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Hair is an important structure cosmetically. It forms the framework of the face, how we look is largely decided by the appearance of hair.

• Hair loss causes significant psychosocial problems and impacts the men.

• Fall of hair up to 100 per day is a natural phenomenon, but when these hairs do not grow again because of some reason, it results in baldness.

Male pattern baldness, also called androgenic alopecia, is the most common type of hair loss in men.

Androgenic alopecia is seen in both men and women. The hair loss in men is often faster, earlier onset, and more extensive. Male Pattern Baldness is a genetic condition that can be passed down from either side of the family tree. Combination of hormones and heredity (genetics) is needed to develop the condition.

The androgens have many functions, including regulating hair growth. Each hair on your head has a growth cycle. With male pattern baldness, this growth cycle begins to weaken and the hair follicle shrinks, producing shorter and finer strands of hair. Eventually, the growth cycle for each hair ends and no new hair grows in its place.

Causes of Hair Loss /Alopecia in Men –

There are various reasons of hair fall, some important one is as follows-

• Androgenetic –

This is the most common cause of hair loss in men. Men carry genes for hair loss from either or both parents. Testosterone hormone activates the genetic sequence which is responsible for hair loss. The age of onset, rate of fall and grade of baldness also depends on some other factors and may be different in different persons.

Other causes are severe illness, Malnutrition, Vitamin deficiency, improper lifestyle, stress and pollution.

Male Pattern Hair Loss (MPHL)

Male pattern Hair loss is an inherited condition. It can be there even if Androgens level are in normal range. It is aggravated if genes for baldness are inherited from mother or father. In men who develop MPHL, the hair loss may begin any time after puberty. The severity of MPHL increases with age and is a progressive condition. The clinical appearance is typical first thinning starts, the recession of temporal area followed by hair loss in the crown.

Treatment of MPHL –

To prevent or decrease the rate of hair fall medical treatment is a must. But for a lost hair transplant is needed.

US FDA approved Medical Treatment for men is-

• Finasteride 1mg Per Day –

It prevents the effect of Hormone DHT on the hair by blocking the enzyme 5 alpha reductase. It takes a year to show its result. Side effects of finasteride are rare and reversible. For more detail you should consult your doctor.

• Minoxidil 5% –

It promotes hair growth by increasing the duration of hair follicle growth cycle (Anagen). It is most effective if applied twice a day on the scalp. It takes 6-12 months before results are visible.

• LLLT –

Low light laser therapy is also useful for hair growth. It works by photobiomodulation at the cellular level.

The FDA approval of oral finasteride and minoxidil for treatment of androgenic alopecia.


The exact mechanism by which minoxidil works is not known, but the drug is felt to increase the duration of the hair follicle growth cycle (called anagen). This improves the quality of the hair by increasing the diameter and length of fine, miniaturized hair. Minoxidil is most effective if applied to the scalp twice a day. The medication only works if it is in direct contact with the scalp (not the hair) and only works in areas where it is applied. Therefore, it is important to use the medication in the front part of the scalp if this is an area of thinning. When using minoxidil, it may take 6‐12 months before any results are seen. The majority of patients who see an effect from minoxidil experience a decrease, in the rate of hair loss. The drug also serves to thicken already existing hair, but most patients who do have results, grow only short, thin fuzz hair. It will not grow any new hair on a bald scalp. If minoxidil is discontinued, the effects of the drug wear off within three months and the previous pattern of hair loss resumes. When minoxidil is restarted, one generally does not regain the hair that was lost, so it is best not to stop and start the mediation, but to use it regularly. It is sold in concentrations of 5% for men and 2% for women. Only the 2% concentration of minoxidil has been approved for use in women.

Female patients are generally more sensitive to the side effects of minoxidil in decreasing blood pressure (hypotension) and may get light headache from the medication. Women also have an increased risk of developing allergic skin reactions (contact dermatitis).


Male pattern baldness or androgenetic alopecia is caused by the effects of the male hormone dihydrotestosterone (DHT) on genetically susceptible hair follicles that are present mainly in the front, top, and crown of the scalp (rather than the back and sides). DHT causes hair loss by shortening the growth (anagen) phase of the hair cycle, causing a decreased size or miniaturization of the follicles. The effected hair becomes progressively shorter and finer until it eventually disappears. DHT is formed by the action of the enzyme 5‐alpha reductase on testosterone. Finasteride is a drug that works by blocking the enzyme 5‐alpha reductase Type II that converts testosterone to dihydrotestosterone (DHT) in the hair follicle. Finasteride decreases both scalp and blood levels of DHT and its effect is felt to be related to both of these factors. Finasteride 1‐mg/day decreases serum DHT levels by almost 70%, it can hold on hair at any age, but works best to re grow hair in those who are younger. Occasionally we see patients in their 50s re‐grow some hair with finastride, but this is the exception rather than the rule. The benefits of finasteride will stop if the medication is discontinued. Over the 2‐6 months following discontinuation of treatment with finasteride, the hair loss pattern will generally return to the state that it would have been if the medication had never been used. Of course, if there is no hair in the area at all, the medication is not going to work. Since finasteride takes up to a year or more to exert its full effects, in either re‐growing hair or preventing further hair loss, patients must take finasteride for one year, or longer, before its effects can be accurately assessed. During the first six months, one may note some thinning of ones existing hair as the new growing hair replaces the miniaturized hair, so it is important to be patient during this period.

Side Effects

Side effects from finasteride at the 1‐mg dose are uncommon, and fortunately reversible. Of men taking finasteride 1mg, 3.8% experienced some form of sexual dysfunction verses 2.1% in men treated with a placebo. Finasteride and minoxidil work synergistically since their mechanisms of action are different. Minoxidil stimulates the hair follicle directly, but finasteride permits hair growth by blocking the negative effects of DHT.