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The Non-Surgical Management of Men’s Hair Thinning
Male androgenic alopecia (male pattern balding) is the ‘natural’, & most common form of hair loss seen in post-pubertal males; readily identified by its familiar pattern of progression.
Until recently it was believed male balding was not a sex-linked characteristic (not transmitted on the X or Y chromosomes) and we could inherit the problem from either parent. However a 2005 German study found the X-linked androgen receptor (AR) genes – which we inherit from our mothers - to be the major determinant in early-onset male pattern hair loss.
The percentages for male balding are around 20% of men in their 20's; 30% in their 30's and so on. At this time the condition cannot be "cured" (because there's nothing wrong with you) but can usually be stabilised (>80%) and a good percentage of hair recovered.
When a male has the genetic inheritance to exhibit androgenic alopecia, it’s a part of the same hormonal changes that gives him his facial & body hair, muscle bulk, & deepening voice. Statistics suggest it’s more common for mature-age males to exhibit some degree of androgenic alopecia than not.
Dawber & Van Neste (2004) suggests 100% of young males will show some changes in the shape of their hairline (termed recession) following puberty - this does not always indicate the onset of androgenic alopecia. Recession is determined by genetics & male hormone levels, & is a process of maturation.
How Male Hormones affect the hair...
In susceptible men, a percentage of the main male hormone Testosterone (TT) is converted to a more potent androgen (male hormones are known as androgens) - Dihydrotestosterone (DHT). DHT progressively exerts a ‘miniaturising’ effect on the hair follicles across the top of the scalp. Within a reduced growing phase affected follicles then produce fine-textured, unpigmented hair (termed vellus) that rarely grow beyond a couple of centimetres in length – thus thinning of the hair density is seen in this androgen-sensitive area.
Male androgenic alopecia usually begins with a receding of the hairline at the temples, with a concomitant thinning of the hair density on the crown. Over time all the hair follicles across the top and sides of the scalp may be affected - resulting in total baldness.
Once exhibited, male balding is most vigorous in the late teens through to the early 30’s. Quite simply the reason is hormone levels are at their peak during these years.
Assessing & Treating Male Thinning
With accepted treatments available today, the management of androgenic thinning in young males is generally straightforward and uncomplicated.
Diet, lifestyle, & medical history should always be reviewed as well as a preliminary blood test for nutritional/metabolic pathology. Any underlying disturbances in these have the potential to adversely affect treatment outcomes and should be corrected before commencing hair loss therapies.
Minoxidil topical solution in combination with the oral prescription medication Finesteride or Dutesteride is the present non-surgical treatment regime for male genetic thinning.
Minoxidil remains the only topical lotion medically approved to stimulate follicle hair growth. Under various brand names, minoxidil is available ‘over the counter’ in 2% and 5% strengths. However these commercial preparations are known to be poorly absorbed and the 30% basic propylene glycol additive is the predominant cause for scalp irritation.
The current generation Minoxidil formulations boast advanced penetration agents, DHT hormone blockers, Minoxidil activators, ‘vellus-reversal’ properties, and anti-inflammatory agents. They can be ‘tailored ‘to the client’s hair loss problem, their skin sensitivity, & even the way it feels on the scalp (“sticky” or too drying).
The oral medication Finesteride (Propecia) and its newer competitor Dutesteride (Avodart) are both inhibitors of the enzyme 5-alpha reductase. 5-Alpha reductase converts testosterone to DHT. Both medications stabilise androgenic alopecia in about 80% of men.
For those wanting to accelerate their hair regrowth, an addition to a combined therapy approach would be the short-term use of the blood pressure drug Loniten – from which topical minoxidil was originally derived. Under medical supervision, one half of a 10mg tablet is taken at bedtime (to minimise the blood pressure lowering effects) for two months only. Increased facial/body hair is side effect of Loniten therapy (>80%), so its use in women to accelerate scalp hair regrowth is not advisable.
There is still some debate whether or not herbal supplements such as Saw Palmetto (serenoa serrulata), has an inhibiting effect on 5-alpha reductase iso-enzyme that influences the hair follicle. Studies suggest that taking saw palmetto for prostate problems can be as effective as finesteride, but there is little documented research on the herb as a treatment for hair loss. Testosterone pathways in women can be altered and testosterone levels lowered with saw palmetto 160mg twice daily.
At 50mg per day the mineral zinc is an inhibitor of 5-alpha reductase, but as it antagonises the absorption of copper & iron it should only be taken at full dosage for 3-4 months – and not in conjunction with copper or iron supplementation.
Laser Light Therapy....
Photo-biotherapy such as ‘soft/cold’ low level laser light (LLLT) is a strong vasodilator & moderates the skin’s immune response. To be therapeutically effective these laser appliances should be classified ‘3A’; be in the wavelength vicinity of 660-780nm & with a power output of 60-400mW. LLLT is a non-UV light source.
LLLT as a sole therapy will not regrow hair to any aesthetically-satisfying degree in my experience. As a combination therapy however, LLLT will enhance the scalp environment due to its anti-inflammatory & blood perfusion properties - so hair growth potential is maximised. LLLT is consistently effective (in a combined therapy approach) for inflammatory scalp problems, & for settling telogen effluvium hair shed.
 Genuine* Laser Therapy at a Price You Can Afford!!
Shampoos...
There is strong evidence to support the use of sodium lauryl sulphate-free shampoos for healthy follicle function and optimal hair growth. Shampoos with natural ingredients & mild enough for daily use are the best options.
As a continuously growing & metabolically-active tissue, hair requires high levels of available nutrients for hair cell DNA synthesis & development. In terms of nutrient supply however, hair is a ‘non-essential’ tissue – receiving its full nutrient supply only after vital tissues have been accommodated. For this reason the taking of a quality multi vitamin/mineral & amino acid supplement is strongly advised.
Other general causes of hair loss in males are alopecia areata, poor dietary habits, illness/accidents, surgical procedures (especially where significant blood loss has occurred), certain prescription or illicit drugs (including anabolic steroids), or severe stress.
About the Author: Tony Pearce RN is a specialist trichologist and a registered nurse. He is a founding member of the Society for Progressive Trichology. Tony has a clinical practice in Sutherland & Rozelle NSW. He is the Clinical Director for Trichology of Virginia/DC in the United States. In Australia Tony can be contacted on 02 9542 2700, or through his website at www.hairlossclinic.com.au
*References for this article available on request.
© Anthony Pearce (Revised May 2007).
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