Ed Harris. Mr. Clean. Some men can pull it off.

Although my pseudo-coifed crop of hair currently remains intact, I come from a strong line of follicly-challenged hair loss survivors. I know that in the next few years, I too will likely don the family emblem of my forefathers: a shiny and sunburn-prone hairless dome.

Rationally, I comprehend that there is a limited amount of time I have with the hair on my head, and I cherish every moment of it. Emotionally, I am devastatingly unprepared to part ways.

Before my shower begins to get clogged with my mud-colored locks, my hat collection increases exponentially, and my medicine cabinet overflows with novel anti-hair-loss creams, sprays and ointments, I thought to do some investigative work on male-pattern baldness with the hopes of getting a better idea of how this condition occurs and why I am marked for hair failure.

The Biology

To understand male-pattern hair loss, properly known as androgenic alopecia, one must understand the life cycle of a normal scalp full of hair.

The hair on our head goes through three phases of existence:

Phase 1: Anagen, or growth phase, lasting 2-3 years

Phase 2: Catogen, or recession phase, lasting 2-3 weeks

Phase 3: Telogen, or resting phase, lasting 3-4 months

Most of the hair on our scalp is in the anagen phase. While about 100 hairs on the human scalp are shed each day (occurs at the end of telogen stage), around the same number of follicles are regrown (occurs at the beginning of anogen stage). [1] Therefore, in a normal scalp, there is no net loss of hair.

Contrary to common belief, this same cycle remains true in male-pattern baldness.

The Pathology

Androgenic alopecia does not cause the whole piece of hair to fall out, but rather causes hair follicles to shrink to near microscopic size after each shedding. This occurs due to the progressive shortening of the anagen phase, causing each hair follicle to become thinner and smaller during each cycle.

Many men who experience hair loss may feel emasculated by the thinning. Fear not. The pathogenesis behind androgenic alopecia is in fact due to an overproduction of testosterone converters and an underproduction of estrogen converters. [2] This change in hormone production occurs in the hair follicles themselves, directly affecting the hair on one’s scalp.

Women can also experience androgen alopecia; however, their thinning is typically well-distributed throughout the scalp and less complete than men.

So why the moniker male-pattern baldness?

The Genetics

The currently-accepted theory of the hereditary nature of androgenic alopecia is that genes responsible for this condition are found primarily in an affected X chromosome. Because men carry XY chromosomes and women carry XX chromosomes, men do not have a second X chromosome to help overshadow the gene defect of the affected X such as women do. Therefore, when men are passed down this gene from their mother, they are likely to fully express it.

Thus, this condition commonly reveals itself in males more completely than females.

Of note, this is a very important concept when choosing which family member to blame for your pending baldness. If you haven’t already, please apologize profusely to your bald father for mistaking him as the source for your balding genes and instead confront your mother, for it is she who has likely passed it down.

The Bald Truth

Intellectualizing baldness is never a dull time. But in the end, it does not change my fated path to the cue-ball look that only ’90s action heroes like Bruce Willis proudly advertise.

The ultimate question is: to treat or not to treat.

There are a multitude of topical treatments available for hair loss, many that are fairly effective. However, these sprays and lotions come with a caveat: Once they are discontinued, much of the hair that was genetically destined to miniaturize into oblivion usually does so.

Other less mainstream and often more invasive methods of hair restoration treatments, usually seen amongst a string of late-night infomercials, are always available to those who pooh-pooh the FDA. Hair transplantation is also a treatment option; however, I’d prefer to limit my transplant surgeries to only those organs that I need to survive.

Until either the wonder drug of the century that safely and effectively treats male-pattern baldness comes to fruition or short, skinny bald men become the sex symbol of our time, I and the rest of those thinning or soon-to-be thinning men of my generation must emotionally prepare for what our ancestors bestowed upon us, just as they have done in ages past.

But for now, I will have to settle with an angry phone call to my mother.


1. Price VH. Treatment of Hair Loss. N Engl J Med. 1999 Sep 23;341(13):964-73.

2. Sawaya ME, Price VH. Different levels of 5alpha-reductase type I and II, aromatase, and androgen receptor in hair follicles of women and men with androgenetic alopecia. J Invest Dermatol. 1997 Sep;109(3):296-300.

Brian Secemsky, M.D.

Medical writing for patients, students
and practitioners.

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