Looking at Male Pattern Thinning

Pattern thinning is a specific kind of hair loss that occurs gradually
over time. Both men and women can experience pattern thinning,
but they experience it differently. In men, pattern thinning some-
times goes by the scientific name androgenetic alopecia (ANA). You
hear a lot about ANA, as it’s the most common reason for hair loss
in men. Easily 98 percent of men who are balding have ANA.
Men with ANA usually first notice a thinning or receding hairline in
the front at a fairly young age. The pattern progresses to thinning
on the crown of the head that may slowly thin over a decade or
more. The pattern thinning process tends to begin during early or
mid-20s, possibly with some thinning in the teen years, but until
the thinning reduces the hair density by 50 percent most of it goes
unnoticed.
For the man with patterned hair loss, general areas thin but may
not become completely bald initially. Over many years, the hair
loss can progress to complete balding, but it’s also possible that
total loss of hair may not occur.
Male hair loss starts when hair shafts grow thinner in a process
called miniaturization. As fewer hairs remain after shedding starts,
men notice, especially in bright light, that their hair has a “see-
through” look. They generally start off denying what they are
seeing, and then eventually panic sets in.
Early evidence of pattern thinning
Because male pattern thinning is a genetic condition, a man who
comes from a family with many bald members is more likely to be
on the lookout for baldness symptoms than a man from a family
with full heads of hair. However, because of the nature of ANA,
genetics can play tricks on men.
In some families, balding isn’t transmitted to the offspring, while in
families with full heads of hair, the genes for balding may lie dor-
mant in one generation and then just appear in the next. All too
often, a young man can’t believe that he’s balding because he can’t
find relatives on either side of the family with balding; the reverse is
also true — a man with a full head of hair may see extensive balding
in his family line. It’s just a role of the genetic dice, we suspect.
Nine out of ten times, men first discover that they’re shedding
when their shower or bathtub drains get clogged with hair.
Regardless of details of the discovery, they may adopt a different
hairstyle to cover the signs of hair loss. Some men may abandon
combing their hair straight back and adopt a side-to-side combing
style that more easily hides thinning hair, continuing this sleight of
hand to a point when even this style doesn’t cut it. Some men just
comb their hair forward so that no one can see what’s happening
to the front of the head. Look at Rudolf Giuliani and John
McCain, who use comb-overs as their slight of hand that is not as
slight as they think.
Some men are all too aware of their family’s balding problem. They
may have teased their father or older brothers about their balding,
but it’s not so funny when it happens to them.
Those who look for signs of balding or thinning have the opportu-
nity to catch it early. Despite the drug company Merck’s promotion
of Propecia, many men are unaware that hair loss can be slowed,
stopped, or possibly reversed if they take this drug early enough in
the pattern thinning process. Treatment can be very successful if
the diagnosis is made when the hair loss first become evident,
hopefully before substantial thinning has occurred.
The only way to determine if you’re at the very beginning of the
balding process is to get your hair and scalp mapped out for minia-
turization, which is always present when the balding process
starts. Mapping requires the use of a video microscope, which
examines the hairs all over your head for miniaturization.
As experts in this field, we believe very strongly that if a man is
concerned that he may develop hair loss, he should see a doctor
to map the scalp hair for the frequency and distribution of minia-
turized hairs. Even early pattern thinning corresponds to the
balding patterns seen in the Norwood Classification Chart (see
Figure 4-1), so doctors can predict the eventual hair loss pattern
early on. Annual scalp hair mapping can detect the earliest signs
of genetic hair loss before balding can be detected by the naked
eye. It can also follow the benefits or lack thereof, of the treat-
ments for balding.
For men, the drug Propecia can be effective at stopping the balding
process or at least slowing it down. Unfortunately for women,
there’s no comparable drug other than Minoxidil, which works
only in a small percentage of women.