Causes of Hair Loss in Men 
Hair loss in men is not unusual. At least half of all men will experience some type of hair loss by age 50 and a quarter of men will lose some hair by the age of 25. Hair loss in men can be caused by many factors, but the number one reason men lose their hair is due to a hereditary condition called Male Pattern Baldness or Androgenic Alopecia. This type of hair loss is responsible for about 90% of hair loss in men. The result is ordinarily a receding hairline or thinning hair at the top of the crown of the head. Though most men fail to recognize the issue until 50% of their hair has already been lost. 

What Male Pattern Baldness Looks Like
The disease typically begins at the hairline. The hair follicles that are most sensitive to DHT are located at the temples, the hairline and on the crown of the head. Male Pattern Baldness gets its name from this “pattern” of sensitive hair follicles. 

When Male Pattern Baldness is the culprit of hair loss the following signs are often present:
The hair line often recedes to form an “M” shape Hair at the crown of the head begins to thin.
Existing hair becomes finer and shorter
The top of the hairline eventually meets the thinned crown, leaving a horseshoe pattern of hair around the sides of the head that continues to grow.


Other Causes of Hair Loss in Men
Other hair loss causes account for 10% of cases in men (and an even larger percent of hair loss in women). Hair loss in patches, diffused shedding of hair, breaking hair shafts, or hair loss associated with redness, scaling, pain or rapid progression is probably indicative of a condition other than Male Pattern Baldness. These different types of hair loss can be caused by medical conditions, poor nutrition, certain medications, stress or other factors. If any of these symptoms are present in conjunction with hair loss, it is recommended to consult a physician. 

What Causes Male Pattern Baldness?
The culprit is a hormone called dihydrotestosterone (DHT), which is converted from testosterone in the scalp. Over time, DHT builds up around the hair follicle, thinning or “miniaturizing” the hair and ultimately stopping growth. The follicle regresses as a result, causing each new hair that cycles through the follicle to be gradually thinner than the previous one. Eventually the follicle shuts down altogether, ending hair growth completely and permanently. Both a follicles resistance to DHT and the levels of DHT in the scalp are genetically determined , which explains why some people go bald and others do not. The gene can be inherited from both the mother and the father, so men with balding relatives (on either side of the family) have increased odds of losing their hair too. 

Treatments for Male Pattern Baldness
hair restoration experts are specially trained to determine the current level of one’s Male Pattern Baldness and recommend a customized hair loss treatment. Hair Club is constantly refining techniques, testing new technology and closely following emerging research to ensure men get the most advanced and effective hair loss treatments available today. 

By far the most common cause of hair loss in menis androgenetic alopecia, also referred to as “male pattern hair loss” or “common” baldness. It is due to the male hormone dihydrotestosterone (DHT) acting on genetically-susceptible scalp hair follicles that causes them to become progressively smaller and eventually disappear. This process is called “miniaturization.” 

This sensitivity to DHT is characteristic of hair follicles that reside in the front, top, and crown of the scalp — rather than the back and sides — producing a characteristic and easily identifiable pattern. This pattern, described by Norwood in his widely used Norwood Classification, typically begins with recession of the hairline at the temples and thinning of the crown. It may progress to total baldness, leaving just a wreath of hair around the back and sides of the scalp. 

The Miniaturization of Hair Follicles
DHT is formed by the action of the enzyme 5-alpha reductase on testosterone, the hormone that causes sex characteristics in men. DHT causes male hair loss by shortening the growth, or anagen, phase of the hair cycle, causing miniaturization (decreased size) of the follicles, and producing progressively shorter, finer hairs. Eventually these hairs totally disappear (see image below). 

In the following patient, we see a close-up of the side of his scalp where the hair is not affected by DHT. We see mostly groups of full thickness hairs (called terminal hairs) and a few scattered fine, vellus hairs, normally seen in a donor area. The pointer (left) indicates the location on the scalp in the close-up view. 

In the area of thinning (see circle below), we see that most of the hair has been miniaturized, although all of the hair is still present. 

The hairs, while still present on the scalp, are so much finer in diameter than the patient’s original hair that they give the visual appearance of thinning. 

Do not use tar shampoo (a dark-colored, medicated shampoo used for psoriasis) on the transplanted area for 10 days following your procedure, as this may interfere with the growth of the grafts. 

Classification of Hair Loss in Men
The Norwood classification, published in 1975 by Dr. O’tar Norwood, is the most widely used classification for hair loss in men. It defines two major patterns and several less common types (see the chart below). In the regular Norwood pattern, two areas of hair loss–a bitemporal recession and thinning crown–gradually enlarge and coalesce until the entire front, top and crown (vertex) of the scalp are bald. 

Class I represents an adolescent or juvenile hairline and is not actually balding. The adolescent hairline generally rests on the upper brow crease. 

Class II indicates a progression to the adult or mature hairline that sits a finger’s breath (1.5cm) above the upper brow crease, with some temporal recession. This also does not represent balding. 

Class III is the earliest stage of male hair loss. It is characterized by a deepening temporal recession. 

Class III Vertex represents early hair loss in the crown (vertex). 

Class IV is characterized by further frontal hair loss and enlargement of vertex, but there is still a solid band of hair across the top (mid-scalp) separating front and vertex. 

Class V the bald areas in the front and crown continue to enlarge and the bridge of hair separating the two areas begins to break down. Class VI occurs when the connecting bridge of hair disappears leaving a single large bald area on the front and top of the scalp. The hair on the sides of the scalp remains relatively high. 

Class VII patients have extensive hair loss with only a wreath of hair remaining in the back and sides of the scalp. 

The Norwood Class A patterns are characterized by a front to back progression of hair loss. Norwood Class A’s lack the connecting bridge across the top of the scalp and generally have more limited hair loss in the crown, even when advanced. 

The Norwood Class A patterns are less common than the regular pattern (< 10%), but are significant because of the fact that, since the hair loss is most dramatic in the front, the patients look very bald even when the hair loss is minimal. Men with Class A hair loss often seek surgical hair restoration early, as the frontal bald area is not generally responsive to medication and the dense donor area contrasts and accentuates the baldness on top. Fortunately, Class A patients are excellent candidates for hair transplantation. 

Diffuse Patterned and Unpatterned Alopecia Two other types of genetic hair loss in men not often considered by doctors, “Diffuse Patterned Alopecia” and “Diffuse Unpatterned Alopecia,” pose a significant challenge both in diagnosis and in patient management. Understanding these conditions is crucial to the evaluation of hair loss in both men and women, particularly those that are young when the diagnoses may be easily missed, as they may indicate that a patient is not a candidate for surgery. (Bernstein and Rassman “Follicular Transplantation: Patient Evaluation and Surgical Planning”) 

Diffuse Patterned Alopecia (DPA) is an androgenetic alopecia manifested as diffuse thinning in the front, top and crown, with a stable permanent zone. In DPA, the entire top of the scalp gradually miniaturizes (thins) without passing through the typical Norwood stages. Diffuse Unpatterned Alopecia (DUPA) is also androgenetic, but lacks a stable permanent zone and affects men much less often than DPA. DUPA tends to advance faster than DPA and end up in a horseshoe pattern resembling the Norwood class VII. However, unlike the Norwood VII, the DUPA horseshoe can look almost transparent due to the low density of the back and sides. Differentiating between DPA and DUPA is very important because DPA patients often make good transplant candidates, whereas DUPA patients almost never do, as they eventually have extensive hair loss without a stable zone for harvesting.

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