Categorized | Causes

Types of hair loss in males

Androgenetic Alopecia

Androgenetic alopecia

Androgenetic alopecia

Androgenetic Alopecia is the most common and widespread type of hair loss. According to the American Hair Loss Association, this type of hair loss accounts for as much as 95% of all hair loss cases in men. Approximately 2/3 of American men will face some degree of hair loss by the age of 35 and about 85% of American men will have noticeably thinning hair by the age of 50.

The main cause of Androgenetic Alopecia (AGA) lies in genetics. AGA results from the damaging effects that dihydrotestosterone (DHT) – the active form of male sex hormone testosterone – has on the hair follicles. DHT is converted from testosterone under the influence of the enzyme present in the hair follicles.  The scientific term for this is 5-alpha-reductase. DHT, when penetrating into the cells of the hair follicles, causes the degeneration and miniaturization of the hair these follicles produce. Scalp hair gradually thins, shortens, and becomes colorless turning into vellus hair, and then hair loss progresses to baldness. In other words, the hair follicles produce more miniaturized hair strands with every new growth cycle. Also the growth phase of the hair follicle shortens and gradually more and more follicles enter the resting phase (the period of not producing hair).  Ten to fifteen (10-15) years after the onset of AGA, the openings of the hair follicles are overgrown with connective tissue and can no longer produce even vellus hair.

The development of androgenetic alopecia can be shown in the following chain:

reproductive system -> testosterone -> 5-alpha-reductase -> DHT -> hair follicles damage ->baldness

The sensitivity of the hair follicles to DHT largely depends on the set of genes which is determined by an individual’s heredity.  Since the female body also produces testosterone and has 5-alpha-reductase in the hair follicles, AGA can develop in women according to the same principles, but  differs in clinical presentation.

For men, Androgenetic Alopecia is often referred to as Male Pattern Baldness (MPB) due to a specific hair loss pattern – it starts from the frontal and parietal parts of the head and gradually spreads over all the head. There is a special classification of hair loss in men which helps to understand the progression of MPB. It is called The Hamilton-Norwood scale and covers 7 stages of hair loss.

Traction Alopecia

Traction alopecia

Traction alopecia

This condition refers to hair loss resulting from an excessive pulling force being applied to the hair itself. It mainly develops on the frontal and temporal areas of the scalp and its progression is associated with certain types of hairstyles like cornrows, tights braids, etc.  Traction alopecia is mainly developed by people with long and curly hair requiring constant tying.

Although this disorder is more common in women, men practicing tight hairstyles can develop it as well. It is also common in males with initial stages of androgenetic alopecia because they tend to use various instruments to hide their baldness (wigs with special clips, separate hair locks affixed to the hair, etc.).  Any such ‘masking instruments’ that are fixed on the person’s own hair has its own weight and, thus, exerts an excess load on the already weakened hair follicles and will promote intensive hair loss.

Traction Alopecia may also result from a psychological disorder such as Trichotillomania. This is characterized by the compulsive urge to pull out one’s own hair and, thus, cause baldness. Pulling the hair damages the hair follicles which can recover only if the damage is mild.  Constant hard pulling may irreversibly damage the follicles and result in persistent hair loss with hair follicles being replaced by scar tissue – Scarring Alopecia. 

Telogen Effluvium

telogen-effluvium

Telogen effluvium

This type of hair loss is more common in women rather than in men.  However, men who experience severe stresses or acute infections may also face such a problem.

At any given moment, approximately 90% of human hair follicles are actively growing hair (that means they are in the anagen or growing phase of their lifecycle) and only 10% are resting (called the telogen phase). Somewhere near the end of the telogen phase, the hair follicle loses the old hair and prepares for the production of a new one –  a natural process of the hair lifecycle. Telogen Effluvium happens when a lot of hair follicles prematurely enter the resting phase due to causes such as trauma, surgery, severe stress, infection accompanied with fever, taking drugs like antidepressants, β-blockers, calcium channel blockers, etc.  In severe cases this can cause the loss of up to 50% of the scalp hair within a short period of time.

The good news regarding Telogen Effluvium is that it is fully reversible because the hair follicles are not permanently damaged.  The remedy is to find the provoking factor, eliminate it, treat the consequences and within a period of several months, your hair will restore its growth.

Anagen Effluvium

Anogen effluvium

Anogen effluvium

This condition is when the hair falls out of the follicles that are still in the active (anagen) phase. Such hair loss is quite common in patients with malignant neoplasms who are undergoing chemo or radiation therapy.  It’s a reaction of the body to the intoxication with cytostatic agents and radiation which affects all body cells including hair follicles and makes the follicles abruptly stop the production of hair.  Such hair loss starts in 4-10 days after the toxic influence and may lead to a complete hair loss. While the progression of such hair loss is very rapid, once the therapy ends, the recovery is equally rapid as well.

Sometimes, the causes of Anagen Effluvium may be the result of poisoning with arsenic, pesticide, thallium, or other highly toxic substances.

Alopecia Areata

Alopecia areata

Alopecia areata

This is a pathological hair loss resulting from the damage to the hair follicles and root cells caused by the human immune system and therefore, it is an autoimmune disorder.  It develops on the scalp as bald patches of different sizes and forms and, in severe cases, all over the body. Usually the size of the patches do not exceed several centimeters in diameter.  In most of the cases, there is a lack of any other symptoms, such as itching, pain or redness of the skin.  Alopecia Areata (AA) affects both sexes and even children. According to researchers, genetic predisposition to AA plays a great role in the development of this condition.  The trigger factors that activate the genes responsible for this type of hair loss include emotional stresses, viral infections, vaccination, anesthesia, etc.

There are several forms of AA:

  • Alopecia Areata Monolocularis –  characterized by only one bald patch on the scalp;
  • Alopecia Areata Multilocularis – progresses into multiple bald spots of different sizes;
  • Alopecia Areata Barbae –  the spots of hair loss are found only in the area of the beard and it is evident only in males;
  • Diffuse Alopecia Areata –  is unique because it lacks the characteristic bald spots of AA and instead it progresses into a widespread thinning of the scalp hair. The mechanism of this hair loss remains unclear;
  • Alopecia Totalis – it is characterized by the loss of all hair from the scalp;
  • Alopecia Universalis – it is characterized by a complete hair loss all over the body.

According to statistics, approximately 1 in every 125,000 men suffer either from Alopecia Totalis or from Alopecia Universalis.

Scarring (Cicatricial) Alopecia

Scarring alopecia

Scarring alopecia

This condition affects about 3% of all the patients (men and women) suffering from hair loss. Scarring Alopecia (SA) is associated with constant and irreversible damage of the hair follicles which are replaced with scar tissue. The causes that provoke this type of hair loss can be divided into several groups:

  • hereditary disorders and defects (ichthyosis, dermal aplasia, etc);
  • neoplasms;
  • specific infections (syphilis, tuberculosis, leishmaniasis, etc.);
  • physical injuries (wounds, chemical or thermal burns);
  • the terminal stages of some diseases (lichen ruber planus, lupus erythematosus, sarcoidosis).

The areas of skin affected with SA usually differ from the skin formed in patients with Alopecia Areata in that SA bald spots have uneven bordering. The destruction of the hair follicles happens below the surface of the skin; therefore, any other signs of this condition except for bald spots are very difficult to notice. The affected skin may be smooth and clean, or reddish, flaking, with increased or reduced pigmentation; it may even have blisters with pus or fluid. These visible indicators can help establish a diagnosis, but they cannot be the decisive diagnostic signs of SA. Skin biopsy is required to make the correct diagnosis.

Alopecia Mucinosa

Alopecia mucinosa

Alopecia mucinosa

This condition is characterized by the deposition of mucin in the follicular epithelium which leads to hair loss. There are two types of Alopecia Mucinosa:

  • Idiopathic (primary) type –  a benign condition occurring in young, otherwise healthy, people. It is characterized by one or several patches of hair loss that are oval or round in shape.  It tends to have a shorter course but can progress into permanent hair loss;
  • Symptomatic (secondary) type –  is found in patients with mycosis fungoides. The patients suffering from this condition are older than those with idiopathic Alopecia Mucinosa and they have extensive areas of hair loss, skin plates or erythema.

According to some studies, Alopecia Mucinosa is more common in men between 30-40 years of age.

Involutional Alopecia

This condition is associated with gradual thinning of hair which occurs with age – the lifecycle of the hair follicles becomes shorter and the follicles enter the resting phase earlier. This is a natural condition.