Male Pattern Baldness
Also known as: Androgenetic alopecia, Androgenic alopecia, Male pattern hair loss
Male pattern baldness, medically called androgenetic alopecia, is the most common type of hair loss in men. It follows a recognisable pattern: the hairline recedes at the temples, the crown thins, and over time the two areas may meet, leaving a band of hair around the sides and back. It is caused by a genetically determined sensitivity of scalp hair follicles to dihydrotestosterone (DHT), a hormone derived from testosterone, which gradually shrinks the follicles until they produce only fine, short hairs. The process can begin any time after puberty and affects a majority of men to some degree by their fifties. It is harmless, but many men find it distressing. Treatments can slow or partially reverse the loss, and they work best when started early.
At a Glance
- Common symptoms
- A receding hairline forming an 'M' shape at the temples, Thinning hair on the crown of the head, often first noticed in photographs or mirrors, Gradual widening of the parting or a more visible scalp
- Main treatments
- Topical minoxidil applied to the scalp once or twice daily, which can slow loss and stimulate regrowth; effects take 4 to 6 months and stop if treatment stops, Oral finasteride, a daily tablet that blocks the conversion of testosterone to DHT, which slows loss and can promote regrowth in most men; it requires ongoing use and discussion of possible side effects, Low-dose oral minoxidil, prescribed off-label by some specialists
- Category
- Dermatological · Extremely common; affects a majority of men to some degree by middle age
- See a doctor if
- Hair loss that is sudden, patchy, or accompanied by itching, scaling, or pain, which suggests a different cause
Symptoms
Causes
- Inherited sensitivity of hair follicles to dihydrotestosterone (DHT)
- DHT causing follicles to shrink (miniaturise) and the growth phase of hair to shorten
- Genes inherited from both parents, not only the mother's side as commonly believed
- Ageing, which increases the cumulative effect of DHT on susceptible follicles
Risk Factors
- A family history of baldness on either side of the family
- Increasing age
- Anabolic steroid or testosterone use, which can accelerate loss in predisposed men
- Some evidence links metabolic syndrome, obesity, and smoking to earlier or more severe loss
Diagnosis
- A history of gradual hair loss and family pattern, plus examination of the scalp
- Dermatoscopy showing miniaturised hairs and variation in hair thickness in the typical distribution
- Blood tests (thyroid, iron, and sometimes hormones) if the pattern is unusual, loss is rapid, or there are other symptoms
- Scalp biopsy only when the diagnosis is unclear
Treatment
- Topical minoxidil applied to the scalp once or twice daily, which can slow loss and stimulate regrowth; effects take 4 to 6 months and stop if treatment stops
- Oral finasteride, a daily tablet that blocks the conversion of testosterone to DHT, which slows loss and can promote regrowth in most men; it requires ongoing use and discussion of possible side effects
- Low-dose oral minoxidil, prescribed off-label by some specialists
- Hair transplant surgery, which moves follicles from the back of the scalp to thinning areas and gives permanent results in suitable candidates
- Low-level laser therapy devices, which have modest evidence for improving hair density
- Platelet-rich plasma injections, offered by some clinics with limited but growing evidence
- Supportive: cosmetic approaches such as hair fibres, scalp micropigmentation, shorter hairstyles, or simply accepting and embracing the change
Prevention
- Male pattern baldness cannot be prevented, but starting treatment early preserves more hair than trying to regrow it later
- Avoid anabolic steroids and unnecessary testosterone supplementation
- Do not smoke
- Maintain a balanced diet; deficiencies can worsen thinning but supplements do not help unless you are deficient
- Be gentle with hair: avoid tight hairstyles and harsh chemical treatments that can add to loss
When to See a Doctor
- Hair loss that is sudden, patchy, or accompanied by itching, scaling, or pain, which suggests a different cause
- Hair loss in a young man that is rapid or distressing, to discuss early treatment
- Loss that includes eyebrows, body hair, or occurs with other symptoms such as tiredness or weight change
- You are considering finasteride, hair transplant, or other prescription treatments and want to weigh the benefits and risks
- Hair loss is affecting your mood, confidence, or relationships
Frequently Asked Questions
Related Conditions
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