The male pattern baldness (MPB) form of androgenetic alopecia (there is also a female pattern baldness) accounts for more than 95% of hair loss in men. By age 35, two-thirds of American men will have some degree of appreciable hair loss and by age 50 approximately 85% of men have significantly thinning hair. About 25% of men who suffer from male pattern baldness begin the painful process before they reach 21.

Contrary to societal belief, most men who suffer from male pattern baldness are extremely unhappy with their situation and would do anything to change it. Hair loss affects every aspect of their life. It affects interpersonal relationships as well as their professional life. It is not uncommon for men to change their career paths because of hair loss.

The American Hair Loss Association recognizes how devastating male pattern baldness can be for men of all ages and has created resources for men to get completely objective answers to their hair loss questions.

We strongly advise against researching your options through the Yellow Pages or commercial websites. Hundreds of products and services are sold to the vulnerable hair loss consumer but currently only two FDA-approved products have been clinically proven to stop or prevent hair loss.

Androgenetic alopecia or male pattern baldness (MPB) is responsible for the vast majority of hair loss in men. While there are many possible reasons people lose hair, including serious diseases, reaction to certain medications and in rare cases, extremely stressful events, most hair loss in men can be blamed on heredity.

What male pattern baldness sufferers inherit are hair follicles with a genetic sensitivity to dihydrotestosterone (DHT). Hair follicles sensitive to DHT begin to miniaturize, shortening the lifespan of each hair follicle affected. Eventually, these affected follicles stop producing cosmetically acceptable hair.

Male pattern baldness is generally characterized with the onset of a receding hairline and thinning crown. Hair in these areas including the temples and mid-anterior scalp appear to be the most sensitive to DHT. This pattern eventually progresses into more apparent baldness throughout the entire top of the scalp eventually leaving only a rim or "horseshoe" pattern of hair remaining in the more advanced stages of MPB.

What Is DHT?

Dihydrotestosterone (DHT) is a derivative or by-product of testosterone. Testosterone converts to DHT with the aid of the enzyme 5-alpha-reductase. While the entire genetic process of MPB is not completely understood, scientists do know that DHT shrinks hair follicles and that when DHT is suppressed, hair follicles continue to thrive.

Hair follicles that are sensitive to DHT must be exposed to the hormone for a prolonged period of time for the affected follicle to complete the miniaturization process. Today, with proper intervention this process can be slowed or even stopped if caught early enough.

In the past few years, medicine has made tremendous strides in the treatment of men's hair loss. With the advent of 5-alpha-reductace inhibitors such as Propecia and the evolution of surgical hair restoration, living with noticeable hair loss is no longer inevitable. For the first time in the history it is now possible to stop or slow the progression of hair loss and to replace lost hair through surgery with completely natural results.

However, with that said, the vast majority of hair loss treatments being marketed today are still nothing but "snake oils."

You may have seen the ads in the back of men's magazines, you've heard the commercials on the radio, and you've seen the infomercials promoting miracle treatments for hair loss. The bottom line is that most advertised "treatments" do not work for the prevention and treatment of hair loss. If a hair loss treatment is not approved by the FDA or recommended by the American Hair Loss Association, chances are you are wasting your time and money.

The following two treatments have been clinically proven to successfully treat hair loss in men to varying degrees.

Finasteride (Proscar, Propecia)

Finasteride is the generic name for the brand name drugs Proscar and Propecia. Finasteride was originally developed by the pharmaceutical company Merck as a drug (Proscar) to treat enlarged prostate glands.

During the trials on men with prostate problems, researchers noted an intriguing side effect: hair growth. Since finasteride had already been approved by the FDA to treat enlarged prostates in men, Merck decided to pursue the possibility of developing finasteride as the first pill to treat male pattern baldness. Minoxidil, a topical liquid solution, was already on the market (see below).

In December 1997, the FDA approved a 1mg dose of finasteride for the treatment of androgenetic alopecia (male pattern baldness) in men. Propecia is the first drug in history to effectively treat male pattern baldness in the majority of men who use it.

How Finasteride Works

Finasteride's hair-raising success is due to its ability to specifically inhibit 5-alpha-reductase, the enzyme that converts testosterone into a more potent androgen dihydrotestosterone (DHT).

Propecia's 1 mg dose of finasteride can effectively lower DHT levels in the scalp by as much as 60% when taken daily. It is DHT that shrinks or miniaturizes the hair follicle, which eventually leads to baldness. This 60% reduction in DHT has proven to stop the progression of hair loss in 86% of men taking the drug during clinical trials. 65% of trial participants had what was considered a substantial increase of hair growth.

At this point, the only truly effective medically proven way to arrest the hair loss process is to lower DHT levels. The American Hair Loss Association recommends finasteride as the first line of attack for all men interested in treating their male pattern baldness.

Minoxidil (Rogaine)

Minoxidil was the first drug approved by the FDA for the treatment of male pattern baldness. For many years, minoxidil, in pill form (brand name Loniten), was widely used to treat high blood pressure. Just like Finasteride, researchers discovered a very interesting side effect of the drug. People taking the medication were growing hair in unexpected places, such as on their cheeks and the back of their hands. Some people grew hair on their foreheads.

Some enterprising researchers had the notion that applying minoxidil topically, directly on the head, might grow hair on balding areas. It did, to varying degrees depending on the extent of the hair loss, but at the time it was revolutionary.

While minoxidil has been clinically proven to slow the progression of hair loss and regrow some hair. Most experts see it as a relatively marginally effective drug in the fight against hair loss. Since minoxidil has no effect on the hormonal process of hair loss, its positive effects are at best temporary and usually yield somewhat disappointing results.

The American Hair Loss Association still recommends the drug for those who have not responded favorably to Finasteride treatment or for those who would like to add another product to their regimen. The AHLA does not recommend minoxidil as the first line of attack for men suffering with male pattern baldness, but does recognize it as an effective treatment for a small percentage of its users.