Hair loss in men


As they get older, men frequently develop signs of male pattern hair loss. It's so common that around 50 percent of all men over 50 have some hair loss, but it can still be a cause of upset and distress for some. You may also feel unsure why you're experiencing hair loss.

What is male pattern hair loss?

Human hairs go through three stages: a growing phase, an intermediate phase, and a shedding phase. Most hairs are in the growing phase, but, after three to five years, they enter the shedding phase and fall out. We normally lose about 50 to 100 hairs a day.

As a man ages, more hairs enter the shedding phase than the growing phase. This is when hair starts thinning. Hair follicles start shrinking, causing hair to become lighter in colour and grow less in length than before, until finally, it doesn't grow on the scalp.

This process can take from a few years to a few decades. It affects men differently with some men experiencing only partial hair loss, while others may become completely bald.

How common is it?

By the age of 50, half of all men are affected by male pattern hair loss. This type of hair loss may start in the teenage years and can simply become more marked as the years go by.

White men are affected four times as much as men of Afro-Caribbean origin. Asian men get male pattern hair loss even less frequently.

Women can also be affected by hair loss associated with ageing, known as female pattern hair loss, but this is less common than the male equivalent.

Why does it happen?

It's thought to have three main contributing factors:

• Age

• Genetics

• Hormones – the male hormone testosterone is converted to another hormone called dihydrotestosterone (DHT) which causes the hair follicles to shrink in size

If you notice that most men in your family have male pattern hair loss, you have a good chance of getting it too. However, your mother may also pass on genes that cause this type of hair loss.

Men have naturally high levels of testosterone, but men who get male pattern hair loss don't necessarily have higher levels of this hormone. Hair follicles in the scalp become extra sensitive to DHT and begin to shrink. You won't notice any effect on other parts of your body though.

What are the signs?

You may see the following:

• A receding hairline. You'll notice either a central recession or recession at both sides of the forehead

• Pronounced hair loss at the top of the crown

• General hair thinning

• Hair becomes lighter in colour

• Slow progression of hair loss over the years

When should I be worried?

Male pattern hair loss is part of the normal ageing process and there's nothing to be concerned about. It doesn't affect your general health and there aren't any complications, except a higher risk of sunburn. You can avoid this by wearing hats and sunscreen containing at least SPF15.

However, if you're unsure whether your hair loss is age-related or suspect you have a physical problem causing your symptoms, see your Doctor who'll be able to offer you advice. You should also visit your Doctor if you're distressed about your hair loss, as they may be able to refer you for counselling. Additionally, make an appointment if you notice any of these symptoms:

• Patches of affected scalp

• Itching or burning of your scalp

• Hair falling out in clumps

Male pattern hair loss is the most common, but there can be other reasons behind it. Here are some less common causes of hair loss in men:

• Stress or recent trauma

• Underactive or overactive thyroid

• Diabetes

• Autoimmune disorders like lupus

• Chemotherapy, usually part of cancer treatment

• Illness

• Sudden weight loss

• Nutritional deficiencies like iron and protein

Your Doctor will help you recognise these conditions and may ask you to have some tests done to identify the cause.

What are the treatments available?

Many men choose not to try to treat their hair loss. Male pattern hair loss is progressive and develops slowly, giving you time to adjust to the change and accept it. You'll also need to weigh the benefits of using medicines against possible side effects, considering that hair loss is a condition that's not harmful to your health. However, if you find it distressing, you may want to try medicines to help stop your hair loss.

There are two main treatments for male pattern hair loss. Discuss any other conditions you may have with your doctor or pharmacist to make sure that you can take these medicines safely. 

  • Minoxidil in 2 percent or 5 percent concentrations may be used to prevent further hair loss and help hair regrowth. This is available from pharmacies without a prescription. For the first two weeks, you may experience a higher rate of hair loss. After a few more weeks, you may notice there's some regrowth of hair – this can take up to four months. Treatment needs to be continued for hair growth to be maintained, and stopping treatment will result in new hair falling out after three to four months. It comes as a liquid or foam. Sometimes, it can cause irritation of the skin and you may get redness and itching. Be careful not to apply it over broken skin.
  •  Finasteride is a prescription medicine which is available as a generic or as the brand Propecia. It is intended for use by men aged 18 and over who have male pattern hair loss. It works by reducing the level of the hormone dihydrotestosterone (DHT) in the scalp, which increases hair regrowth and helps prevent further hair loss. Finasteride should be used continuously – when you stop the treatment, you'll often get hair loss again within nine to 12 months.

Are there any options besides medicines?

Some men find wearing a wig or a hairpiece helps them feel better. Wigs may use synthetic fibres, real hair, or a mix of synthetic and real hair.

You may also try disguising hair loss with sprays that contain coloured fibres. They run off easily when you sweat, in the rain or in the shower so you'll need to reapply frequently. They also need to be applied every time you wash or brush your hair.

You can also consider getting surgical treatment. You can get hair transplants where hair follicles from the back of the scalp are transferred to the bald areas, or get a scalp reduction of the bald area. Both treatments need to be sought privately.

Remember that when not covered by hair, your scalp is very prone to getting sunburned so it's important to cover your head with a hat or sunblock before going outdoors. 

Next steps

• Knowing that male pattern hair loss is part of the natural ageing process may put your mind at rest

• If you find your hair loss distressing, ask your doctor or pharmacist to explain the available options

• Speak to your GP if you're unsure why you're experiencing hair loss