Male Pattern Baldness: Causes & Treatment

Male pattern baldness (also known as androgenetic alopecia) is a very common condition that causes hair loss on the head. The risk of male pattern baldness increases with age but the key factors that cause it are thought to be genetic and hormonal. Male pattern baldness is not curable, but some treatments can help to slow it down.

Balding usually begins with receding around the temples and hairline, and/or the crown of the head. The back and sides are often unaffected. It can often be a gradual process over 15-25 years. The length of time balding takes and which areas go bald and in what order varies between people.

Male pattern baldness is believed to be hereditary, meaning it runs in families through genes. It is also thought that hormonal changes can be a cause, and the risk of male pattern baldness increases with age.

As you get older, the follicles on your scalp which produce hair get smaller. This leads to the newer hair not being as thick. Hormones also affect hair loss as testosterone is converted into another hormone called DHT (dihydrotestosterone) by cells in your scalp. DHT can cause hair follicles to decrease in size until they stop producing hair.

Some men’s hair follicles are more prone to diminishing, and some men produce DHT more readily than others. Genetics are thought to determine both of these processes, and so male pattern baldness often runs in families. The genes from both your mother and father can play a role. Men with a balding father are at increased risk compared to those with a non-balding father. Age is also a key factor, as the risk of male pattern baldness increases as a man gets older.

Several health-related factors and medications are also linked to hair loss. However, the hair loss caused by these factors is different to male pattern baldness, as it can often be temporary. Male pattern baldness is characterised by a permanent loss of hair.

The most obvious sign of male pattern baldness is hair loss. However, the way in which this begins and develops will be different for each individual. Below are the most typical signs of male pattern baldness.

Receding hairline and/or thinning crown

Male pattern baldness often starts with an M-shaped receding hairline. Some men can develop a bald patch on the crown of the head to begin with, in the centre of the scalp near the back. In some cases, both of these occur at the same time. Over time, the two areas of baldness can join up, leaving the top of the head without any hair.

Diffuse thinning

In other cases, hair loss can be found across the entire scalp in an evenly spread pattern. It gradually gets thinner over time, and this can take anything from a few years up to decades.

Other signs of male pattern baldness

• shedding more hair than normal, particularly whilst washing, styling, or brushing your hair
• noticing your hair is shorter and finer in certain areas
• your scalp becoming increasingly visible (diffuse thinning)

It is important to note that the symptoms of male pattern baldness are not the same for all men.

There are a number of medical conditions, medications and health treatments which can sometimes cause hair loss. However, the hair loss caused by these is often not the same as male pattern baldness, which exclusively refers to permanent hair loss.

Medical conditions

• thyroid disorders
• vitamin deficiencies
• iron deficiency
• auto-immune disorders
• stress
• weight loss (including after weight loss surgery)
• alopecia areata, an immune disorder

Medications and treatments

• cancer treatment (chemotherapy)
• blood thinners (anticoagulants)
• high blood pressure medication (beta blockers)

Health and lifestyle factors

Several other health and lifestyle factors have also been linked to an increased risk of male pattern baldness. They include:

• alcohol consumption
• high body-mass index (BMI)
• smoking

However, the evidence for these is not as strong as that in relation to genetics and hormones.

Male pattern baldness does not typically need a doctor’s diagnosis and is normally easy to self-diagnose. However, if you are not sure what is causing your hair loss, or you think it may be due to something else, you may wish to get your scalp assessed by a doctor. They can examine it to determine what is causing any hair loss you are experiencing. A doctor may also ask you for information regarding your family history, medical history, and any medications which could be contributing.

How does a doctor measure and check baldness?

The Norwood Scale (also called the Hamilton-Norwood scale) is often used by healthcare providers to determine the severity of your baldness. There are several common patterns of hair loss and the scale breaks them down into seven stages to measure the pattern and severity of hair loss. This can help to decide the best treatment options, or to determine how effective an existing treatment is.

A dermatoscope can also be used to closely examine your scalp and rule out any other possible causes for your hair loss. It allows the doctor to see your hair follicles in detail and identify any issues. In some cases they may need to take a biopsy (tissue sample) from your scalp or a blood test to be assessed in a laboratory.

There are various treatments available which can help to reduce hair loss that is due to male pattern baldness. They include medications, supplements, vitamins, shampoos, and foams. There are also surgical options.

Hair loss medication

There are two main prescription medications available that can help to prevent and reduce male pattern baldness. These are Finasteride and Propecia. These treatments both work in the same way by stopping testosterone from turning into DHT, which causes hair loss. They are the same product, however Propecia costs more because it is a brand name, whereas Finasteride is a generic equivalent. Both products can slow down hair loss, and, in some cases, encourage regrowth, but this depends on the individual. Find out more about DHT blockers here.

Shampoos and foams

Shampoos and foams applied to the scalp can also help to thicken your hair and reduce or prevent hair loss. Alpecin is a shampoo which claims to help to thicken and strengthen hair, however this is only based on anecdotal accounts and not backed by clinical evidence. Minoxidil (also sold as Regaine) is a product applied directly to your scalp. It works by stimulating and prolonging hair growth, as well as thickening hair by widening the openings in your hair follicles.

Hair loss supplements and vitamins

If you are experiencing hair loss due to a vitamin deficiency, hair growth vitamins and supplements may help. However, if you have not been diagnosed with a vitamin deficiency, there is no evidence they will help.

Vitamins and supplements which are linked to hair growth include:

• vitamins A, B, D and E
• iron
• zinc
• amino acids
• omega acids, especially omega-3 fatty acids
• Nourkin, a nutritional supplement derived from fish
• biotin, a water soluble B-vitamin

You can find out more information about hair growth related vitamins by clicking here.

Other options

Although some of the above products can help reduce or prevent hair loss, and encourage regrowth, there are also alternatives like hair transplant surgery or low-level laser light therapy. These treatments come with risks attached including side effects and can be very costly.

Another option is called scalp micropigmentation. This involves artificially inserting pigment (colour) into the scalp with a needle to give the illusion of thicker hair growth.

Finally, hair pieces and wigs may be a good option for some people.

A note on male pattern baldness treatments

The success of male pattern baldness treatments can vary between individuals. Some can cause side effects or may not be suitable or effective. Always thoroughly check the patient information leaflet on any treatment product before taking it.