Pattern Hair Loss in Men

Diagnosis and Medical Treatment
Published:September 24, 2012DOI:


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        • Wells P.A.
        • Willmoth T.
        • Russell R.J.
        Does fortune favour the bald? Psychological correlates of hair loss in males.
        Br J Psychol. 1995; 86: 337-344
        • Cash T.F.
        Losing hair, losing points?: the effects of male pattern baldness on social impression formation.
        J Appl Soc Psychol. 1990; 20: 154-167
        • Alfonso M.
        • Richter-Appelt H.
        • Tosti A.
        • et al.
        The psychosocial impact of hair loss among men: a multinational European study.
        Curr Med Res Opin. 2005; 21: 1829-1836
        • Kaufman K.D.
        Androgens and alopecia.
        Mol Cell Endocrinol. 2002; 198: 89-95
        • Yip L.
        • Rufaut N.
        • Sinclair R.D.
        Role of genetics and sex steroid hormones in male androgenetic alopecia and female pattern hair loss: an update of what we now know.
        Australas J Dermatol. 2011; 52: 81-88
        • Ziller C.
        Pattern formation in neural crest derivatives.
        in: Van Neste V.R. Hair research for the next millennium. Elsevier Science, Amsterdam1996: 1
        • Jaenisch R.
        • Bird A.
        Epigenetic regulation of gene expression: how the genome integrates intrinsic and environmental signals.
        Nat Genet. 2003; 33: 245-254
        • Foley D.L.
        • Craig J.M.
        • Morley R.
        • et al.
        Prospects for epigenetic epidemiology.
        Am J Epidemiol. 2009; 169: 389-400
        • McGrath J.
        • McLean I.
        Genetics in relation to the skin: mosaicism.
        in: Fitzpatrick’s dermatology in general medicine. vol. 1. McGraw Hill Medical, New York2008: 83-84
        • Ellis J.A.
        • Stebbing M.
        • Harrap S.B.
        Polymorphism of the androgen receptor gene is associated with male pattern baldness.
        J Invest Dermatol. 2001; 116: 452-455
        • Hillmer A.M.
        • Flaquer A.
        • Hanneken S.
        • et al.
        Genome-wide scan and fine-mapping linkage study of androgenetic alopecia reveals a locus on chromosome 3q26.
        Am J Hum Genet. 2008; 82: 737-743
        • Hillmer A.M.
        • Brockschmidt F.F.
        • Hanneken S.
        • et al.
        Susceptibility variants for male-pattern baldness on chromosome 20p11.
        Nat Genet. 2008; 40: 1279-1281
        • Sawaya M.E.
        • Price V.H.
        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; 109: 296-300
        • Vierhapper H.
        • Maier H.
        • Nowotny P.
        • et al.
        Production rates of testosterone and of dihydrotestosterone in female pattern hair loss.
        Metabolism. 2003; 52: 927-929
        • Shapiro J.
        • Price V.H.
        Hair regrowth. Therapeutic agents.
        Dermatol Clin. 1998; 16: 341-356
        • Sinclair R.D.
        Male pattern androgenetic alopecia.
        BMJ. 1998; 317: 865-869
        • Jahoda C.A.B.
        Cellular and developmental aspects of androgenetic alopecia.
        Exp Dermatol. 1998; 7: 235-248
        • Obana N.J.
        • Uno H.
        Dermal papilla cells in macaque alopecia trigger a testosterone dependent inhibition of follicular cell proliferation.
        in: Neste D.V. Randall V.A. Hair research in the next millennium. Elsevier, Amsterdam1996: 307-310
        • Oliver R.F.
        • Jahoda C.A.
        The dermal papilla and the maintenance of hair growth.
        in: Roger G.A. Reis P. Ward K.A. The biology of wool and hair. Chapman and Hall, London1989: 51-67
        • Randall V.A.
        • Hibberts N.A.
        • Hamada K.
        A comparison of the culture and growth of dermal papilla cells from hair follicles from non-balding and balding (androgenetic alopecia) scalp.
        Br J Dermatol. 1996; 134: 437-444
        • Whiting D.
        Scalp biopsy as a diagnostic and prognostic tool in androgenetic alopecia.
        Dermatol Ther. 1998; 8: 24-33
        • Whiting D.A.
        Diagnostic and predictive value of horizontal sectioning of scalp biopsy specimens in male pattern androgenetic alopecia.
        J Am Acad Dermatol. 1993; 28: 755-763
        • Headington J.T.
        Transverse microscopic anatomy of the human scalp. A basis for a morphometric approach to disorders of the hair follicle.
        Arch Dermatol. 1984; 120: 449-456
        • Hamilton J.
        Patterned loss of hair in man; types and incidence.
        Ann N Y Acad Sci. 1951; 53: 708-728
        • Norwood O.T.
        Male pattern baldness: classification and incidence.
        South Med J. 1975; 68: 1359-1365
        • Kaufman K.D.
        • Olsen E.A.
        • Whiting D.
        • et al.
        Finasteride in the treatment of men with androgenetic alopecia. Finasteride Male Pattern Hair Loss Study Group.
        J Am Acad Dermatol. 1998; 39: 578-589
        • De Lacharriere O.
        • Deloche C.
        • Misciali C.
        • et al.
        Hair diameter diversity: a clinical sign reflecting the follicle miniaturization.
        Arch Dermatol. 2001; 137: 641-646
        • Tosti A.
        • Whiting D.
        • Iorizzo M.
        • et al.
        The role of scalp dermoscopy in the diagnosis of alopecia areata incognita.
        J Am Acad Dermatol. 2008; 59: 64-67
        • Blume-Peytavi U.
        • Orfanos C.E.
        Microscopy of the hair—the trichogram.
        in: Serup J. Jemec G.B. Grover G.L. Handbook of non-invasive methods and the skin. 2nd edition. CRC Press, Boca Raton (FL)2006: 875-881
        • Van Neste D.J.
        • Dumrotier M.
        • de Brouwer B.
        • et al.
        Scalp immersion proxigraphy: an improved imaging technique for phototrichogram analysis.
        J Eur Acad Dermatol Venereol. 1992; 1: 187-191
        • Hoffmann R.
        • Happle R.
        Current understanding of androgenetic alopecia. Part II: clinical aspects and treatment.
        Eur J Dermatol. 2000; 10: 410-417
        • Arias-Santiago S.
        • Gutierrez-Salmeron M.T.
        • Castellote-Caballero L.
        • et al.
        Androgenetic alopecia and cardiovascular risk factors in men and women: a comparative study.
        J Am Acad Dermatol. 2010; 63: 420-429
        • Yassa M.
        • Saliou M.
        • De Rycke Y.
        • et al.
        Male pattern baldness and the risk of prostate cancer.
        Ann Oncol. 2011; 22: 1824-1827
        • Phillips K.A.
        Body dysmorphic disorder: the distress of imagined ugliness.
        Am J Psychiatry. 1991; 148: 1138-1149
        • Li M.
        • Marubayashi A.
        • Nakaya Y.
        • et al.
        Minoxidil-induced hair growth is mediated by adenosine in cultured dermal papilla cells: possible involvement of sulfonylurea receptor 2B as a target of minoxidil.
        J Invest Dermatol. 2001; 117: 1594-1600
        • Olsen E.A.
        • Weiner M.S.
        • Amara I.A.
        • et al.
        Five-year follow-up of men with androgenetic alopecia treated with topical minoxidil.
        J Am Acad Dermatol. 1990; 22: 643-646
        • Olsen E.A.
        • Dunlap F.E.
        • Funicella T.
        • et al.
        A randomized clinical trial of 5% topical minoxidil versus 2% topical minoxidil and placebo in the treatment of androgenetic alopecia in men.
        J Am Acad Dermatol. 2002; 47: 377-385
        • Blumeyer A.
        • Tosti A.
        • Messenger A.
        • et al.
        Evidence-based (S3) guideline for the treatment of androgenetic alopecia in women and in men.
        J Dtsch Dermatol Ges. 2011; 9: S1-S57
        • Canadian Pharmacists Association monograph, minoxidil and finasteride
        Compendium of pharmaceuticals and specialities (CPS). 34th edition. Canadian Pharmacists Association, Ottawa (Canada)1999
        • Drake L.
        • Hordinsky M.
        • Fiedler V.
        • et al.
        The effects of finasteride on scalp skin and serum androgen levels in men with androgenetic alopecia.
        J Am Acad Dermatol. 1999; 41: 550-554
        • Van Neste D.
        • Fuh V.
        • Sanchez-Pedreno P.
        • et al.
        Finasteride increases anagen hair in men with androgenetic alopecia.
        Br J Dermatol. 2000; 143: 804-810
        • Rossi A.
        • Cantisani C.
        • Scarno M.
        • et al.
        Finasteride, 1 mg daily administration on male androgenetic alopecia in different age groups: 10-year follow-up.
        Dermatol Ther. 2011; 24: 455-461
        • Stough D.B.
        • Rao N.A.
        • Kaufman K.D.
        • et al.
        Finasteride improves male pattern hair loss in a randomized study in identical twins.
        Eur J Dermatol. 2002; 12: 32-37
        • Traish A.M.
        • Hassani J.
        • Guay A.T.
        • et al.
        Adverse side effects of 5alpha-reductase inhibitors therapy: persistent diminished libido and erectile dysfunction and depression in a subset of patients.
        J Sex Med. 2011; 8: 872-884
        • Price V.H.
        Treatment of hair loss.
        N Engl J Med. 1999; 341: 964-973
        • Roberts J.L.
        • Fiedler V.
        • Imperato-McGinley J.
        • et al.
        Clinical dose ranging studies with finasteride, a type 2 5alpha-reductase inhibitor, in men with male pattern hair loss.
        J Am Acad Dermatol. 1999; 41: 555-563
        • Leyden J.
        • Dunlap F.
        • Miller B.
        • et al.
        Finasteride in the treatment of men with frontal male pattern hair loss.
        J Am Acad Dermatol. 1999; 40: 930-937
        • McClellan K.J.
        • Markham A.
        Finasteride: a review of its use in male pattern hair loss.
        Drugs. 1999; 57: 111-126
        • Canfield D.
        Photographic documentation of hair growth in androgenetic alopecia.
        Dermatol Clin. 1996; 14: 713-721
        • Stough D.
        Dutasteride improves male pattern hair loss in a randomized study in identical twins.
        J Cosmet Dermatol. 2007; 6: 9-13
        • Olsen E.A.
        • Hordinsky M.
        • Whiting D.
        • et al.
        The importance of dual 5alpha-reductase inhibition in the treatment of male pattern hair loss: results of a randomized placebo-controlled study of dutasteride versus finasteride.
        J Am Acad Dermatol. 2006; 55: 1014-1023
        • Khandpur S.
        • Suman M.
        • Reddy B.S.
        Comparative efficacy of various treatment regimens for androgenetic alopecia in men.
        J Dermatol. 2002; 29: 489-498
        • Kassimir J.J.
        Use of topical minoxidil as a possible adjunct to hair transplant surgery. A pilot study.
        J Am Acad Dermatol. 1987; 16: 685-687
        • Roenigk H.H.
        • Berman M.D.
        Topical 2% minoxidil with hair transplantation.
        Face. 1993; 4: 213-216
        • Avram M.R.
        • Cole J.P.
        • Gandelman M.
        • et al.
        The potential role of minoxidil in the hair transplantation setting.
        Dermatol Surg. 2002; 28 ([discussion: 900]): 894-900
        • Leavitt M.
        • Perez-Meza D.
        • Rao N.A.
        • et al.
        Effects of finasteride (1 mg) on hair transplant.
        Dermatol Surg. 2005; 31 ([discussion: 1276]): 1268-1276
        • Wolf R.
        • Matz H.
        • Zalish M.
        • et al.
        Prostaglandin analogs for hair growth: great expectations.
        Dermatol Online J. 2003; 9: 7
        • Kucerova R.
        • BM
        • Novotny R.
        • et al.
        Current therapies of female androgenetic alopecia and use of fluridil, a novel topical antiandrogen.
        Scripta Med (Brno). 2006; 79: 35-48
        • Jahoda C.A.
        Induction of follicle formation and hair growth by vibrissa dermal papillae implanted into rat ear wounds: vibrissa-type fibres are specified.
        Development. 1992; 115: 1103-1109
        • Horne K.A.
        • Jahoda C.A.
        Restoration of hair growth by surgical implantation of follicular dermal sheath.
        Development. 1992; 116: 563-571
        • Oliver R.F.
        Whisker growth after removal of the dermal papilla and lengths of follicle in the hooded rat.
        J Embryol Exp Morphol. 1966; 15: 331-347
        • Jahoda C.A.
        • Horne K.A.
        • Oliver R.F.
        Induction of hair growth by implantation of cultured dermal papilla cells.
        Nature. 1984; 311: 560-562
        • Chase H.B.
        Growth of the hair.
        Physiol Rev. 1954; 34: 113-126
        • Teumer J.C.
        Follicular cell implantation: an emerging cell therapy for hair loss.
        Semin Plast Surg. 2005; 19: 193-200
        • McElwee K.J.
        • Kissling S.
        • Wenzel E.
        • et al.
        Cultured peribulbar dermal sheath cells can induce hair follicle development and contribute to the dermal sheath and dermal papilla.
        J Invest Dermatol. 2003; 121: 1267-1275