Hi everyone, and welcome to The Hair Loss Show, Episode number two. Today, we’re going to discuss the most common form of hair loss in men, which occupies a major part of the market for hair loss treatments: Male Pattern Balding.
So, what is Male Pattern Balding? The word “pattern” refers to the fact that the hair loss primarily occurs on the upper scalp. It is very common around the world. Over 50% of men will experience Male Pattern Balding at some point in their lifetime. While it’s often seen as part of aging, it causes a lot of distress, particularly for younger men who seek advice urgently to delay or stop the onset of hair loss.
This condition typically begins after puberty, and there’s a reason for that. As Russell mentioned, Male Pattern Balding is something we see every day in our practice. It occurs in a predictable pattern, which is why it’s called Male Pattern Hair Loss. There are several factors that contribute to this condition, some of which we can control, but most of them are beyond our control. The primary factor is genetics.
We know that a number of genes control the process of hair thinning and, ultimately, hair loss. So, Male Pattern Balding is essentially a genetic condition.
Currently, we’ve identified a couple of major genes that are responsible for Male Pattern Baldness, but they account for only about three-quarters of the balding population. We haven’t yet cracked the full genetic puzzle. There may be other genes yet to be identified. People often ask why we can’t simply “switch off” the genes responsible for hair loss, similar to how gene therapy is used for other conditions. The reason we can’t do this right now is that we don’t know enough. If the genes we’ve identified also control other functions that we’re not aware of, turning them off could have detrimental health effects. So, gene therapy for Male Pattern Balding isn’t on the horizon just yet.
It’s also important to note that there are likely other genes we haven’t identified yet that contribute to the condition.
Another common misconception is that people don’t always realize Male Pattern Balding is genetic. Many patients think there are other causes for their hair loss. There are a lot of myths that circulate, so let’s address a few of the common ones.
When patients come in, they often say, “I hear washing my hair every day causes hair loss,” or “Wearing hats restricts blood flow to the scalp, causing hair loss.” These myths are widespread. We also hear more credible-sounding myths, such as “I heard hair loss is inherited only through the mother’s side of the family.” The truth is, in some families, it may appear to be more common through the mother’s side, but we can show just as many cases where it’s passed down from the father’s side. The reality is, it’s a bit like rolling the genetic dice. You inherit genes from both your mother and your father, and you roll the dice to see what you get.
In my family, for example, my father was bald, my elder brother was bald, but I’m not bald, and my younger brother isn’t bald either. I’ve never been on therapy and likely never will need it. It’s just a hit and miss situation.
In contrast, my father is bald. I’m an only child, so I didn’t have any other siblings to compare to. But genes are something you’re stuck with. You’re dealt the hand you’re given, and that’s one of the things you have to contend with.
So, the first factor we discussed is genetics. The second major factor is male hormones.
Male Pattern Balding was first linked to male hormones in the 1940s when scientists synthesized Testosterone, the principal male sex hormone, in the laboratory. They injected it into men who had underdeveloped or injured testicles and discovered that many of these men started to lose hair on their upper scalp. This was the first time the connection between male hormones and hair loss became apparent.
In fact, I read that Aristotle documented that eunuchs, who had no Testosterone, didn’t go bald. That was a very insightful observation for his time, even though many people still don’t fully accept it, which is why some funny therapies like rubbing crocodile dung on the scalp emerged over the years. There were also attempts using onions, potatoes, and oils to prevent hair loss. But the truth is, you need a combination of genetics and the male hormone Testosterone for Male Pattern Balding to occur.
Now, what Dr. Vikram is going to show you is what happens at the level of the hair follicle. To be clear, men who are going bald do not have higher levels of Testosterone in their blood than men who are not balding. This is a common myth. What happens in the hair follicle is what matters.
For Male Pattern Hair Loss to occur, you need the gene, as we’ve discussed. The second step involves a chemical reaction at the hair follicle. Testosterone in the follicle is converted into another form called Dihydrotestosterone (DHT). There’s an enzyme called 5 Alpha Reductase that causes this conversion. If you have high activity of this enzyme, you’ll convert more Testosterone into DHT. The presence of more DHT, along with the genetic predisposition for hair loss, affects the hair follicle, leading it to undergo a process called miniaturization.
In the early stages of Male Pattern Balding, the hair starts off thick, but under the influence of DHT, it falls out over time. In its place, a thinner hair grows back, and each subsequent hair growth cycle produces an even thinner strand. Eventually, the follicle shrinks so much that it can no longer produce any hair, resulting in baldness.
Interestingly, the amount of the enzyme 5 Alpha Reductase varies across different follicles on the scalp. This explains why Male Pattern Balding doesn’t follow a consistent pattern in every person. For example, the hairs in the upper part of the scalp tend to have higher levels of the enzyme, while the hairs at the back of the scalp have lower levels. This explains why some men may have significant baldness on the top of the head but maintain a rim of hair around the sides and back.
What’s even stranger is that, below the eyebrows, DHT actually stimulates hair growth. This is why men often experience increased body hair as they get older. So, while the scalp becomes balder, other parts of the body get hairier. It’s a paradox from the same hormone—truly fascinating.
Now, you might be wondering, why should you care about this mechanism if you’re going bald? Well, this is where the psychological impact comes in. The general perception is that losing hair from the upper scalp is part of the aging process. If it happens early, people feel they are aging prematurely and looking older than they actually are. For young men, this can be particularly distressing because they want to present themselves as youthful, vital, and healthy, especially when they are out in the social environment looking for a life partner. They don’t want to look 10 or 15 years older than they really are.
This psychological impact isn’t limited to younger men. Older men also express dissatisfaction with their appearance and report feeling less confident. Interestingly, when we discuss therapies for hair loss, nearly all of our patients say that if we can improve the amount of hair on their head, it gives them a significant boost in self-confidence. It’s not about vanity; it’s about self-confidence.
Finally, it’s important to note that Male Pattern Balding is an ongoing process. It happens in a predictable pattern, but what we don’t know is where it starts or where it will end. For some men, it starts at the front and progresses backward. For others, it may start at the crown and move forward. In some cases, it can start at both the front and the crown, meeting in the middle. We don’t know where it ends, either. For some men, the end point may just be some thinning in the front, while for others, it may result in a completely bald scalp.
The challenge for us as doctors is that we can’t predict where the hair loss will stop. However, what we do know is that the earlier someone presents with significant hair loss, the more likely they are to experience further progression.
A hundred years ago, men had an average lifespan of around 60 years. Today, it’s closer to 83 or 84 years. That’s an extra 25 years of potential balding. As a result, Male Pattern Balding is becoming increasingly common due to longer life expectancy and the natural progression of hair loss. So, it’s not going away anytime soon.
I hope this episode helps explain some of the basics behind the biology of Male Pattern Balding. In our next episode, we’ll discuss therapeutic options for dealing with hair loss.
Thank you for listening to today’s show. If you are experiencing hair loss, please make sure to seek the advice of a professional medical practitioner. While this podcast is a useful tool for raising awareness, it’s essential to be on the right track with proper guidance. We’ll see you in the next episode!
