Male pattern hair loss: what can be done to prevent it

This type of hair loss is an inherited and, essentially, not abnormal hair loss that is caused by male sex hormones (androgens). 

Androgenetic alopecia is the most common type of hair loss. It affects men and women, but men far more often. Up to 70% of men and 40% of women are affected. The prevalence and severity of androgenetic alopecia increases with age.

The appearance of androgenetic hair loss differs from men to women: women usually lose hair from the crown, while men typically develop a receding hairline and a bald patch on the top towards the back of the head (tonsure). As it progresses, men can develop a bald patch with a fringe of hair. 

In cases of male pattern hair loss, there is not usually any disorder in the hormonal balance, because the reason for progressive hair loss is not, for example, excess testosterone, the best-known male sex hormone. It is rather caused by the hair’s oversensitivity to an active form of testosterone, dihydrotestosterone (DHT). 

As a result of this oversensitivity, the growth phase of the hair shortens and the hair follicles visibly shrivel. As a result, the affected hairs become thinner and thinner and vanish in the typical places, for example the brow and the top of the head towards the back, often entirely.

Doctors get major indications of androgenetic alopecia just by talking to the person about their family case history: if the father or a grandfather is or was affected by hair loss, it is probable that it is a case of inherited hair loss.

The pattern of the hair loss is another important pointer, because in men with inherited hair loss, the progressive hair loss usually passes through typical phases: from an initial receding of the hairline at the brow, via the forming of bald spots at the temples, through to, potentially, a bald patch that is fringed by the remaining hair. When this typical pattern is present, no other diagnostic measures are needed.

For many men, inherited hair loss is not a big problem, but some people suffer a great deal. While only replacement hair (a toupee) used to be able to help, there are now effective medical treatment options, too.

In general, it can be said that the earlier inherited hair loss is treated, the better the prospects of success, in terms of “saving” as much hair as possible. Depending on the stage, and on the individual’s own wishes, the treatment of inherited hair loss can pursue two objectives which can be combined:

• to stop the hair loss (particularly in its early stage)
• to also fill in the thin or bald patches (advanced stage)

A policy of the European Dermatology Forum (EDF) involved evaluating the therapies available for treating androgenetic alopecia. This showed that the following three options are particularly suitable, and they can also be combined with one another.

Minoxidil for external use

Originally developed as a medication for use against high blood pressure, Minoxidil can help improve the hair’s nutrient supply. This can also have a positive impact on hair thickness, ideally stop hair loss, and promote hair regrowth. The policy recommends minoxidil in mild to moderate cases.

The active ingredient is applied to the areas affected (hair and scalp) in the form of a solution or as a foam. A little patience is called for: months can go by before there is any visible effect. There may even be increased hair loss in the short-term if inactive hairs are displaced by new, growing hairs. 

While it is true that products containing minoxidil can be bought without a prescription from pharmacies, there could be side effects so a doctor should always be consulted before they are used. This particularly applies to men with a cardiovascular disease.

Taking finasterid tablets

The active agent finasterid was also initially developed not for hair loss, but for treating benign prostate enlargement (benign prostatic hyperplasia). As an inhibitor, finasterid stops the sex hormone testosterone from being converted to the active dihydrotestosterone (DHT). Reminder: the cause of stunted hair growth is thought to be caused by the hair follicles being oversensitive to DHT.

A milligram of finasterid, taken once a day in tablet form, the agent continually acts on the man’s hormone balance. Long-term studies have shown that finasterid can stimulate new hair growth in this way. However, visible effects can often only be expected after 6 to 12 months. A combination of using minoxidil externally and taking finasterid can achieve even better results.

The hair transplant as a surgical measure

A hair transplant involves transplanting the person’s own hair from the back of the head to the top of the head. In so doing, surgeons are making use of a particular property of the follicular units being transplanted: in contrast to the hair roots on the top of the head, they are insensitive to the hair-shriveling effect of dihydrotestosterone (DHT).

After a detailed assessment and consultation by a hair surgeon, two basic transplant methods are considered:

• taking a 10 to 35 centimeter long strip of skin with the hair from the suitable donor area on the back of the head (the so-called strip technique) and then sewing up the wound
• taking individual groups of hair roots using hollow needles or hollow drills (the so-called FUE technique)

In both methods, the donated tissue is prepared in such a way that many, even thousands, of small follicular units are available for the transplant. Micro-hole, or micro-incision, technology is used to create tiny openings for them at the recipient area, the top of the head.

While a large number of follicular units can be transplanted in one session using strip technology (FUT), no scar is created with the more time-consuming FUE technique, as the hair roots are removed individually. Which method is ultimately the more suitable must always be decided with the doctors involved, based on the individual situation.

Whatever the hair transplant method, it involves a surgical intervention, which is always associated with risks. Possible complications include noticeable scarring, poor wound healing and inflammations. 

As well as the treatments described above, there are other types of therapy, the effectiveness of which still has to be studied more carefully. These include, particularly, low-level light therapy (LLLT) and platelet‐rich plasma (PRP) therapy.

Low-level light therapy is also sometimes called soft laser therapy, and it claims to stimulate hair growth with a low dose of laser light. To be able to better compare it with established treatment options, however, European treatment guidelines indicate that there need to be further studies.

PRP therapy is a special method involving taking so-called growth factors from the person’s own blood, processing it, and then injecting it into the scalp. The European treatment guidelines currently desist from recommending for or against this treatment because there is still no standard treatment method on which to base an objective evaluation of the therapy’s effectiveness and safety.

Whether and to what extent inherited hair loss becomes a severe problem for a man usually depends on a number of factors. One very important factor, for example, can be whether the person feels alone with his increasing hair loss, or whether he is one of many. While most men in Germany over the age of 70 are affected by androgenetic alopecia, a man in his 20s who has a strongly receding hairline is still in a small minority.

So early hair loss can be a very stressful experience for young men, in particular. Their peers think they are older than they really are. Their self-confidence can suffer badly as a result: male models in adverts and stars in Hollywood films usually have a full head of hair. But there are also many examples of men who deal self-confidently with thinning hair.

This aside, it is of course true that someone suffering from inherited hair loss no longer needs to put up with it because there are modern therapy options that are recognized by orthodox medical experts. Men who are affected can consult a skin specialist to find out about their treatment options.

These treatment options have continued to improve and expand in recent decades. However, one cannot expect miracles: a man with a bald patch will not be able to achieve the same hair density as before even via a hair transplant.