Male pattern baldness

Do not think that beautiful thick hair is a source of pride only for women. Men, just like the weaker sex, want to have a luxurious head of hair, but their desires do not always coincide with reality. Progressive baldness in men is no longer a new problem, but it not only does not lose its relevance, but on the contrary, it acquires new dimensions. More and more young people suffer from the fact that their appearance is distorted by early bald spots. And although men do not have such a reverent attitude to their appearance as women, baldness at an early age is often a serious psychological trauma, although it is not customary to talk about it publicly.

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Epidemiology

Without going into such details, and focusing on male baldness as one of the pressing problems of our time, we can see that the pathology is not limited to older people. Statistics say that 50-70% of men face the problem of baldness in middle age (40-50 years). But at the same time, slightly less than 1/3 of the stronger sex have the same problems already at the age of 20-25. Moreover, baldness in men at a young age in 80% of cases is due to hereditary predisposition, which is rare in the weaker sex (although recently this figure has been steadily growing, both in women and in guys).

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Causes male pattern baldness

If a person loses 100 hairs a day, there is no particular reason to worry. But more active hair loss, especially young and growing hair, cannot be considered a normal condition. This is already a pathology, which always has certain causes that must be understood, because without this, effective treatment of the disease is impossible. A lasting result can only be achieved if you fight the cause of the disease, and not its consequence.

But what factors can trigger active hair loss in men of different ages? Let's try to understand each of them:

• Hereditary predisposition. We have already noted that according to statistics, most young men go bald for this reason. Hereditary baldness in men is one of the biggest problems that does not respond to traditional treatment.

If a father, grandfather, or great-grandfather on the mother's or father's side had problems with their hair in their youth, it is highly likely that subsequent generations will have them as well. The cause of such a predisposition is considered to be the baldness gene, which can be found in both men and women.

The baldness gene, which is the most common cause of hair loss in young men, was discovered by German scientists about 13 years ago. We are talking about the gene in the X chromosome Sox21, which both daughters and sons receive from their mothers at conception. This indicated that hereditary baldness in men is transmitted through the maternal line, in other words, the mother is indirectly to blame for the son's baldness, whose father was bald and passed on this gene to his daughter, and she to her son.

But three years later, the baldness gene was also found in chromosome 20 of men. This gene can also be passed on by inheritance, and its influence on the boy's future is stronger than the genetic material of the female X chromosome. Receiving such a gene by a child increases the risk of baldness at an early age almost sevenfold.

And what can we say about those guys who receive both baldness genes from their father and mother. According to some calculations, the risk of alopecia in this case is twice as high as when receiving only one male gene, i.e. in this case, a young man's chances of having beautiful hair until old age are extremely small.

• Hormonal imbalances. It is a mistake to think that such imbalances are specific to women only and are the cause of many women's problems. Hormonal imbalances can also occur in men. Scientists have long discovered a connection between the male sex hormone testosterone and baldness in men. Testosterone itself is responsible for the presence of hair on the head and body of men, but its variety, dihydrotestosterone, on the contrary, contributes to hair loss.

Men owe the conversion of testosterone to dihydrotestosterone to the enzyme 5-alpha-reductase. Thanks to this enzyme, the active fraction of dehydrogenase enters the blood, which blocks the flow of nutrients carried by the blood into the hair follicle. That is, this enzyme does not destroy hair and hair follicles, but contributes to the fact that the hair becomes thinner and weaker.

Hormonal hair loss in men occurs in several stages. At first, the hair simply becomes thinner and loses color (becomes thin and colorless, like fluff). Then the weakened hair falls out, and in their place even thinner and weaker specimens appear, which are almost invisible on the head. Over time, in the place of the damaged hair follicles, hair stops growing altogether.

So far we have only talked about the imbalance of sex hormones, i.e. about the increase in the level of dihydrotestosterone, the cause of which can be pathologies of the pituitary gland, hypothalamus and adrenal glands, congenital diseases and syndromes, tumors, drug therapy with androgens. But the growth and development of hair is also affected by thyroid hormones.

Thyroid hormones triiodothyronine (T3) and thyroxine (T4) affect hair growth activity and limit hair loss, and thyroxine also prolongs the hair growth phase (anagen). With normal thyroid function, less than 10% of hair is usually in the resting phase. But if thyroid hormone production is disrupted (both hypothyroidism and thyrotoxicosis), the anagen period decreases and telogen is extended, with a much larger number of hairs in the latter stage, which leads to thinning of the hair. By the way, hair loss is often the first sign of thyroid dysfunction that a person has not even thought about.

• Stressful situations. Despite the fact that men often remain outwardly calm even in the most dramatic situations, they are subject to stress no less than women. It's all about the ability to cope with your emotions. But experiencing stress in your soul is no less dangerous than splashing out your emotions for everyone to see.

Under the influence of stress, there is a spasm of blood vessels, including those that feed the hair follicles. The disruption of nutrition and respiration of the hair leads to their weakening and growth retardation. Mature hair begins to actively fall out, and new ones are in no hurry to grow.

But you need to understand that this is not a process that happens every minute. It may take several weeks after a strong nervous shock before hair starts to fall out actively.

• Eating disorders. An unbalanced diet causes various disorders in the body. Hair, like other tissues of the body, requires an adequate supply of trace elements (zinc, iron, calcium, phosphorus, etc.) and vitamins (vitamins A, C, E, group B) with the blood. A deficiency of these substances, caused by the prevalence of processed foods and fast food in the diet, weakens the hair (and around the entire perimeter of the head) and leads to its premature loss, while new hairs are in no hurry to grow again due to a lack of nutrients.
• Metabolic disorders. But in order for hair to receive sufficient nutrition, it is not enough to simply introduce the necessary substances into your diet. It is very important that they are then absorbed by the body. Metabolic disorders of individual substances will lead to the fact that hair nutrition will be incomplete.
• Infectious diseases. Both acute infections occurring against the background of increased temperature and chronic infectious pathologies are associated with intoxication of the body with the waste products of pathogenic microorganisms. It is clear that toxic substances will have a detrimental effect on hair follicles, which receive toxins with blood.
• Taking certain medications. Yes, medications can also have toxic effects and negatively affect hair growth.
• Skin injuries in the scalp area. Violations of the integrity of the skin (burn surfaces, deep wounds and cuts) are associated with the subsequent formation of a scar or cicatrices at the site of injury, the tissues of which are designed only to cover the defect and are not capable of reproducing new hair.
• Skin diseases. The situation here is identical to injuries. At the site of the lesion, a lesion is formed, where hair growth stops or slows down. In the head area, seborrhea, lichen, pustular lesions of hair follicles, infectious cutaneous leishmaniasis, leprosy, cicatricial pemphigus and other pathologies can be diagnosed, in which a dense crust forms on the skin, preventing normal breathing and nutrition of the hair.
• Some autoimmune systemic diseases. In this case, there is an inadequate response of the immune system to some internal factors. Hair loss in small areas of the head is possible with psoriasis, lupus erythematosus, scleroderma, sarcoidosis of the skin, Addison's disease and some other pathologies.

In addition, baldness in men and women can develop against the background of:

• diabetes mellitus (metabolic disorder),
• iron deficiency anemia (micronutrient deficiency),
• fungal skin lesions (formation of scar tissue, toxic effects of microorganisms, artificial deficiency of nutrients),
• cardiovascular diseases (impaired blood circulation and hair nutrition),
• oncological pathologies, for example, baldness is possible with basal cell carcinoma, syringoma (change in cell properties and formation of scar tissue),
• developmental defects such as aplasia of the skin, hemiatrophy of the face and scalp, epidermal moles, and hair follicle hematomas.

Up to this point, we have been talking mainly about internal factors that influence hair growth and loss. But we cannot exclude the impact of some external conditions. From this perspective, we can consider the following external risk factors for baldness in men and women:

• the use of low-quality shampoos and detergents not intended for washing hair, containing harmful substances or affecting the condition of the skin,
• traumatic injuries to the scalp and hair, which result in impaired blood circulation and deterioration of the nutrition of the hair follicles,
• unfavorable environmental conditions (negative impact of ultraviolet radiation, polluted air, water containing heavy metal salts),
• ionizing radiation (radiation therapy).

The causes of baldness in men at a young age usually come down to genetic predisposition and hormonal imbalances, as a result of which they already have bald spots at the age of 20-30. Although it is impossible to exclude the contribution that other factors can make to the baldness process.

For example, ¼ of the population suffers from seborrhea, the onset of which is noted in adolescence during puberty. At first, the young man notes that his hair has become greasy, quickly gets dirty and sticks together in clumps, and yellowish greasy scales have appeared on the scalp. At first, the person is tormented by unaesthetic greasiness of hair and itching on the head, then crusts appear on the skin, reminiscent of eczema. If the disease is not treated, a little later moderate hair loss is noted. In their place, new hairs are formed, which gradually become thinner and fall out prematurely, a bald spot is formed, having a clearly defined border.

It is clear that stress, taking medications, unfavorable environmental conditions, poor nutrition, head injuries can also leave their mark on the head of a young person. And the more such factors there are, acting simultaneously or one by one, the more noticeable this trace of thinning hair will be. If we talk about the treatment of oncological diseases, which can affect even children, then chemotherapy and radiation of the body can deprive a person of hair even in the absence of a hereditary predisposition. But this is already a forced measure when you do not have to choose between life and a beautiful hairstyle.

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Pathogenesis

So, daily hair change should not be considered something unnatural and should not be feared. The fact is that the life cycle of a hair is limited to approximately three years, after which a new hair comes to replace it, which pushes out the old one, clearing the way for itself.

Folk wisdom says: "a holy place is never empty." It is especially relevant in relation to hair replacement. When a dead hair falls out, a hair follicle remains in the place where it grew, in which a new hair is formed, replacing the old one.

The life cycle of hair includes 3 main stages:

• the anagen period, when active division and growth of young hairs occurs,
• the catagen period with reverse root development (atrophy of the hair papilla, located at the bottom of the follicle and regulating hair growth, begins already at the end of this period),
• the telogen period, when the hair follicle is in a state of rest (as if hibernating), old hairs fall out, and young hairs begin to appear in their place.

A hair that dies naturally has a white thickening at the end, which is not found if you forcibly pull out a healthy, young hair. If there is no such thickening, then the cause of hair loss was its increased fragility, which is evidence of unhealthy hair. But the presence of a dark bulb on the fallen hair indicates that a healthy, strong hair that has not yet outlived its usefulness has been lost. And if this is not a mechanical effect, then you need to look for internal causes that lead to alopecia.

Doctors consider male pattern baldness as a disease of polyetiological nature. Thus, there are many reasons that can correct the process of natural hair replacement in such a way that in place of multiple falling hairs, no new ones will appear or they will be very weak, like vellus hair. It is not surprising that there are different types and degrees of baldness, the approach to treatment of which is significantly different, because the causes of baldness in this case are different.

It turns out that we need to consider not the general concept of alopecia, but individual types of the disease, which in each specific case can have specific manifestations. After all, we are often talking about a multifactorial effect, and each of the factors can leave its mark on the clinical picture of the pathology.

When do they talk about alopecia?

Different people have different attitudes towards the problem of hair loss. Some do not bother with this issue at all, calmly brushing off single or multiple hairs that have separated from the scalp, while others panic when they see even one hair on their clothes. Who is right, and when should you start worrying about hair loss?

There is nothing surprising in the fact that the hairs on the head and body periodically fall out. A living organism is not eternal, but even during its existence, renewal processes are constantly taking place in the body, and they concern not only the skin and nails. Our hair is also renewed once every 3-5 years. And this applies to both women and men.

And since hair grows unevenly, its replacement also falls on different time periods, so we notice hair loss almost daily. There is clearly no need to be scared about 1-2 hairs falling out. In fact, from 50 to 150 of them fall out per day, we just do not notice it. This moment becomes especially noticeable during washing or combing the head, which is quite natural, because mechanical action on the scalp helps to remove hairs that have outlived their life.

It is important to understand that by losing such a quantity of hair per day we do not risk going bald, because on the head of an ordinary person there are from 60 to 160 thousand hairs. And at the moment when some fall out, others begin to grow, i.e. a natural process of hair renewal occurs.

The normal daily hair loss rate for men ranges from 80 to 150 hairs, depending on hair color. Blondes are considered to have the thickest hair, so losing 150 hairs a day is natural for them. For fair-haired and dark-haired people, daily loss of about 100 hairs is considered normal. Redheads are the least lucky, because their hair density is usually the smallest (80-90 thousand hairs), but they rarely lose more than 80 hairs a day.

When counting the hair lost per day, you need to understand that only those hairs that fall out with the root (bulb) are taken into account. If the hair is unhealthy and prone to breakage, there will still be a certain portion of broken hairs that have nothing to do with the process of hair loss and baldness. We only take into account those hairs that leave the hair follicle completely, which corresponds to the natural process of hair replacement or the pathological process of baldness (alopecia).

The hair loss rate is an indicator that does not affect the thickness of the hair and is explained by the natural physiological process of renewal of individual components of a living organism. But exceeding the norm already indicates certain disorders that cause excessive hair loss. If hair begins to fall out more actively, it is time to think about the reason for this state of affairs, which leads to baldness in men, because the involvement of an unsuitable shampoo, comb, too hard pillow, etc. in this process has not been scientifically proven.

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Symptoms male pattern baldness

The influence of various factors on a man's health causes the appearance of different types of baldness, the manifestations of which also differ somewhat. Doctors do not have a single classification of alopecia, but it is still customary to distinguish several types of baldness in men.

Despite the fact that different types of baldness can have different manifestations, the first sign of pathology can be considered hair loss above the norm, which can be noticed by the increase in the number of hairs on clothes, a comb, during washing your hair. Or you can simply not wash your hair for 3-4 days, and then gently pull the hair on your head. If a decent bunch of 5-10 hairs appears in your hand, this is already a reason to get examined for the danger of baldness.

The appearance of bald spots on the temples or areas with sparse hair on the crown is observed somewhat later. And this allows you to determine the type of alopecia, because the localization of areas of pathological hair loss is also of great diagnostic importance. However, this is already a question for specialists, and we will talk about what types of baldness in men a doctor can identify, what they are associated with and how they manifest themselves.

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Androgenetic alopecia

This type of baldness has no equal in terms of prevalence among the male population. Androgenic alopecia is called male-pattern baldness, since this type of pathology is typical for men. This is exactly the case when hair problems are not associated with a specific disease. And the reason for this condition lies in a type of male hormone - dihydrotestosterone

The level of dihydrotestosterone varies from man to man. And it is not always a matter of pathological processes that promote increased production of testosterone or the enzyme that converts it into a hydrolyzed fraction. The fact is that some features of the endocrine system responsible for the production of sex and other hormones are inherited. And it is not surprising that some people have thick hair, while others suffer from a lack of hair from a young age.

It is important to understand that with androgenic alopecia, the hair on a young man's head does not fall out in an instant. This is a gradual process, it just starts prematurely. At first, a change in the appearance of the hair is observed: it becomes thinner and lighter, stops growing, and over time turns into almost invisible fluff. After such hairs complete their life cycle and fall out, their place remains empty, because dihydrotestosterone does not allow the follicle to accumulate a sufficient amount of nutrients to reproduce a new hair.

Since not all hair follicles are affected at the same time, thinning of the hair is first observed, and then a full bald spot is formed. The process usually begins with the forehead and temples, gradually moving towards the parietal area. These areas are most susceptible to the influence of the male sex hormone, so it is not surprising that most men begin to develop bald spots on the forehead. But the picture may differ slightly in different men, so several types of androgenic baldness are considered:

• Horseshoe type, when the process of baldness formation affects the temple area, gradually moving deeper into the frontal-parietal zone.
• Nest type, when hair loss in men is observed in different places, but on the crown of the head a rounded bald spot is always formed, resembling a bird's nest. It must be said that this form of baldness is temporary, because gradually all the lesions merge and converge in the shape of a horseshoe, it is just that the first line of hair growth in the parietal zone, like the frontal-temporal zones, is more sensitive to testosterone than other areas of the head.
• Mixed type (in this case, hair loss on the temples, forehead and crown occurs simultaneously and begins with simple thinning of hair, which turns into a voluminous bald spot).

A variant of androgenic alopecia can be considered baldness caused by genetic factors, i.e. the transmission of the Sox 21 gene, which significantly increases the risk of baldness. Both women and men can be carriers of the gene in the X chromosome, because this type of chromosome is in the chromosome set of any person. However, women have two X chromosomes, so if the second one does not have the baldness gene, a compensatory mechanism is triggered and the risk of alopecia becomes small. In men, this deficiency cannot be compensated for, because in their set there is only one X chromosome, which means it can be of decisive importance.

But even the presence of such a gene does not necessarily lead to early baldness in men. It is not for nothing that androgenic alopecia is often called androgenetic. The fact is that very often the genetic factor is superimposed on the endocrine factor associated with the content of testosterone in the body, and such a combination increases the risk of baldness many times over.

It should be said that with androgenetic alopecia in men, partial hair loss is observed, i.e. hair does not fall out over the entire head, but mainly on the temples, frontal and parietal areas, while the hair on the back of the head and on the sides of the head remains quite thick.

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Symptomatic alopecia

This type of baldness has completely different roots. Here we are no longer talking about genetics or the peculiarities of the endocrine system, but about the influence of certain internal and external conditions on the body. Among the reasons for this type of baldness are considered:

• intoxication of the body with harmful and toxic substances,
• negative impact of ionizing radiation,
• drug therapy:

• Baldness often occurs after chemotherapy, since antitumor drugs can kill active cells of the hair follicles,
• increased hair loss in mature hair can be caused by anticoagulants, interferon preparations, retinoids, interferons, beta-blockers,
• But hair loss is associated with the use of bromocriptine, allopurinol and drugs used to treat cancer.

• lack of vitamins and microelements due to chronic diseases or poor nutrition,
• various health pathologies that affect the metabolism in the tissues of the scalp,
• stress factor.

It is worth dwelling on the last point in more detail, because it is no secret that stress and anxiety are the cause of most of the various health problems in humans. Everything is interconnected in our body, so it is not surprising that the load on the nervous system causes disruptions in the work of other organs, has a depressing effect on the immune system, leads to the development of neuropsychiatric disorders, one of the first signs of which can be hair loss for no apparent reason.

The fact that men do not react to stressful situations as emotionally as women does not mean that they remain indifferent. There are situations that throw the stronger sex off track, which can subsequently result in hair loss.

Psychosomatics of baldness in men, although expressed to a lesser extent than in women, can still act as both a primary and secondary factor in hair loss:

• A strong nervous shock, especially a sudden one, can provoke increased hair loss by itself. The sensation of hairs moving on the head and body is not accidental, they are caused by spasms of blood vessels and muscles. Already at this moment, the hair becomes less stable, so it is easily pulled out with any mechanical impact. If the situation does not repeat itself, hair restoration will take no more than 4 months.
• Chronic stress acts more covertly. Hair loss in this case will be gradual. If a person is constantly in a state of nervous tension, this leads to failures in the work of various systems, including the circulatory system. The cause of hair loss is a violation of blood circulation, as a result of which the hair follicles do not receive enough nutrients to grow healthy and strong hair. The more a person is under stress, the harder it will be to restore the hair on his head.
• But even if we are talking about situational experiences, against the background of a man having a baldness gene, they also become a risk factor for premature hair loss.

How to understand that baldness has become a psychosomatic disorder? I will point this out:

• A long period of hair loss, i.e. they fall out gradually, but the deeper a person gets into his experiences, the longer the depression, the more hairs fall out every day.
• Along with hair loss, there is a deterioration in their appearance and the condition of the scalp: the skin quickly becomes oilier, and the hair begins to look greasy and dull, the hairstyle loses its former volume, and hair becomes more brittle. Hormonal imbalances are to blame, which is also caused by constant nervous tension.
• Along with the hair and scalp, nails begin to change (become brittle), and the skin of the rest of the body (acquires an unhealthy color, becomes drier and less elastic).

It should be said that symptomatic baldness can be observed equally in both men and women. And the causes of such pathology can be different.

The impact of the above external and internal factors, not related to hereditary predisposition, leads to the fact that the hair thins and falls out all over the head, i.e. diffuse baldness in men and women occurs. In this case, the success of the treatment depends on how quickly it is possible to eliminate the cause of hair loss, but the situation rarely becomes hopeless.

Nesting (focal) baldness in men

It is considered the opposite of diffuse alopecia, because total hair loss is not observed in this case. Limited foci of baldness of various localizations are formed on the patient's head. Such foci most often have a circle or oval shape and are relatively small in size.

The cause of focal baldness in men (and such pathology can also occur in women and children) are malfunctions in the immune system, which begins to perceive its hair as something foreign, pushing it out like a splinter. It is clear that such malfunctions in the immune system are not accidental. They can be caused by chronic stress, nervous exhaustion, infectious pathologies and other factors. Sometimes an inadequate response of the immune system is associated with the effects of anesthesia and autoimmune diseases.

The problem with male pattern baldness is that over time, the lesions can increase in size, appear in other areas of the head, merge with each other, move, which indicates the progression of the pathology and presents difficulties in treating alopecia.

A sharp severe baldness in men is observed with the generalized form of alopecia areata. This is possible with the progression of the pathology, causing failures in the immune system. This form of the disease can be called the terminal stage of focal baldness in men. Hair loss in this case is rapid and in a couple of months a man can go completely bald.

Cicatricial alopecia

This type of baldness is associated with inflammatory and degenerative processes in the scalp. Skin diseases, infectious processes, mechanical and thermal damage to the skin, head injuries and surgeries, malignant tumor processes can cause inflammation of the hair follicle tissue, as a result of which fibrous tissue is formed at the site of damage, the function of which does not include growing hair. Hair usually does not grow at the site of scars and cicatrices.

Scarring alopecia is equally common in men, women and children, as are diffuse and focal alopecia. According to statistics, such types of alopecia are quite rare (no more than 3% of those who seek medical attention with a hair loss problem), but like androgenetic alopecia, they are a serious problem for young men, on whose heads a bald spot does not look at all attractive.

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Stages

When considering the types of baldness in men, it can be noted that the process of hair loss in different types of baldness has its own characteristics. With diffuse and generalized baldness, there is uniform thinning of hair all over the head, differing only in terms. With focal and cicatricial forms of alopecia, the lesions are usually small, but can have different localizations, and the dynamics of the development of the pathology is quite difficult to predict.

The only type of alopecia in which the stages of pathology development are clearly visible is androgenetic baldness in men. It is believed to be caused by the baldness gene and the negative impact of the male sex hormone on hair growth. This type of hair loss is characteristic, according to various sources, of 90 to 97% of men, so it has been studied by scientists most thoroughly.

According to the classical Hamilton-Norwood scheme, the following stages of process development are considered:

• Stage 1 can last quite a long time, manifesting itself only by a slight increase in the number of hairs falling out daily. In this case, hair falls out especially actively along the hairline in the frontal-temporal part of the head, forming small bald spots on both sides of the forehead.
• Stage 2. Progression of baldness on the forehead in men: an increase in bald spots, which now go 1-2 cm deep from the hairline. In most cases, bald spots are located symmetrically and do not spoil the appearance of a man's face much.

At this stage, gradual hair loss begins in the crown area, but from the outside the situation is still practically unnoticeable.

• Stage 3. The bald spots increase in size and deepen by 3 cm or more, forming 2 unsightly peninsulas. The bald spot on the crown may become more noticeable, although it is still covered with hair that is thinning every day.
• Stage 4. The bald spots in the frontal-temporal zone stop their active growth, but at the same time the hair growth zone is raised, which indicates hair loss in the central area of the forehead. But the process on the crown is actively developing with the formation of bald spots that increase in size. In balding areas, strong hair is replaced by barely noticeable fluff.
• Stage 5. The hair between the bald spots on the frontal part becomes noticeably thinner, and the bald spot on the crown increases in size and becomes more noticeable. A strip extends from one ear to the other in the center of the head, which retains almost normal hair density, which allows the bald spot on the crown to be hidden.
• Stage 6. The bald spots in the frontal-temporal and parietal zones gradually begin to merge due to hair loss between these areas. When a single bald spot is formed, the process begins to descend to the back of the head and the sides of the head, reducing the strip of normal hair.
• Stage 7. Usually by this time only a thin strip remains, running along the sides of the head and the back of the head.

It is important to understand that baldness in androgenetic alopecia can last for several years, starting at a young age. This means that a man has enough time to visit a doctor and take all necessary measures to maintain a hairstyle that gives self-confidence. This type of baldness in men is not considered a hopeless situation and responds well to treatment in the early stages.

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Forms

A bald spot on the head is certainly an unpleasant, but not so rare phenomenon. Therefore, the appearance of bald spots and bald patches does not cause such violent emotions as the appearance of areas of hair loss on other parts of the body, where it is customary to observe more or less lush vegetation. On the face, these are cheeks, eyebrows, beard and mustache, on the body: chest, intimate areas, armpits, as well as arms and legs.

If the appearance of hairless areas on the head can be blamed on bad heredity, then baldness of the face, body and limbs is always based on some pathological processes in the body, and therefore should be especially alarming for a man.

Such defects are most noticeable on the face. Recently, beards and sideburns have come back into fashion, and many men try to emphasize their masculinity with a moustache. But such male decorations will seem attractive only if the beard and moustache are thick, well-groomed, and without flaws. After all, only in this case do they indicate good health. The appearance of unsightly bald spots indicates the opposite, and this is a reason to think.

There is no need to talk about hereditary predisposition in men's beard baldness. Heredity usually manifests itself in the density of hair in this area. But the appearance of individual foci with missing hair is usually associated with the influence of pathological factors:

• stress,
• nervous and physical fatigue,
• infectious diseases (both local skin and systemic infections),
• various types of skin diseases (ringworm, dermatitis, mycoses, etc.),
• metabolic disorders (for example, diabetes) and hormonal imbalances,
• deficiency of vitamins and minerals,
• autoimmune diseases,
• taking certain medications,
• skin injuries in this area,
• poor quality beard and moustache care products,
• radiation, poor environmental conditions, etc.

There are a great many such factors and often we are talking about their combined influence, which only complicates the situation.

It is easy to notice balding spots on the beard, you just need to not shave for a few days, and then assess the condition of the hair on the face. Usually, hairless spots are limited in size and rounded in shape, as with focal alopecia. "Bare" areas may differ in color, acquiring a pinkish, whitish or reddish tint, the skin on them may be either excessively soft and tender, or rough, depending on the cause of the pathology.

Itching or burning may be felt at the site of bald spots, which is typical for fungal diseases. If, in addition to bald spots on the beard, there is a change in the appearance of the hair on the head and a change in the structure of the nails, one can suspect a vitamin deficiency or hormonal imbalance.

Hair loss on the head, eyebrows, beard, and moustache at the same time indicates a generalized process. In this case, baldness most often occurs rapidly.

Men, due to the high testosterone content, tend to have quite abundant hair growth on their legs. However, hair loss in this area becomes an alarming factor, since it mostly has pathological causes:

• deficiency in the body of vitamins and microelements necessary for normal hair growth,
• taking strong drugs, the side effect of which is baldness of the legs and other parts of the body in men,
• high blood sugar levels (in this case, hair on the legs will fall out, while on the face, on the contrary, hair will grow more actively),
• hormonal disorders caused by malfunctions of the thyroid gland.

But before you start to panic about your health, you should pay attention to your clothes. The fashion for tight jeans and pants can do a disservice, because the fabric can rub the skin, rubbing or breaking off hairs on it, hence the formation of "bare" areas on the legs. An identical situation is observed when wearing rough boots.

Simultaneous or progressive hair loss in men on the arms, legs, head, chest and face most likely indicates serious autoimmune problems characterized by the appearance of focal alopecia, which can take different forms:

• if a single bald spot appears on the head, which has a round or oval shape and does not increase in size, we are talking about the most harmless local form of focal alopecia,
• the appearance of a large number of small bald spots on the head indicates alopecia areata,
• Subtotal alopecia is spoken of in the case of the appearance of multiple large lesions on the head and their spread to the face, body, armpits,
• Universal focal alopecia is characterized by the appearance of hairless, clearly defined lesions on the head, body and limbs, accompanied by changes in the condition of the skin and nails, as well as the development of neurasthenia and VSD,
• in focal alopecia, large hairless areas appear on the head and body,
• Total focal alopecia is hair loss on both the head and body, considered the most serious stage of the disease, which is practically untreatable.

Hair loss on the face, body and limbs rarely occurs on its own. Usually it is a combined process affecting the head and body, the man simply noticed only one symptom (the focus) at the time, while the problem may exist in other areas of the body, as well as inside the body.

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Complications and consequences

It should be said that baldness in men is more of an aesthetic problem (unless of course it is a skin infection). The absence of hair on the head even makes it easier to take care of it, it is not for nothing that young guys like to have their hair cut "under zero". True, in this case, you have to pay more attention to protecting your head from active sun rays.

But jokes aside, the appearance of balding areas on the head may hide serious health problems that will subsequently affect not only the hairstyle. Fungal diseases, dermatitis, leading to the appearance of wounds on the skin with a high risk of infection, cardiovascular pathologies, diabetes, thyroid dysfunction and some other pathologies require serious treatment before they cause complications that are far from aesthetic.

But even if we do not take into account the pathological causes of the phenomenon, and consider baldness from the point of view of psychology, the picture is not very encouraging. It is clear that each man will treat the problem in his own way. Someone will simply shave his hair bald and accept the new hairstyle as a given, and for another, a bald spot will become a stumbling block, reducing self-esteem and confidence in his attractiveness to the opposite sex, which is very important at a young age. A luxurious head of hair will in any case look more advantageous than a bald haircut.

Baldness caused by poor nutrition and deterioration of the scalp can be accompanied by the formation of dandruff, which looks very unattractive against the background of a thin hairstyle, hinting at the lack of proper care for the head and hair. Greasy, matted hair and crusty dandruff will repel people, and sometimes it is so difficult to explain to others that the reason for this state of affairs is an illness, and not rare washing of the head. And bald spots on the parietal zone of young guys can become a reason for laughter behind the back and offensive jokes.

The appearance of a bald spot on the crown of the head, among other things, increases the risk of sunburn and heat stroke in the spring and summer, when the activity of the sun's rays is quite high. A balding man will have to regularly wear hats to protect the skin from aggressive rays that can cause burns and even cancer. And in the absence of a hat, regularly use sunscreens on the hairless area of the head and where the hair is not thick enough.

Baldness can have the most negative impact on a man's quality of life. This is especially true for sensitive and emotionally unstable individuals, for whom such a situation can cause prolonged depression, which only worsens the condition. After all, a stress factor can increase hair loss even against the background of a genetic predisposition, not to mention pathological causes of alopecia.

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Diagnostics male pattern baldness

Baldness in men and women is a condition that has clear external manifestations. Bald spots on the forehead or a "nest" on the crown are visible to the naked eye, and thinning hair is noticeable if you take a closer look at a person's hairstyle. It is not surprising that diagnosing the very fact of alopecia development does not cause difficulties for a doctor, even if he is a simple therapist.

But the fact of baldness is not a residual factor for making a final diagnosis and prescribing appropriate treatment. It is important to establish the type and degree of alopecia, because the treatment regimen for different forms of baldness will differ, which is not surprising due to the difference in the causes of early hair loss.

A separate doctor, a trichologist, deals with issues related to hair problems. It is he who should be contacted regarding hair thinning. After all, neither a therapist nor a dermatologist will be able to help if we are talking about the most common cause of alopecia – the influence of genes. It is a different matter if we are talking about skin or internal diseases, but even here the trichologist often has the final say. If necessary, he will refer the patient for a consultation with the right specialist.

Although in practice, everything usually happens exactly the opposite. A man comes to a therapist with complaints, who prescribes all sorts of examinations and consultations with various specialists depending on the identified diseases, and if he fails to identify the cause of alopecia, the patient is referred to a trichologist.

To identify the problem of baldness, a doctor only needs to perform a physical examination of the man's head (and, if necessary, other parts of the body where pathological hair loss is observed). But to identify the cause of such a condition, it will be necessary to study the patient's medical history and information about the presence or absence of facts of early baldness in his family. If close relatives had such problems, one can immediately suspect androgenetic alopecia, which will be indicated by the shape of bald spots or bald patches.

But even with androgenetic alopecia, it is difficult to say what caused early hair loss: a baldness gene inherited from the mother or father or hormonal problems. The latter can be easily detected with the help of laboratory tests.

Since the cause of baldness in men can be not one, but a whole range of factors that may not even be related to each other, the diagnosis of alopecia involves a comprehensive examination of the patient, including a number of laboratory tests:

• general and detailed blood analysis,
• thyroid hormone analysis, which allows to assess the functionality of the organ,
• blood test for male sex hormone levels,
• examination of biomaterial for the presence of parasites, which are often the cause of vitamin and mineral deficiency,
• determination of iron content in blood serum (calculation of ferritin concentration in the blood, allowing to estimate iron reserves in the body),
• to rule out syphilis, which often causes hair loss, a serological blood test and the Wasserman reaction are prescribed, or a more modern method is used - the anticardiolipin test,
• if there is a suspicion of a fungal infection of the skin, as indicated by peeling and itching, tests are carried out with potassium hydroxide (if dermatophytes are present, the test is positive) and illumination with a special lamp,
• A biopsy followed by examination of the biomaterial under a microscope also allows for the diagnosis of dermatomycosis, but this study is also informative for alopecia areata and cicatricial alopecia.

Individual bald spots on the head and body can be detected with fungal infections and with alopecia areata, caused by an inadequate response of the immune system. A blood test can help clarify the situation, showing a reduced number of T- and B-lymphocytes, which is typical for alopecia areata. A test that involves lightly pulling a hair will also confirm the diagnosis: with alopecia areata, hair is pulled out unusually easily.

Instrumental diagnostics gives the doctor a lot of information about the causes of baldness: examination of the hair shaft under a microscope and spectral analysis of hair, which allows identifying mineral metabolism disorders in the body. Spectral analysis allows not only to identify a deficiency of microelements necessary for hair, but also to diagnose many diseases associated with this: diabetes, osteoporosis, thyroid and gastrointestinal pathologies, psoriasis, etc.

After the pathological cause (or several causes) of baldness in a man is identified, the trichologist can refer the patient for consultation with other specialists: a cardiologist, endocrinologist, neurologist, psychologist, etc. These doctors, depending on the identified disorder, can prescribe additional laboratory and instrumental studies that will help develop an effective treatment plan for the underlying disease.

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Differential diagnosis

Since alopecia is considered a multifactorial disease and further treatment depends entirely on the identified cause of hair loss, a large role should be given to differential diagnostics. The doctor's task is to differentiate androgenic alopecia caused by a specific gene from hormonal disorders. Manifestations of alopecia areata should be distinguished from fungal lesions and manifestations of secondary syphilis, which is characterized by the appearance of multiple small foci of baldness. In cicatricial alopecia, it is important to determine the nature of the skin, because foci of fibrous tissue can appear both at the site of traumatic skin damage and against the background of diseases such as lupus erythematosus, sarcoidosis of the skin, lichen, etc.

It is very important to determine the cause of diffuse (symptomatic) alopecia, which is associated not only with the negative impact on the scalp from the outside, but also with internal problems in the body, without the treatment of which it is impossible to restore hair.

Prevention

As for the prevention of baldness in men, there are no measures and requirements that could protect a person from hair loss with a 100% guarantee. If diffuse baldness has clear external and internal causes that can be prevented with a healthy lifestyle, proper nutrition, and timely visits to doctors, then it is much more difficult to prevent focal and androgenic baldness.

However, this is not a reason to give up and wait for what will happen next. Some moments in a person's life can even help weaken the hereditary predisposition, because it is known that not all men who received the baldness gene from their parents go bald early. And the evidence that the grandfather, great-grandfather and father were bald is not at all an indicator that the same fate awaits their descendants.

Measures such as short haircuts (supposedly they reduce the load on the skin and hair follicles, and it is also believed that hair begins to grow back more actively) and refusal to wear hats (due to the fact that they do not allow the scalp to breathe) have no evidence base. Moreover, walking around with an uncovered head only increases the negative impact of external factors on the skin and hair.

But there are other measures that can really reduce the risk of early hair loss:

• Adequate hair care: regular washing with gentle detergents, using folk recipes to strengthen hair, carefully combing hair with a wide-toothed comb. During and after washing, you need to be extremely careful with your hair, since at this time it is most susceptible to injury. Do not rub or scrape your scalp too much during the procedure, and after washing, simply blot your hair with a soft towel and never comb it wet.
• Regular massage procedures on the head in the hair growth zone. Combing can be considered only one of the head massage options, which activates blood circulation in the skin, increases blood supply and nutrition of hair follicles, makes hair healthy and strong.
• A balanced diet is the key to strong hair and nails, because what we eat determines what our hair is nourished with. If the food is depleted of vitamins and minerals, even in the absence of a predisposition, you cannot count on thick hair.
• An active lifestyle that allows you to maintain normal metabolism, unlike physical inactivity, will only have a positive effect on the condition of your hair and body.
• Controlling your neuropsychic state, the ability to respond correctly to stressful situations, avoiding strong emotions, and, if necessary, taking sedatives will help avoid many health problems, including stress-induced diffuse alopecia.

But even compliance with all the above requirements does not guarantee that hair will not start to actively fall out at some point. And here it is important not to delay a visit to the doctor. After all, baldness in men, if it is not caused by the impact of severe stress, is most often a gradual and progressive process. It is much easier to treat it in the early stages in the first six months than after several years, when the baldness becomes obvious. This is confirmed by studies of drugs used to treat alopecia, most of which are simply unable to help if time has been lost.

Forecast

These are probably the most controversial points in the study of the problem of baldness in men, which can have various origins. Even the course of the most studied androgenic alopecia is often difficult to predict, because the process of hair loss itself is delayed in this case for many years. In addition, the intensity of hair thinning largely depends on the level of testosterone in the blood and the activity of 5-alpha-reductase, which can differ significantly in men.

Treatment of androgenic alopecia is a long process and does not always bring the desired results. In theory, a man will have to fight baldness all his life even after a hair transplant. Another option is to look at the problem differently and love yourself in a new guise.

The prognosis for the treatment of diffuse alopecia is more favorable, because in order to stop hair loss on the head, it is enough to remove the factor causing such a disorder. Thus, it is enough to remove external irritants and treat internal problems, paying attention to the neuropsychic state, so that normal metabolism is restored and the hair receives normal nutrition for life and growth. In this sense, it is most difficult for patients with chronic pathologies, the treatment of which is carried out in courses or constantly throughout life.

A controversial prognosis is also observed with focal alopecia. In most cases, it goes away within 3 years, but there is always a risk of relapse and a repeated course of treatment is required. Hair transplantation helps to solve the problem somewhat, but even in this case there is no guarantee that the immune system will not reject the transplanted hair.

However, in case of cicatricial alopecia, surgical treatment is the only possible and quite effective way to restore scalp hair.