Hair loss is a globally prevalent problem that restricts you from various hairstyles. Hair extensions and frequent hair cutting are helpful with hair loss.

I Don’t Have Less Hair, I Just Have More Head

Introduction

Who wants baldness? Except for some versatile actors in Hollywood, not everyone can pull that look off. Yes, I’m talking about Dwayne (The Rock) Johnson, Bruce Willis, Jason Statham, Sir Ben Kingsley, and Patrick Stewart! What did you think?

Understanding Male Baldness

Male pattern baldness or correctly termed as Male Androgenetic <a href="https://merisehat.pk/disease/alopecia" target="_blank">Alopecia </a>(MAA) is a common cause of progressive hair loss in men. 

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There are 2 types of hair we have on our body, vellus and terminal. Vellus is derived from the Latin language which means wool and refers to the thinner, not longer than 2mm hair that we have on our body, while terminal hair refers to the hair on our scalp. 

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In MAA, a gradual conversion of terminal hair to vellus hair takes place which completely denudes the scalp leading to baldness<a href="#accordion">[1]</a>. It&rsquo;s one thing to lose some of your hair due to androgens after puberty, which happens to almost everyone. But losing hair to alopecia is a whole other ballgame, or shall I say bald game? No pun intended.

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Studies show that the prevalence of <a href="https://merisehat.pk/disease/alopecia">alopecia increases</a> with advancing age. Apparently, hair loss is also a genetically-determined phenomenon. So, if your father lost hair, there is a high probability you will, too. Moreover, baldness is an important risk factor for both melanoma and non-melanoma cancers (squamous cell carcinoma and basal cell carcinoma) of the scalp (skin)<a href="#accordion">[1]</a>. 
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Around 30-50% of men develop MAA by the age of 50. MAA is more common in caucasian men. Black, Oriental, Native American, and African-American men face less extensive and late onset baldness than Caucasians. 

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According to a survey conducted in the USA, a 53% prevalence of moderate or severe MAA was observed in the participants who were between the ages 40-49. 

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Moreover, prevalence of MAA in Singaporean males was estimated to be 63%; it increased with age, from 32% at the age of 17-26 years to 100% after 80<a href="#accordion">[1]</a>.

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Each hair on your head has a growth cycle. However, with male pattern baldness, the growth cycle of hair weakens and the hair follicle reduces in size, giving rise to shorter, weaker, and finer hair. Eventually, the growth cycle ends and the only thing that grows is baldness. 
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According to the Hamilton-Norwood Scale or simply the Norwood Scale, there are 7 stages of the progression of male pattern baldness<a href="#accordion">[3]</a>:

Stage 1

There is no significant hair loss or recession of the hairline.

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Stage 2

Slight recession of the hairline around the temples is observed. This stage is also termed as an adult or mature hairline.

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Stage 3

Stage 3 is when the first signs of clinically significant balding are appreciated. The hairline is greatly recessed at both temples, resembling either an M, U, or V shape. There is hardly any hair left at the recessed spots. They are either completely bare or, in some cases, scantily covered in hair.

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Stage 3 (Vertex)

The vertex variant is termed when the hairline is at stage 2, but there is a significant hair loss on the top of the scalp, known as the vertex.

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Stage 4

In Stage 4, your hairline recedes more severely as compared to stage 2, and there is no hair left on the vertex. Characteristically, the two hairless areas are separated by a band of hair which joins the remaining hair on the sides of the scalp.

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Stage 5

The hairless area is larger in stage 5. Although they are still separated, the band of hair between them is narrower and dispersed.

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Stage 6

At the 6th stage, the balding areas at the temples join with the balding area at the vertex.

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Stage 7

This is the most severe stage of all. Only a band of hair going around the sides of the head is what remains. This hair is not dense and is a lot thinner than the normal hair. 
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There are a bunch of treatment options available for male baldness<a href="#accordion">[3]</a>. 

<h5>Over-the-counter</h5>

Usually, people use the over-the-counter options, after doing some research on their own. It&rsquo;s mostly one of the following two options:

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<ul>
	<li>Minoxidil </li>
</ul>

This is a pharmacological agent which is applied directly to your scalp. Minoxidil stops your hair from getting thinner. In fact, it can also stimulate hair growth on the top of the scalp.

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<ul>
	<li>Laser Devices</li>
</ul>

The goal of such devices (for example, brushes and combs) is to stimulate hair growth. It is important to mention that till date the effectiveness of these devices has not been proven within a clinical context.&nbsp; 

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<h5>Prescription Drugs </h5>

Drugs used to treat male pattern baldness include finasteride. Finasteride is approved by the U.S. Food and Drug Administration to treat men with characteristic hair loss. Studies show that it slows hair loss in about 88% of men and stimulates regrowth in about 66%.&nbsp;

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<h5>Medical Procedures</h5>

Medical procedures can also be performed to combat MAA. Some of the procedural modalities used are<a href="#accordion">[3]</a>:

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<ul>
	<li>Hair Transplantation</li>
</ul>

In this procedure, potentially healthy hair is removed and the hair follicles are then transplanted to the balding areas, ensuring growth in the balding areas. 

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<ul>
	<li>Scalp Reduction </li>
</ul>

Some parts of the bald scalp are surgically removed, and the parts of the scalp which have good hair growth are brought nearer. This procedure can also be paired with a hair transplant to maximize results.

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<ul>
	<li>Scalp Expansion </li>
</ul>

Scalp expansion is a procedure in which devices are inserted under your scalp for about 3-4 weeks in order to stretch the skin. This is done right before a scalp reduction. It could be used as an independent treatment as well.

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<ul>
	<li>Scalp Micropigmentation </li>
</ul>

Essentially, small tattoos are applied to the scalp in order to create an illusion of a shaved head. 
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According to a study consisting of 1,717 men with varying degrees of male pattern baldness, their hair loss caused them significant distress. It was deduced that people going through alopecia felt more worried and helpless, compared to people who did not. 

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Moreover, in a Korean study, balding men were naturally perceived as older and less attractive by more than 90% of non-bald men and women. 

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Some patients have reported to have intense emotional concerns about their hair loss<a href="#accordion">[2]</a>. This is evident by men reporting they spend hours every day, compulsively checking their scalp in the mirror. They dedicate a significant portion of their time in combing and re-combing their hair, which causes considerable social anxiety and depression. 

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Furthermore, increasing degrees of hair loss were linked to loss of self-esteem, depression, introversion, and neuroticism. According to NCBI, neuroticism is the trait disposition to experience negative effects, including anger, anxiety, self‐consciousness, irritability, and emotional instability. 
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In 2018, multiple Japanese research groups brought forth cases that portray a breakthrough in battling male pattern baldness. At Yokohama National University, scientists led by Junji Fukuda have now developed an experimental method for producing new hair follicles from your stem cells in much higher quantities than ever before. 

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In 2019, scientists at the Riken Centre for Developmental Biology launched the first ever clinical trial with hair follicles grown entirely from stem cells<a href="#accordion">[4]</a>. 
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Conclusion

Nobody likes baldness. However, as discussed above, males are looked down upon in a different fashion which leads to a disturbed mental state. Beauty standards for men and women have to become a trend to be considered as acceptable; which only adds on to the pain and anguish that bald people are suffering from. 

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It is important to be open to having different standards of beauty and also respecting these differences. Considering the negative emotions baldness generates, treatment for both the issues should be highlighted: for what is above the scalp and what is inside the head.&nbsp;&nbsp; 
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Key Points

<ul>
	<li>Male androgenetic alopecia (MAA) is a common cause of progressive hair loss in men.</li>
	<li>In MAA, a gradual conversion of terminal hair to vellus hair takes place which completely denudes the scalp leading to baldness.</li>
	<li>Studies show that the prevalence of alopecia increases with advancing age.</li>
	<li>Baldness is an important risk factor for both melanoma and non-melanoma skin cancers of the scalp.</li>
	<li>A study revealed that around 30-50% of men developed MAA by the age of 50.</li>
	<li>MAA is more common in Caucasian men.</li>
	<li>According to a survey conducted in the USA, a prevalence of 53% is considered moderate or severe MAA, and it is apparent in the participants between the ages 40 and49.</li>
	<li>Prevalence of MAA in Singaporean males was at 63%, which increased with age - from 32% at the age of 17-26 years to 100% after 80.</li>
	<li>With male pattern baldness, the growth cycle of hair weakens and the hair follicle reduces in size, giving rise to shorter, weaker and finer hair, and eventually causing baldness.</li>
	<li>In order to understand the progression of male pattern baldness, a scale was developed. It&rsquo;s known as the Hamilton-Norwood Scale or simply the Norwood Scale.</li>
	<li>According to this scale, there are 7 stages.</li>
	<li>OTC treatment includes laser devices and minoxidil.</li>
	<li>Finasteride is approved by the U.S. Food and Drug Administration to treat men with the characteristic hair loss.</li>
	<li>Studies show that Finasteride slows hair loss in about 88% of the men and stimulates regrowth in about 66%.</li>
	<li>Medical procedures to battle male pattern baldness include hair transplantation, scalp reduction, scalp expansion, and scalp micropigmentation.</li>
	<li>According to a study consisting of 1717 men who had varying degrees of male pattern baldness, their loss of hair caused significant distress.</li>
	<li>In a Korean study, balding men were naturally perceived as older and less attractive by more than 90% of non-bald men and women.</li>
	<li>Increasing degrees of hair loss were linked to loss of self-esteem, depression, introversion, and neuroticism.</li>
	<li>At Yokohama National University, Junji Fukuda led a team of scientists who have now developed an experimental method for producing new hair follicles from your stem cells.</li>
</ul>

[1] Cranwell W, Sinclair R. Male Androgenetic Alopecia. [Updated 2016 Feb 29]. In: Feingold KR, Anawalt B, Boyce A, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-.

[2] Aronson, J. K., & Ramachandran, M. (2009). The diagnosis of art: Van Gogh and male pattern baldness. Journal of the Royal Society of Medicine, 102(1), 32–33.

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