Dear Dr. G,

I am a proud man at the peak of life inside and outside the bedroom.

I thrive on my youthful energy and enjoy my enormous appetite for sex, which I feel could be due to high levels of testosterone.

However, I am concerned about my receding hairline on the side of my head and I have noticed falling hair in the shower over the past few months. Thinking back to what my father went through when he was in his forties, I guess my balding days are coming.

I hate to put Dr G on the spot when it comes to this issue, but your advice can prepare me for the day when I lose my crowning glory. Is there a correlation between testosterone and hair loss, and is male pattern baldness genetic? Can it get worse with age, and is there anything I can do to restore my hair without compromising my testosterone?

reigning testosterone?


Crowned Christopher

Most men should have anywhere between 100,000 to 150,000 follicular hairs on their head, and an average hair loss of 100 strands a day is considered healthy. Men typically associate a full head of hair with youth and vigour, and therefore a thinning “crown” is often a sensitive issue.

For most men, the first sign of excessive hair loss is seen in the bathroom, and this is well-recognised to be a source of psychological distress, as hair is often considered an essential part of an individual’s identity. When it comes to male pattern baldness – or androgenic alopecia – some men will get a single bald patch while others may experience a receding line to form an “M” shape which often continues until all the hair is gone. This is a common type of hair loss in men that can affect more than 50% of men over the age of fifty, and is closely linked to hereditary factors.

Although baldness is likely to occur in adulthood, individuals with male pattern baldness can begin in the teenage years, especially if it also affects those on the maternal side of the family. And although testosterone levels are also closely linked to male pattern baldness, the association has more complexity than previously speculated. 98% of total circulating testosterone itself is generally bound to sex hormone binding globulin (SHBG) and largely remains inactive. The remaining unbound free testosterone needs to be further converted to the active substance, dihydrotestosterone (DHT), that is believed to shrink the hair follicles in the scalp leading to baldness. Each strand of hair on the head has a growth cycle, and repeated stimulations of DHT are known to weaken the hair follicles, producing shorter andfiner strands of hair. Eventually the growth cycle for each hair ends and no hair growth will occur leading to overall baldness.

Apart from androgenic alopecia, other medical conditions can also lead to hair loss. Dermatological complaints such as eczema and psoriasis on the scalp are well recognized to induce the loss of hair. Thyroid function disorder and nutritional deficiency are common reasons for hair loss. Other common causes also include poor hygiene and malnutrition also resulting in regular scalp infections, rash and peeling of scalp causing patchy hair loss mimicking male pattern baldness.

The treatment for various forms of hair loss have emerged over the last few decades. The medications that are 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. 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. However, the drug is reported to have 2% risk of decreasing sex drive and inducing erectile dysfunction and this figure is believed to be higher.

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.” Instead of the complications of medications, and the hideousness of comb-over, most men would concede to the receding hairline and embrace the baldness. Even the action superhero, Bruce Willis, well known for his trademark male pattern baldness once admitted: “Hair loss is God’s way of telling me I am human!”

Men losing the crowning glory with the testosterone reign often Dr. G is put on the spot for assistance. His advice is living a healthy lifestyle with focus on hair care is what is humanly possible to keep the crowning glory without losing the virile reign and “The ultimate measure of a man is not where the follicles stand in the comfort and convenience, but where the manhood rise to the occasions despite challenges in the head.”

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