1) Male pattern baldness, also known as androgenetic alopecia, is caused by a combination of genetic and hormonal factors. Genes inherited from both parents play a role in baldness susceptibility. 2) The male hormone dihydrotestosterone (DHT), which is produced from the conversion of testosterone by the enzyme 5-alpha reductase, attaches to receptors on hair follicles and causes them to miniaturize over time. 3) Baldness is a progressive condition that develops over many years as the genetically inherited tendency interacts with aging and DHT levels in the scalp. There is no permanent cure except for surgical hair transplants.

1. Hair Loss In Men
Normal Hair cycle
A look at the above image will give you a fair idea of what your scalp is made up of and what
happens with hair fall. Reasons for hair loss are probably the most debated topic around the
world for decades now. Let us try to attempt and understand the following.
What causes baldness?
Androgenetic Alopecia is commonly known as Male patterned baldness. Three main reasons for
baldness are :
Heredity- Genes play a vital role in the onset of baldness in men. A person most likely has an
inherited tendency become bald early. Approximately over 150 genes control hair growth. So,
the pattern of this kind of inheritance may vary from one individual to another. In the same
family although parents are bald, the children may never go bald but grand children may be
affected.
Male hormone -DHT is the major hormone for the baldness which is originating from
Testosterone.
Age and time is another influence – Baldness is a progressive phenomenon with the advancing
age. It usually takes time for the genetically inherited balding tendency to establish itself.Did you
know that the normal hair fall per day is 50 to 100 strands
MALE PATTERN BALDNESS or ANDRO GENETIC ALOPESIA is actually gradual
balding of the scalp which occurs commonly in men and occasionally in women also. There is
gradual transformation of terminal hair follicles to smaller vellus ones with a much shorter
growth period. This condition occurs in well defined patterns and is believed to require both
ANDROGENS (a male hormone which stimulates and controls male characteristics) and genes.
This basically non scarring alopecia which results from genetically determined end organ
sensitivity to the hormone DHT. The change in the terminal to vellus hair ratio is usually 6:1-8:1
to 4:1 or possibly even less.With this condition there is interaction of several genes along with
various environmental factors. Usually it affects 25% of men aged 25-30 yrs and over 50% of
men aged 50 yrs and above.

2. It is imperative to remember that there is no other corrective and permanent treatment for this
condition except for hair transplantation via surgery.
Inheritance is usually influenced by both maternal and paternal side genetic penetration. Hence it
is usually poly genic inheritance with variable penetrance. There is no specific treatment yet to
resolve this kind of genetic defect that causes baldness.
Learn about HAIR LOSS INDEX, PROFILE AND SEVERITY SCALE
Now this concept was specially designed to describe a given individual patient’s hair distribution
and density; the PROFILE is a graphic display of the loss in each 10 zones. INDEX is the score
for cumulative loss across all 10 zones.
Surface map is a 3 dimensional view graphic scalp with 10 zones that corresponds to sequence of
classification by MPHL [NORWOOD]
Process of Miniaturization
Time : Baldness is a progressive phenomenon with the advancing age. It takes time for the
genetically inherited balding tendency to establish itself.Hair loss severity is basically the visual
ratio of hair to skin. It has been sub-divided into 6 categories.
Scalp laxity
The density and laxity of the donor area is the most important factor which decides the number
of grafts that we can get in one session.
Some times the Scalp laxity is excessive due to genetic variation and connective tissue disorder
like Ehlar-Danlos Syndrom. These conditions leads to Keloid Tendency and Wide Scars.
What is the role of the male hormone- Androgen?
In normal hair growth the Papilla nurtures the specific Matrix cells with growth factors such as
insulin. These matrix cells also secrete several growth factors which stimulate the papilla. The
dermal papilla is Mesenchymal in origin which play major role in induction and maintenance of
hair growth.
The scalp hair follicles take up Testosterone and with the help of 5-alpha reductase type 2-
enzyme converts it into Dihydro testrosterone or [DHT] . This binds with the above AR enzymes
and activates the Androgen receptor genes.
Due to this combination of 5 alpha – DHT in the hair follicles there is decreased concentration of
“C AMP” which causes the shortening of hair cycle. Now this finally leads to transition of

3. Anagen hairs into Telogen hairs with total loss of hair and baldness.
In addition the balding scalp also contains less Aromatase which converts testosterone to
estradiol. In women it is this enzyme that maintains the hairline on the forehead area.
Here are more specific details about Androgen
As we have been seeing all along, the 2 androgens namely, testosterone and dihydro testosterone
(DHT) play a pivotal role in hair growth in men and are also directly responsible for hair loss.
The hair growth on the face and body, acne, prostrate enlargement and Male pattern Baldness
(MPB) are all under the control of DHT. DHT which is directly responsible for MPB needs to
necessarily be produced from testosterone only.
To refresh your memory remember that the enzyme 5-alpha reductase converts the testosterone
to DHT.