Male pattern baldness is the common type of hair loss that develops in most men at some stage. The medical term for this is androgenetic alopecia. It usually takes 15-25 years to go bald, but can be quicker.
Typically, at first the hair begins to thin (recede) at the sides (temples). At the same time, the hair usually becomes thin on the top of the head. A bald patch gradually develops in the middle of the scalp. The receding sides and the bald patch on the top (the crown) gradually enlarge and join together, leaving a patch at the front. The patch at the front eventually thins as well.
A rim of hair is often left around the back and sides of the scalp. In some men, this rim of hair also thins and goes, leaving a completely bald scalp.
How common is male pattern baldness?
Up to 80% of men have some hair loss by the age of 70. However, the age the hair loss starts is variable. About three in ten men aged 30 years and half of men aged 50 years have significant balding.
Hair thinning in women
A similar condition affects women but in a different pattern. In women it tends to particularly affect the top of the head. It may also be a more general thinning of hair all over the head. Hair thinning in women is much more common after the menopause, but around 10% of women have some hair loss before the menopause.
Around half of all women have some hair loss once they reach the age of 70. The frequency is much lower in women of Oriental ethnic origin than those who are Caucasian - there is limited information on other ethnic groups. You can read more about this in the separate article called Understanding female hair loss.
Causes of male pattern baldness
Hair is made in hair follicles which are like tiny pouches just under the skin surface. A hair normally grows from each follicle for about three years. It is then shed and a new hair grows from the follicle.
This cycle of hair growth, shedding and new growth, goes on throughout life. The following is thought to occur in men as they gradually become bald:
- Affected hair follicles on the scalp gradually become smaller than normal.
- As the follicle shrinks, each new hair is thinner than the previous one.
- Before falling out, each new hair grows for much less time than the normal three years or so.
- Eventually, all that remains is a much smaller hair follicle and a thin stump of hair that does not grow out to the skin surface.
Male hormones are involved in causing these changes:
- Cells in the skin of the scalp convert testosterone into another hormone called dihydrotestosterone.
- Affected hair follicles become more sensitive to dihydrotestosterone, which causes the hair follicles to shrink.
- The condition usually runs in families.
Complications from male pattern baldness
Understandably most men can feel less good about their appearance when they lose hair. This can sometimes affect their mood and well-being. Some counselling can help men come to terms with this natural process of ageing.
There is more risk of sunburn and sun-related skin damage when the skin is not protected by hair. This can be avoided by the use of suntan lotions and hats.
Women with male pattern baldness should be checked for causes of raised male hormone levels. For example, conditions such as polycystic ovary syndrome - a condition in which cysts develop in the ovaries.
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Treating male pattern baldness
Coming to terms with losing one's hair is difficult for many men. Unfortunately there are plenty of private clinics out there who promise incredible results, but often don't warn you about what can go wrong.
Hair replacement treatments are not always that effective and can rapidly become very expensive. Before you commit to anything, get a few opinions from different places.
To become gradually bald is a normal part of the ageing process for most men. No treatment is wanted or needed by most affected men. Normal washing and combing of hair will not make it fall out any quicker, so continue with your normal hair routine.
It helps to find a style that suits you: many people opt for a short, cropped style. Finding a good hairdresser or barber can make you look and feel a lot better.
For some men, baldness can be distressing, particularly if it is excessive or occurs early in life. Treatment may then help.
Currently there are two medicines that help - finasteride and minoxidil. Neither is available on state-funded systems like the NHS, so you need to pay the full price for them and will usually also need to pay for a private doctor to see you and prescribe, rather than getting the prescription from your GP. If taking medications from a private doctor, it is always sensible to let your GP know - they can enter this information on the computer, so that if anything is prescribed for another reason, interactions will be picked up.
Finasteride was launched in the UK in 2002, although it has been available in the USA since 1997. It works by blocking the conversion of testosterone to dihydrotestosterone. The hair follicles are then not affected by this hormone and can enlarge back to normal.
In around 1 in 3 to 6 men taking finasteride, enough hair regrowth occurs for them to consider treatment helpful.
Some points about finasteride include the following:
- It takes about four months for any effect to be noticed and up to 1-2 years for full hair growth.
- The balding process returns if treatment is stopped. Therefore, if successful, you need to carry on treatment to maintain the effect.
- Side-effects are uncommon. The most common is that about 2 in 100 treated men report loss of sex drive (libido).
- It does not work in women with male pattern baldness.
- You need a private prescription to get it from a pharmacy.
- You need to keeping taking it for it to work. Once you stop, the hair goes back to how it was.
- In 2017, an alert was published in the UK warning of depression and suicidal thoughts in those using finasteride for male pattern hair loss and those using it for other reasons. Any such side-effects should be reported to a doctor.
Minoxidil lotion is a rub-on treatment that you can buy at pharmacies, without a prescription. It is not clear how it works. The higher-strength solution (5%) is for men only and is more effective than the 2% solution. The 5% strength is now also available as a foam.
There is debate as to how effective it is. It is most effective when used early on, rather than when a lot of hair has already been lost. It seems that it is best used to prevent further hair loss but some hair regrowth occurs in some users.
A wig is the traditional option for baldness. Some people find them useful; others find them uncomfortable and not very convincing. For male pattern baldness, they cannot be prescribed on the NHS, so they may be expensive.
Techniques such as hair transplantation, scalp flaps and other procedures have been used for a number of years. Newer techniques are giving better results. Success rates vary. It is expensive and not available on the NHS.
Some men may find it helpful to receive support to help them come to terms with hair loss - this might be from a counsellor, or from other people who are going through the same thing, such as through a support group or online forum.
Further reading and references
Mella JM, Perret MC, Manzotti M, et al; Efficacy and safety of finasteride therapy for androgenetic alopecia: a systematic review. Arch Dermatol. 2010 Oct146(10):1141-50. doi: 10.1001/archdermatol.2010.256.
Female pattern hair loss (female androgenetic alopecia); NICE CKS, November 2021 (UK access only)
Male pattern hair loss (male androgenetic alopecia); NICE CKS, February 2022 (UK access only)