What is male-pattern baldness?
Male-pattern baldness, or androgenic alopecia, is the main type of hair loss in men. It causes 95% of hair loss in men and affects approximately 50% to 60% of those between ages 30 to 50. Your risk of developing male-pattern baldness increases as you get older.
You’ll first probably notice a receding hairline—this is how it starts—meaning your hairline gradually moves farther up your scalp. Thinning on the top (crown) of your scalp is also common, creating a horseshoe or u-shaped hair pattern. The entire top and front of your scalp may become bald over time.
Hair loss can start as early as your 20s, and it usually progresses slowly over the next few decades. (It can take anywhere from 15 to 30 years to become bald.) In extreme cases, hair loss can even occur during the teen years.
If you think you’re losing your hair, see your doctor. There are many treatments that can help slow down the balding process and regrow hair.
Spotting the signs of balding with the Norwood scale
The Norwood scale is a classification system that categorizes the extent of hair loss in men. (Not everyone goes through all the stages.) Doctors use it to monitor the progression of hair loss and to determine if a particular treatment is effective.
- Stage 1: This is the baseline stage. You have a full head of hair without thinning and with no receding hairline.
- Stage 2: Your hairline starts to recede around your temples (the side of the scalp just in front of your ears).
- Stage 3: Hair loss becomes noticeable. The hairline recedes farther along the sides of your scalp and may resemble the letter M, with more hair at the center and decreased hair at the sides. Thinning hair on the top of the scalp begins during this stage.
- Stage 4: There’s significant hair loss in stage 4. The hairline recedes farther back and the bald spot on your crown becomes larger. Some hair remains between the hairline and the bald spot on the crown.
- Stage 5: The hairline moves slightly farther back. Balding at the crown is more significant, and the strip of hair between it and your hairline is thinner than in stage 4.
- Stage 6: Your scalp is mostly bald on the top and front of your head. There’s no longer a strip of hair between the hairline and the bald spot on the crown, but there may be hair on the sides of your scalp.
- Stage 7: This is the most severe stage of hair loss. There’s only a band of hair around the sides of your head, and that hair is usually very thin.
What causes hair loss?
Dihydrotestosnere (DHT), a hormone found in the scalp, skin, and prostate gland, plays a major role in male-pattern baldness. It acts on the hair follicle and can reduce the length of the anagen phase, or growth phase, of the hair cycle, causing poor hair growth and hair loss. DHT can also cause hair follicles to shrink (known as miniaturization), leading to the follicle producing thinner hairs. The follicle continues to shrink over time and eventually becomes inactive.
Having high levels of testosterone in your body can lead to worsening hair loss. This is because testosterone is converted to DHT. The hair follicles along your hairline and on the crown of your head are very sensitive to DHT, which is why hair loss occurs in those areas. The follicles on the side of the head are not as sensitive to DHT, so these hairs are more likely to remain on your head during a normal growth cycle.
Male-pattern baldness is genetic, meaning that it runs in families. If people in your family are bald, particularly your parents and grandparents, there’s a good chance that you’ll become bald as well.
There is no one gene that controls hair loss. In fact, several hundreds of genes have been shown to cause male-pattern hair loss. Your sensitivity to DHT, testosterone, and other androgens—the hormones that act on the hair follicle to trigger hair loss—is passed down on these genes.
Is your mother to blame?
You may have heard that baldness is passed down from your mother’s side of the family, or that if your mother’s father is bald you’ll likely be bald too. But these are myths.
The gene for the receptor that testosterone must attach to in order to affect the hair follicle is located on the X chromosome. The X chromosome is passed down from the mother, which is why this myth began. But there are other genes on every chromosome—passed down from mothers and fathers—that are involved in hair loss.
Scarring hair loss can occur in conditions like lupus (discoid lupus), lichen planopilaris, or folliculitis decalvans. In these conditions there is a rash on the scalp, itching or burning, and the hair follicles may be scarred down. A biopsy of the scalp can help diagnose these conditions if they are not obvious by clinical exam. —Dr. Lauren Levy
The science behind hair loss treatments
Hair loss can be frustrating, but there are several well-researched treatments that can prevent it from worsening and help regrow hair. Scientists have studied all types of treatments, including topical (applied to the scalp) and oral medications, laser treatments, and surgical procedures.
Many times a combination approach is used to achieve maximum possible hair regrowth. Your doctor will evaluate your hair loss, review your medical history, and recommend a treatment regimen.
Minoxidil is a blood pressure medication that also happens to increase hair thickness and strength and promote hair growth. It’s not clear how minoxidil works because it was simply a side effect researchers noticed when the medication was being studied for treating high blood pressure. One way it may help promote hair growth is by dilating (widening) blood vessels, which allows more nutrients to reach the hair follicle.
Topical minoxidil is FDA-approved to treat patterned hair loss and is available over the counter at concentrations of 2% and 5%.
If these don’t help, your dermatologist can prescribe a stronger version that a pharmacist mixes together (compounds). All hair types can use minoxidil. The main side effect is scalp drying or irritation, and some people may get headaches. If you accidentally apply the medication on your face (like your forehead), you may notice increased hair growth in those areas.
There is also a new oral version of minoxidil. A recent article in the Journal of the American Academy of Dermatology found that taking low dose oral minoxidil can successfully regrow hair. Doctors may prescribe it off-label (meaning the drug is not FDA-approved for hair loss).
Low blood pressure, heart problems, and swelling of the legs may occur if you take minoxidil orally. Tell your doctor if you have any of these conditions before they prescribe it to you. It may also cause hair growth on other parts of your body.
1. It takes time to notice hair growth and improvement. I mean 3 to 6 months of sticking to the treatment plan. 2. When you first start using topical minoxidil, your hair may shed a little. This is OK. 3. Most treatments work better in combination—a topical and oral finasteride, oral finasteride with PRP, or adding a laser light therapy. —Dr. Levy
Finasteride is the only oral medication that is FDA-approved for male-pattern baldness. It works by blocking 5-alpha reductase, the enzyme that converts testosterone to DHT. With less DHT produced, the hair growth phase is not shortened, hair follicles are less prone to shrinking, and there’s less hair loss.
Clinical trials have shown improvement in hair growth and reduction in hair loss in men who take finasteride, according to a review in the Journal of Investigative Dermatology Symposium Proceedings. Keep in mind that the medication doesn’t work immediately and must be taken for several months before you see an improvement.
While you may have heard that this medication can cause prostate cancer, it has not been proven in the medical research.
In fact, a landmark study in the New England Journal of Medicine found that men on finasteride were less likely to get prostate cancer than those who didn’t take it. However, men who used it were more likely to develop a higher-grade (more dangerous) type of prostate cancer if they did get it. It’s important to note that the study was for treating men with benign prostate hyperplasia, who are given a much higher dose than if treating hair loss, so these benefits and risks are likely lower if you’re taking it for hair loss. The most recent study did not find an increased rate of death from prostate cancer in men taking finasteride.
The good news is that finasteride is usually very well tolerated, and most men who take it don’t experience side effects. Side effects of finasteride include erectile dysfunction, decreased sex drive, increased breast size (gynecomastia), and depressed mood. But it’s still important to talk to your doctor about your medical history and any concerns you have before starting this medication.
Dutasteride is another oral 5-alpha reductase inhibitor that works more broadly than finasteride, meaning it blocks different types of the enzyme. It’s not approved for treating hair loss but doctors may prescribe it off-label. Dutasteride was more effective at improving hair growth than finasteride, according to a study in the Journal of the American Academy of Dermatology.
The majority of men who take dutasteride don’t experience side effects, though these may include loss of libido, erectile dysfunction, increased breast size (gynecomastia), and depression. If you do experience them, they usually go away once you stop taking the medication.
Saw palmetto is a palm-like plant that has been reported to have numerous health benefits, including promoting hair growth. It’s thought to work by inhibiting 5-alpha reductase (similar to finasteride or dutasteride). Small studies have shown it can prevent some hair loss in those taking saw palmetto. It’s available as a tablet, liquid, or powdered capsule. The suggested dosage is 320 mg daily.
It’s important to be aware that saw palmetto can thin your blood and increase your risk of bleeding, so be sure to tell your doctor that you are taking this supplement before having any surgical procedure or starting new medications. Avoid taking this supplement if you are on prescription blood thinners or aspirin. It may also cause stomach upset and nausea.
Ketoconazole is an antifungal medication used as a shampoo. It may help treat male pattern baldness by blocking testosterone and other androgens in the scalp. This may increase the diameter of the hair follicle. It doesn’t regrow hair but may make other hairs less likely to fall out.
The shampoo may cause your hair to become dry, but most people who use it don’t have any side effects. The oral form of the medication can cause severe liver toxicity and is not used to treat hair loss.
Procedures to treat male-pattern baldness
Platelet-rich plasma (PRP) therapy has been shown to reduce hair loss and increase the number of hairs on your head. Your dermatologist will draw your blood and place it in a machine called a centrifuge, which separates the components of your blood. The platelet-rich plasma part of your blood is removed and then injected back into your scalp, which stimulates the follicle to grow hair.
You’ll likely need 3 to 4 treatment sessions of PRP over 4 to 6 months to get the most benefit. The main side effect is scalp pain during the procedure.
Low-level laser treatment, also known as red light treatment, is an FDA-approved treatment for patterned hair loss. The laser emits photons to your scalp, which can stimulate the hair follicle to grow hair. The procedure can be done in your doctor's office or you can purchase a red light laser device in the form of a cap, comb, or lamp for home use.
Laser treatment can be effective for some people with hair loss but it doesn’t work for everyone. It’s a very safe treatment with no side effects, but it can be time-consuming because you have to undergo several treatments a week (often daily) to get the best results.
If other therapies don’t work for you, hair transplantation may be an option to restore your hair. This procedure is performed by a doctor who has special training in hair transplantation.
Your doctor removes hair follicles from another part of your scalp where you have hair (usually the back of the scalp near the neck), and places them in the balding areas by making several holes in the skin with a scalpel or needle. The process takes several hours. Injectable numbing medication, such as lidocaine, is used for the pain.
Your scalp may be painful or swollen for several days to a week after the procedure, but your doctor will likely give you pain medication to make you more comfortable. After a few weeks, the transplanted hair will fall out and new hairs will grow in. Your surgeon may recommend using topical minoxidil on the transplanted hair to stimulate hair growth. The biggest complication of a hair transplant is transplant failure, meaning that the hair will not grow in, and scarring.
At your follow-up visits, ask your doctor to take pictures and show them to you to compare hair growth. It may be hard for you to notice any improvements since you see yourself everyday. The photos can be very helpful! —Dr. Levy
Habits that can slow hair loss—and those that don’t
Male-pattern hair loss is genetic so there’s nothing that could be done to completely prevent it from happening. But catching it early and treating it can stop it from progressing. Early treatment with topical medications like minoxidil (Rogaine) or oral finasteride (Propecia) can slow hair loss and promote hair growth.
Eating a balanced diet with protein and proper vitamins and minerals (such as zinc, iron, and vitamin D) can help keep your hair healthy. Poor nutrition shouldn’t cause male-pattern baldness, but it can affect the quality of your hair.
Rapid weight loss and fad diets that are low in these vital nutrients can lead to hair shedding, which will further worsen the appearance of any male-pattern baldness you may have.
You may have heard that washing your hair with a certain temperature of water can slow hair loss. This isn’t true, so wash with whatever temperature water you prefer.
Since hormones are a main driving factor of male-pattern hair loss, you shouldn’t take extra hormones, such as testosterone.
Hair loss supplements
You may have seen anti-balding supplements promoted online but it’s best to avoid them. These are unregulated and haven’t been shown to prevent balding.
Was this article helpful?