Common Questions about Male Pattern Baldness
Q: Can I prevent male pattern baldness?
A: Stress management and a diet rich in protein, iron, vitamin A, vitamin C, zinc, and omega-3 can keep your hair full and healthy for much of your life.
However, if your hair loss is primarily due to male pattern baldness, there is, unfortunately, no lifestyle change, secret supplement, or exercise regimen that can stop what is essential at its root: aging and genetics.
Q: How do I know if I have male pattern baldness?
A: Male pattern baldness accounts for 90-95% of hair loss in men, but it is important to rule out other causes.
- Alopecia areata: This is an autoimmune condition that results in patchy hair loss. In mild cases, hair often spontaneously regenerates within a few month to a year.
- Alopecia totalis/ alopecia universalis: This is a more advanced form of alopecia areata, affecting the entire scalp and body respectively. Hair generally does not grow back.
- Thyroid conditions: Hyperthyroidism or hypothyroidism can both trigger a condition called telogen effluvium which causes hair loss. Hair on the scalp and eyebrows can be affected. It often presents as brittle and weak before falling out in clumps when agitated. A distinct sign of this condition is the root of the hair is abnormally club-shaped at the root. Hair often grows back when the underlying thyroid condition is treated.
- Thyroid conditions can be accompanied by a wide range of symptoms including swollen neck, nervous tremor, mental fogginess, weight changes, temperature sensitivity and more.
- Stress or trauma: Chronic or acute events in your life can trigger hair loss. In these instances, hair is likely to shed from all places on the scalp or come out in clumps. Hair is likely to regrow once the stress or trauma is alleviated or managed.
Male pattern baldness—androgenetic alopecia—will generally present differently than the conditions above. Here are some telltale signs:
- Hair loss in an “m” pattern at the hairline and/or hair loss from the crown of the head
- Symmetrical hair loss
* Hair thinning is present before hair loss
- Little to no hair loss on the sides of the head or nape of the neck
* Hair does not regrow
These patterns might not be noticeable for some time. If you’re unclear or concerned about the cause of your hair loss, it is best to speak with a professional. You can find a local dermatologist specializing in hair disorders by visiting aad.org/find-a-derm.
A more comprehensive list of the causes of hair loss can be found here.
Q: What causes male pattern baldness?
A: Why are you going bald? Blame your genes. Male pattern baldness is a hereditary condition that makes the hair on the top of your head more susceptible to a male sex hormone called dihydrotestosterone (DHT). DHT binds to the hair follicle, shrinks it, and over time causes it to stop producing altogether. For a more detailed account of what causes male pattern baldness, click here.
Q: When do most men begin to go bald?
A: The prevalence of baldness roughly correlates with each decade you age. Twenty percent of men see noticeable baldness in their twenties, increasing by about ten percent per decade. About half of all men will experience hair loss by their fifties, 70% by their 70s, and so on.
Q: How long does it take to go bald?
A: Once you see thinning, it generally takes 15-25 years for the process to be complete. Again, it is important to note that this is an average; some men reach the last stage of the balding process in less than five years.
Q: What can I expect after I notice my hair thinning?
A: The Norwood-Hamilton Scale is the accepted standard for the stages and progression of typical male pattern hair loss.
Most men’s experience of hair loss will generally follow this trajectory:
- Stage I: Baseline—no hair loss.
- Stage II: The hair begins to thin at the front and temples, often in a symmetrical “m” shaped pattern. Hair loss is usually not noticeable to others during this phase.
- Stage III: This is the first stage that is considered “baldness.” There is a deepening recession in the front and thinning at the vertex, or crown of the head, begins.
- Stage IV: Hair recedes more dramatically, often leaving a triangular patch above the forehead. The “bald spot” is more pronounced in the back. However, there is still a relatively thick band of hair that separates the two distinct areas.
- Stage V: The two prominent areas of hair loss in the front and back are still separate, but the bridge between the two begins to thin.
- Stage VI: The two balding areas merge in this stage. Hair loss deepens further down the sides of the head.
- Stage VII: The only substantial hair that remains is confined to the sides of the head forming a “horseshoe” pattern.
Though this is the typical progression, some men will experience hair loss primarily from the crown first or a general thinning throughout the top of the head.
Q: What are my treatment options?
A: Male pattern baldness is a complex conditions with few viable treatment options. Here is a survey of the most common treatments on the market today.
Strip Excision Harvesting
- Surgeons remove a thin 8-10 inch strip of skin from the back of the head in an area unaffected by male pattern baldness. They then disassemble the strip and graft each unit of functioning hair individually to fill in the sections of the head affected by hair loss.
- This technique has about a 90% success rate for implantation, but some men are concerned with the distinct, lateral scar this procedure leaves and the potential for the transplant to look unnatural.
Follicular Unit Extraction
- Follicular Unit Extraction (FUE) is similar to the Strip Harvesting procedure, except the donor site consists of individual follicle units instead of one large strip.
- FUE is more time consuming, costs about 50% more, and has a somewhat lower success rate at 75-85%. The major advantage is that it does not leave a scar and does not require a large, viable donor site like strip harvesting, making it potentially a more viable option for men with more advanced hair loss.
- Finasteride works by blocking enzyme 5-alpha reductase, which converts testosterone into DHT—the hormone responsible for your receding hairline.
- Only about 30% of men see improvement in six months of treatment, and your hair will return to its pretreatment state if you stop taking the medication. There is also concern surrounding rare but serious and sometimes permanent sexual side effects after taking Finasteride, including loss of sexual desire and erectile dysfunction.
- Minoxidil is a topical treatment for male pattern baldness. The medical community does not know how exactly Rogaine works. Some experts speculate that it dilates blood vessels in the scalp to stimulate hair growth and function.
- Only about 40% of men experience regrowth in six months of treatment. Your hair loss will return to its pretreatment state if you stop taking the medication. It is less effective on treating large areas, and is recommended for younger men who have experienced hair loss for five years or less.
Both medications are more effective for slowing hair loss, as opposed to regrowing hair.