How does AGA differ from Male Pattern Hair Loss (MPHL)?
Male hair loss has suffered from inconsistent terminology. It has been called – Hereditary/ Familial Baldness/Common Baldness/Male Pattern Baldness (MPB)/AndroGenetic Alopecia (AGA). It can be defined as “Patterned, progressive and potentially reversible hair miniaturization limited to the frontal and central areas of the scalp in genetically predisposed individuals”. The term which is commonly used is Male Pattern Hair loss and is in fact easy to identify even for somebody with no clinical experience as it only affects hair on the top of the scalp and not the sides, causing a horseshoe-shaped pattern of hair loss. There are a number of different common patterns of hair loss – a receding hairline, a thinning crown, or general thinning spread over the top area of the head.
It is generally recognized that men in their 20’s have a 20 percent incidence of male pattern baldness, in their 30’s a 30 percent incidence of male pattern baldness, in their 40’s a 40 percent incidence of male pattern baldness, etc. Using these numbers one can see that a male in his 90’s has a 90 percent chance of having some degree of male pattern baldness.
How does one diagnose male pattern hair loss?
Typical male pattern baldness is usually diagnosed based on the appearance and pattern of the hair loss, along with a detailed medical history, including questions about the prevalence of hair loss in your family.
At Hairrevive we try and arrive at a diagnosis of hair loss in every patient. The diagnosis depends on various steps:
- History: The onset of hair loss, pattern of hair loss and family history of male pattern hair loss in close family members (both from paternal and maternal side)
- Examination: Scalp examination revealing a typical pattern of hair loss – fronto-temporal thinning/recession and/or thinning in the crown area
- Trichoscopy: Revealing a variability of diameter of hair shafts in the affected area and no variability of diameter in the permanent zone of the scalp (the back and sides of the scalp)
- Haircheck: This revolutionary device reveals the cross sectional volume of hair in a unit area. The difference between the affected areas and the non-affected areas is demonstrated. Haircheck is a new patented technology that provides the answers to all your hair loss and hair breakage questions. It’s a scientific instrument designed to precisely and accurately measure hair loss, growth and breakage on any area of the scalp. No hair needs to be cut and testing takes about 5 minutes. When hair loss or breakage is detected, your hair professional can make appropriate suggestions and measure the response to take-home products and salon treatments.
How does hair loss progress in males?
Male pattern hair loss (Androgenetic Alopecia) is an inherited condition manifested when androgens are present in normal amounts. The gene can be inherited from the mother or father’s side. The onset, rate, and severity of hair loss are unpredictable. The severity increases with age and if the condition is present it will be progressive and relentless.Men with male-pattern hair loss may have an expectation of hair loss if they have male relatives who lost hair in a recognizably male pattern.Hair loss is graded as per severity according to the Norwood Hamilton Classification:
- Grade 1 – Normal adolescent hair line with no evidence of thinning or recession
- Grade 2 – Slight progress to mature hair line incorporating mild fronto-temporal recession. This is not a stage of baldness.
- Grade 3 – The fronto-temporal recession gets deeper leading to the earliest stage of male pattern hair loss.
- Grade 4 – Vertex – Same as grade 3 but with some thinning of the crown area.
- Grade 5 – Further recession of fronto-temporal angles, but solid transverse band of hair in the centre.
- Grade 6 – The recession in the front and the thinning in the crown continue to enlarge and the bridge of hair separating the two areas begins to break down.
- Grade 7 – When the hair loss progresses and the connecting central bridge of hair disappear the frontal and crown areas get connected into one large bald area. The hair on the sides of the scalp remains relatively high.
- Grade 8 – The most advanced form of male pattern hair loss where only a fringe to hair bearing area remains on the back and sides of the head.
The anterior or “A” pattern of hair loss are when the hair loss is more in the front (anterior) as compared with the crown areas. The frontal or anterior patterns of male pattern hair loss are less common than the regular pattern but these patterns make the hair loss look worse even if the hair loss is not very severe.As this variety of hair loss compromises the hair line and the person loses facial framing, these persons are good candidates for hair transplantation.
Can male hair loss be present in non-patterned manner?
Male hair loss can present in a manner different from the usual patterns of hair loss described above. The two known variants of this – Diffuse Patterened Alopecia (DPA) and Diffuse Unpatterened Alopecia (DUPA).
Diffuse Patterned Alopecia is an androgenetic alopecia manifested as diffuse thinning in the front, top and crown, with a stable permanent zone; the hair line does not show recession. In spite of significant hair loss in the middle of the scalp and crown areas the hair line and framing of the face remains intact. On the other hand, Diffuse Unpatterned Alopecia (DUPA) has diffuse hair loss but the permanent hair bearing area on the sides and back of the head is also impacted. It is less common than the DPA. DUPA tends to advance faster than DPA and end up in a horseshoe pattern resembling the Norwood class VII. However, unlike the Norwood 7, the DUPA horseshoe can look almost transparent due to the low density of the back and sides. Presence of significant miniaturization in the permanent zone signifies the possibility of DUPA
Differentiating between DPA and DUPA is very important because DPA patients may be eligible for a hair transplant by the virtue of an intact permanent donor zone, whereas DUPA patients almost never do, as they eventually have extensive hair loss without a stable zone for harvesting hair follicles.