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Male Pattern Hair Loss

MALE PATTERN HAIR LOSS 
Male pattern hair loss is a hair disorder that shows hereditary qualities caused by testosterone and dihydrotestosterone known as androgen. The hair loss can start in any period following transition to puberty. The relationship between the period that testosterone and DHT start to increase, and the period that hair loss problem starts can cause a mistake of thinking that male pattern hair loss is proportionally related to the increase in androgen levels. In fact there is no relationship between hair loss in men and androgen level, and an average androgen level is enough for hair loss. 
The classification in male pattern hair loss is made according to NORWOOD-HAMILTON SCALE. 
 
 
Phase 1: This is the initial phase. It defines a male pattern hair loss that the patients don’t recognize generally. The chance of catching the patient at this phase is really low. It is generally confused with seasonal losses and it is not treated.
Phase 2: It is the first phase that patients visit a doctor for their hair loss problem. It generally occurs during the initial periods of puberty, and most of the patients go through this phase by changing their shampoos and trying products that are hoped to be effective in stopping hair loss.
Phase 3: It is the phase that the medical treatments should be initiated. The patients in this group are generally patients who tried so many different shampoos and products, who are interested in clinical practices, and who are trying to make a decision between thermotherapy, other clinical practices and hair transplant. It is the period that hair loss is accepted as a problem by the patient, and that the idea that the disease will progress unless it is treated is formed. Since the patients are generally young, they try to avoid surgical practices and they prefer non-invasive methods. It is a period that mesotherapy can work. Yet, it would take time for the patients to make a decision between hair transplant and other methods. 
Phase 4: It is the period that the problem is seen clearly with bald foreheads, temples. The patients are bored of different treatment options and they are ready for radical methods. Besides phase 5, it is known as the phase that hair transplant surgery is mostly performed. It is seen more widely in the age group of 28-35. It is easier for the doctor to convince the patient to hair transplant. This phase, which requires the implantation of 1600-1800 grafts in average, is also the phase that the healthy region called hair bridge between top of the head and temples has the risk of hair loss. And the patient may need a second session of hair transplant. 
Phase 5: In this phase that Norwood defines as critical, the progress is really past. The phase 4 to transform into phase 5 is generally a process not recognized by the patients. The hair bridge should be accepted as bald since either the hair on that area is totally lost or it is covered with velluses. There is no specific characteristic that distinguishes this phase from phase 4. Many of the hair transplant patients are either in one of these phases or in between them. This phase, which requires the implantation of minimum 1800-2200 grafts, is the initial phase of middle age hair loss problem. In patients, who are in phase 5a, generally require two sessions of hair transplant operation. It defines a severe phase since it is the beginning of the transition to phase 6. 
Phase 6: In this phase, the hair bridge is totally bald. The bald areas on temples, front and vertex merge. It is phase that a single session of hair transplant will not provide satisfactory results. Since the minimum number of grafts that should be implanted is more than 3000, it is required to plan 2 or more sessions. In this phase, the probability of the hair on the donor area to be rare is high. That’s why it should be considered that the number of grafts taken from scalp may not be enough and the body hair of the patient (especially back and shoulder areas should be preferred, chest hair should be avoided since keloid formation possibility is high) should be checked about their appropriateness for transplant. 
Phase 7: This is a phase that is placed inside the scale as a mere formality. It generally defines the patient group who can’t be treated for hair loss problem. It is the patient group that is in the worst condition in respect of hair loss. The area that hair loss is seen is obvious, lines are formed, the hair strands on the healthy side is also rare and the scalp has a shiny appearance. It is highly probable for the doctor to refuse the treatment method that the patient demands. It is accepted as mortal loss and the solution is closer to non-medical options (wig, prosthesis etc.). If the patient wants to have some hair on the bald regions even though it is rare, the hair transplant procedure can be performed in few sessions if the donor area has strong hair. 
This scale, which is a practical way to classify hair loss problem for all of the literature studies, is used as three phases and sometimes as five phases in female pattern hair loss. Regardless of the phase, it is not correct to name one of the parents as the reason of this problem. There is a wrong idea in the society and even among doctors that the baldness gene is carried by the mother. The hair loss problem seen in one parent can be seen differently in different children. And even some children may not face such a problem at all. Knowing that the hair loss is progressive after it starts and taking precautions decrease the likelihood and severity of hair loss. 

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