Male Pattern Hair Loss
Medically reviewed by C. Fookes, BPharm. Last updated on Apr 13, 2019.
Male-pattern hair loss is an inherited condition that is also known as androgenetic alopecia or balding. It is the most common type of permanent male baldness and affects all men to some degree as they age, although Caucasian males are more prone to it than other ethnicities. The condition is characterized by a receding hairline and/or hair loss at the top and front of the head.
Male-pattern hair loss is caused by an inherited increased sensitivity to dihydrotestosterone (DHT). DHT shortens the anagen phase of the hair cycle (see hair loss for an explanation of the phases), causing progressively finer hairs to be produced. The usual duration of hair growth of three to six years drops to just weeks or months. The hair follicle also changes, becoming smaller and producing a shorter, thinner hair shaft. As a result, thick, pigmented, longer-lived hairs are gradually replaced with shorter, thinner, non-pigmented hairs. The production of DHT is regulated by the 5-alpha-reductase enzyme.
Men who do not produce testosterone (because of genetic abnormalities or castration) do not develop this pattern of baldness. Male-pattern hair loss affects about 20% of men in their 20s, 30% in their 30s, nearly half in their 40s, and as many as 80% by the age of 70.
Male pattern hair loss can be associated with low self-esteem, depression, and have other negative psychological impacts, especially in Western societies which place great value on a youthful appearance and attractiveness.
Symptoms of Male-Pattern Hair Loss
Hair loss typically begins at the temples in men with male-pattern hair loss, with the hairline gradually receding and taking on an “M” shape. Hair at the crown (back of the head) also starts to thin. Hair loss typically is a long and slow process that can last anywhere from a few short years to several decades. Eventually, the top of the hairline meets the thinned crown, leaving a horseshoe pattern of hair around the sides of the head.
Hair loss in patches, diffuse shedding of hair, breaking of hair shafts, or hair loss associated with redness, scaling, pain, or rapid progression could be caused by other conditions (see hair loss for more information).
Dermatologists and clinicians may use either one of two main classification systems to describe the degree of hair loss:
- Norwood Modification of the Hamilton Scale for Hair Loss in Men: Scale that progresses through 12 grades of hair loss starting with thinning at the temples (Grade I) to complete hair loss of the crown leaving a horseshoe ring of hair at the base (Grade VII)
- Sinclair Classification of Male-Pattern Alopecia: Breaks degrees of hair loss down into 7 different stages, starting with a mild thinning of hair at the crown (Stage 1) to complete loss of hair at the crown (stage 7).
See your doctor
See your doctor if:
- You are losing hair in an atypical pattern.
- You are losing hair rapidly or at an early age (for example, in your teens or twenties).
- You have any pain or itching associated with hair loss.
- The skin on your scalp under the involved area is red, scaly, or otherwise abnormal.
- You have moderate-to-severe acne
- You have bald spots on your beard or eyebrows.
- You have been gaining weight or have muscle weakness, intolerance to cold temperatures, or fatigue.
Diagnosis of Male-Pattern Hair Loss
Your doctor will take a detailed medical history and will examine the condition of your hair and scalp; this is usually enough to diagnose the nature of your hair loss. Your doctor will also ask questions such as:
- Are you losing hair only from your scalp or from other parts of your body as well?
- Is there a pattern to the hair loss like a receding hairline, thinning or bald areas on the crown, or is the hair loss throughout your head?
- Have you had a recent illness or high fever?
- Do you dye or blow dry your hair?
- Have you been under unusual stress lately?
- Do you have nervous habits that include hair pulling or scalp rubbing?
- Do you have any other symptoms like itching, flaking, or redness of your scalp?
- What medications do you take, including over the counter drugs?
Diagnostic tests that may be performed (but are rarely needed) include:
- Microscopic examination of a plucked hair
- Skin biopsy (if skin changes are present).
Treatment Options For Hair Loss
Treatment is not necessary if you are comfortable with your appearance. Hair weaving, hairpieces, or a change of hairstyle may disguise the hair loss. This is usually the least expensive and safest approach for male baldness.
There are two main drugs used to treat male pattern baldness:
- Minoxidil topical (eg, Rogaine) -- a solution that you apply directly to the scalp to stimulate the hair follicles. It slows hair loss for many men, and some men grow new hair. The previous degree of hair loss returns when you stop applying the solution.
- Finasteride (eg, Propecia, Proscar) -- a prescription pill that inhibits the production of the male hormone dihydrotestosterone. Like minoxidil, you are more likely to have slower hair loss than actual new hair growth. In general, it is somewhat more effective than minoxidil. The previous degree of hair loss returns when you stop taking the drug. Finasteride works by inhibiting the conversion of testosterone into 5 alpha-dihydrotestosterone (DHT), a hormone that plays an important role in hair loss in men. Finasteride can cause a decrease in sex drive and sexual function.
Hair transplants consist of removing tiny plugs of hair from areas where the hair is continuing to grow and placing them in areas that are balding. This can cause minor scarring in the donor areas and carries a modest risk for skin infection. The procedure usually requires multiple transplantation sessions and may be expensive. Results, however, are often excellent and permanent.
Suturing hair pieces to the scalp is not recommended. It can result in scars, infections, and abscess of the scalp. The use of hair implants made of artificial fibers was banned by the FDA because of the high rate of infection.
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.