General Health

Male Pattern Baldness: Causes, Symptoms, and Treatments

As men age, hair loss can become an increasing source of anxiety, resulting in low self-esteem, frustration, and even depression.

Male pattern hair loss, also known as androgenic alopecia, is the most common type of hair loss in men, affecting over 50% of men over the age of 50, and 80% of men by the age of 80 years.

It’s easy to start panicking when you spot a receding hairline, and while some men embrace going bald, others may wish to seek treatment.

This article will discuss what causes male pattern baldness, the symptoms to watch out for, and will weigh up the treatments available.

Who is at Risk of Male Pattern Baldness

Although growing bald is associated with aging, it is important to note that men can experience hair loss at a young age. In fact, an increasing number of millennials in the United States say they’re experiencing hair loss.

Some possible risk factors include:

  • Family history of balding, in either of your parent’s families

  • Age

  • Stress

Male pattern baldness has also been associated with an increased risk of several health conditions, most prominently prostate cancer and cardiovascular disease.

In recent years, researchers have explored whether male pattern baldness (or androgenic alopecia) is a potential indicator for future prostate cancer incidence.

A 2017 meta-analysis based on 15 cohorts and case-control studies found that men with vertex baldness may have an increased risk of prostate cancer. However, the study authors affirmed that very studies are necessary to support these preliminary findings.

A large scale Australian case-control study found that vertex balding was associated with a 50% increase in the risk of prostate cancer, and 11 years follow up data suggests that vertex androgenetic alopecia at the age of 40 years might be a marker of increased risk of early-onset prostate cancer.

In relation to cardiovascular disease, results of a study led by Dr. Kamal Sharma, an associate professor at the U.N. Mehta Institute of Cardiology and Research Centre, found that male pattern baldness increased the risk of coronary artery disease by 5.6 times.

What Causes Male Pattern Baldness

There is no single identifiable cause of male pattern baldness. On a day to day basis, people lose around 100 hairs. This usually doesn’t cause noticeable thinning as new hair is growing in at the same time.

However, in the case of male pattern baldness, this cycle of hair growth is disrupted, resulting in hair loss. The following factors can cause male pattern baldness:

Genetics

Several studies have identified heredity as accounting for around 80% of the predisposition to baldness (37). Each hair has a growth cycle., but in the case of male pattern baldness, this growth cycle starts to weaken.

As a result, the hair follicle shrinks, producing shorter and finer strands. Genetic factors modify the size of the hair follicle response to g androgens. Those with a strong genetic predisposition go bald in their teenage years, while those with a weak predisposition may not go bald until they are in their 60s or 70s.

A 2017 genomic study identified more than 200 genetic regions involved in male pattern baldness.

Hormones

DHT, an androgen that helps give men male characteristics, is thought to cause hair follicles to miniaturize, contributing to male pattern hair loss. When DHT (dihydrotestosterone) binds to the hair follicles that are located on the scalp, it can actually harm hair growth in the area.

Androgen receptors are proteins that allow hormones like testosterone and DHT to bind to them. Some people are more susceptible to the effects of DHT based on variations in their androgen receptor gene.

Changes in the androgen receptor gene can increase androgen receptivity in your scalp follicles, increasing your risk of male pattern hair loss.

As the follicle shrinks, the hair that comes out of the follicle will become thinner, resulting in thinning hair. This is when the first signs of balding are usually noted.

The shrinkage of the follicle also shortens the cycle that the hair strand has to go through. Eventually, the hair will not be able to grow as long as it used to. This is when balding becomes more visible.

Symptoms of Male Pattern Baldness

Symptoms for hair loss vary depending on the type of hair loss that you are experiencing. In terms of male pattern baldness (MPB), the front hairline usually recedes first, at the sides, forming an M shape. At other times, some men may get bald spots or bald patches. In some cases, the hairline will continue to recede until most hair is gone.

Treatment for Male Pattern Baldness

Medications

Minoxidil– is a topical treatment applied to the scalp. Initially tested to treat blood pressure, some people noticed additional hair growth as a side effect while using it.

FinasterideFinasteride is a 5-Alpha Reductase Inhibitor commonly prescribe to treat an enlarged prostate. It works by blocking the production of dihydrotestosterone (DHT), a hormone that plays a role in shrinking the scalp hair follicles. The effects can take up to 3 months to manifest, and if the pill is stopped, the results will reverse. Finasteride can also have several side effects, including:

  • Sexual dysfunction

  • Tenderness in male breasts

  • Rashes

  • Allergic reactions

  • Itching, hives

  • Swelling of the lips and face

Hair Transplantation

Hair transplants have become popular in recent years, with an increasing number of men turning to this treatment.

Follicular unit transplantation (FUT), also referred to as strip surgery, involves taking a thin strip of skin with hair intact follicles from the back or side of the head and transporting it to the bald section as to replicate natural hair regrowth. This is a minimally invasive procedure but does require significant skill and expertise on behalf of the surgeon.

Follicular unit extraction (FUE) is a type of hair transplant that involves transferring hair grafts from the scalp to areas affected by hair loss. In comparison to FUT, FUE avoids causing a linear scar. Individual follicular units are taken, leaving only tiny dot scars that are barely noticeable.

Side effects of hair transplantation can include:

  • Infection

  • Inflammation of hair follicles (folliculitis)

  • Noticeable scarring

  • Pigmentation

  • Poor hair growth

Laser/light treatment

Laser/light treatment has also become a very popular option for hair loss in the last few years for a number of dermatological conditions. While there is evidence that laser light can stimulate hair growth, clinical data from large scale, placebo-controlled trials are lacking.

Cosmetic

For men who do not want to take medication or undergo a surgical procedure, cosmetics such as wigs and Hair weaves are an option. A few decades ago, finding a wig that didn’t look cheap and ill-fitting could be a challenge.

Luckily, many sites now offer high quality, realistic looking hairpieces, and wigs. So much so, that it’s pretty hard to tell the difference from a real head of hair.

Counseling

Male pattern hair loss can leave many men feeling less physically attractive. We tend to associate hair with youth, beauty, and virility, and the loss of it can cause stress, anger, and depression.

One study published in the journal Current Medical Research and opinions investigated the psychosocial impact of hair loss among men. Of the 729 men who responded to the survey:

  • Over 70% of these men reported hair to be an important feature of image.

  • 62% agreed that hair loss could affect self-esteem.

  • 43% of men found that losing hair was linked to concern about losing an important part of personal attractiveness.

  • 42% fear of becoming bald, concern about getting older (37%), negative effects on social life (22%), and feelings of depression (21%).

  • Reduced self-confidence in personal attractiveness was also reported by 38% of men who were not in stable romantic relationships.

If you find that you are experiencing feelings of anxiety or depression as a result of your hair loss, discuss this with your GP, who can advise counseling sessions and group therapy.

Conclusion

For many men, hair can be a significant facet of their identity, and losing it can cause a range of emotions. Although there is no known method of preventing hair loss, certain medications and treatments can help to slow the rate of hair loss and increase hair growth.

For those worried about the potential side effects of treatments, wigs and hairpieces are also very viable options. Much high quality and realistic looking ones are now available on the market.

If you are experiencing emotional distress attributed to your hair loss, considered talking to your GP about counseling sessions.

Sources

  1. Hagenaars SP, Hill WD, Harris SE, et al. Genetic prediction of male pattern baldness. PLoS Genet. 2017;13(2):e1006594. Published 2017 Feb 14. doi:10.1371/journal.pgen.1006594
  2. https://www.ncbi.nlm.nih.gov/books/NBK278957/
  3. Yap, C.X., Sidorenko, J., Wu, Y. et al. Dissection of genetic variation and evidence for pleiotropy in male pattern baldness. Nat Commun 9, 5407 (2018) doi:10.1038/s41467-018-07862-y
  4. Alfonso M1, Richter-Appelt H, Tosti A, Viera MS, García M.. (2005). The psychosocial impact of hair loss among men: a multinational European study.. Current medical research and opinion. 21 (11), p1829-36.
  5. Kaufman KD1, Olsen EA, Whiting D, Savin R, DeVillez R, Bergfeld W, Price VH, Van Neste D, Roberts JL, Hordinsky M, Shapiro J, Binkowitz B, Gormley GJ.. (1998). Finasteride in the treatment of men with androgenetic alopecia. Finasteride Male Pattern Hair Loss Study Group.. Journal of the American Academy of Dermatology . 4 (1), p578-89.
  6. He H, Xie B, Xie L. Male pattern baldness and incidence of prostate cancer: A systematic review and meta-analysis. Medicine (Baltimore). 2018;97(28):e11379. doi:10.1097/MD.0000000000011379
  7. https://ghr.nlm.nih.gov/condition/androgenetic-alopecia
  8. Zhou CK, Levine PH, Cleary SD, Hoffman HJ, Graubard BI, Cook MB. Male Pattern Baldness in Relation to Prostate Cancer-Specific Mortality: A Prospective Analysis in the NHANES I Epidemiologic Follow-up Study. Am J Epidemiol. 2016;183(3):210–217. doi:10.1093/aje/kwv190
  9. Hagenaars SP, Hill WD, Harris SE, et al. Genetic prediction of male pattern baldness. PLoS Genet. 2017;13(2):e1006594. Published 2017 Feb 14. doi:10.1371/journal.pgen.1006594

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