Male pattern hair loss

Male pattern hair loss is the most common type of hair loss and typically affects men starting from about the age of 30. It is also known as inherited male pattern baldness and androgenetic alopecia. It is an inherited condition that involves hair loss as you get older. It is inherited from either your mother or father or both of your parents. How quickly or slowly your hair loss progresses and the pattern of hair loss are also inherited.

This type of hair loss is more common in men of Caucasian (European) and Australian Aboriginal backgrounds than men of Asian or African background. Male pattern hair loss affects about half of all men by the age of 50.

Although this inherited type of hair loss can also affect women, the pattern of hair loss is different in female pattern hair loss.

hair loss stages

Symptoms of male pattern hair loss

The typical sequence of hair loss in men with male pattern hair loss is loss of hair from the temples (sides of the head), which progresses to loss of hair from the front of the head. The hair loss is gradual and referred to as a receding hairline.

Over time, a bald spot may develop at the back or crown of the head, and, in some men, the entire top of the head may become bald over time, leaving a horseshoe-shaped rim of hair. And even that can be lost in some men.

Hair loss can start as early as puberty, although this is uncommon. Many men start to notice thinning of their hair in their late 20s or early 30s, and about 80 per cent of men are affected to some degree by the age of 70.

Some men find that their hair loss progresses quickly, losing much of their hair within 5 years. However, it is more common for hair loss to progress more slowly, usually over 15 to 25 years.

What causes male pattern hair loss?

The changes that occur in male pattern hair loss are caused by an increased sensitivity of scalp hair follicles (the tiny sacs from which the hairs grow) to male hormones. This increased sensitivity is an inherited condition which runs in families.

Normally, in the hair cycle, 90 per cent of the hairs on a man’s scalp are in a growth phase (anagen). The other 10 per cent are mostly in a resting phase (telogen). Up to 100 telogen hairs fall out each day, and are replaced by the growth of new hairs.

In male pattern hair loss, the hair follicles become sensitive to a male hormone called dihydrotestosterone (DHT). Dihydrotestosterone is a normal male hormone that comes from the conversion of testosterone.

Scientists are still investigating why men with male pattern baldness inherit this sensitivity to DHT, but it causes changes in the hair follicle (called miniaturisation), which results in:

  • fewer hairs emerging from each follicle;
  • each hair becoming finer;
  • the anagen growth phase of each hair gradually becoming shorter, so that each hair exists for a shorter time;
  • the telogen hairs are shed faster; and
  • the lag time between the end of the resting phase and the next growth phase increases.

So the hair becomes progressively shorter and finer, and can eventually stop growing altogether, resulting in baldness.

It is your genes that will determine whether or not you will develop this type of hair loss and at what age it starts, as well as how extensive it will be and the pattern that the hair loss will follow. You can inherit male pattern hair loss from your mother or your father (or both).

When should I see my doctor?

If you are worried or distressed about hair loss, see your doctor.

Also see your doctor if:

  • your hair loss is not typical of that of the other men in your family;
  • you are unwell in any way or you have recently had a major illness, injury or emotional stress;
  • your hair loss is not limited to your scalp, but involves hair on other parts of your body, as occurs in alopecia areata; or
  • your hair loss is accompanied by changes in the appearance of the underlying skin, which may indicate an infection or skin condition.

Your doctor will ask about your hair loss and how long it has been a problem. They will examine your scalp and perform a general physical examination.

Tests are unlikely to be needed unless your doctor suspects that your hair loss may be due to a cause other than male pattern hair loss.

What treatments are available for male pattern hair loss?

Many men are comfortable with hair loss as they get older and do not seek treatment for male pattern hair loss. However, there are treatments available for those men who wish to slow down hair loss, stimulate hair regrowth or disguise hair loss.

Medicines for hair loss

Medicines available in Australia for the treatment of male pattern hair loss include minoxidil and finasteride. In severe cases of hair loss, these treatments can be used together.

Minoxidil

Minoxidil is a medicated solution that is applied to the scalp twice daily to help stop hair loss and stimulate hair regrowth. Brand names available in Australia include Regaine for Men and Hair A-Gain. Minoxidil for hair loss is available over-the-counter from pharmacies and does not require a prescription.

It generally takes at least 4 months of applying minoxidil twice a day for any effect to be seen. There may actually be some hair loss at the beginning of treatment, as hair follicles in the resting phase are stimulated to move to the growth phase. Also, continued treatment is needed to maintain any effect - the scalp will return to its previous state of hair loss within 3 to 4 months of stopping treatment.

Be aware that minoxidil is not effective for all men, and the amount of hair regrowth will vary among people. Some men experience hair regrowth while in others hair loss is just slowed down. If there is no noticeable effect after 6 months, it’s recommended that treatment is stopped.

Side effects associated with minoxidil

The most common side effects of minoxidil include a dry, red and itchy scalp. Higher-strength solutions are more likely to cause scalp irritation.

Bear in mind that minoxidil is also used in tablet form as a prescription medicine to treat high blood pressure, and there is a small chance that minoxidil solution could possibly affect your blood pressure and heart function. For this reason, minoxidil is generally only recommended for people who do not have heart or blood pressure problems.

Always follow the directions on the product, making sure you use minoxidil only when your scalp and hair are completely dry. Wash your hands after use.

Finasteride

Finasteride is a medicine that can be taken to prevent further hair loss and increase hair growth in men with male pattern baldness aged 18 years and over.

Finasteride tablets (brand name Propecia) work by blocking the enzyme that changes testosterone to dihydrotestosterone (DHT), the form of the male hormone that is thought to be involved in male pattern hair loss.

The usual dose of finasteride is one tablet daily, with regrowth or reduction of further hair loss visible after about 4 months. However, it may take 2 or more years before a noticeable effect is seen. Also, the effect of finasteride is only maintained while you continue to take the medicine - if you stop taking the tablets hair loss will resume.

Be aware that finasteride does not lead to hair regrowth in all men who try it, although it does stop further hair loss in most men. In order to decide how effective the treatment is for you, it may be a good idea to photograph your scalp before treatment and again after 6-12 months. Finasteride is only available on prescription from your doctor.

Side effects of finasteride

Side effects of finasteride are uncommon and usually mild.

A small number of men report a decreased libido (sex drive) and problems with their erections (erectile dysfunction), which may be related to the medication.

In rare cases, gynaecomastia (male breast enlargement) has occurred in men taking finasteride.

Hair transplant surgery

Hair transplant surgery is an option for men with hair loss that has not responded to other treatments.

Tiny clusters, or plugs, of hair-producing tissue (each containing up to 4 hairs) are taken from areas of the scalp where hair is growing well (usually the back of the head) and surgically attached (grafted) onto bald or thinning areas.

The procedures used to transplant hair are called micrografting or follicular unit transplantation. They can be expensive and painful and multiple procedures may be needed to achieve the desired effect. Side effects such as infection and scarring are possible.

Procedures that involve transplanting body hair to the scalp or implanting artificial hair fibres may be used in some cases, although there is a higher rate of complications with artificial hair implants.

Talk to your doctor about whether these procedures would be suitable for you and about the risks and benefits of these treatments. Your doctor should be able to refer you to a dermatologist or hair transplant surgeon if hair transplant surgery is likely to be a suitable treatment for you. Note that in Australia, Medicare rebates and private health insurance may not cover these procedures unless they have resulted from burns or trauma.

Cosmetic treatments

Cosmetic treatment options include the following.

  • Wearing a wig, hairpiece or toupee. Synthetic and real hair wigs are available.
  • A special type of tattooing called scalp micropigmentation or dermatography can give the appearance of a shaved head of hair or thicker hair.
  • Colouring the scalp with a camouflage dye may be recommended in some cases where the hair is thinning.
  • The use of hair thickening fibres, such as natural keratin fibre, is a treatment that is inexpensive. It involves applying tiny, microfibre ‘hairs’ that bond to existing hair through static electricity to give the appearance of thicker hair.

Talk to your doctor about these options before deciding which, if any, may be suitable for you.

Unproven treatments for hair loss

Remedies for hair loss which have not been shown or proven to be effective include:

  • nutritional supplements;
  • platelet-rich plasma injections - sometimes known as PRP rejuvenation;
  • acupuncture;
  • scalp massage; and
  • laser treatment.

Discuss with your doctor any treatments that you are interested in trying. It’s important to discuss the risks and benefits before opting for any hair loss treatment options.

If you consult a hair loss clinic or alternative medicine practitioner about treatments for hair loss, make sure you understand exactly what treatments they offer and whether there is any proven scientific evidence for their effectiveness.

It’s always a good idea to check with your doctor before using any treatment, to avoid unwanted effects and spending time or money on a treatment that is unlikely to help.

Opting for no treatment

If your hair loss is not worrying you, then no treatment is needed. Wear your bald pate with pride!

Sun protection

One important thing to remember if you have any degree of hair loss is that your scalp is not as protected as it once was from the sun’s harmful UV rays.

Areas of the scalp that are thinning or bald need to be protected with sunscreen (spray-on sunscreen can be helpful if applied correctly according to instructions) and a hat to prevent sunburn and sun damage (including the development of skin cancers).

Support

Some men find that their hair loss impacts on their confidence and self-esteem and in some cases may even lead to depression. Talk to your doctor about how you are feeling, or try reaching out to a support group where you can connect with other people with similar concerns.

Last Reviewed: 6 February 2017
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References

1. Hair loss disorders (published November 2015). In: eTG complete. Melbourne: Therapeutic Guidelines Limited; 2016 Nov. http://online.tg.org.au/complete/ (accessed Jan 2017).
2. Andrology Australia. Male pattern hair loss (updated Sep 2015). https://www.andrologyaustralia.org/male-pattern-hair-loss/ (accessed Jan 2017).
3. DermNet New Zealand. Male pattern hair loss (updated July 2015). http://www.dermnetnz.org/topics/male-pattern-hair-loss/ (accessed Jan 2017).
4. Mayo Clinic. Hair loss (updated 6 Jul 2016). http://www.mayoclinic.org/diseases-conditions/hair-loss/basics/causes/con-20027666 (accessed Jan 2017).
5. NHS Choices. Hair loss (updated 7 Jan 2015). http://www.nhs.uk/Conditions/Hair-loss/Pages/Introduction.aspx (accessed Jan 2017).
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