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Male Pattern Baldness

Male pattern baldness is a form of baldness which affects most men and some women. It is also known as common baldness or androgenetic alopecia, a name which suggests it has something to do with androgens and genes.

Male pattern baldness may be due to three factors:

Androgens are influential for the following reasons.

Women who produce excess androgens can develop very severe male pattern baldness. It has also been found that the hair follicles of individuals with male pattern baldness convert circulating androgens to more potent androgens at a faster rate than normal follicles. These androgens accumulate in the skin and cause the hair follicles there to regress.

Male pattern baldness develops as a result of this. The increase in androgens occurs locally, which is why many individuals with male pattern baldness have normal levels of circulating androgens, and women with male pattern baldness still look feminine and can conceive and have babies normally.

The importance of androgens is further illustrated by the following report by Dr James B. Hamilton of the State University Medical Center in New York City in the American Journal of Anatomy. In an identical twin study, one twin who had been castrated before puberty retained all his hair at 40 but his uncastrated twin brother had slowly become bald. When the castrated twin was treated with testosterone (an androgen), he became as bald as his twin brother within six months.

Genes are the blueprints of our body, and several thousands of these can be found on paired structures called chromosomes.

We inherit one chromosome from each of our parents. Many of our characteristics such as the colour of our hair and eyes, height and facial appearance are inherited. This is why there is often a resemblance between family members.

The tendency to develop male pattern baldness is also believed to be inherited. According to one theory, men who inherit one or both genes for male pattern baldness will develop it whereas only women who inherit both genes are affected.

Genetic Make-up Men Women
Bb Bald Normal
BB Bald Bald
bb Normal Normal
(where B is the gene for male pattern baldness.)

However, not everyone agrees with this theory and it is likely that the genetics of male pattern baldness is much more complex.

The importance of inheritence is illustrated by Dr Hamilton's observations that a eunuch with normal male relatives did not develop male pattern baldness, whereas one whose male relatives were affected tended to develop male pattern baldness when treated with the same amount of androgens.

Age

Male pattern baldness becomes more common as a person ages. Significant male pattern baldness, defined as at least a deep receding of the front hairline, occurs in 5% of men under 20, 30% of men at the age of 30, and 50% of men at the age of 50.

You may recall that the number of hair follicles decreases with increasing age and hair becomes thinner as a result. It seems to affect the same areas affected by male pattern baldness, accentuating it.

Theoretically, male pattern baldness can occur at any age after puberty. In men, it commonly develops during the 20s and 30s. Women usually develop male pattern baldness after menopause unless they have inherited susceptible genes. If so, male pattern baldness may begin just as early.

Fortunately, male pattern baldness in women is never as severe as in men because the female hormone, oestrogen, Counteracts the effect of androgens on the hair follicle. However, if it is severe in young women, this may indicate excess androgen secretion. Besides menstrual qisturbances, these women usually suffer from infertility, hirsutism (excessive and coarse facial hair, particularly on the upper lip, chin and cheeks), and severe acne. Hormone investigations need to be done.

In men, male pattern baldness usually begins as a receding hairline along the front and temples (Fig. 8) and then a thinning of the crown. In severe cases, these areas merge until only a horseshoe rim of hair remains on the sides and back.

Severe male pattern baldness in young men is, fortunately, not very common and affects only 2% of them by the time they reach 30. Severe male pattern baldness is not normally seen in women and the pattern of baldness is also different. Women usually develop diffuse thinning of the crown rather than a receding hair line. Figs. 9 and 10 illustrate the pattern of male pattern baldness in men and women.

In male pattern baldness, there is a reduction in the duration of anagen and a consequent increase in telogen hairs. This is reflected in a lower anagen:telogen (A:T) ratio. Shorter hairs are produced because of the shortened anagen stage. The hair follicle also shrinks in size over each successive hair cycle. Consequently, the hairs produced are finer and lighter in colour.

Initially, indeterminate hairs are produced. These are intermediate in length, thickness and colour between terminal and vellus hairs. Eventually, even these are reduced to a fluff. Another characteristic finding in male pattern baldness is the discovery of telogen hairs of different thickness. It is due to hair follicles of different sizes entering telogen.

You may recall that under the influence of androgens, vellus hair on some parts of the body such as the face, chest, armpits, and pubic region changes to coarse, pigmented terminal hairs. On the scalps of individuals with male pattern baldness, however, the same androgens seem to do the opposite-cause terminal hairs to revert back to vellus hairs. That androgens should exert opposite effects on hairs on the scalp and hairs elsewhere is a paradox.

There is also racial variation in the severity of male pattern baldness. Caucasians, for example, have the most severe form of male pattern baldness. Blacks have less severe forms and Orientals the least.

Seborrhoea (increased sebum or oil production) often accompanies male pattern baldness. This is because the sebaceous glands are stimulated by the same androgens that cause male pattern baldness.

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