Male Pattern Baldness


This article is published for general information. Professional advice should be sought.


Androgenetic Alopecia 'AGA' (termed Male Pattern Baldness). This familiar permanent baldness located within the hat line in males is associated with the conversion of the androgen testosterone into dyhydrotestosterone (DHT) by the enzyme 5 alpha reductase. This is a multi-factorial condition in which genetic predisposition + DHT are the key factors in initiating a cyclical reduction of the anagen (hair growing) phase with progressive miniaturisation of follicles and their encumbent hairshafts. Follicles effectively 'shrink' and eventually produce only fine vellus hairs.
In some patients, regional hair characteristics change also. Previously long straight hairshafts at the scalp’s occipital and auricular margins become short wavy and wirey - similar to beard/pubic hair.

Caucasoids have a higher susceptibility than Afroids or Mongoloids.
The Eunuch (post-pubertal castrated male) does not usually suffer this form of alopec although exceptions have been recorded which may be associated with the inter-follicular presence of the enzyme 3 alpha-hydroxy-steroid-dehydrogenases.

Over the years, many ‘treatments’ for this condition have emerged. Indeed rarely full a year passes without the announcement of more 'miraculous hair re-growth pills/potions/gadgets'.
To date the best have been less than edifying, the majority have been a con.

However science moves on and we live in hope that the next 'cure' will be effective.

Research is currently reconsidering the existing anti-androgen medication Spironolactone administered topically.
This drug possesses the following properties:
It is a potent anti-androgen but does not apparently interfere with proper testosterone levels.
Applied topically it does not have systemic side effects.
It is a potent competitive inhibitor of DHT at receptor sites and therefore effectively prevents DHT from attaching to the receptor sites in the hair follicles.
It is anticipated that follicular anagen will increase allowing terminal hair growth to resume without decreasing the circulating levels of DHT.

Current Treatment Options:

Medicines which may assist some people - not everyone !
I) Finasteride (Propecia(TM) ).
2) Minoxidil (Regaine(TM)).
3) Dutasteride (Avodart™).

Hair Redistribution Surgery performed well remains a practical option.

This surgical redistribution of scalp hairs currently offers the best overall prospect for patients fortunate enough to have generous numbers of donor hairs
Surgically implanting the individual's 'cloned' hair follicles will be an option within a few years.

Hair Restoration Surgeons are listed on this website. Please go to Hair Consultants (title bar).
Graduate Trichologists who may be consulted for an independent opinion are also listed. Please go to Hair Consultants(title bar).

Wigs and hairpieces are a viable and sometimes the only option. Care should be exercised in the selection of a supplier. The Society has a limited list of reputable suppliers to date.

The Norwood-Hamilton Scale (categories numbered 1-7) is used below to describe the level of development of MPA.

AGA (Male pattern hair loss) may or may not travel through each of these stages, the development may cease at any time.


Norwood-Hamilton Scale


Bonafide medical specialists with appropriate reputation are invited to apply for membership of The Society and listing on these web pages This email address is being protected from spambots. You need JavaScript enabled to view it.


© Prof. B Stevens FTTS  Contact the author

The President 2016-2018

Dr Janet Palin


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