World Hair Research

Can a man diagnose himself of having MPB?

Yes! In men, male pattern baldness (MPB) or Androgenic Alopecia (AGA) can be identified and defined visually. The use of the Hamilton Norwood Classification scale or other scales aids in this process and offers a more accurate classification.

Let me repeat: Self diagnosis for MPB is possible. I diagnosed myself, I then went to see the family doctor and asked him “what’s happening to my hair” he answered “male pattern baldness”. Don’t take my word for it, a study published in December, 2004 entitled “Validity of self reported male balding patterns in epidemiological studies” examined and compared the accuracy and reliability of the assessment of balding patterns when conducted by “trained observers” verses assessments of balding patterns conducted by “men” who are experiencing the balding themselves.

In this study, the trained observers and “men” used a classification system known as the “Hamilton-Norwood classification system” (shown below). This study found while it was best to have a trained observer assess the balding pattern, it found that “men’s self evaluation is accurate enough to ensure reliability and validity of results.” In other words, a man should be able to assess his own hair loss pattern using this scale reliably. [*1]

How to identify?

MPB causes a gradual thinning of the hair on the scalp, following a certain pattern. With MPB, the hair line either recedes uniformly from the forehead (this is known as frontal hair loss or frontal balding) or it recedes in a manner that follows an “M” shape (known as vertex hair loss). Vertex hair loss is also accompanied by hair loss at the crown or back of the head. [21] [23]

Both patterns could progress to partial baldness that leave hair around the sides of the head (resembling a “U” shape) or even to total baldness. The Hamilton Norwood scale is used by researchers and individuals to access or quantify their baldness pattern. [21] [23]

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About 60 years ago Hamilton made an important observation when he noticed that castrated men did not have AGA. He concluded that hair growth on the scalp was androgen-dependent.

Despite androgens causing hair loss in many men, androgens are actually crucial as they are responsible for the development of puberty; they also aid in, if not cause, male maturation, growth of muscles and the appearance of other sexual characteristics in young humans. [25]

Androgens, such as testosterone (T) and dihydrotestosterone (DHT), have been identified by researchers to be the main regulators of hair growth. Androgens contribute to the changing of vellus (tiny, un-pigmented) hairs into terminal (thicker) hair follicles. [18]

Paradoxically, androgens are also are often thought of as the main culprit behind male pattern baldness.

Androgens in the scalp of adults with androgen-dependent hair follicles seem to have two undesirable effects. The first being that they shorten the anagen phase (long growth phase). [6]

A study published in November 2002 further explained that the follicles experience a “transformation from long growth (anagen) and short rest (telogen) cycles, to long rest and short growth cycles.”  [3]

The second effect always accompanies the first and maybe the manifestation of it. This effect is manifested as the gradual changing of (thick) terminal hair follicles to (thinner) vellus hair (due to the reduction of the cellular hair matrix volume). This change in thickness has been referred to as a “progressive miniaturisation of the follicle.”[3] [5] [18] [23]

In summary, androgens shorten the long growth cycle (anagen phase) and cause follicles to enter into the resting cycle (telogen phase) faster and remain in that phase longer; this results in finer and finer hair. This process  is what we’ve identified as, or termed, AGA.

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In men, male pattern baldness (MPB) or Androgenic Alopecia (AGA) can be identified and defined visually.

A study published in December, 2004 entitled “Validity of self reported male balding patterns in epidemiological studies” examined and compared the accuracy and reliability of the assessment of balding patterns when conducted by “trained observers” verses assessments of balding patterns conducted by “men” who are experiencing the balding themselves.

In this study, the trained observers and “men” used a classification system known as the “Hamilton-Norwood classification system” (shown below). This study found while it was best to have a trained observer assess the balding pattern, it found that “men’s self evaluation is accurate enough to ensure reliability and validity of results.” In other words, a man should be able to assess his own hair loss pattern using this scale reliably. [*1]

A related article posted today 9/18/2011 Male Pattern Baldness: classification and Incidence – by NORWOOD, O’TAR T. MD features a PDF document with the full text by Dr Norwood himself and his scale.

The Hamilton Norwood Classification Scale was created in 1975 and is shown next.

Figure 1. Hamilton Norwood Classification Scale (OT Norwood, 1975)

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