Male Pattern Baldness

1. Background

In 1974 there was a research study published in Science Journal3, one of the most respected medical journals, which had a significant impact on our understanding of the causes of hair loss.
In a village in the Dominican Republic, there is a group of men with no hair loss. They also have a small or absent prostate gland and no acne.
The reason is that they are missing a hormone called dihydrotestosterone.
Some generations previously, one woman in this village had a mutation in her DNA, and she could not make the enzyme that converts the man's hormone Testosterone into the related hormone DihydroTestosterone(DHT). This resulted in 24 of her male descendants having Testosterone but no DHT.
By looking at the consequences of not having DHT, scientists were able to find out what were the roles of each of these hormones.
Testosterone causes increase in muscle size, deepening of the voice and sex drive.
Dihydrotestosterone causes prostate growth, hair loss and acne.

A number of scientists realized that if they could make a medicine that blocks the enzyme that converts Testosterone into Dihydrotestosterone, (called 5alpha reductase enzyme), then they would have a potential treatment for hair loss, prostate enlargement and acne.

2. Treatment

We now have a treatment, a tablet, which is a 5alpha reductase enzyme blocker. This was first licensed in the USA in 1997 and is now available in more than 40 countries. It was licensed in Britain in 2002 and is a prescription-only medicine
Results using the tablet alone:
At 2 years, 32% of patients get moderately or greatly increased hair, whilst 90% of patients have no deterioration in hair loss. By 5 years, 65% have no deterioration in hair loss, compared to the group taking a dummy pill, in which 0% of patients had no deterioration of hair loss4.
Our most effective treatment at present is to combine the tablet with a lotion that increases the blockade of the 5alpha reductase enzyme.
Results using a combination of the tablet, plus the lotion:
90% of patients get 30% (cosmetically significant) increased hair, with no deterioration over time5.

The best results are in men with mild or moderate hair loss. In severe hair loss, the hair follicle undergoes a process of miniaturization1, and reaches a point where the root is so small, that the hair cannot regenerate. We can still achieve 30% increased hair and no progression of hair loss, in patients with severe hair loss, but this may not be enough for the patient, and we do not want to give our patients false expectations.
We do not perform any kind of surgical or laser treatments for hair loss.