Male Pattern Baldness 101: Causes, Risk Factors, Treatment

Male pattern baldness or androgenic alopecia is the most common form of hair loss faced by men. During a man’s lifetime, hormone level changes which relate to receding hairline and hair thinning. Learn more about its causes, risk factors and how you can treat and live with male pattern baldness.

by Calvyn Ee

What is Male Pattern Baldness?

Male pattern baldness, sometimes referred to as androgenic (or androgenetic) alopecia, is the most common form of hair loss among men. It is characterised by gradual hair loss that begins at the temples, which slowly recedes to form an “M” shape. Hair also thins and the top (or “crown”) of the head. As hair loss continues, it eventually forms a distinctive horseshoe pattern of hair around the sides of the head, while a bald area forms on the back of the head. Male pattern baldness commonly affects older men, but even younger men are known to exhibit symptoms of male pattern baldness.

Male pattern baldness generally does not cause harmful side effects, but the gradual loss of hair can adversely affect a person’s self-esteem and confidence over time. It commonly affects Caucasian men and is less prevalent among other population groups (such as people of Asian descent, for example). If affected, though, their symptoms may be milder

Women are also likely to experience androgenetic alopecia; in their case, it is commonly referred to as female pattern baldness. For the purposes of this article, however, we will be discussing male pattern baldness.

Causes of Male Pattern Baldness

Under normal circumstances, hair grows in cycles. There are three components to a cycle: first, the anagen phase is a growth phase for hair, lasting between 2 to 6 years. This is followed by a transitional phase, the catagen phase, before reaching a short resting phase called the telogen phase. Once the telogen phase ends, the old strand of hair falls out and a new cycle takes place, where a new hair grows from the follicle. Hair is grown inside follicles, which are basically gaps in the skin where hair grows. Baldness occurs when the follicle shrinks over time, which leads to shorter and finer hair.

Studies have found that genetics play a key role in determining whether someone will have male pattern baldness. For example, if both your father and grandfather are bald, you are more likely to develop male pattern baldness as well. Even if it was your father and your maternal uncle (an uncle on your mother’s side), you are at risk of male pattern baldness.

If you are genetically predisposed to baldness, then hormones (testosterone) produced by the body will “interact” with your genes and cause hair follicles to shrink. Over time, the hair follicles eventually “shut down” and no longer grows new hair.

The reason this occurs is that testosterone interacts with an enzyme called 5-alpha reductase (abbreviated as 5AR), which converts testosterone into dihydrotestosterone (DHT). DHT is what affects the hair follicles by acting on a hormone receptor found in the follicle, which then has the effect of slowing down hair growth, producing shorter and weaker hair, and then eventually shutting down the follicle entirely.

Risk Factors of Male Pattern Baldness

The primary risk factors of male pattern baldness stem from a person’s age, genetics and hormones. As stated earlier, men are more prone to develop baldness as they age, or if certain genetic characteristics are inherited from a first- or second-degree relative that has gone through, or is going through, hair loss. The latter is especially true if it is a relative on one’s maternal side of the family.

There may be other causes for baldness, however, that are unrelated to a person’s age, genetic makeup or hormone levels. In such cases, baldness may occur due to:

  • An iron deficiency
  • Chemotherapy/radiotherapy
  • Use of specific medications
  • Scalp infections
  • Malnutrition

If you or your loved one suddenly experience baldness after starting on new medications for a separate medical condition, or if either of you experiences other health conditions alongside the baldness, consider speaking to your doctor as soon as possible for a consultation and a thorough check-up.

Other Forms of Baldness

Alopecia areata is also another type of hair loss that can affect both men and women. However, the fundamental difference between male pattern baldness and alopecia areata is that the latter is an autoimmune disorder. This means that the immune system is wrongly attacking the body’s tissues, whereby white blood cells are attacking the cells in the hair follicles. The subsequent hair loss that happens is characterised by hair irregularly falling out in round patches.

There is also telogen effluvium, a reversible hair loss condition caused by various factors, including severe stress, poor nutrition, the use of certain medications, and even hormonal changes caused by menopause. It is usually characterised as significant shedding of hair that occurs for more than 6 months. Having telogen effluvium does not mean you will lose all your hair, but it will become much thinner. You or your loved one may notice an increase in the volume of hair shed. Addressing the root cause of telogen effluvium can help to reverse its effects, allowing hair to grow once again.

Diagnosing Male Pattern Baldness

Your doctor may conduct a few tests to determine if it is indeed male pattern baldness. Generally, they will assess the pattern at which hair loss occurs, and whether it matches typical characteristics of male pattern baldness. You or your loved one’s medical history will be taken, and a physical examination will be conducted. Questions will also be asked on when the hair loss started, how long it has gone on for if there has been an increase in the amount of hair loss, and so forth.

A scalp biopsy may also be performed, where the doctor collects skin samples or a few strands of hair for further examination. A pull or pluck test may also be done, where the doctor pulls or plucks, a number of hairs in order to examine under a microscope for any changes to their phase of growth, or to assess the state of the hair shafts.

Treatment of Male Pattern Baldness

Male pattern baldness is treatable with the right options, and there are a few available to you or your loved one. It is entirely possible to slow down the hair loss or reverse it entirely. Treatment will depend if male pattern baldness is caused due to specific causes, or by relying on hair replacement methods.

Treating Specific Causes

Certain factors may cause male pattern baldness, and these may include (but are not limited to):

  • Medications that cause hair loss
  • Hormonal imbalance or disorders
  • Nutritional deficiencies (e.g. iron)
  • Excess vitamin A intake
  • Scalp ringworm
  • Certain diseases

Once the cause is identified and treated, you or your loved one’s male pattern baldness should eventually subside, and hair growth will return to normal levels.

Medications

Minoxidil is a topical medication that is applied to the scalp at regular intervals – for men, it should be applied twice a day. It comes in either a liquid, foam, or shampoo form; foam users tend to apply it while their hair is wet. A six-month treatment regimen generally results in positive results, being able to prevent further hair loss while promoting hair regrowth. Continuous use will be able to retain the benefits for an indefinite period of time. Possible side effects include skin irritation and a possible increase in hair on the face and hands.

Finasteride is an oral prescription that helps prevent the conversion of testosterone into DHT. Those that take finasteride also see an improvement in hair growth and a reduction in the rate of gradual hair loss, within a period of 6 to 8 months. It is sometimes used in tandem with minoxidil prescriptions to further improve the effectiveness of treatment. Like minoxidil, it must also be taken consistently to retain its benefits. Side effects of finasteride include decreased libido, possible erectile dysfunction, and an increased risk of prostate cancer.

Dutasteride is another oral prescription that may be considered if finasteride therapy is ineffective in treating male pattern baldness. Studies have found that it is a more effective prescription than finasteride, though it still carries the risk of similar side effects as finasteride. One study found that daily doses of 0.5mg of dutasteride were more effective at treating male pattern baldness than standard doses of finasteride and even minoxidil.

Hair Replacement

Hair replacement includes permanent options to restore hair growth in the affected areas, as well as “camouflage” methods that hide the symptoms of male pattern baldness.

The most common permanent treatment method is hair transplantation. Male pattern baldness commonly affects the top of the head, so hair follicles will be removed from one part of the scalp, and then transplanted to the balding area. In some cases, a large piece of skin with multiple hair groupings is taken and transplanted. If you or your loved one opt for a hair transplant, there may be a number of sessions of transplanting needed to achieve the desired results, as mini- and micro-grafts of varying sizes will be used, each of which has one or many hairs. The success of the transplant will depend on the grafts used.

There is also scalp reduction surgery. Areas that are balding will be surgically removed, while areas with healthy hair growth will be stretched to cover up the areas that were surgically removed. This may be conducted in conjunction with hair transplants, but the need for such a procedure will depend on factors determined by the medical team.

Another option is laser therapy, which entails the use of a low-level laser to irradiate scalp tissues with photons in the hopes of promoting hair growth in the affected areas. Some studies have found it is a safer, less invasive treatment method that delivers positive results and with far fewer risks or side effects. However, it can be an expensive option to consider and requires multiple sessions in a week for an extended duration. While its efficacy is proven, results may still vary from person to person. Further studies will also be needed to examine its long-term impact and safety.

Camouflage Options

The “camouflage” methods involve the use of scalp prostheses or wigs to hide areas that are balding. Wigs are an affordable, non-invasive method recommended for those with extensive balding on the head.  If you or your loved one are not considering hair transplants, this is an ideal choice. You or your loved one simply need to consult a wig maker to ready an appropriate wig that either of you wants, based on the input of the wig maker, and if you or your loved one have thought about what the wig should be like.

Other considerations include hair extensions, simple headpieces, or even hats or headscarves.

Living with Male Pattern Baldness

It is difficult to predict when you or your loved one might experience hair loss, or how severe it might be. Male pattern baldness might not be life-threatening, but the sudden onset of balding can take a toll on a person’s self-esteem and confidence, especially if they may be relatively young when it happens. It can cause some men to feel that they are no longer attractive to women.

If you or your loved one are going through a difficult time adjusting to the hair loss, it is always good to speak to someone you can trust – whether it may be a close friend, a family member, or even a professional psychologist. Being able to vent your frustrations and fears to someone can help to alleviate the stress you feel, releasing pent-up emotions that could end up hurting you over time if you keep them shuttered away.

The least you or your loved one can do is to take control of what you can control in your life, especially your feelings. Talk things through about your current emotional state, how you feel about the hair loss, and so on. Be frank about the experience, but do not let your emotions run too wild. It helps to speak to people you know so that they can help anchor you and keep you focused on the important things. They might be able to help you reorient your outlook and share new insights that can help you get back on the right track.

It is worth exploring your available options with an open mind. Maybe you or your loved one would want to try something new, like a new hairstyle, or putting on a hat that either of you has always liked. Maybe you or your loved one might eventually find it liberating to shave your remaining hair and be happy with the new look. The important thing is to take it slowly and find comfort through small, affirmative steps.

Be sure to consult your doctor at all times if there might be changes in your hair, or if you suddenly develop an unexpected side effect from treatment. Keeping communication channels open with your medical provider can help you stay ahead with your progress, make sure everything is smooth sailing, and ensure that the results of said treatment are highly positive at all times.


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About the Writer
Calvyn Ee
Calvyn is an aspiring author, poet and storyteller. He spends his time reading, gaming and building stories with his action figure photography.
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