregnant women.

Recently there has been greater concern about the risk of severe side effects from finasteride. Although they don’t appear to be common, some men experience depression, suicidal thoughts, breast enlargement, decrease libido, erectile dysfunction, and sexual dysfunction. There is also greater awareness of the “post-finasteride syndrome”, with some disabling side effects continuing long after stopping the medicine. Young men should discuss the risks and benefits with their doctor before starting treatment.

Non-drug treatment options

General non-drug treatments include eating a nutritionally balanced diet; avoiding tight hairstyles, such as braids, buns or ponytails; avoiding compulsively twisting, rubbing or pulling your hair; and treating your hair gently when washing and brushing. 

If you prefer not taking medicines, cosmetic aids such as creative hair styling, hairpieces and hair lightening can help improve hair appearance. Furthermore, you can explore hair transplant and low-level laser treatment with a dermatologist or plastic surgeon.

Conclusion

Many men will choose to do nothing about their hair loss. For those who are concerned about male pattern hair loss, it is important to address risk factors and make sure another medical condition or drug is not causing the hair loss. There are two conventional drug treatments for androgenic alopecia: minoxidil is a non-prescription drug that is applied directly to the skin whereas finasteride is a prescription drug taken by mouth on a daily basis. Men should discuss the drug treatment options with their pharmacist and doctor. They will help you use your preferred treatment correctly and can help you monitor for potential side effects.

Contributors: Jason Tong and Cheng Wai Chung.
A Chinese version of this post appeared here.