Causes of male alopecia and ways to solve the problem

Why do men lose hair? Has nature laid down the mechanism of hair loss, or is it a disease that can be avoided? Why do young people increasingly face the problem of baldness, while other men walk around with a luxurious head of hair until they go gray? And most importantly, how to effectively solve the problem and not harm your health - we discuss these and other questions in our article.

What is alopecia?

Alopecia is hair loss. Hair loss can have different causes.

The most common reason why men lose hair is androgenetic alopecia (male pattern hair loss). There are also other, less common types of alopecia in men, such as Alopecia Areata (alopecia areata), primary scarring alopecia.

Prevalence of different types of alopecia in men

Hair loss in men can create great psychological stress and significantly change the quality of life. The presence of bald spots not only spoils the mood, but often affects the business and personal spheres of life. The state of stress takes away energy and does not allow you to realize your potential, achieve goals, be successful and live a full life. Fortunately, in the vast majority of cases, the right approach to solving the problem of hair loss gives good results.

Androgenetic alopecia

"Androgenetic alopecia cannot be called a disease, it is a condition that affects half of the male population of the Earth. You should not worry that something is wrong with you, rather, those who are not affected by androgenetic alopecia can be called an exception."

Professor of the American Academy of Esthetics
Medicine, Doctor of Science, A. Tsilosani.

More than 97% of hair loss cases in men are androgenetic alopecia (AGA). In the case of androgenetic alopecia, hair loss is caused by genetic factors and the effect of dihydrotestosterone, an active form of the male sex hormone. But how exactly does this happen? The effect of dihydrotestosterone and genetic predisposition lead to atrophy and death of follicles. A typical phenomenon with AGA is that the hair becomes vellus-like, falls out, and new hair stops growing altogether. Hardware diagnostics of AGA is carried out using a trichoscope. According to the results of trichoscopy, the phenomenon of hair miniaturization can be seen.

"Hair loss in androgenetic alopecia is the result of the implementation of the genetic program of certain cells of the hair follicles growing in the forehead, crown and crown area, which can be strengthened or weakened by various external and internal effects on both the cells of the hair follicles and perifollicular tissues, and on the body as a whole. In this case, the basis for the development of androgenetic alopecia is the genetic sensitivity of the hair follicles to androgens."

Doctor of Medical Sciences, Head of the Department of Clinical Dermatovenereology and Cosmetology of the State Budgetary Healthcare Institution "Moscow Scientific and Practical Center for Dermatovenereology and Cosmetology" of the Moscow Department of Health, Chief Physician of the Clinic "Institute of Beautiful Hair" Gadzhigoroeva A.G.

Hippocrates was the first to hypothesize that hair loss in men was related to male sex hormones.
It should be noted that genetic predisposition does not necessarily mean that your immediate ancestors had baldness. Even if your father and grandfather did not experience age-related hair loss, in your case this is not a guarantee against androgenetic alopecia.

The process of hair loss

There are also age-related features. Since testosterone appears after puberty, there is simply no risk of developing androgenetic alopecia before this age.

More testosterone, less hair?

No. It would be a mistake to think that the higher the testosterone level, the more active the hair loss will be. In fact, the age of the onset of the baldness process, the activity of hair loss and the degree of hair loss depend on another factor. All these points are determined by the degree of sensitivity of the follicles to dihydrotestosterone, and not its amount in a particular man. That is, two different men who have the same testosterone level can have completely different degrees of sensitivity of the follicles and as a result - one will actively lose hair already at 27 years old, and the other will have a thick hairstyle until gray hair.

Hair loss in men with androgenetic alopecia occurs in typical areas - these are the frontal-temporal zones, the growth line disappears, deep depressions appear that go towards the crown. Also, the center of hair loss can be on the crown. Such changes not only make a man look older, but also change facial features, it looks too elongated, sometimes an unsightly thinning tuft remains in the middle. It is completely natural that a man does not want to put up with the ongoing processes and is looking for a solution to the problem.

The most effective solution is hair transplantation . Therapeutic treatment can also be used.

"A reasonable question arises - if the hair affected by testosterone has fallen out irreversibly, then why will the hair transplanted in this place grow throughout life?! Obviously, if new hair fell out some time after the transplant, the procedure would make no sense. So why is the transplanted hair so resistant to loss and grows throughout life? Of course, in the case when the procedure is carried out at a high professional level.

The first reason is inherent in nature. Not everyone knows that hair follicles on the head are divided into 2 types: some are influenced by genetic and hormonal factors, while others are not. These are genetically insured follicles. If such follicles, not subject to loss, are identified correctly and transferred to the necessary areas, they will grow there all their lives. Even on the palm of your hand!

A. Tsilosani - Doctor of Sciences, plastic surgeon,
author of two world records in hair transplantation.

Before and immediately after hair transplantation (method "hairstyle immediately", performed by A. Tsilosani)

Read more about why transplanted hair does not fall out with androgenetic alopecia here: https://doctor-tsilosani.ru/blog/pochemu-peresazhennye-volosy-ne-vypadayut/

Alopecia areata

*Alopecia Areata

About 2% of men suffering from hair loss are diagnosed with this condition. And while androgenetic hair loss is a condition, Alopecia Areata is a disease.

How does the disease look and develop? At first, small round areas of hair loss appear, usually the size of a coin. They have a clear border. This is the first stage of Alopecia Areata - focal alopecia. The peculiarity is that the areas of follicle loss appear quickly. Sometimes these areas begin to grow, increase, expand, merge. This is the next stage of the disease - diffuse alopecia. Then there are areas of hair loss not only on the head, but also on the eyebrows and beard, on the body. The last stage of alopecia areata is a complete loss of hair on the entire body, it is called total alopecia.

The etiology of alopecia areata is poorly understood. It is known for sure that stress plays a special role in the development of the disease. It can be both conscious and unconscious. Stress triggers the mechanisms of autoimmune aggression. Usually, patients note that the disease occurs unexpectedly.

Primary cicatricial alopecia

This disease occurs in only 1% of cases when we talk about hair loss in men. This autoaggressive disease is also associated with the presence of hidden or obvious stress. It often happens that stress does not manifest itself externally and a person does not even know about its presence, but changes occur at the level of internal processes.

It has been established that the disease is not infectious or hereditary. Primary cicatricial alopecia can remain unnoticed for years, but can progress rapidly and become an obvious problem within a few months. This type of alopecia leads to the destruction of the hair follicle, resulting in hair loss.

There are several types of primary cicatricial alopecia, such as Frontal Fibrosic Alopecia*, Pseudopellada-Bork desease*, Lichen Planopilaris* and others.

*1- frontal fibrosis,

*2- pseudopelade, Broca's disease,

*3- lichen planus

Trichoscopic examination of this disease shows typical cicatricial changes in the skin.

Treatment of alopecia in men

In case of nesting and primary cicatricial alopecia, only therapeutic treatment is used; hair transplantation is not indicated. Treatment is selected individually by a trichologist. It may include steroid therapy, anti-inflammatory drugs, and a referral to a psychologist.

Sudden, unexpected hair loss can sometimes indicate serious health problems, so it is necessary to consult a specialist in time so as not to miss the moment.

In case of androgenetic alopecia, treatment is complicated and long, often for many years. Also, treatment may lose its effectiveness over the years. It cannot be said that after a course of therapy, this condition can be cured. When treatment is stopped, AGA can progress with renewed vigor and lead to an even worse condition than before treatment.

“Today, treatment for androgenetic alopecia is defined by FDA standards*

*American Food and Drug Administration

According to the FDA, only 2 medications are effective in treating androgenetic alopecia:

• minoxidil (Rogaine)
• taking drugs that block alpha reductase, an enzyme that converts testosterone into its active form, orally."

Professor of the American Academy of Aesthetic Medicine,
Doctor of Science, A. Tsilosani.

American Food and Drug Administration

Therapeutic treatments for male pattern baldness can help slow down the process of hair loss and also make hair thicker. The hair shaft becomes more voluminous and the hair looks thicker. Is minoxidil as a topical treatment really that effective or are there pitfalls that everyone should be aware of?

We asked an expert to answer this question: President of the Association "Professional Society of Trichologists" , Head of the Department of Clinical Dermatovenereology and Cosmetology of the State Budgetary Healthcare Institution "Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology" of the Moscow Department of Health, Aida Guseykhanova Gadzhigoroeva:

"Minoxidil (2,4-pyrimidine-6-(1-piperidinyl)-3-oxide) is a white powder, soluble in water, propylene glycol and ethanol, a vasodilator antihypertensive agent that, when applied topically, can slow or stop hair loss and stimulate new hair growth.

The era of minoxidil did not begin with the discovery of its unique property to stimulate hair growth. The drug began to be used in the mid-1950s as a regenerating agent in the treatment of gastric ulcers. Much later, after lengthy studies aimed at studying the hemodynamic effects of minoxidil in patients with hypertension, the inexorable side effect of hypertrichosis, including on balding areas of the scalp, forced researchers to seriously study the "side" phenomenon. Topical application of minoxidil on the scalp for the first time made it possible to realize a long-standing human dream - the ability to stimulate hair growth" (Clinical Dermatology and Venereology Journal, 2016; 15 (4): 96-101).

According to our expert, Doctor of Sciences Gadzhigorova A. G., in accordance with international standards for the treatment of AGA, minoxidil is prescribed externally to men in a concentration of 5%. To evaluate the effectiveness of the treatment, at least 6 months of regular use of the lotion twice a day are required (Blumeyer A1, Tosti A, Messenger A, Reygagne P, Del Marmol V, Spuls PI, Trakatelli M, Finner A, Kiesewetter F, Trüeb R, Rzany B, Blume-Peytavi U; European Dermatology Forum (EDF). Evidence-based (S3) guideline for the treatment of androgenetic alopecia in women and in men. J Dtsch Dermatol Ges. 2011 Oct;9 Suppl 6:S1-57).

“The efficacy and safety of 5% minoxidil foam applied twice daily for topical application was demonstrated in a study in men with AGA (35). A 16-week, randomized, placebo-controlled study using 5% minoxidil foam found that 70.6% of 180 patients with AGA experienced an increase in hair growth compared to 42.4% of 172 participants using placebo. The incidence of pruritus was 1.1% in the 5% minoxidil foam group, which was significantly lower than the 6% observed in an earlier study using 5% minoxidil lotion twice daily for 16 weeks (Olsen EA, Dunlap FE, Funicella T, Koperski JA, Swinehart JM, Tschen EH, et al. A randomized clinical trial of 5% topical minoxidil versus 2% topical minoxidil and placebo in the treatment of androgenetic alopecia in men. J Am Acad Dermatol 2002;47:377–85). Based on the results of these studies, the U.S. Food and Drug Administration (FDA) approved 5% minoxidil foam for use in men with AGA in 2006."

President of the Association "Professional Society of Trichologists",
Doctor of Science, Gadzhigoroeva A.G.

After topical application, minoxidil accumulates in the upper layer of the epidermis and then gradually distributes throughout the body. The half-life after cessation of topical application is 22 hours. When the drug is administered orally, the half-life is 1.5 hours. Minoxidil is excreted in the urine; 95% of minoxidil is eliminated within 4 days after application (Franz TJ Percutaneous absorption of minoxidil in men. Arch Dermatol 1985 Feb;121(2):203-6).

"In general, the use of minoxidil in AGA in some cases supports hair growth that is prone to fading, and is especially effective in the early stages of baldness. In the absence of such a powerful external stimulus as minoxidil, a sensitive follicle is unlikely to retain the ability to regularly convert the awned hair shaft. The cessation of the functional activity of the follicle inexorably leads to its morphological degradation: reduction and subsequent fibrosis. This is why regular use of minoxidil is an optimistic circumstance, since it helps to maintain hair density, including that which would not grow without minoxidil. Stopping treatment, voluntary or forced, will not lead to irreversible hair loss in AGA, but will only return them to their independent physiological fading - to inevitable regression, since the accelerated aging program embedded in the genes of sensitive follicles was not stopped, but only slowed down. And until science can change the vector of this program, until new drugs and technologies appear that allow follicles to be grown de novo or to replenish the potential of hair follicle stem cells, minoxidil will be an available drug capable of maintaining hair growth in AGA in patients with high activity of sulfotransferases in the cells of hair follicle bulbs."

Gadzhigoroeva A.G., Doctor of Medical Sciences, Head of the Department of Clinical Dermatovenereology and Cosmetology, State Budgetary Healthcare Institution “Moscow Scientific and Practical Center for Dermatovenereology and Cosmetology” of the Moscow Department of Health,
Chief physician of the clinic "Institute of Beautiful Hair",
President of the association "Professional Society of Trichologists".

Not all patients are immediately ready to make a decision about hair transplantation , so they can try therapeutic measures. However, medications have a list of contraindications. In addition, it is worth considering addiction and withdrawal syndrome.

"Cold infrared laser also has some positive effect. However, all these measures in many cases do not allow us to count on an impressive long-term result.

The most effective way to restore hair growth in AGA at the moment is modern hair transplantation . Modern transplantation technology guarantees hair growth for life. I have been performing hair transplantation for over 23 years and I can definitely say this. If the procedure is performed correctly, according to all international standards and technologies, the transplanted hair will outlive you."

A. Tsilosani - Doctor of Science, transplantologist,
author of two world records in hair transplantation.

Before and 12 months after hair transplantation (volume 1800 grafts, performed by A. Tsilosani)