The most common kind of hair loss is pattern baldness. It happens when hair follicles shrink and stop working. The first sign is the appearance of strands that are thinner and more fragile. Then the scalp becomes more visible as fewer hairs grow to replace those that shed. That’s because the anagen phase becomes too short for the hair to grow out of the scalp. Plus, the hairs that remain aren’t securely anchored. And this condition happens to both men and women.
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During the trials on men with prostate problems, researchers noted an intriguing side effect: hair growth. Since finasteride had already been approved by the FDA to treat enlarged prostates in men, Merck decided to pursue the possibility of developing finasteride as the first pill to treat male pattern baldness. Minoxidil, a topical liquid solution, was already on the market (see below).


“We’ve all heard the old wives’ tale that a guy’s hair is based on their mother’s father. That’s sort of true, but it’s not,” said primary care physician Dr. John Hong. “It’s really the total number of guys in your family that have male pattern baldness that will affect your risk, particularly your dad. If your dad is bald, you’re more likely to be bald.”

In either sex, hair loss from androgenetic alopecia occurs because of a genetically determined shortening of anagen, a hair's growing phase, and a lengthening of the time between the shedding of a hair and the start of a new anagen phase. (See "Life cycle of a hair.") That means it takes longer for hair to start growing back after it is shed in the course of the normal growth cycle. The hair follicle itself also changes, shrinking and producing a shorter, thinner hair shaft — a process called "follicular miniaturization." As a result, thicker, pigmented, longer-lived "terminal" hairs are replaced by shorter, thinner, non-pigmented hairs called "vellus."
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