Two out of every three men in the UK will experience male pattern baldness to some extent. Family history can be a strong indicator of your chances of losing your hair. Hair loss tends to be linked to the mother’s side of the family, so you are most likely to lose your hair at a similar age to your maternal grandfather.
Race is also a factor: for example, Caucasian and Afro-Caribbean men have a much higher rate of male pattern baldness than do East Asian men.
Some men are excessively paranoid about hair loss. Others may be in denial, and so do not accept their own hair loss for several years. Either, it can be difficult to objectively identify hair loss, especially because baldness tends to occur very slowly.
Generally, though, you or someone else will notice that your hairline has gradually receded or that your hair has thinned. You may also notice that hair is coming out in the shower or on your pillow.
Male pattern baldness is characterised by a loss of hair on the top of the head. It does not affect the back or sides of the hair. The pattern of hair loss can occur starting at the crown, the hairline, or both.
No, there is no cure. Other causes of hair loss may, however, be reversible.
Male pattern baldness cannot be prevented, though there are treatments and techniques which may delay baldness or suppress the symptoms.
Women tend to lose hair when they are especially sensitive to DHT in the scalp. This most often happens during and following the menopause, due to the decrease in female hormones and relative increase of male hormones such as DHT. This hair loss does not occur in the same pattern as it does for men, and is rarely as severe.
Pregnant women, who have increased levels of progesterone, may experience some hair loss. The progesterone causes hair follicles to briefly stop. Again, this is only temporary.
Women with a deficiency of iron called anaemia can suffer from hair loss. This can be reversed with a diet with sufficient iron.
Minoxidil is the only lotion that is approved in the UK to treat hair loss. Its trade name is Regaine. It tends to take up to four months to take effect. Start by using the weaker 2% lotion – only move on to the stronger 5% lotion if you do not notice any improvement after three months. For about one-third of men, Regaine will be ineffective. Only one-third of Regaine users will see a full regrowth of hair on bald patches. The remaining third will have some regrowth, but it will be finer and thinner than their natural hair.
Even for men who do not see regrowth after using Regaine, they will likely notice that further hair loss has stopped. However, baldness will continue if you stop using the lotion.
Regaine must be purchased from a pharmacy when a licensed pharmacist is present but does not require a prescription. A month’s supply of Regaine usually costs about £30 – be careful not to pay significantly more over the internet for Regaine or an equivalent. A pharmacist will ensure that you can safely take Minoxidil. It may be unsuitable if your blood pressure is high.
Finasteride tablets prevent hair loss by inhibiting 5-alpha-reductase, the enzyme involved in converting testosterone to DHT (discussed below).
You can get a private prescription for Finasteride from your GP or dermatologist – it is not available on the NHS. Finasteride was formerly sold as Propecia or Proscar. These patents expired in recent years, meaning that the tablets have decreased in cost.
2% of Finasteride users experience side effects including impotence, reduced libido and reduced semen production. These will tend to go away once you stop taking the tablets.
Finasteride and Regaine have shown to have similar rates of effectiveness, though there is no definitive comparative study of the two treatments. Within six months of stopping either treatment, symptoms of male pattern baldness will resume.
The action of DHT can be directly blocked through anti-androgen therapy. This is a hormone therapy regime you should only pursue under the advice of an endocrinologist or an appropriately experienced dermatologist.
Hair replacement surgery is a more drastic solution which involves reconstructing the skin on the scalp such that bald patches are minimised and areas with hair are made more prominent. This is done by grafting skin from the back of the head, where hair still grows, to the top of the scalp. Grafts can be made to look natural by moving very small plugs of skin – usually less than five hairs at a time. A surgeon will likely construct a new hairline using individual hairs (micrografts) at the front and plugs of 3-6 hairs (minigrafts) for the subsequent rows of hair.
This is a complex surgery. Even with a skilled surgeon, hair loss may continue around the grafts, leading to a very patchy appearance. The procedure can be very expensive, especially if further work is required in the future. Consult your GP thoroughly and be sure to select a reputable surgeon.
It is difficult to predict the extent to which male pattern baldness will cause hair loss. Generally, though, men who experience hair loss earlier in life will be most likely become fully bald. If you do not notice symptoms of pattern baldness until after your mid-twenties, you will likely still have hair, albeit thinner hair, when you reach old age.
It may be worth finding out the extent to which male pattern baldness has affected older men in your family, especially your maternal grandfather. Comparing their history to your own experiences may give you an indication of your eventual hair loss.
It is easier to reverse symptoms of male pattern baldness the earlier that treatment is started. So, if you wish to stop the process of balding, you should consult a specialist as soon as you notice significant hair loss.
If you do not pursue treatment, the process of hair loss will continue, and it will become more difficult to minimise or hide the symptoms.
Outside of medical treatments, there are some changes to lifestyle and hair care that may mitigate male pattern baldness.
In terms of your hair care routine:
There is also a link between diet and hair loss. Ensure that you have sufficient iron and protein each day.
Dihydrotestosterone, or DHT, is a hormone that is present in men’s hair follicles in the scalp. It shortens the lifespan of hair follicles, leading to hair loss. Without DHT, most hair follicles can grow hair for nearly eight years.
Some women experience hair loss during the menopause, due to the decrease in female hormones and relative increase of DHT.
Finasteride blocks the conversion of testosterone to DHT; anti-androgen therapy blocks DHT activity directly.
Men tend to first notice male pattern baldness from the age of 25 to 35, though it can sometimes start as early as a man’s late teenage years. Baldness tends to accelerate with age.
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