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Male Androgenetic Alopecia

  • Chapter
Hair Growth and Disorders

Abstract

• Male balding is a common androgen-dependent trait in which there is a progressive decline in the activity and size of scalp hair follicles.

• Male balding can cause significant adverse effects on psychosocial wellbeing in some men.

• The predisposition to male balding is genetically determined and is polygenic in nature.

• Dihydrotestosterone, a 5α-reduced metabolite of testosterone, is the androgen responsible for driving hair loss. The primary target of androgens within the hair follicle is probably the follicular dermal papilla.

• Topical minoxidil lotion and oral finasteride, an inhibitor of type 2 5α-reductase, are the only medical treatments of proven efficacy in male balding. They help to prevent or delay the progression of hair loss and can stimulate some regrowth of hair in some men.

• Redistribution of terminal hair, using surgical techniques such as hair transplantation, can produce effective cosmetic results in selected cases.

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References

  1. Akgun S, Ertel NH, Imperato-McGinley J et al (1986) Familial male pseudohermaphroditism due to 5-alpha-reductase deficiency in a Turkish village. Am J Med; 81: 267-74

    Article  PubMed  CAS  Google Scholar 

  2. Arca E, Acikgoz G, Tastan HB et al (2004) An open, randomized, comparative study of oral finasteride and 5% topical minoxidil in male androgenetic alopecia. Dermatology; 209: 117-25

    Article  PubMed  CAS  Google Scholar 

  3. Asada Y, Sonoda T, Ojiro M et al (2001) 5 alpha-reductase type 2 is constitutively expressed in the dermal papilla and connective tissue sheath of the hair follicle in vivo but not during culture in vitro. J Clin Endocrinol Metab; 86: 2875-80

    Article  PubMed  CAS  Google Scholar 

  4. Bang HJ, Yang YJ, Lho DS et al (2004) Comparative studies on level of androgens in hair and plasma with premature male-pattern baldness. J Dermatol Sci; 34: 11-16

    Article  PubMed  CAS  Google Scholar 

  5. Birch MP, Messenger AG (2001) Genetic factors predispose to balding and non-balding in men. Eur J Dermatol; 11: 309-14

    PubMed  CAS  Google Scholar 

  6. Carey AH, Chan KL, Short F et al (1993) Evidence for a single gene effect causing polycystic ovaries and male pattern baldness. Clin Endocrinol (Oxf); 38: 653-8

    Article  CAS  Google Scholar 

  7. Carey AH, Waterworth D, Patel K et al (1994) Polycystic ovaries and premature male pattern baldness are associated with one allele of the steroid metabolism gene CYP17. Hum Mol Genet; 3: 1873-6

    Article  PubMed  CAS  Google Scholar 

  8. Cash TF (1999) The psychosocial consequences of androgenetic alopecia: a review of the research literature. Br J Dermatol; 141: 398-405

    Article  PubMed  CAS  Google Scholar 

  9. Courtois M, Loussouarn G, Hourseau C (1995) Aging and hair cycles. Br J Dermatol; 132: 86-93

    Article  PubMed  CAS  Google Scholar 

  10. Demark-Wahnefried W, Lesko SM, Conaway MR et al (1997) Serum androgens: associations with prostate cancer risk and hair patterning. J Androl; 18: 495-500

    PubMed  CAS  Google Scholar 

  11. Diani AR, Mulholland MJ, Shull KL et al (1992) Hair growth effects of oral administration of finasteride, a steroid 5 alpha-reductase inhibitor, alone and in combination with topical minoxidil in the balding stumptail macaque. J Clin Endocrinol Metab; 74: 345-50

    Article  PubMed  CAS  Google Scholar 

  12. Drake L, Hordinsky M, Fiedler V et al (1999) The effects of finasteride on scalp skin and serum androgen levels in men with androgenetic alopecia. J Am Acad Dermatol; 41: 550-4

    PubMed  CAS  Google Scholar 

  13. Elliott K, Stephenson TJ, Messenger AG (1999) Differences in hair follicle dermal papilla volume are due to extracellular matrix volume and cell number: implications for the control of hair follicle size and androgen responses. J Invest Dermatol; 113: 873-7

    Article  PubMed  CAS  Google Scholar 

  14. Ellis JA, Stebbing M, Harrap SB (1998) Genetic analysis of male pattern baldness and the 5a-reductase genes. J Invest Dermatol; 110: 849-53

    Article  PubMed  CAS  Google Scholar 

  15. Ellis JA, Stebbing M, Harrap SB (1999) Insulin gene polymorphism and premature male pattern baldness in the general population. Clin Sci; 96: 659-62

    Article  PubMed  CAS  Google Scholar 

  16. Ellis JA, Stebbing M, Harrap SB (2001) Male pattern baldness is not associated with established cardiovascular risk factors in the general population. Clin Sci; 100: 401-4

    Article  PubMed  CAS  Google Scholar 

  17. Ellis JA, Stebbing M, Harrap SB (2001) Polymorphism of the androgen receptor gene is associated with male pattern baldness. J Invest Dermatol; 116: 452-5

    Article  PubMed  CAS  Google Scholar 

  18. Gutersohn T, Scheidegger EP (2005) Is baldness bad for the heart? Dermatology; 211: 72-4

    Article  PubMed  Google Scholar 

  19. Hamilton JB (1942) Male hormone stimulation is prerequisite and an incitant in common baldness. Am J Anat; 71: 451-80

    Article  Google Scholar 

  20. Hamilton JB (1951) Patterned loss of hair in man: types and incidence. Ann N Y Acad Sci; 53: 708-28

    Article  PubMed  CAS  Google Scholar 

  21. Harris H (1946) The inheritance of premature baldness in men. Ann Eugenics; 13: 172-81

    Google Scholar 

  22. Hayakawa K, Shimizu T, Ohba Y et al (1998) Intrapair differences of physical aging and longevity in identical twins. Acta Genet Med Gemellol (Roma); 41: 177-85

    Google Scholar 

  23. Hayes VM, Severi G, Eggleton SA et al (2005) The E211 G>A androgen receptor polymorphism is associated with a decreased risk of metastatic prostate cancer and androgenetic alopecia. Cancer Epidemiol Biomarkers Prev; 14: 993-6

    Article  PubMed  CAS  Google Scholar 

  24. Herrera CR, D’Agostino RB, Gerstman BB et al (1995) Baldness and coronary heart disease rates in men from the Framingham Study. Am J Epidemiol; 142: 828-33

    PubMed  CAS  Google Scholar 

  25. Hillmer AM, Hanneken S, Ritzmann S et al (2005) Genetic variation in the human androgen receptor gene is the major determinant of common early-onset androgenetic alopecia. Am J Hum Genet; 77: 140-8

    Article  PubMed  CAS  Google Scholar 

  26. Hsieh CC, Thanos A, Mitropoulos D et al (1999) Risk factors for prostate cancer: a case-control study in Greece. Int J Cancer; 80: 699-703

    Article  PubMed  CAS  Google Scholar 

  27. Imperato-McGinley J (2002) 5alpha-reductase-2 deficiency and complete androgen insensitivity: lessons from nature. Adv Exp Med Biol; 511: 121-31; discussion 31-4

    Google Scholar 

  28. Imperato-McGinley J, Miller M, Wilson JD et al (1991) A cluster of male pseudohermaphrodites with 5 alpha-reductase deficiency in Papua New Guinea. Clin Endocrinol (Oxf); 34: 293-8

    Article  CAS  Google Scholar 

  29. Inui S, Fukuzato Y, Nakajima T et al (2002) Androgen-inducible TGF-beta1 from balding dermal papilla cells inhibits epithelial cell growth: a clue to understand paradoxical effects of androgen on human hair growth. FASEB J; 16: 1967-9

    PubMed  CAS  Google Scholar 

  30. Itami S, Kurata S, Sonoda T et al (1991) Characterization of 5 alpha-reductase in cultured human dermal papilla cells from beard and occipital scalp hair. J Invest Dermatol; 96: 57-60

    Article  PubMed  CAS  Google Scholar 

  31. Itami S, Kurata S, Takayasu S (1995) Androgen induction of follicular epithelial cell growth is mediated via insulin-like growth factor-I from dermal papilla cells. Biochem Biophys Res Commun; 212: 988-94

    Article  PubMed  CAS  Google Scholar 

  32. Jaworsky C, Kligman AM, Murphy GF (1992) Characterization of inflammatory infiltrates in male pattern alopecia: implications for pathogenesis. Br J Dermatol; 127: 239-46

    Article  PubMed  CAS  Google Scholar 

  33. Jenkins EP, Hsieh CL, Milatovich A et al (1991) Characterization and chromosomal mapping of a human steroid 5 alpha-reductase gene and pseudogene and mapping of the mouse homologue. Genomics; 11: 1102-12

    Article  PubMed  CAS  Google Scholar 

  34. Kaufman KD, Olsen EA, Whiting D et al (1998) Finasteride in the treatment of men with androgenetic alopecia. J Am Acad Dermatol; 39: 578-89

    Article  PubMed  CAS  Google Scholar 

  35. Kligman AM (1988) The comparative histopathology of male-pattern baldness and senescent baldness. Clin Dermatol; 6: 108-18

    Article  PubMed  CAS  Google Scholar 

  36. Knussmann R, Christiansen K, Kannmacher J (1992) Relations between sex hormone level and characters of hair and skin in healthy young men. Am J Phys Anthropol; 88: 59-67

    Article  PubMed  CAS  Google Scholar 

  37. Kuster W, Happle R (1984) The inheritance of common baldness: two B or not two B? J Am Acad Dermatol; 11: 921-6

    PubMed  CAS  Google Scholar 

  38. Lee HJ, Chang C (2003) Recent advances in androgen receptor action. Cell Mol Life Sci; 60: 1613-22

    Article  PubMed  CAS  Google Scholar 

  39. Lotufo PA, Chae CU, Ajani UA et al (2000) Male pattern baldness and coronary heart disease: the Physicians’ Health Study. Arch Intern Med; 160: 165-71

    Article  PubMed  CAS  Google Scholar 

  40. Maffei C, Fossati A, Rinaldi F et al (1994) Personality disorders and psychopathologic symptoms in patients with androgenetic alopecia. Arch Dermatol; 130: 868-72

    Article  PubMed  CAS  Google Scholar 

  41. Matilainen VA, Makinen PK, Keinanen-Kiukaanniemi SM (2001) Early onset of androgenetic alopecia associated with early severe coronary heart disease: a population-based, case-control study. J Cardiovasc Risk; 8: 147-51

    Article  PubMed  CAS  Google Scholar 

  42. Messenger AG, Rundegren J (2004) Minoxidil: mechanisms of action on hair growth. Br J Dermatol; 150: 186-94

    Article  PubMed  CAS  Google Scholar 

  43. Nordstrom REA (1979) Synchronous balding of scalp and hair-bearing grafts of scalp transplanted to the skin of the arm in male pattern baldness. Acta Derm Venereol; 59: 266-8

    PubMed  CAS  Google Scholar 

  44. Norwood OT (1975) Male pattern baldness: classification and incidence. South Med J; 68: 1359-65

    PubMed  CAS  Google Scholar 

  45. Nyholt DR, Gillespie NA, Heath AC et al (2003) Genetic basis of male pattern balding. J Invest Dermatol; 121: 1561-4

    Article  PubMed  Google Scholar 

  46. Oliver RF (1970) The induction of hair follicle formation in the adult hooded rat by vibrissa dermal papillae. J Embryol Exp Morphol; 23: 219-36

    PubMed  CAS  Google Scholar 

  47. Olsen EA, Weiner MS, Amara IA et al (1990) Five-year follow-up of men with androgenetic alopecia treated with topical minoxidil. J Am Acad Dermatol; 22: 643-6

    PubMed  CAS  Google Scholar 

  48. Olsen EA, Dunlap FE, Funicella T et al (2002) A randomized clinical trial of 5% topical minoxidil versus 2% topical minoxidil and placebo in the treatment of androgenetic alopecia in men. J Am Acad Dermatol; 47: 377-85

    Article  PubMed  Google Scholar 

  49. Olsen EA, Messenger AG, Shapiro J et al (2005) Evaluation and treatment of male and female pattern hair loss. J Am Acad Dermatol; 52: 301-11

    Article  PubMed  Google Scholar 

  50. Orentreich N (1959) Autografts in alopecias and other selected dermatological conditions. Ann N Y Acad Sci; 83: 463-79

    Article  PubMed  CAS  Google Scholar 

  51. Osborn D (1916) Inheritance of baldness. J Hered; 7: 347-55

    Google Scholar 

  52. Paik JH, Yoon JB, Sim WY et al (2001) The prevalence and types of androgenetic alopecia in Korean men and women. Br J Dermatol; 145: 95-9

    Article  PubMed  CAS  Google Scholar 

  53. Patterson MN, McPhaul MJ, Hughes IA (1994) Androgen insensitivity syndrome. Baillieres Clin Endocrinol Metab; 8: 379-404

    Article  PubMed  CAS  Google Scholar 

  54. Price VH, Menefee E, Strauss PC (1999) Changes in hair weight and hair count in men with androgenetic alopecia, after application of 5% and 2% topical minoxidil, placebo or no treatment. J Am Acad Dermatol; 41: 717-21

    Article  PubMed  CAS  Google Scholar 

  55. Randall VA, Hibberts NA, Thornton MJ et al (2000) The hair follicle: a paradoxical androgen target organ. Horm Res; 54: 243-50

    Article  PubMed  CAS  Google Scholar 

  56. Rexbye H, Petersen I, Iachina M et al (2005) Hair loss among elderly men: etiology and impact on perceived age. J Gerontol A Biol Sci Med Sci; 60: 1077-82

    PubMed  Google Scholar 

  57. Rittmaster RS, Uno H, Povar ML et al (1987) The effects of N,N-diethyl-4-methyl-3-oxo-4-aza-5a-androstane-17b-carboxamide, a 5a-reductase inhibitor and antiandrogen, on the development of baldness in the stumptail macaque. J Clin Endocrinol Metab; 65: 188-92

    PubMed  CAS  Google Scholar 

  58. Setty LR (1970) Hair patterns of scalp of white and Negro males. Am J Phys Anthropol; 33: 49-55

    Article  PubMed  CAS  Google Scholar 

  59. Shapiro J, Kaufman KD (2003) Use of finasteride in the treatment of men with androgenetic alopecia (male pattern hair loss). J Investigat Dermatol Symp Proc 8: 20-3

    Article  CAS  Google Scholar 

  60. Sigelman L, Dawson A, Nitz M et al (1990) Hair loss and electability: the bald truth. J Nonverbal Behav; 14: 269-83

    Article  Google Scholar 

  61. Smith MA, Wells RS (1964) Male-type alopecia, alopecia areata, and normal hair in women. Arch Dermatol; 89: 155-8

    Google Scholar 

  62. Sreekumar GP, Pardinas J, Wong CQ et al (1999) Serum androgens and genetic linkage analysis in early onset androgenetic alopecia. J Invest Dermatol; 113: 277-9

    Article  PubMed  CAS  Google Scholar 

  63. Thigpen AE, Davis DL, Milatovich A et al (1992) Molecular genetics of steroid 5 alpha-reductase 2 deficiency. J Clin Invest; 90: 799-809

    Article  PubMed  CAS  Google Scholar 

  64. Thigpen AE, Silver RI, Guileyardo JM et al (1993) Tissue distribution and ontogeny of steroid 5 alpha-reductase isozyme expression. J Clin Invest; 92: 903-10

    Article  PubMed  CAS  Google Scholar 

  65. Thompson IM, Goodman PJ, Tangen CM et al (2003) The influence of finasteride on the development of prostate cancer. N Engl J Med; 349: 215-24

    Article  PubMed  CAS  Google Scholar 

  66. Van Scott EJ, Ekel TM (1958) Geometric relationships between the matrix of the hair bulb and its dermal papilla in normal and alopecic scalp. J Invest Dermatol; 31: 281-7

    Google Scholar 

  67. West PM, Packer C (2002) Sexual selection, temperature, and the lion’s mane. Science; 297: 1339-43

    Article  PubMed  CAS  Google Scholar 

  68. Whiting DA (1993) Diagnostic and predictive value of horizontal sections of scalp biopsy specimens in male pattern androgenetic alopecia. J Am Acad Dermatol; 28: 755-63

    Article  PubMed  CAS  Google Scholar 

  69. Zappacosta AR (1980) Reversal of baldness in patient receiving minoxidil for hypertension. N Engl J Med; 303: 1480-1

    PubMed  CAS  Google Scholar 

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Messenger, A. (2008). Male Androgenetic Alopecia. In: Blume-Peytavi, U., Tosti, A., Trüeb, R. (eds) Hair Growth and Disorders. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-46911-7_9

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  • DOI: https://doi.org/10.1007/978-3-540-46911-7_9

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