| Male hair loss is caused by a combination of factors including a genetic component. This is felt to be the major cause and is most likely an as yet unclear combination of autosomal and x-linked genes. No other major cause is known. Other factors can modify the effect such as age and androgen (male hormone) production. There is no relationship between baldness and virility or an increase in testosterone levels.
It is associated with normal androgen levels and only occurs in people who have a genetic predisposition. The genetically susceptible follicles show increased activity of an enzyme, 5-alpha-reductase.
The younger a man is when the baldness begins the more severe it usually becomes. Half of the patients who are going to have baldness are already thinning significantly by the age of fifty and one in three by their mid-thirties.
Surgery is not indicated when there is a medical cause for hair loss. Sudden hair loss, often due to alopecia areata, is not treated with surgery.
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