A 33-year-old man comes to you with bitemporal receeding hairline. After discussion of the treatment options, he decides to start oral minoxidil 2.5 mg/day and oral finasteride 1 mg per day.

ANDROGENETIC ALOPECIA IN A MALE

Androgenetic Alopecia in a man (AAM) causes the typical bitemporal recession (receeding hairline) and a balding vertex (bald spot). The hairs gradually miniaturize and finally are lost. Typical onset is anytime after age 30 although it may occur earlier.

• Male pattern hair loss is the most common hair loss in men.
• Its incidence increases with age. Beyond 70 years of age, about 80% of men are affected.
• Vertex pattern AAM of all ages is associated with an increased risk of prostate cancer.
• Male hormones drive this condition with dihydrotestosterone (DHT) being the principal androgen that causes the condition.
• There is increased 5 alpha-reduction of testosterone to DHT leading to miniaturization of the hair.
  

The hairline gradually moves backward, forming a characteristic "M" shape as hair is lost from the temples and forehead (bitemporal recession)]. The hair on the vertex also thins, leading to a bald patch or complete baldness in the crown area. The terminal (thick, pigmented) hairs gradually convert to vellus (thin, fine, and less pigmented) hairs as the condition progresses.

RegionalDerm

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