Your comprehensive guide to understanding male pattern baldness
CNA – It’s a moment no man eagerly anticipates: gazing into the mirror and acknowledging the reality of a receding hairline or feeling the cool breeze on a thinning crown.
By the age of 50, up to half of men will face some degree of male-pattern baldness, with the number increasing as they age.
While genetics and hormones are major factors in hair loss, the precise mechanisms remain somewhat elusive.
This complexity contributes to the ongoing challenge of developing perfect treatments to prevent and reverse hair loss, explains Dr Arash Mostaghimi, vice chair of clinical trials and innovation in the dermatology department at Brigham and Women’s Hospital in Boston.
However, there are steps you can take both before and after noticing hair loss. Here’s a guide to what works, what’s new, and what to avoid.
Understanding Male Pattern Baldness
The average human scalp has around 100,000 hairs, each connected to a follicle that can contain one to five hairs.
“A scalp follicle is essentially its own organ,” says Dr Arash Mostaghimi, vice chair of clinical trials and innovation in the dermatology department at Brigham and Women’s Hospital in Boston. “It has its own stem cells and regenerates.”
Male hair loss typically results from an increase in an enzyme in the scalp that converts testosterone to dihydrotestosterone (DHT), a more potent form, according to Dr Mostaghimi. The exact reasons why some men have higher DHT levels than others are not fully understood, but genetics play a significant role.
When men have excessive DHT in their scalp, this hormone triggers a process leading to hair miniaturisation, causing hairs and follicles to shrink. This results in finer hair or even peach fuzz in balding areas.
Hair loss follows a predictable pattern: it starts around the temples and then affects the crown, where higher levels of DHT and its activity are found, explains Dr Mostaghimi. This progression is what gives rise to the term “male-pattern baldness.”
Treating and Preventing Hair Loss
If you’re concerned about hair loss, your first step should be to consult a dermatologist. Dermatology is a broad field, so it’s important to find a specialist who focuses on hair loss, advises Dr Danilo C. Del Campo, a dermatologist in Chicago.
When should you seek help? Ideally, before hair loss becomes a major concern. According to dermatologists, medications are generally more effective at preventing hair loss than reversing it. “The earlier you start, the more likely you are to retain the hair that you have,” says Dr Mostaghimi.
First-Line Medications
Dermatologists typically recommend two FDA-approved medications: Minoxidil and finasteride.
Minoxidil is the most well-known. “It does help to grow hair,” says Dr Del Campo, provided that patients apply it at least once daily, and preferably twice. Available as a foam or drops, Dr Del Campo suggests opting for a formulation without propylene glycol to avoid scalp irritation.
It can take a few months to see mature hair regrowth, but topical minoxidil doesn’t work for everyone, and many users find the frequent application inconvenient. Additionally, as Dr Mostaghimi points out, discontinuing the treatment will result in the loss of any gains and continued hair loss.
Another option is oral minoxidil, an off-label use that some dermatologists have practised for years. However, the pill can cause hair growth in unwanted areas, such as the beard or armpits, though this effect varies among patients, according to Dr Del Campo.
Finasteride is FDA-approved in pill form for treating male hair loss with a prescription. Research indicates that most men using finasteride maintain or improve their hair coverage over five years.
Dr Del Campo notes that oral finasteride carries a slight risk of erectile dysfunction, typically resolving upon cessation of treatment. He emphasises discussing this potential side effect seriously with patients.
While topical finasteride is not FDA-approved, it has gained popularity through online sources that may prescribe it based on surveys. Dr Del Campo acknowledges its efficacy with fewer side effects compared to the pill but underscores the importance of consulting a dermatologist before purchasing prescription medications online.
Comparing finasteride to minoxidil poses challenges due to differing study methodologies. Minoxidil generally receives higher ratings for hair regrowth, while finasteride is often preferred for maintaining existing hair, according to Dr Mostaghimi.
However, Dr Carolyn Goh from UCLA Health highlights that combining treatments is typically more effective than using either alone. This approach leverages their distinct mechanisms and strengths to optimise results for patients.
Secondary Therapies
Several alternative options exist, but experts emphasise they are not standalone treatments and should complement medications. One such option is platelet-rich plasma (PRP) injections, where a patient’s blood is drawn, plasma separated, and injected into the scalp.
PRP therapy is costly, with patients typically undergoing three to four initial sessions followed by monthly maintenance, explains Dr Del Campo. Recent meta-analyses suggest PRP shows promise for some patients, although varying study methodologies make definitive conclusions challenging. Consequently, Dr Del Campo advises against relying solely on PRP as a treatment.
Another alternative is low-level laser light therapy, often in the form of helmets or combs. While some evidence supports scalp stimulation with these devices promoting hair growth, they can be expensive, costing up to USD2,500. Dr Mostaghimi warns of the difficulty in distinguishing between legitimate medical devices and scams, recommending them only as supplementary to other therapies.
Hair Transplants
Hair transplants are widely considered the pinnacle of hair restoration by many dermatologists. Over the past 25 years, the technology has advanced significantly from the era of hair plugs. During a hair transplant procedure, follicles are extracted from one area and meticulously relocated where needed. This can involve removing a strip from the back of the scalp or transplanting individual follicles from around the head.
However, the process has its nuances. Transplants typically do not yield immediate results, and the original hairline may continue to recede, underscoring the importance of the surgeon’s skill. Dr Goh advises that patients achieve optimal outcomes when they continue using medication post-transplant. Cost is another consideration, with transplants starting at approximately USD7,000 and increasing based on complexity.
Misinformation and Scams
Misconceptions about baldness abound, often leading to ineffective or harmful remedies. For instance, claims that frequent hat-wearing causes baldness or that cold weather exacerbates hair loss are unfounded, according to Dr Del Campo.
Other myths include beliefs that washing hair too often or too little effects balding (both untrue), and that a scalp sunburn can stimulate hair growth (advised against). Additionally, applying onion or garlic on the scalp is not a hair growth remedy and may irritate the skin, cautions Dr Del Campo.
Despite viral trends on platforms like TikTok, such as using rosemary oil for hair growth, dermatologists caution that evidence supporting such practices is lacking. Dr Del Campo acknowledges the popularity but advises caution due to potential allergic reactions from added chemicals in some products.
Genetics play a significant role in baldness, but predicting it based on paternal or maternal lineage is unreliable. Balding can onset at earlier ages across generations, notes Dr Goh, emphasising that it can occur unexpectedly early in life.
Hair loss impacts self-perception and interpersonal interactions, causing genuine distress for many men. However, starting a dialogue with a doctor upon noticing signs of hair loss can lead to effective treatments and alleviate unnecessary suffering.
“There are numerous options, and the outlook is promising for individuals dealing with hair loss,” assures Dr Del Campo. “No one should have to face it alone.”
