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Hair Loss in Men

Good looks, social acceptance, professional success. 

Rich hair seem to play an important role in self-esteem, a starting point for acceptance by the opposite sex, in the social environment, and in the professional setting. When hair loss starts, our whole inner world may be “shaken”.

H
air loss may affect the head only or the whole body. If early diagnosis is achieved, it is possible to stop the progress of hair loss since the proper treatment of the causes may be followed and the person can be informed of the ways hair loss can be prevented, avoiding its progress to alopecia (i.e. permanent and visible thinning of hair).

It is also important to note that hair loss progress in men is classified according to the Norwood scale.

Normal hair loss

In a scalp there are around 100,000 hairs approximately. Due to natural processes on average 50-100 hairs are shed every day, which have gone through all three phases of their life cycle (anagen, catagen and telogen phases). 

This is normal hair loss and hairs that fall out are immediately replaced by new ones. The degree of hair loss does not lead to significant differences in terms of hair density.

Seasonal hair loss

Seasonal hair loss usually lasts for two months and it is a reversible condition. It usually appears in spring and in autumn, and, in general, women are more affected than men.

Pathological Hair Loss

In certain cases diffuse hair loss may act as a precursor to some type of alopecia (i.e. permanent apparent hair thinning). Hairs are lost, re-grow and shed more quickly. Or they may be lost and re-grow but hairs are different in terms of colour, quality and quantity. Or they may be lost and never re-grow, because hair follicles shrink and become idle. In this case, hair loss is characterised as a pathologic condition, which can lead to alopecia.

Hereditary predisposition (male pattern hair loss)

Hereditary predisposition is the most common cause of hair loss, the scientific term of which is “androgenetic alopecia”. Genes cause sensitivity of hair follicles to the body’s male hormones (androgens), independently of the hormonal levels.

Five percent of men start having hair loss before the age of 20 years old. Hair follicles start producing thinner hairs, and progressively they only produce vellus hair. In men hair thinning usually starts from the frontal hairline, in a pattern similar to the letter M.

Patchy hair loss (Alopecia areata)

This is an autoimmune disorder, in which the immune system attacks its own hair follicles and causes intense hair loss. If it progresses, it creates patches without hair (hairless areas) of round or oval shape on the scalp or on the whole body. Typically, hair loss is not permanent. In most patients hair re-grows within a year.

It has been estimated that patchy hair loss (alopecia areata) affects approximately 1-2% of the population. Many times, it coexists together with other autoimmune disorders, such as vitiligo, Hashimoto’s thyroiditis, etc.

Diffuse Hair Loss

In this type of hair loss, a large number of hair enter the rest (telogen) phase too soon, a phase that also leads to hair thinning and hair shedding. Usually, it does not affect more than 50% of the hair in the scalp. Hair loss may appear up to three months after the initial cause. Among the causes the following are included:

Mental or physical stress, such as a recent surgery, an illness, or high fever, sudden or excessive weight loss, a divorce or losing a family member.

Endocrine system disorders, such as hyperthyroidism, hypothyroidism and uncontrolled diabetes mellitus.

Poor nutrition, such as lack of protein, iron, zinc, magnesium, vitamins D and B12, folic acid and fatty acids.

Side effects of medicines, such as anticoagulants, anti-thyroid drugs, chemotherapeutics, antipsychotics, cholesterol-lowering drugs, thallium, and boric acid. 

Typically, the hair loss stops, and the hair is restored after discontinuing the medication.

Traumatic Hair Loss

There are two types of hair loss, which are not related to a defect in hair’s life cycle.

Trichotillomania

Trichotillomania is a compulsive behaviour in which a person pulls his/her hair out of the scalp, eyelashes, or eyebrows. There is usually mounting tension before pulling the hair and a feeling of relief afterward. Hair loss is observed in certain areas and the shape is irregular.

Traction Alopecia

Traction alopecia may be caused by your method of hair styling, and it involves hair loss around the edge of the hairline. It is especially noticeable around the face.

Pathogenic Hair Loss

This is a type of hair loss which is caused by a medical condition.

Developmental disorder and hereditary conditions: skin aplasia, epidermal nevi, porokeratosis of Mibelli, ichthyosis, Darier disease, etc.

Defects due to natural causes: mechanical traumas, burns, x-ray dermatitis.

Microbial infections: tinea/ringworm infections, bacterial infections (lupus vulgaris, leprosy, tertiary syphilis, furuncle, carbuncle, folliculitis, acne necrotising), leishmaniasis, viral infections (herpes zoster, chickenpox, smallpox).

Neoplasias: basal cell carcinoma, cicatricial (scarring) basal cell carcinoma, metastatic carcinomas.

Various other dermatoses/skin diseases of unknown aetiology: lichen planus, lupus erythematosus, scleroderma, etc.