Male (and Female Pattern) Baldness

Male pattern baldness is a hereditary condition in which fewer new hairs grow to replace those that shed. It is passed down from generation to generation in our genes. Male pattern baldness can be inherited from the father or the mother. The gene that causes male pattern baldness was identified in 2008, raising hopes that a cure may be found in the not too distant future. Drug companies are currently spending billions trying to discover a cure. Male-pattern baldness is the commonest type of hair loss. Its medical name is androgenic alopecia.
As well as affecting men, it can sometimes affect women (female-pattern baldness). It affects about one third of the population. It can start early, sometimes in the teens and early 20s. Pattern baldness only affects the scalp; it does not affect hair on other parts of the body.

Male pattern and female pattern baldness is caused by hair follicles becoming oversensitive to the hormone dihydrotestosterone (DHT), which is made from the male hormone testosterone. The follicles react to DHT and eventually shrink. The hair becomes thinner and grows for a shorter length of time than normal. The balding process is gradual because different follicles are affected at different times.

Treatment for male pattern baldness

There is no cure for male pattern baldness however there are some treatments which can slow down its progression or stimulate hair growth. Examples include minoxidil, tretinoin and zinc (which I will discuss again in my blog).

A low dose of a drug called finasteride can prevent hair loss and cause re-growth in male pattern hair loss. It works by stopping the conversion of testosterone to dihydrotestosterone (DHT). The strength of finasteride used to treat male pattern baldness approximately 1.25mg which is not available in Ireland. Finasteride 5mg tablets are only available in Ireland and is licensed to treat benign prostatic hyperplasia (enlarged prostate) in men. The brand Propecia^® is available in many countries such as the UK and US. Propecia^® contains finasteride 1mg and is specifically licensed to treat male pattern baldness; however it is not available in Ireland. Therefore, consultants in Ireland prescribe finasteride 1.25mg as an unlicensed indication for male pattern hair loss and pharmacists split the 5mg tablet in quarters so the patient has the correct strength (1.25mg). There is a good success rate from finasteride with about 2 out of 3 men experiencing hair re-growth. One in three men experience no hair growth from finasteride however it does stop further hair loss. It can take up to 6 months to notice results from finasteride and up to 2 years for full hair growth. Side effects are rare at the low dose used for male pattern baldness but it can cause loss of libido (sex drive) in about 2 in 100 patients. It should not be used by women. Because finasteride is not licenced at a low dose in Ireland, a specialist will only prescribe the low dose version if he/she feels the benefits outweighs the risks.

Techniques such as hair transplantation, scalp flaps, and other procedures may be considered. Success rates vary, specialist advice is needed if surgery is considered and they are generally expensive.

Disclaimer: Information in this article is general; consult with your healthcare professional before making any changes recommended.

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By Eamonn Brady MPSI, pharmacist and owner of Whelehans Pharmacy, 38 Pearse St, Mullingar