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Male pattern baldness is dependent on the interaction of
three factors: age, a genetic pre- disposition, and male hormones.
This hair loss may begin as early as the teenage years and gradually
worsens with time. (1) The male hormone, testosterone, is converted
to another male hormone, 5-DHT, in the hair follicles. In genetically
susceptible men, the hair on the front and top of their scalps tends
to miniaturize (become more fine and not grow as long) over the
years under the influence of 5-DHT. Eventually, this hair will completely
disappear, leaving a balding pattern behind.
 Figure
1-2. The incidence of cosmetically significant male
pattern hair loss (types III, IV, V, VI, and VII) increases
steadily with age and is represented by a solid line. The
incidence of hair loss characterized by only a remaining horseshoe
fringe of hair (types V, VI, and VII) is depicted by the dotted
line. The significance of this is that once hair loss begins,
it does not stop. It progresses through life. |
 Figure
1-3. During male pattern baldness, the original hair
slowly miniaturizes, moving slowly through progressive cycles
becoming more fine and unable to grow as long until it eventually
disappears. |
It is critical for patients to be certain that they are dealing
with male pattern baldness if they are losing hair. A visit to the
dermatologist is warranted if they are not absolutely certain.
Alopecia areata is a fairly common form of hair loss in which the
hair falls out in small coin-sized spots anywhere on the scalp.
Severe forms rarely progress to complete hair loss. This is a medical,
not a surgical problem, and it should not be treated with transplants
unless it has remained stable for many years. Even then, the transplanted
hair will likely fall out if the disease is reactivated.
Various primary dermatologic diseases can affect the scalp, leading
to hair loss due to scar formation. Treatment is aimed at medical
control of the disease. If the disease remains under control for
years, transplants can be considered for the scarred areas, but
just like with alopecia areata, if the disease returns, that transplanted
hair could be lost.
Rarely, patients will actually pull out their own hair. This condition
is known as trichotillomania. In adults, it is usually seen in the
setting of psychological problems such as anxiety, depression, or
frank psychosis. Again, this can be treated with transplants, but
it is not uncommon for patients to relapse and begin pulling out
the hair again.
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