Alopecia in men; Baldness - male; Hair loss in men; Androgenetic alopecia
Male pattern baldness is the most common type of hair loss in men.
Male pattern baldness is related to your genes and male sex hormones. It usually follows a pattern of receding hairline and hair thinning on the crown.
Each strand of hair sits in a tiny hole (cavity) in the skin called a follicle. Generally, baldness occurs when the hair follicle shrinks over time, resulting in shorter and finer hair. Eventually, the follicle does not grow new hair. The follicles remain alive, which suggests that it is still possible to grow new hair.
The typical pattern of male baldness begins at the hairline. The hairline gradually moves backward (recedes) and forms an "M" shape. Eventually the hair becomes finer, shorter, and thinner, and creates a U-shaped (or horseshoe) pattern of hair around the sides of the head.
Exams and Tests
Classic male pattern baldness is usually diagnosed based on the appearance and pattern of the hair loss.
Hair loss may be due to other conditions. This may be true if hair loss occurs in patches, you shed a lot of hair, your hair breaks, or you have hair loss along with redness, scaling, pus, or pain.
A skin biopsy, blood tests, or other procedures may be needed to diagnose other disorders that cause hair loss.
Hair analysis is not accurate for diagnosing hair loss due to nutritional or similar disorders. But it may reveal substances such as arsenic or lead.
Treatment is not necessary if you are comfortable with your appearance. Hair weaving, hairpieces, or change of hairstyle may disguise the hair loss. This is usually the least expensive and safest approach for male baldness.
Medicines that treat male pattern baldness include:
- Minoxidil (Rogaine), a solution that is applied directly to the scalp to stimulate the hair follicles. It slows hair loss for many men, and some men grow new hair. Hair loss returns when you stop using this medicine.
- Finasteride (Propecia, Proscar), a pill that interferes with the production of a highly active form of testosterone that is linked to baldness. It slows hair loss. It works slightly better than minoxidil. Hair loss returns when you stop using this medicine.
- Dutasteride is similar to finasteride, but may be more effective.
Hair transplants consist of removing tiny plugs of hair from areas where the hair is continuing to grow and placing them in areas that are balding. This can cause minor scarring and possibly, infection. The procedure usually requires multiple sessions and may be expensive.
Suturing hair pieces to the scalp is not recommended. It can result in scars, infections, and abscess of the scalp. The use of hair implants made of artificial fibers was banned by the FDA because of the high rate of infection.
Male pattern baldness does not indicate a medical disorder, but it may affect self-esteem or cause anxiety. The hair loss is usually permanent.
When to Contact a Medical Professional
Call your health care provider if:
Your hair loss occurs in an atypical pattern, including rapid hair loss, widespread shedding, hair loss in patches, or hair breakage.
Your hair loss occurs with itching, skin irritation, redness, scaling, pain, or other symptoms.
Your hair loss begins after starting a medicine.
You want to treat your hair loss.
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Sperling LC, Sinclair RD, El Shabrawi-Caelen L. Alopecias. In: Bolognia JL, Schaffer JV, Cerroni L, eds. Dermatology. 4th ed. Philadelphia, PA: Elsevier Saunders; 2018:chap 69.