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Dr. Bertram Medical Hair Transplant
眉 髮 醫 學 移 植 中 心 ( 香 港 ) |
( 852 ) 3421-1138
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Hair Loss in Men - Androgenetic Alopecia
Terminology
Androgenetic Alopecia ( AGA ) causes 95% of all hair loss in men. When we talk about hair loss in men this is what we usually refer to. AGA is also known as Male Pattern Baldness ( MPB ).
Classification
The most commonly used chart for men is the one developed by Dr Hamilton and then later modified
by Dr. O'Tar Norwood called the Norwood-Hamilton scale.
The first signs of balding are increased frontotemporal recession accompanied by midfrontal recession (type II). Hair loss in a round area on the vertex follows, and the density of hair decreases, sometimes rapidly, over the top of the scalp (types III through VII).
4 Important Points about AGA
- Progresses with age
- Unpredictable
- You may be the first one with AGA in family
- No actual loss of hair follicles
Incidences of AGA in Men
- 19.9% of Chinese have AGA
- About age 21, 25% of men with AGA first notice hair loss
- About 25% by age 25-30 will have AGA
- About 40% by age 40 will have AGA.
- About 50% by age 50 will have AGA.
Causes of AGA
The primary pathology is progressive miniaturization of scalp hair transforming to fine vellus hairs. Androgens, specifically dihydrotestosterone ( DHT ), cause miniaturization in men. Patients with AGA are inherited with hair follicles more sensitive to DHT.
Miniaturization is a complex multifactorial process driven by both genetic and non-genetic factors. Not every follicle is affected at the same time or to the same extent. Miniaturization can take place within a few years for some, or decades for others.
Signs and Symptoms
Increase the number of the miniaturized follicles causes baldness. Hair follicles in hairline, midscalp, crown, and temples are most sensitive to DHT. In men the first appearance is therefore a receding hairline and/or thinning crown. Thinning eventually progresses into other areas.
In the more advanced AGA only a rim or "horseshoe" pattern of hair remains. In some men even this remaining rim of hair can be affected by DHT.
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| Early Miniaturization |
Late Miniaturization |
Physical Examination
Presence of miniaturized hair follicles smaller than 0.02mm is an early marker of AGA even when a normal number of thick hair is still present. In advance AGA the Terminal / vellus hair ratio change from the normal 8 : 1 to 4 : 1. The total number of hairs remains the same in 90% of cases.
Psychological Impacts of AGA
AGA can adversely affect the social interaction and employment opportunity.
Read More »
Medical Treatment of AGA
The miniaturization can be reversed or inhibited in 2 ways :
- By adding a hair growth stimulator, or
- By blocking the action of DHT
Only 2 FDA approved medications are on the market :
Others which may be useful are:
Many over-the-counter medication has limited efficacy.
A lot of money has been invested in researches looking for the magic bullet. Success on treatment depends on early intervention and continuation of treatment. Once the hair diameter falls below 0.04mm, it cannot be rescued.
AGA and Hair Transplant
- 70% of men of all age can consider hair transplant
- Virtually all with less than Class VII can expect good result
- No age limit for hair transplant as each case must be assessed individually.
AGA and Coronary Heart Disease
Thinning in the crown, not receding hairline, is associated with risk of heart attack, especially if onset of hair loss before age 30 and with a rapid progression. Frequent check of blood lipid profile is recommended.
- Mild to moderate AGA: risk increases by 1.3 X
- Severe AGA: risk increases by 3.4 X
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