Male Pattern Baldness

Question 1

Background

Answer 1

Can be:
Male pattern baldness (MPB) or
Androgenic alopecia (AGA)

Question 2

Diagnosis / Assessment

Answer 2

Detailed history to find risk factors
- PMH, Meds, Family Hx, Hair routine, Psychological impact of loss
Examine the man
Suspect underlying cause or ALT diagnosis if:
- Random shedding/rapid loss
- Temporal hair thinning
- Absent/reduced eyebrows/lashes
- Inflammation/opus/scaling on scalp
- systemic disease
- new meds
- Change in diet

Hamilton-Norwood Scale:
7 levels ranks the amount of hair loss. 7 is highest

Hair pull test: tests activity and severity of hair loss

Lab testing (Optional)
- Check TFT, FBC, Ferritin and VIT D levels esp if:
Underlying cause/ ALT diagnosis
Atypical
Features of Hypothyroidism, anaemia or VIT D deficiency

Question 3

Treatment

Answer 3

Options:
- No treatment in mild
- Aesthetic options (Hairpiece, wig, styling colourant)
- Drug treatment
- Surgical (hair transplant)

DRUGS:
- Topical minoxidil or
- Oral finasteride 1mg tabs

Minoxidil - Stimulate limited hair growth in a small proportion of adults but only when used
Finasteride - inhibitor of the enzyme 5α-reductase, which metabolises testosterone into DHT (induces baldness) so stops this.

Refer if:
Atypical, possible underlying cause, no response, Adverse psychological affects

Question 4

Drug info

Answer 4

Minoxidil:

5 A reductase inhibitor:
(Finasteride for MPB, F and Dutasteride for LUTs due to BPH (>30g/cc or PSA>1.4)
MOA- block synthesis of DHT from testosterone and can reduce symptoms. Effect of androgen inhibition is hair growth
AEs- Impotence, Reduced libido, breast tenderness/ Enlargement, hair growth. F- Breast cancer and suicidal thoughts in men. AE are short lasting.
Contraindicated - women of child bearing age.
Can take 6 months to work and if treatment is stopped b4 that benefit wont be shown
Women must not even handle tablets. Wear condom during sex.
follow up 3-6 months Then every 6-12 months whilst on drug.