Thinning hair and an inability to rise to the occasion

Dear Dr G,

Greetings on Mother’s Day. I would like to take this opportunity to wish my wife and all your readers a safe and Wonderful Mothering Sunday.

I am a happily married man with a nine-month-old baby boy. As the days go by, I thank God for being such a lucky man, having such a wonderful wife and family.

While counting my blessings, I also cannot help but think of certain thinning issues in my head, literally. Perhaps, it’s the stress of fatherhood but I am more and more conscious of losing my crowning glory.

As a Chinese man, I am not just depleted in the facial hair department; now I am also getting follicularly challenged on the crown.

I noticed shedding hair in the shower. And the balding patch in my crown began to appear like the expanding water of the Mediterranean Sea.

Feeling rather depressed and deflated, I started using a medication to bulk up the scarcity in the head.

To my horror, three months after starting the medication, I did not notice significant changes to my crowning glory and worse, now I have even lost my morning glory down there.

I also notice weakening erectile rigidity, even when fully aroused.

I read the medical instructions on the medication and it states that there is a small side effect of lessening libido and erectile dysfunction (ED).

I would like to put Dr G on the spot about Male Pattern Baldness.

What is Male Pattern Baldness and why is it happening to me so early?

What treatment is available to help men who are follicularly challenged?

Is there any treatment that can revive the follicles without challenging the manhood? Although I understand the risk of ED is quite small but is it transient?

For men starting such medication and facing challenges in the crown and from the waist down, what can we do now?

Regards
Botak Chin

Hair loss – or male pattern baldness – is also medically known as androgenic alopecia. This is the most common form of hair loss in men and the US National Library of Medicine has revealed more than 50% of all men over the age of 50 will be affected.

This is known to affect up to a quarter of at-risk adolescents and become progressive with age. The extent of the hair loss can be confined to a small patch in the crown, or receding up the sides of the forehead in the shape of an “M”.

The common etiology of male pattern baldness is related to hormonal imbalances and genetic causes, however medical reasons for hair loss such as side effects of the medicine or autoimmune conditions are also noted.

Alopecia is well recognised to be a source of psychological distress, as hair is often considered an essential part of the individual identity. Men typically associate a full head of hair with youth and vigour, and therefore the thinning crown is often a sensitive issue of discussion.

Treatments for various forms of hair loss have emerged over the last few decades. Obviously, for men not so keen on creative hair comb-overs, wigs, weaves, or hairpieces, definitive solutions are often preferred.

The medications used in the treatment of alopecia include minoxidil and finasteride. Minoxidil is applied by rubbing into the scalp twice a day to stimulate hair regrowth. This can take between one to six months to be evident. Although the application is topical, side effects including erectile dysfunction (ED) and loss of libido have been reported.

On the other hand, finasteride is responsible for depleting the conversion of testosterone to its active form. This has the effect of increasing hair retention and regrowth.

The drug is reported to have 2% risk of decreasing sex drive and inducing ED, however the impact of Post-finasteride Syndrome (PDS) is widely published.

This is described as a constellation of sexual, neurological and psychological side effects that persist after the cessation of the medication. The British Medical Journal article described the syndrome as “ill-defined and controversial”

Hair transplantation is the most invasive and ultimate restoration of hair loss. A surgeon will move the healthy hair from the back and side of the head to the thinning area. Surgical techniques such as follicle transplant, scalp flaps and scalp reduction are also adopted for men to regain their crowning glory.

Martin Luther King once said: “The ultimate measure of a man is not where he stands in moments of comfort and convenience, but where he stands at the time of challenge and controversy.”

Although losing both the crowning and morning glory is inevitable at some stage for most men, living a healthy lifestyle and minimising the levels of stress are often the best measures to slow down the progression of alopecia.

Instead of the complications of medications, cumbersome transplants and the hideousness of comb-overs, most men would concede to the receding hairline and embrace baldness.

When Dr G is put on the spot by the follicularly challenged men troubled by losing their crowning and morning glory, his response is “The ultimate measure of a man is not where the follicles stand in comfort and convenience, but where the manhood rises to the occasion despite all challenges in life.”

On that note, I also would like to take this opportunity to wish all the mothers in the world an Amazing Mother’s Day!