MALE PATTERN HAIR LOSS (MPHL)
DR. LEON ALEXANDER
Specialist Plastic SurgeonUniversal Hospital, Abu Dhabi
The terminology used to describe pattern hair loss in men and women has been inconsistent and now there is a consensus that pattern hair loss that physicians come across in their practice is actually more unpatterned and irregular and depends more on individual factors, genetic factors and environmental influences.
Although androgenetic alopecia(AGA) is an appropriate term for use in men to describe patterns of hair loss in men but now it has been shown that men with normal levels of androgens also suffer from baldness and hence it is more appropriate to use the term male pattern hair loss (MPHL).
The androgen receptor gene has been widely associated with MPHL and now it has been shown that androgens, genetic factors and environmental or exogenous factors(non-androgenic factors) all work together to produce this recognized clinical hair loss pattern.
Hair loss can be due to androgens, genetics, nutritional, micro inflammation and disruption or deregulation of hair growth cycles. Apart from androgens many more factors affect hair growth - stress, pollution, nutrition, lifestyle, prolonged illness, medications, metabolic disease, smoking, alcohol, which disrupt or deregulate the hair growth cycles, have been associated with hair loss, thinning and poor growth. These factors affect the hair growth directly and also make the hair roots more sensitive and susceptible to the action of androgens.
Classification systems of MPHL
The standard classification used for description of hair distribution in MPHL is the Norwood-Hamilton scale.
The categories are as follows:
Norwood-HamiltonType I: The Juvenile Hairline, AKA the Reagan
There is minimal or no recession of the hairline. Norwood one is often regarded as a “juvenile” hairline, even though it may indicate slight recession along the hairline corners; those corners often have a “rounded” appearance.
Norwood-Hamilton Type II – The Mature Hairline
There are triangular, usually symmetrical, areas of recession at the frontotemporal hairline. Their hairline corners will also recede, creating a v-shaped pattern of sorts. This maturation is usually not considered to be a form of male pattern baldness.
Norwood-Hamilton Type III - The First Stage of Balding
This represents the minimal extent of hair loss sufficient to be considered as baldness according to Norwood. There are deep symmetrical recession at the temples that are bare or only sparsely covered by hair. In type III vertex, the hair loss is primarily from the vertex with limited recession of the frontotemporal hairline that does not exceed the degree of recession seen in Type III.
Norwood-Hamilton Type IV - Further recession, with a growing bald spot
The frontotemporal recession is more severe than in type III and there is sparse hair or no hair on the vertex. The two areas of hair loss are separated by a band of moderately dense hair that extends across the top. This band connects with the fully haired fringe on the sides of the scalp.
Norwood-Hamilton Type V
The vertex hair loss region is still separated from the frontotemporal region but it is less distinct. The band of hair across the crown is narrower and sparser and the vertex and frontotemporal regions of hair loss are bigger. The bridge that separates the two balding areas starts to deteriorate.
Norwood-Hamilton Type VI
The bridge of hair that crosses the crown is gone with only sparse hair remaining. The frontotemporal and vertex regions are joined together and the extent of hair loss is greater.
Norwood-Hamilton Type VII - The Classic Horseshoe
The most severe form of hair loss and only a narrow band of hair in a horseshoe shape remains on the sides and back of the scalp. This hair is usually not dense and may be quite fine.
Verdict: The Good news and the Bad news
Less common patterns of alopecia in Men
There are usually two types of patients which transplant surgeons encounter that fall outside of the Norwood classification.
1. Those in which a generalized thinning occurs.
2. Those in which hair persists within a single zone in spite of nearby hair loss.
Diffuse patterned alopecia
This pattern resembles the common Norwood scale but involves thinning without true balding.
Diffuse unpatterned alopecia(DUPA)
This pattern shows a general thinning usually of the entire scalp, though frequently more severe in the vertex and frontal regions.
Persistent frontal forelock
This pattern can occur in combination with any pattern of balding but retains at least medium density in the mid-frontal forelock region.
Persistent frontal fringe:
This pattern presents as total or neat total preservation of the frontal fringe with significant thinning or balding occurring behind.
Verdict: The Good news and the Bad news
The first two grades of hair loss (Norwood 1 & 2) don’t require any treatment.
Norwood 3 is a normal receding hairline which is hard to spot and does not actually require any treatment; in fact, it can look quite fashionable to sport a receding mature hairline, but if you are conscious about it you can opt for medical therapy and if that has no effect, can always go for hair transplants to “fill in the gaps".
The other advanced degrees of hair loss (Norwood 5 to 7) are also amenable to therapy but will require body and beard hair transplants and these also depend on individual patients.
The bad news is that advanced degrees of hair loss (Norwood 6 & 7) are not easy to treat with very few donor hairs available and such men may have to live the rest of their lives being bald.
But here’s the good news: this is the best time in history to be a balding man! There are a wide variety of hair loss treatment options available, new and exciting scientific breakthroughs are coming, and moreover, the shaved look has never been cooler. So relax, keep calm, and carry on.
Lastly if you just can’t afford it, take heart from the fact that you are at least “GQ worthy” as countless Norwood 3 men have graced the cover of the iconic men's magazine (“Gentlemen’s quarterly GQ”) like Roger Federer, Sting, Keifer Sutherland … to name a few.