If you’re watching your hair go down the drain, or looking at yourself in the mirror and seeing more of your forehead, you may be worried. As we age, we lose hair. That’s normal. But how much hair loss is normal for a man?
What is androgenic alopecia?
It’s the fancy medical term for male or female pattern hair loss, which causes thinning of hair, and possibly, baldness. It’s related to androgen hormones and genetics with genes being inherited from both parents.
It can start from as early as age 15-25 in men, and age 25-30 in women
In androgenetic alopecia, there’s sensitivity to an androgen hormone, called DHT (dihydrotestosterone), in certain areas of the scalp.
- DHT shortens the growth phase of the hair cycle from the usual 3-6 years, to weeks or months
- DHT also leads to miniaturisation of hair follicles
What does male pattern hair loss look like?
- Gradual hair thinning, most commonly involving the crown and front of the scalp
- Regression of the temple hairline, resulting in the typical “M” shape forehead
- Hair in affected areas may be of different lengths, thickness and texture
What is meant by “hair miniaturisation”?
Hairs on the scalp grow in tufts, or so-called “follicular units” containing 1-4 full thickness hairs (this differs from other areas of the body). In androgenetic alopecia, the tufts progressively lose hairs: individual hairs produced by these follicles decrease in size (in diameter and length) and eventually disappear altogether, causing balding
Well, how much hair loss is normal then?
A standardised “60 second hair count” is regarded as a reliable method of assessing hair shedding How to do the hair count:
- wash your hair over 3 days
- on the 4th day, comb your hair forwards for 60 seconds over a contrasting colour towel or pillowcase before shampooing
- then count the hair loss for three consecutive days
- usually only about 10 hairs on average are lost per day in normal healthy males, regardless of whether you’re young or middle-aged
- the test can be repeated on a monthly basis to keep a check on your hair health
What can be done about male pattern hair loss?
Minoxidil liquid or foam
- it promotes hair growth by lengthening the growth phase of hair follicles and causing more hair follicles to produce hair
- hairs that are produced tend to be larger and thicker
- the scalp is treated, not the hair
- it must be used for at least 6 months to see a difference, and if effective, must be continued indefinitely, otherwise the beneficial effect will be lost
- it works best in men where baldness has been present for less than 5 years, when it affects the crown of the head and where the hair loss area is less than 10cm in diameter
Finasteride pills
- it decreases the production of one of the hormones associated with androgenetic alopecia, resulting in an increased amount of hair covering the scalp
- it cannot be used in women and should not be handled by any woman who is, or may become pregnant
Surgical techniques
- Hair transplantation: healthy follicles from other parts of the scalp (often the back and sides) are transplanted to areas affected by baldness
- Scalp reduction: bald patches of scalp are removed and remaining skin is sewn together
- FUT (follicular unit transplantation): the surgeon harvests a strip of scalp and cuts it into groups of 3-4 hairs
- FUE (follicular unit extraction): this involves robotically harvesting individual follicles from the back of the head
- Hair pieces/wigs, tattoo techniques (micro-pigmentation to resemble a shaven scalp).
