Hair Loss in men
Published: 15/7/22
by Dr Filip Vukasin.
Published: 15/7/22
by Dr Filip Vukasin.
What causes male pattern baldness?
These areas of the scalp are sensitive to a certain type of male sex hormone (DHT), which leads to the hairs in these areas to thin, become more sparse and eventually stop growing. Other hair types at the back of the head and on the sides above the ears are not sensitive to DHT and so will continue to grow normally.
The genes that lead to this type of male pattern baldness are inherited from both parents and there are ethnic differences in incidence. The pattern or hair loss is generally gradual over time as opposed to sudden. Initially there is more hair shedding which isn’t replaced at the same rate as hair loss. The affected hairs
gradually become thinner, shorter and more wispy until eventually they stop growing at all. This process is different from one person to the next and varies in the amount of hair loss, the timeline and which areas on the scalp are affected and to what extent.
Other causes of hair loss in men
Male pattern baldness is very different to some other causes of hair loss such as alopecia areata, alopecia totalis, telogen effluvium, tinea capitis, hypotrichosis as well as hair loss associated with conditions like iron deficiency, cancer and thyroid disease. If you or your doctor suspect any of these conditions they need to be promptly diagnosed and addressed.
Diagnosis of hair loss
Diagnosis of male pattern baldness is usually made by talking with the patient and examining them. Sometimes investigations are undertaken to exclude the conditions listed above.
When should hair loss be treated?
Male pattern baldness does not have to be treated. Many men only want serious medical conditions excluded and then are content to deal with their hair loss or manage it with hairstyles that cover or embrace their changing hairline. However some men have a profound psychological reaction to their hair loss which can include depression, anxiety, introversion and feelings of unattractiveness. These issues can be addressed with a mix of counselling and medical intervention, depending on preference and other medical conditions.
What does treatment involve?
For men that are struggling around self image, counselling about ageing and changing appearance can be undertaken with a psychologist, psychiatrist or other mental health practitioner. Men can also watch online videos and read books and articles about embracing or overcoming the psychological difficulty with baldness, including reading research that has found bald men are perceived as strong, successful and attractive.
Topical treatment
For those who prefer medical intervention for male pattern baldness, management can include using a medicated topical solution that is applied to the scalp to improve hair regrowth. It is typically marketed as Regaine in Australia. This medication is thought to work by temporarily enlarging blood vessels in the scalp to help the hair regrow and usually takes over 4 months to see effects. It needs to be used continuously because as soon as it’s stopped, the hair will fall out. Some side effects can include rash and itch on the applied areas. Its is available over the counter from most chemists.
Oral treatments
Prescription medication is available that is taken daily and blocks the effect of the male sex hormone (DHT) on the hair follicle, thereby stopping further hair loss and in some instances allowing hair to regrow. It generally takes over 6 months to start seeing effects and needs to be continuously used because as soon as it’s stopped, the hair will fall out again. Some side effects include reduced libido, lower mood and erectile dysfunction.
There is also a tablet form of Regaine, which requires a prescription from a doctor and usually needs to be compounded by a pharmacist. It’s a blood pressure medication and also needs to be taken continuously otherwise the hair falls out again . Some side effects can include lightheadedness, swelling and fatigue.
Surgical options
There are two main surgical procedures that are currently used to address male pattern baldness. Each has pros and cons and should be discussed with the treating doctor. Broadly speaking these are:
Follicular Unit Extraction (FUE)– this is a procedure that involves taking individual strands of hair from the back or sides of the head and transplanting them to the areas of baldness.
Follicular Unit Transplantation (FUT)– this procedure involves taking a strip of scalp from the back of the head, then removing individual hairs and transplanting them to the areas of baldness.
Does anything else actually work?
Other therapies that some men use include biotin, zinc, lasers, platelet rich plasma (PRP) and microneedling. The evidence for these therapies alone is pretty low, but they are nonetheless frequently offered in combination with the more mainstream treatments.
The bottom line
Many men are comfortable with male pattern baldness, embrace it or are unfazed by it. They should not be made to feel like they must act on their changing hair.
Men who suffer from the condition can be vulnerable and spend large sums of money on unproven treatments or go to glamorous clinics which inflate their fees for the same treatments that GPs, dermatologists and cosmetic doctors offer at markedly cheaper rates.