Understanding Male Pattern Baldness: Causes, Myths, and Diagnosis

Understanding Male Pattern Baldness: Causes, Myths, and Diagnosis

Male pattern baldness (MPB), also known as androgenetic alopecia, is the most common reason men experience hair loss. It usually starts with a receding hairline or thinning on the crown, eventually leading to complete baldness in some cases. While many blame stress, poor diet, or shampoo choices, the real culprits are genetics and hormones—specifically, DHT (Dihydrotestosterone) and the enzyme 5-alpha reductase.

Role of Genetics in Male Pattern Baldness

Baldness often runs in families, which means your genes play a big role in determining whether you’ll experience hair loss. If your father, uncles, or grandparents had early baldness, you might be more likely to lose hair too. However, it’s not a single-gene inheritance; multiple genes from both parents influence how sensitive your hair follicles are to DHT.

DHT: The Key Hormone Behind Baldness

DHT is a byproduct of testosterone, but it’s much more potent. It binds to hair follicles, shrinking them over time. As a result:

1. Hair strands become thinner.

2. Hair growth slows down.

3. Eventually, follicles stop producing hair altogether.

This process happens because of 5-alpha reductase, an enzyme that converts testosterone into DHT. While testosterone itself doesn’t cause baldness, its conversion into DHT does.

Common Myths About DHT and Testosterone

1. "High DHT means high testosterone" – FALSE

   • DHT is made from testosterone, but having high DHT doesn’t mean you have high testosterone. Some men have normal testosterone levels but higher 5-alpha reductase activity, leading to more DHT and faster hair loss.

2. "Men with high testosterone levels always go bald" – FALSE

   • Baldness is about how sensitive your hair follicles are to DHT, not just testosterone levels. Some men with high testosterone never go bald, while others with normal levels lose hair early.

3. "Blocking DHT completely is good for hair" – FALSE

   • DHT has other functions in the body, such as supporting prostate health, muscle growth, and libido. Completely blocking DHT can lead to unwanted side effects like fatigue or lower sex drive.

How 5-Alpha Reductase Impacts Baldness (In Simple Terms)

Think of 5-alpha reductase as a machine that turns testosterone into DHT. If this machine is overactive, more DHT is produced, which speeds up hair follicle shrinkage. Medications like finasteride work by slowing down this machine, reducing DHT levels and delaying hair loss.

How to Differentiate Male Pattern Baldness from Other Hair Loss Conditions

Since not all hair loss is due to DHT, certain tests help distinguish male pattern baldness from conditions like alopecia areata or fungal infections (tinea capitis).

1. Trichoscopy (Hair and Scalp Analysis)

   • Helps identify miniaturized hair follicles typical of DHT-related hair loss.

2. Blood Tests

   • DHT and Testosterone Levels: To assess hormonal imbalances.

   • Iron and Vitamin D Levels: To rule out nutritional deficiencies.

   • Thyroid Function Test (T3, T4, TSH): To check if hypothyroidism is contributing to hair loss.

3. Scalp Biopsy

   • A small tissue sample is taken to check for inflammatory conditions like alopecia areata or scalp infections.

4. Fungal Culture (For Tinea Capitis – Scalp Ringworm)

   • If hair loss is patchy with redness and itching, a fungal test may be done to detect tinea capitis.

Final Thoughts

Male pattern baldness is mostly genetic and hormone-driven, but it’s important to separate facts from myths. DHT is a major player in hair loss, but having high DHT doesn’t necessarily mean you have high testosterone. If you’re experiencing unusual hair loss, getting proper tests done can help rule out other causes and guide treatment options.