There is a number of reasons why men start to go bald, but in men aged 20 to 45 who are losing hair, the chances are 95 percent that male pattern baldness is the cause. In the United States, some 35 million men are losing or have lost their hair from male-pattern baldness, according to the American Hair Loss Council.

It has been proven that one of the main reasons men have more significant hair loss than women has to do with hormones. Men have much higher levels of male hormones, or androgens – such as testosterone, androsteinedione, dihydrotestosterone, which increase alopecia in individuals who are genetically susceptible. One can determine if he has such a genetic inheritance simply by looking at the male members of the family – father, grandfathers; if they have what is called male pattern baldness, chances are he will experience it too, later in life.

Testosterone, a hormone that is present in large quantities in males after puberty, interacts with an enzyme called 5-alpha reductase, which resides in the hair cell, producing dihydrotestosterone (DHT). DHT acts on a hormone receptor on the hair follicle, causing the hair follicle to shrink; the hair follicle starts producing weaker, shorter hair, and sometimes hair growth is stopped.

Both men and women tend to lose hair thickness and amount as they age. Inherited or "pattern baldness" affects many more men than women. About 25% of men begin to bald by the time they are 30 years old, and about two-thirds are either bald or have a balding pattern by age 60.(1)

Thus, common baldness in men, scientifically called androgenetic alopecia or male-pattern baldness, is the result of the contribution of three main factors: genetic inheritance, hormones and aging.

As proof that hormones play an important role in the process stands the fact that men who do not produce testosterone (because of genetic abnormalities or castration) do not develop this pattern of baldness. What is even more interesting and has not yet been explained is that DHT, while interfering with the growing process of scalp hair, is absolutely necessary for the growth of the beard and hair on the chest. This explains why bald men can have bushy beards and hairy chests.

Typical male pattern baldness involves a receding hairline and thinning around the crown with eventual bald spots. Ultimately, you may have only a horseshoe ring of hair around the sides. (1)

The very first signs of the effects of these hormones on scalp hair growth may occur soon after puberty (in boys, around age 13), when the reproductive organs reach maturity; after puberty, the frontal hairline may recede. After that, in some men, male pattern baldness may come on very fast, in others may not come at all. Nobody can say to what extent an individual may lose his hair, as every individual is unique.

There is a variation of the balding pattern as well: some men experience a recession of the front hairline while retaining hair in the middle, some lose hair on the center of the scalp, resulting in a "bald spot" surrounded by hair, while in others, the front hairline recession joins up with this area to create a larger balding area. Some develop uniform thinning of the hair with no discernible pattern, which usually progresses to complete baldness.

Apart from the genetic hair loss, men can lose their hair due to certain hair diseases that may affect both men and women:

• Alopecia Areata, an autoimmune disorder that leaves bald patches on the scalp and particularly affects young adults
• Alopecia totalis, a severe from of Alopecia Areata that implies loss of hair all over the scalp, and sometimes eyelashes and eyebrows as well
• Alopecia Universalis, that implies loss of hair all over the body
• Anagen Effluvium, loss of hair caused by chemical damage of follicles
• Telogen effluvium, induced by such factors as sustained high fever, surgery, systemic disease exacerbation, low protein diets, severe emotional stress, and drug reactions
• Traction Alopecia, due to excessive tension put on the hair by pulling or traction; it occurs in men who braid or knot their hair
• Trichotillomania, a form of hair loss caused by excessive and chronic pulling of healthy hair due to psychiatric or emotional problems

Other causes of hair loss in men originate in medical conditions that have or may have as secondary effect loss of scalp hair: high temperature associated with infections or flu, some chronic and serious illnesses, a malfunctioning thyroid and/or pituitary, some medical treatments such as radiotherapy, medications such as interferon or chemotherapy, steroids, severe physical or psychological stress, exposure to dangerous chemicals such as thallium acetate, burns or fungal infections of the scalp (Tinea capitis or ringworm of the scalp).

There are treatment options for almost any type of hair loss; however, special attention must be paid to the so-called “miracle cures”, particularly sold over the Internet, that promise to restore all hair or to make it grow thicker and healthier; do not let yourselves fooled into buying “all-natural” shampoos that are not approved by the medical community, as the result may be even contrary to what you had expected. Men should keep in mind that the only authorized, FDA-approved medications for hair loss are Minoxidil, Finasteride and Dutasteride. Apart from medication, they have options such as surgical procedures (flap surgery) and hair transplants or may choose from the various types of hair replacement systems.

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