Male hair loss | Hair Loss

Male hair loss

Male hair loss (male alopecia androgenetica) is the cause of 95% of all male hair loss. It is both genetically determined and influenced by age. It is based on an increased sensitivity to male sex hormones (androgens).

As more than half of the men in Europe (60-80%) suffer from this more or less pronounced hair loss, it is not considered a disease as such. Therefore, health insurance companies do not cover the costs of treatment. Clinically, there are four different types of hair loss: In grade I, the typical receding hairline is visible, to which a tonsure (hair shearing) (grade II) on the back of the head is added in the further course.

Due to hair loss on the vertex, these areas join together (grade III) and finally a horseshoe-shaped crown of hair remains from the sides of the skull to the lower back of the head. Hair growth in the hairy areas is normal and sharply demarcated from the bald areas, which shine through the still intact sebum production. The processes involved are not yet fully understood.

However, probably a hypersensitivity of the hair follicles to the active form of the hormone testosterone (dihydrotestosterone, DHT), which is produced in the hair follicles, plays an important role. This causes a shortening of the growth phase (anagen phase). As a result, the hair growing from the affected hair follicles becomes smaller and finer until it falls out directly.

The corresponding hair follicles atrophy, so this process is not reversible. However, not all hair follicles become hypersensitive to DHT at the same time, which is reflected in the time course of the loss (grade I-IV). The hair follicles above the ears and at the back of the head usually remain largely insensitive and the hairs remain standing.If an insensitive hair follicle is transplanted from the side into a bald spot on the forehead, hair will grow there again.

The degree of sensitivity and thus the degree of hair loss is also variable. Temporal course and development are genetically predetermined by previously unknown genes, but are inherited to a variable extent. In order to estimate the probable course of hair loss, a comparison of hair density between father and son at the same age is useful.

Environmental influences, such as wearing a headgear or frequent combing, do not play a role due to the strong genetic component. Also the often suspected connection with stress is not true. A change in diet or cosmetic products have only a marginal effect on hair loss.

The level of testosterone in the blood, which is slightly increased, for example, by frequent sexual intercourse, hardly influences hair loss. The hypersensitivity of the affected hair follicles is already so great that the normal testosterone level is sufficient for hair loss. A slight increase no longer has any additional effect. The only drugs for which an effective influence on hair growth is currently sufficiently proven are finasteride (tablet) and minoxidil (tincture). Especially with finasteride, however, the side effects should be considered and weighed up.