Norwood Classification

Male pattern hair loss is known by a few different names, including androgenic alopecia and male pattern baldness. The main reason that men suffer from male pattern hair loss is due to hormonal changes in their bodies but it goes further than that. Anyone that suffers from androgenic alopecia has the genetic predisposition for such a reaction to these hormonal issues. It is a myth that we get our hair loss genes from only our mother’s side of the family as one or both parents can carry the genetic information for hair loss and pass it on to their offspring.

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To have “male pattern hair loss” means that the hair on the scalp is miniaturizing, becoming finer, with time

To have “male pattern hair loss” means that the hair on the scalp is miniaturizing, becoming finer, with time. It is a slow process simply because of the way that hair grows. Hair grows in cycles and to complete one cycle can take three to five years. The cycles of hair growth are as follows…

Anagen

This is the longest part of the hair growth cycle and it is sometimes referred to as the “active” growth cycle. This means that when a hair follicle is in the anagen cycle of growth it is getting longer and longer every day. It is “actively” growing and this will continue for three to five years. Once this part of the growth cycle is completed the follicle will enter the catagen phase.

Catagen

The catagen phase of hair growth lasts for a few weeks. This is the part of the hair growth cycle in which the bottom of the hair follicle, normally referred to as the “bulb”, will shrink and detach from the blood supply in the scalp. While it would be logical to assume this means the follicle is now dead, since it does not have a blood supply, this assumption would be wrong. It is simply going into a state of rest which is where we enter the telogen phase.

Telogen

The telogen phase of hair growth is the part of the growth cycle that can cause anxiety for many people. When the hair transitions from the catagen phase to the telogen phase the follicle will release the hair shaft and the hair will fall out of the scalp. This is what is happening when you see hair on your pillow in the morning or in your sink or shower. These are hairs that have entered the telogen phase, sometimes known as the “resting phase”. We like to refer to this as the “recharge” phase because eventually the follicle will regenerate, reattach to the blood supply in the scalp and form a new hair shaft that will begin to grow for three to five years. The cycle is complete and your hair is growing again. At any given time the average human head has roughly 10% to 15% of all hair in the telogen phase and between 100 and 200 hairs will be shed every day. This is completely normal and is in no way reason to be concerned about hair loss.

Many hair restoration experts agree that by the time you have noticed your hair is thinning you have already lost approximately 50% of the hair in the visibly affected area. 50%!!!
How can this be? It all has to do with visual perception. Because our hair does not stand straight up, like trees in a forest, they length of the hair covers any areas of loss up to a particular threshold. Once this threshold is crossed then the coverage cannot compensate for the reduction of density thus you will see that your hair looks thinner. However, there are some indicators that can tell you if your hair is indeed falling out more than it should.
By the time you are an adult you have a pretty good idea of how your hair behaves in various circumstances and at various lengths. You know that if you get a shorter haircut you can spike your hair and if you have longer hair it will flow and cover your scalp in a particular manner. But once you start hair loss the spike will seem less dense and that flow will appear more scattered. If you are experiencing days where your hair feels or appears “flat” more than usual then you might be experiencing an early onset of hair loss.

Does this mean that your hair is falling out? Maybe not yet but it could be getting there. Remember, when we have normal hair growth cycles and we are not experiencing androgenetic alopecia we have 10% to 15% of our scalp hair in telogen. When we are experiencing androgenetic alopecia however we have a higher percentage of hair in telogen. Furthermore, we may be experiencing an increase of miniaturization of our actively growing anagen hairs. What does this mean?

Androgenetic alopecia is caused specifically by a hormone known as dihydrotestosterone (DHT). This hormone attaches itself at the cellular level to the bulb of the follicle and affects how the follicle receives nutrition. Over time the follicle will not recover from the telogen phase as robustly as it did when it was unaffected by DHT. The anagen state of growth is shortened so the hair shaft cannot grow as long nor does it mature to it’s full diameter. This is known as hair miniaturization and it’s effects can also be seen early on when your hair does not appear to grow as long as it used to. When we notice we can see that we have more hair in telogen we can also see that we have more hairs that are of a less hearty calibre and diameter. We describe healthy hairs as being “terminal” hairs and unhealthy hairs affected by DHT as “miniaturized” hairs.
A simple evaluation of your hair by a trained professional can help you learn if you are experiencing hair follicle miniaturization. This can be by a well trained consultant that works for a clinic, an experienced hair loss or hair transplant physician or your dermatologist. They can view your hair under magnification and see with their eyes that you have a higher proportion of miniaturized to terminal hairs than normal and determine that you have something affecting your hair. Specialized microscopes can also be used that will project an image onto a computer screen and the miniaturization can be mapped and calculated. This is usually not necessary if we are dealing with hair transplantation because by the time you can see the effects of DHT, an experienced hair restoration specialist can easily see the problem.