Approximately 35 million men are affected by male pattern hair loss, which is inherited and caused by the male hormones testosterone and dihydrotestosterone (DHT). In general 20% of men in their 20’s, 30% of men in their 30’s, and 40% of men in their 40’s and so on will experience male pattern baldness. The gene that causes this tendency can be inherited from either the mother or father’s side of the family. The age of onset of hair loss and the extent of hair loss are unpredictable from person to person.
Stages of Hair Loss for Men
The Norwood Hamilton Scale
The Norwood Hamilton Scale is a way to measure the extent of male pattern baldness, and is the generally accepted standard when describing hair loss in general.
Today's Norwood Hamilton Scale originated with Dr James Hamilton in the 1950s who developed the baldness classification system, which was later revised by Dr O'Tar Norwood in the 1970's by modifying the stages and adding 3a, 3 vertex, 4a and 5a.
Men typically lose hair in several patterns. The most common are receding at the temples, on the top back of the head known as vertex, and diffuse thinning where hair over large areas begins to thin, without a specific change to the hairline. Combinations of these types of losses also occur. The following scale can be used to categorise your level of male pattern baldness.
The further along you are on the Norwood scale, unfortunately the fewer options you have. At levels 5 and higher, the use of treatments such as minoxidil or finasteride becomes pretty pointless. In such cases, the most viable solutions are to have a hair transplant, wear a hair system or undergo an MHT treatment.
Norwood Hamilton Scale - Stage 1
Very minor or no recession of the hair line, therefore no need for treatment.
Unless you have a family history of baldness there is no need to worry. If there is a family history of male baldness, you may want to monitor the situation closely and decide the appropriate time for treatment.
Norwood Hamilton Scale - Stage 2
Triangular and typically symmetrical areas of recession at the front temporal area.
Hair loss remains ahead of a line several centimeters in front of the ears. Hair falls and may become less dense in the central front part of the scalp. Initial signs of baldness are becoming evident.
Norwood Hamilton Scale - Stage 3
This represents the lowest extent of hair loss considered sufficient to be called baldness according to Norwood.
Most scalps at this stage have deep symmetrical recession showing at the temples that are bare or only sparsely covered by hair.
With stage 3 vertex, the crown is added since it's a common occurrence with age. Hair loss is primarily from the vertex with limited recession of the front temporal hairline.
Norwood Hamilton Scale - Stage 4
Recession at the front temporal areas is more severe than stage 3.
There is a decisive lack of hair on the crown. A band of moderately dense hair extending across the top separates the two areas of hair loss between front temporal and crown. This band bridges between the hair covered areas on the side of the head.
Norwood Hamilton Scale - Stage 5
At stage 5 hair loss at the vertex region is still separated from the front temporal region but the division is much less distinct.
The band of hair extending across the crown is noticeably narrower and thinner. Hair loss at the vertex and front temporal regions are larger. When viewed from above, stages 5 to 7 show the remaining hair at the sides and back as a distinct horseshoe shape.
Norwood Hamilton Scale - Stage 6
The bridge of hair that once crossed the crown is now been lost with only sparse hair remaining.
The front temporal and vertex regions are now joined into one area. Hair loss on the sides has extended further
Norwood Hamilton Scale - Stage 7
This is the most advanced or severe form of hair loss.
Only a narrow band of hair in a horseshoe shape survives on the sides and back of the scalp. This hair may be fine and less dense than before. At the nape of the neck the hair is sparse with a semi circle over both ears
Who makes a good candidate?
Before the internet, not much information on different types of processes was available, including "hair transplantation" and its benefits and limitations. The very best candidate is someone who has done the research and educated themselves on the causes of their hair loss and what types of hair loss prevention and hair gaining processes, including hair replacement surgery can do for them. A good candidate has a certain level of maturity and understanding.
As far as hair transplantation surgery goes, a good candidate is a man or woman between the ages of 18 and 80. These people would have gone through significant hair loss that would make going through the transplant a viable option. There are some people who have gone through the normal shedding process and are overly concerned they are experiencing the loss needed for the transplantation process. The hairline a person has at 40 is not the same hairline they had at 16, your body compensates for your aging process. You would look odd and out of place if you had a 40 year old face, but a 16 year old head of hair, no matter how much we think we would like that look. People who are in this particular situation or in the very early stages of hair loss would perhaps benefit more greatly with the drugs Rogaine which has been available since the 1980's and Propecia which has been available since the 1990's or even the low level light therapy which is available these days.
A person who is a candidate should also be a person who has ruled out other medically related problems that may be causing what should be the normal hereditary cause of hair loss, such as thyroid problems, which can be diagnosed by your own doctor through simple blood tests.
There is the old wives tale that the gene for hair loss is only on the mother's side of your family, primarily your grandfather, but if that relative has a head of hair and you are going bald, then where did it come from? The fact is that the gene for hair loss can come from either side of your family from 3 generations back, so you can thank your situation to a relative you don't even know existed.
A hair transplant will work, simply because we are transplanting permanent hair from the back of your head to the thinning and balding areas on the top. This process has its limitations due to the fact that if you lose all the hair on top of your head, you've lost 40% of your hair, and the area that we can transplant from naturally covers 1/8 of your head. It's been referred to as "robbing Peter to pay Paul" and that is where the skill of your hair transplant surgeon comes into play, by having a knowledgeable physician who knows how to get the maximum coverage for you with a minimum of material.
Preventative Medicines for Men's Hair Loss
Rogaine is a topical solution that came about rather by accident. The active ingredient “minoxidil ” was developed as a medication to treat high blood pressure, but it had a side effect of darkening or increasing hair growth. Men use the 5% solution, while women use the 2% solution. It's not fully understood how exactly Rogaine does what it does, by the idea is that it widens the blood vessels in the area that it is applied, which increases the blood flow, oxygen and nutrients to the hair follicles increasing their lifespan and causing them to increase growth. The effects of Rogaine build up in the tissue, but if the use is discontinued all of the hair grown or kept by the Rogaine will fall out. The use of Rogaine has its most success by growing hair in the crown area, and seems to work best in the way of growth for men under 30 years of age.
Propecia is the brand name of the drug Finasteride, which is a pill to be taken daily. Men have testosterone in their bodies; an enzyme can cause the testosterone to become dihydrotestosterone, which causes male pattern hair loss. Finasteride blocks this enzyme so the dihydrotestosterone can't form and cause the loss. The Finasteride can cause regrowth in men in both the crown and frontal areas, but has its best results in the crown. It also has the same drawback as Rogaine, meaning if you stop taking the pill Finasteride any hair you've grown or kept with fall out within 1 year.
Low Level Light Therapy
Low level light therapy in the hair loss field is where a person's scalp is exposed to a specific wavelength of light via lasers for a specific amount of time, usually around 20 minutes a day, with 24 hours of time in between each treatment. The action of the low level light therapy on the scalp increases the blood flow to area thus increasing circulation, nutrients and oxygen which increases the hair follicles lifespan and growth.