AGA-Male Pattern Baldness

Definition:  

Androgenetic Alopecia is commonly known in terms of  Male Pattern Baldness affecting male ones majorly causing the hair loss in very unique pattern like 'M' receding from frontal hair line to temporal and gradually reaches to vertex(crown) area.

Description:

 Basically Androgenetic Alopecia(AGA) related to male hormone Androgen and family Genes. And that's why the name itself suggests Androgenetic Alopecia.

So, it is only the 2 factors considered as etiological factors. First is Hormone & second is Genetics.

Statistics to Hair Loss:

-50 % of men become bald before their notice.

-9 out of 10 person said their main concern is hair loss.

-1 out of every 4 person has hair loss problem.

-40% of men will have hair loss at the age of 35.

-80% of women will have hair loss at the age of 60.

-47% of sufferer will spend their life's savings to get full hair growth.

-Hair loss problem becoming the leading problem in men as of now.

-In a survey conducted by International Society of Hair Restoration Surgery 80-85% men  adopt topical solution like Minoxidil or Regain and 10-15% take Finasteride or Propecia. Some remaining percentage of people take other mode of treatment like laser, herbal  etc.

History:

We know this male hormone with common name Testosterone and this hormone was first time made into light by James Hamilton who also classified Male Pattern Baldness into 7 stages.

He had observed in his life that people before the puberty and with natural castration did not go bald.Then he did an experiment with some men like 12 in number and treat them with Testosterone and kept an observation on them.Then he saw that 4 out of those 12 men developed Male Pattern Baldness.

Etiology:

Etiology mainly depends upon the 2 factors.

1) Male Hormone- Androgen

2) Family History-Genetics

1) Male Hormone-Androgen: As we know this hormone commonly by Testosterone. The major determinant of AGA is intra-cellular androgen metabolism which involves things.

a) Androgen metabolizing enzymes( 5a-reductase I & II)

b) Androgen receptor proteins.

Various levels of androgen metabolizing enzymes & androgen receptor proteins help to explain the difference between balding & non-balding men with at different stages and showing the different clinical patterns.

a) Androgen metabolizing enzymes( 5a-reductase I & II):-

   Both the enzymes I & II play very important role in AGA. Type I enzyme is found in sebaceous gland,epidermal & follicular keratinocytes,dermal papilla cells & sweat glands. And type II enzymes located in root sheath of hair follicles also found in epididymis, vas deferens,seminal vesicle, prostate and fetal genital skin.

Both the enzymes are in increased level in frontal area in compare to occipital area & very lesser in women. 5a-reductase I mainly acts in AGA and reduces the testosterone into dihydrotestosterone(DHT).Female has 3 times less 5a-reductase(I & II)  in compare to male and this is only reason female has less severe AGA in compare to male.

b) Androgen receptor proteins:-

   Androgen acts on tissues through a protein called androgen receptor protein. Androgen receptors after a change in conformation resulting into an activated form that binds with androgen specific element on the target genes.Then there is a formation of hormone-receptor complex.This complex now activates the transcription of target genes.

Androgen receptor proteins(AGP) are found in outer root sheath, dermal papilla & fibroblast of hair follicles.AGPs are more in frontal area in compare to ociput. 

2) Family History-Genetics:

   Genetic factor for AGA is believed to be autosomal dominant one from either parents like from father or mother.Genetic involvement for AGA is common in Caucassians, less in Africans, and least frequent in American Indians & Asians.

It has been seen that 50-60% balding men have bald father. But AR located in X chromosome and men inherit it from their mother so on this basis we can say balding is from mother rather than father but genetically there is no any evidence about it confirmation.

Pathogenesis:

Androgens influence many events in the genetically active hair follicles especially in fronto-parietal area turning terminal to miniaturized follicles.Then hair cycle is altered shortening the anagen phase happening over the many hair cycles.This shortening of anagen phase of hair cycle and miniaturization of hairs lead to decrease the scalp coverage with hairs. These deminiaturized hair of different lengths and diameters are the hallmark of AGA.

Histological Changes:

Dermal papilla is the target organ for androgen action because it plays an important role in hair growth regulation and it also determines the size of the hair follicles.In a study it had been seen that dermal papilla are cultured along with hair follicle cells showing that dermal papilla derived from balding scalp release a beta growth factor when incubated with testosterone,which acts a inhibitor of hair growth.

A perifollicular lymphocytic infiltrate around infundibulam & sebaceous are the features of AGA.

Horizontal section shows that diameter of central part of hair shaft is not much thicker as compare to inner root sheath.And out root sheath is 3-5 layer cells thicker.

Clinical Features:

Histogolical changes are same in Male Pattern & Female Pattern Baldness but clinical features would be different in Male Pattern Baldness & Female Pattern Baldness.

A-Male Pattern Baldness:

Following are the clinical features that we have observed & seen in clinics:-

1) There is a pattern baldness from fronto-parietal region.

2 Receding hair line from front to parietal & making an appearance of "M".

3) As it progresses, vertex area also involved.

4) This process may start very early after following the puberty and in some cases it may appear as diffuse one.

5) Hairs getting shorter & shorter & fine in texture and it left untreated, it very soon affects whole scalp except the the temporal side & ultimately complete hair loss done.

Now on this basis of progressive development James Hamilton classified MPT 7 stages.

6) Most of the cases start between 15-25 year of age and for many of them conditions stable for many years.

Peculiar Features:

Some of the persons may have only vertex hair loss more in compare to frontal area & these person may have a high risk of coronary heart disease because it has been found in a study that cholesterol level in balding men with vertex area than balding men with non-vertex area.

Men with AGA has higher chance of getting prostate cancer in compare to those men without AGA at around 60 years of age. Generally persons with any degree of baldness may have 1.5 times.

Management of MPT:

Management for AGA in men comes only on this basis like how this AGA affects that individual. As we had seen that AGA is affecting the individual on Psychological also because hair loss detaches person well-being socially.In our society balding men perceived as older personality & it affects the individual self confidence.Because of these problems person got in search of some solution like coping with hair styling and ultimately they could not reach to any end for AGA  because there is no any cure for AGA.

First of all, its very important to understand the patient what they expect from the treatment and what is the realistic results that opted treatment will give because until & unless you will understand this reality, you do not reach to a satisfied results. Any treatment patient opt for his hair loss, there must be sufficient hair to be acted upon.So,basically it depends on what stage of hair loss you have & if hair loss has moved to an advanced stage then only 2 options will there either surgery or wig. Any treatment for hair loss basically has two options-

1) Hormone Modifiers- 

   Hormone Modifiers has an endocrine effect & act by blocking androgen or 5 alpha reductase, which includes Finasteride, Dutasteride, Androgen receptor protein inhibitor(ARP Inhibitor)

2) Biological Response Modifiers-

   Biological Response Modifiers has a non-endocrine effect & act by affecting the follicular hair cycle, which include Minoxidil.

1) Hormone Modifiers- 

Finasteride:

Finasteride is an specific inhibitor of type-II 5 alpha reductase which is an enzyme that converts the Testosterone into Dihydrotestosterone(DHT).There is no any hormonal property in finasteride itself and estrogenic,non-estrogenic & progestational effects. It blocks the peripheral conversion of Testosterone to Dihydrotestosterone by inhibiting the above mentioned enzyme and resulting in decreased concentration of DHT. 

FDA first time approved its usage in USA on 1997 with 1 mg/day in men having diagnosed with AGA.

There are some side effects also that we can not neglect like 2% cases on the sexual level.

Dutastaride:

It is an inhibitor of both type-I & type-II 5 alpha reductase enzyme which is responsible for conversion of Testosterone to DHT in prostate only and there is high accumulation of DHT causing hyperplasia.

Just like Finasteride it also has side effects on sexual level but some others too like headache , dizziness,throat infection,malaise,erectile dysfunction etc.

ARP Inhibitor:

This ARP Inhibitors decrease both Testosterone & DHT by binding with receptors. These are indicated only for females not male due to impotence , decreased libido,gynacomaastia & feminization.

2) Biological Response Modifiers-

 Minoxidil:

Minoxidil was mainly developed for hypertension as an anti-hypertensive drug but due to its hypertrichosis a topical solution was developed to treat hair loss.And a fact also is there, no exact mechanism of its action is still known because neither it has a hormonal effect nor immuno suppressant effect. 

Basically it increases the duration  of anagen resulting in enlarging miniaturized hair follicles.In 1988 Minoxidil was first time approved by FDA as 2% solution usage and then 5% solution in 1997 for men being diagnosed with AGA but 5% solution was not approved by women even after it was & is being prescribed by dermatologist world wide for many years.

Medical Treatment:

As I always say, there are many modes of treatment available in our great country India for any kind of diseases.

But people mostly prefer to take from Old School of Medicine(Allopathy) as their first choice and when some percentage of them do not get any satisfied results , they would take a move to other options available in medical field.

Yes, here we are talking about the world's 2nd largest practising system of medicine called Homoeopathy.But it does not mean that you should not take Old School of Medicine in your first choice because here I am just expressing the people's thought that I have been seeing in my day to day practice.

Homoeopathy has a great scope for treating the every kind of disease for last 200 years. And had been giving the wonderful satisfied results so AGA can be also treated & managed very well in Homoeopathy.But yes, it does not mean that you would get hairs back in your bald area of scalp.

If other health conditions is not a cause,medical treatment is not necessary. 

Medically there are many treatments available in market as of now with different names as per the different company establishments but motive of  all those treatments available in the medical field is only to give a better coverage of scalp.

Following ones you may opt for your hair loss after getting suggestion from a Trichologist. So, before opting any kind of treatment you should have a proper consultation with Dr.

I am going to give a brief idea of some treatments that are as of now in lime light.

1)Surgery:

  Surgical treatment for male pattern baldness is to cover the bald scalp by the way of hair transplantation.So, basically hair transplantation is the surgical procedure in which  surgeon transplants healthy hair follicles from donor area(back of scalp) to recipient area(front to vertex).

Surgical treatments give the satisfactory results to the patients as per their desire but after careful selection of patients as per their scalp conditions. 

Male Pattern Baldness is a progressive disorder so decision for hair transplantation should be taken into consideration of present as well as future area of involvement.Ideally hair transplant should be done in hair bearing area not the complete bald area so we should not wait until the whole area become bald for hair transplantation.

2) Non-Surgical:

   Where surgical procedure is not possible then we may think of what to do now and then Non-surgical comes to our mind.

Its a not a new thing that we heard now its a  Wig or Toupee that had been used for many years.Men & women might have been using Wig or Toupee to hide their baldness.Hair extension or weaving did not get much importance as they can be easily spotted out from far. 

3) Hair Thickening Fibres:

    Hair thickening fibres are keratin micro-fibres which blend with your hair & scalp. They are applied by sprinkling over the scalp and slowly combing of hair will spread in all over the applied area to give the coverage look.It stays on your scalp until & unless not washed out with shampoo.

4)Natural DHT Blockers:

Inspite of above mentioned options available in the market there are something which related to natural & herbal preventing the hair loss to give satisfactory results at some level.

Followings are the same that we may try to combat with AGA naturally.

a) Sabal serrulata:

Its a native plant of North America growing primarily in atlantic coast of Georgia & Florida.Its active ingredients are found in black brown berries. Sabal serrulata is also popularly used in hair loss.

b) Pygeum:

The active constituent of Pygeum is Phytosterols which inhibit the DHT production.Basically Pygeum reduces the DHT level in blood & ultimately decreases the sites where DHT attaches.

c) Pumpkin seed Oil:

It generally inhibits the DHT formation by affecting the 5 alpha reductase.Inhibition of DHT formation is helpful for hair growth if related to age related hair loss.

d) Green Tea:

Green tea is an extremely anti-oxidant & since has been used for that reason mainly but it also reduces the DHT & Cholesterol.In some studies it is found that drinking green tea can stop hair loss.Green tea has flavonols & such substances which has been found to have anti-oxidant,anti-inflammatory & anti-microbial properties.

e) Soy isoflavons:

Cholesterol can produce the 5 alpha reductase enzyme and we know that enzyme converts testosterone into DHT and this DHT is responsible for hair loss.Soy isoflavons are beneficial as the seem to regulate the bad cholesterol so it basically has DHT blocking properties.

Soy also has other health benefits like bone maintenance,hormone regulation in women.It is specially a good DHT blocker for women as it has advantage of reducing breast & uterine cancers.

 

So, this is all about Male Pattern Baldness as per my best of best knowledge. For any concern kindly inbox me and will ev happy to clear your valuable concern.

  

                                            *HaveGoodHair & LiveGoodLife*