Common pattern baldness, also known as androgenic alopecia, is undoubtedly the most common type of condition causing hair loss in humans. Male pattern baldness is usually seen in about one-fifth of the male population by the age of 20, and its incidence increases progressively with age until it peaks at around 90% in males above 90 years of age. Male pattern baldness is often a stressful and psychologically draining condition amongst men; one that can intensely impact self-esteem, body-image, and social standing.
Recent studies have also begun to associate the development of androgenic alopecia with various negative health complications. Having a case of male pattern baldness increases your risk of developing prostatic hyperplasia, cardiovascular disease, metabolic disorders such as an insulin-resistance, obesity high blood pressure or hypertension.
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Because of the high psychosocial impact occasioned by common pattern baldness, young men around the world regularly ask, will I go bald as I grow older? Historically, studies have shown that male pattern baldness has a complex hormonal and genetic basis, so the answer to the question becomes complicated also.
HOW DO I KNOW IF I HAVE ANDROGENIC ALOPECIA?
Androgenic alopecia develops mainly through a significant increase in the action of androgenic hormones on the scalp and hair follicles. It causes a progressive diminution of follicular activity that manifests in a reduction of the size of the hair follicle until total atrophy of the hair bulb occurs and consequently results in the loss of hair.
Most of the hair lost falls from specific areas, mostly from the frontal and parietal region; this means that typically the patter begins above the temples and crown. In more advanced cases a rim of hair surrounding the sides and rear of the skull will form. Androgenic alopecia will very rarely translate into total baldness.
To accurately evaluate whether an individual suffers from androgenic alopecia a thorough medical examination is needed to eliminate other possible causes of hair loss such as Telogen Effluvium. One of the most evident signs that hair loss is being caused by common pattern baldness is its typically progressive nature. In some cases, trichoscopy, biopsy, and histology can be used to evaluate further.
STATISTICS OF PATTERN BALDNESS
In the United States alone there are over 35 million men and an outstanding 21 million women suffering from pattern hair loss. As young as 35 years of age over 40 percent of men will begin to show signs of balding. By age 80 over 70 percent of the male population will display noticeable hair loss.
Why are some men exempt from pattern hair loss? The secret lies within their family trees.
THE GENETICS OF BALDNESS
Recently, researchers were able to identify more than 287 different genes that have active participation in the appearance of common pattern baldness. A team working out of the University of Edinburgh analyzed the DNA of more than 50 thousand adult men attempting to predict the risk of pattern baldness in each subject. Surprisingly, the study concluded that although pattern baldness is exponentially more common in men, it is the genome of their mothers that applies the most influence since of the 287 genes identified in the study 40 are concentrated on the X chromosome.
Many of the genes determined to be associated with pattern hair loss are genes that regulate and control follicle structure and development. For example, gene FGF5 is crucial in the inhibition of hair growth, and it has been theorized that potential gene variants with higher levels of expression result in marked inhibition of growth and increased risk of pattern baldness.
Another gene identified is RSPO2. RSPO2 is associated with hair growth and the establishment of hair follicles. Variations in its activation may lead to alterations in the levels of hair growth and contribute to pattern baldness. The androgen receptor linked to the X chromosome also suggests heavy hormonal influence. Therefore it is likely that the structural proteins involved in hair growth interact negatively with androgenic hormones and lead to increased risk of male pattern baldness.
HOW CAN YOU TELL IF WILL GO BALD?
If you are now wondering, well, how can I tell if I will go bald? If you have family members with pattern baldness, does that mean that you are destined to lose your hair? The answer is not clear-cut. A male subject who presents variations of any combination of the 287 risk genes will not necessarily go bald. The genetic pattern of risk has a merely predictive function.
For example, in a family with several children whose relatives present androgenic alopecia, not all of the children will have the same levels of pattern baldness because genes are not inherited in the same proportion. This phenomenon can be observed with eye color. The color of the eyes is a multigenic inheritance, meaning multiple genes are involved in its manifestation. It is commonly seen that the offspring of parents with brown eyes will be born with blue eyes by inheriting active genes from some distant family member.
Further evidence against strong genetic predictability comes from a study published in 1964 that observed that only around 30 percent of the fathers of women suffering from severe baldness presented androgenic alopecia themselves. Another study published in the Journal of American Dermatology evaluated the androgenic alopecia present in 410 subjects and found genetic influence from the father’s side in only 236 cases. Therefore attempting to predict if you will go bald based on the presence of previous baldness in the family is a fool’s errand.
Because of the potential action of so many recessive genes and the complex nature of inherited traits, it is not easy to accurately predict if and when pattern baldness will develop. More genes remain to be identified and studied. Baldness can skip generations and also affect some siblings while sparing others, but this is not always the case. If members of your family suffer from androgenic alopecia, you will have a higher risk of developing it as well but just as likely you could be spared.
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- The Genetics of Balding Science