MALE PATTERN BALDNESS

- Temporary hair loss

- Male pattern baldness = permanent hair loss
- Thinning of the hair on the scalp
- Results in a receding hairline and/or balding on the top of the head

CAUSES

- An illness
- Stress
- Cancer treatment
- A combination of genetic factors and a particular hormone DHT – dihydrotestosterone
causes a decrease in the growth phase and thinning of the hair
- Weight loss
- Iron deficiency
- Caused by hair follicles over sensitive to dihydrotestosterone
- Leads to hair follicles to shrink and cease working

PREVALENCE

- Very common = 6.5 million in UK

- Age range from late teens to 60s
- Strong genetic component
- Seek treatments – cosmetic reasons
- No treatment – treatment ONLY slows progression
- Affects half of all men by the age of 50 years

STEPS OF BALDNESS

1. Hair begins to thin – recede at the temples

2. Hair becomes thin on the top of the head
3. A bald patch gradually develops in the middle of the scalp
4. The receding sides and the bald patch on the top (the crown) gradually enlarge and join
together, leaving a patch at the front
5. The patch at the front usually thins as well
 TREATMENT
These treatments:

- Do not work for everyone

- Only work for as long as they're used
- Are not available on the NHS
- Can be expensive

5-alpha reductase inhibitors = Finasteride

- Not to be used by women

- Finasteride (Propecia, Proscar) is an oral medication that slows hair loss in some men.
- It works by blocking the production of the male hormone responsible for hair loss.
- Finasteride has a higher success rate than minoxidil.
- When you stop taking finasteride, your hair loss returns.
- You must take finasteride for three months to one year before you see results.
- If no hair growth occurs after one year, your doctor will likely recommend that you stop
taking the medication.
- Licensed for the treatment of androgenetic alopecia in men
- 1 mg daily private prescription only
- Use for 3-6 months before any benefit apparent
- Effects reversed after 6-12 months of stopping
- Can be accessed via hair retention service – private PGD via a consultation with a pharmacist
to assess suitability

Mode of action

A specific inhibitor of the enzyme 5α-reductase, which metabolises testosterone into the more
potent androgen, dihydrotestosterone. Finasteride is a 5α-reductase inhibitor (it acts as a
competitive and specific inhibitor of type II 5 alpha reductase). It works by blocking the
conversion of the hormone testosterone to the more potent hormone dihydrotestosterone
(more active metabolite). Dihydrotestosterone is the primary androgen (hormone that
contributes to grown and reproduction) in the development and enlargement of the
prostate gland. It is named the hormonal mediator for the hyperplasia upon accumulation in
the prostate gland.

Potassium-channel openers = Minoxidil

- Minoxidil can also be used to treat female pattern baldness

- Slows hair loss for some men and stimulates the hair follicles to grow new hair
- Takes four months to one year to produce visible results.
- Hair loss often happens again when you stop taking the medication.
- Possible side effects associated with minoxidil include dryness, irritation, burning, and
scaling of the scalp.
- Minoxidil is the only drug licensed in the UK for non-prescription use in the treatment of
male and female pattern hair loss.
Currently:

 A 2% solution is available for men and women as a GSL medicine in a maximum pack
size of 1 x 60ml, to be used TWICE daily
 A 5% solution and 5% foam are available for men as GSL medicines in a maximum
pack size of 1 x 60mls and 3 x 73mls respectively
 Regaine for Women Once a Day Scalp Foam 5% w/w Cutaneous Foam is a P
medicine

Minoxidil 5% scalp solution

- Apply topically TWICE a day, if not improved, stop after a year

- Licensed for ages 18 to 65

Minoxidil 5% Foam

- Apply directly to scalp TWICE a day

- Licensed for ages 18 to 49

Minoxidil 2% woman

- Licensed for ages 18-65

- Topical application of minoxidil may stimulate limited hair growth in a small proportion of
adults but for as long as it is used