What is male pattern baldness?

An imbalance of male hormones

that can lead to thinning at the temples, crown, or all over the head

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Disclaimer: This information isn’t a substitute for professional medical advice, diagnosis, or treatment. You should never rely upon this article for specific medical advice. If you have any questions or concerns, please talk to your doctor.

Vitals

  • Both genetic and environmental factors likely cause male pattern baldness.
  • Up to 50% of men aged 50 years old have androgenic alopecia, and the prevalence of male pattern baldness increases with age.
  • In male-pattern baldness, not only do you lose the hair on the top of the scalp, but also the hair above the temples.
  • There is no cure for male pattern baldness. However, some therapies can slow or even partially reverse the process for a time.

Introduction

Everyone experiences hair loss. We all lose up to 100 hairs a day as part of the normal hair life cycle (1). Some people can experience more than the average amount of loss; this is called alopecia. The most common type of hair loss is androgenic alopecia, also known as inherited baldness. This is usually gradual and can affect both men and women, leading to male pattern baldness and female pattern baldness.

What causes male pattern baldness?

Both genetic and environmental factors likely cause male pattern baldness. Having a close family member with this type of hair loss increases your risk of having it as well. Androgenic alopecia is associated with an imbalance of male hormones (androgens), specifically dihydrotestosterone (DHT). This hormone is important for healthy male sexual development, but also seems to function to regulate hair growth in both men and women. Hormone levels change with age, which is likely why male pattern baldness becomes more common with age. Androgens play a role in the hair life cycle, but it is not well understood exactly how they lead to hair loss.

So how do androgens affect hair growth? Hair grows from special structures under the skin called follicles. Approximately 90% of your hairs are in the active growing phase (anagen) and stay there for two to six years. The hairs then go into a transition phase (catagen) for one to two weeks. Lastly, each hair enters the resting (telogen) phase for two to four months. At the end of the resting period, the hair falls out, and the follicles return to the growth phase to start again. In male-pattern baldness, there are increased levels of androgens in the follicles. This leads to a shorter hair follicle life cycle, which then produces shorter and thinner hair strands. Some follicles eventually slow down and stop making hair altogether.

You can learn more about hair loss by clicking here.

What are the symptoms of male pattern baldness?

Men often experience the classic male pattern baldness with androgenic alopecia; this can start as early as right after puberty, but it is more common as you age. In male-pattern baldness, not only do you lose the hair on the top of the scalp, but also the hair above the temples. The hair starts to be finer and then eventually stops growing in specific areas; this is a gradual process. You may see a receding hairline in an M shape or an exaggerated “widow’s peak.” Sometimes male pattern baldness progresses to partial or complete baldness. In female pattern baldness with androgenic alopecia, the hairline typically does not recede; instead, women get general thinning of hair, especially on the top of the scalp, with a widening of the part. Female pattern baldness rarely progresses to complete baldness.

Who gets male pattern baldness?

Approximately 80 million people in the U.S. have androgenic alopecia according to the American Academy of Dermatology (AAD); it is seen most often in white men (1). Up to 50% of men aged 50 years old have androgenic alopecia, and the prevalence of male pattern baldness increases with age (2). Female pattern baldness is less common, affecting around 38% of women over age 70 (2). If you have a close family member with androgenic alopecia, then you are also at a higher risk of having male pattern hair loss.

Treatment options

There is no cure for male pattern baldness. However, some therapies can slow or even partially reverse the process for a time. Some men prefer to embrace their baldness. For others, the hair loss causes psychological distress, and they may turn to medications, surgery, or ways to camouflage the balding.

There are two FDA-approved medications for treating hair loss from androgenic alopecia.

  • Minoxidil (brand name Rogaine) works on the hair follicles on the top of the head and promotes hair growth; it does not work as well on a receding hairline. It is available over-the-counter, and you apply it directly to your scalp twice a day; it can take three to six months for you to see results. You need to use it continuously because once you stop, your hair loss will return within three to four months (3). It is the only FDA-approved medication for androgenic alopecia in both men and women. The most common side effects are mild and include itching or irritation after application.
  • Finasteride (brand name Propecia) is a prescription medication taken by mouth that slows baldness and hair loss in more than 80% of men and stimulates hair growth in over 60% of men (4). Finasteride works by reducing how much DHT is made, thereby decreasing its effect on the hair follicles. It may take several months to see results while taking this medication. Just like minoxidil, if you stop taking it, your hair loss will return. Women and children should not take finasteride, and women who are pregnant should not touch any broken tablets because of the risk of birth defects.

Hair transplant surgery is another option for treating male pattern baldness. The surgeon takes hair from part of the scalp with good hair growth and moves it to areas of thinning or balding. On average, 700-1500 follicular units are transplanted during the surgery (5). In the first three to four months after a hair transplant, you may notice your hair looking thinner; this is because the transplanted hairs fall out, and then the new hairs start growing. Full hair restoration can take 6-12 months. Afterward, most people continue to use medications like minoxidil or finasteride to prevent further hair loss.

Other procedures may benefit people with male pattern baldness; their effects have not been definitively proven; more research is needed in these areas. These include:

  • Low-level laser therapy (LLLT): This is an FDA-cleared medical treatment for hair loss. Reports show that this may stimulate new hair growth, possibly by affecting the follicle stem cells (6).
  • Microneedling: This is also an FDA-cleared medical device for treating hair loss. Small puncture wounds created by tiny needles in the outer layers of the skin of the scalp are thought to encourage hair regrowth by triggering a wound healing response (6).
  • Platelet-rich plasma (PRP): After taking your blood and separating the plasma from the red and white blood cells, your provider will inject it into the skin in areas of hair loss. PRP has many different growth factors that may stimulate hair growth, and research has shown varying results; PRP is not FDA-approved at this time (6).

Other unproven options include stem cell therapy, nutritional supplements, acupuncture, and scalp massage.

Lastly, some men choose to use cosmetic means to camouflage the balding areas. These options include:

  • Wigs or hairpieces
  • Hairstyle changes or shaving the scalp
  • Concealing powders or lotions to decrease the contrast between the scalp skin and the thinning hair and give the illusion of a thicker head of hair
  • Micropigmentation, or tattooing, of the scalp

You can learn more about hair loss treatment options by clicking here.

References

  1. https://www.aad.org/public/diseases/hair-and-scalp-problems/hair-loss#overview
  2. https://www.aafp.org/afp/2017/0915/p371.html
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6691938/
  4. https://www.aad.org/public/diseases/hair-and-scalp-problems/hair-loss#treatment
  5. https://www.ncbi.nlm.nih.gov/pubmed/24656268
  6. https://www.ncbi.nlm.nih.gov/pubmed/31487342

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