Treating male pattern baldness

Hair plays a role in our identity. It's not uncommon to hear someone referred to by the colour or style of their hair. So when you start to lose your hair, it can feel like you are losing a part of your identity.

Moreover, hair loss can indicate an underlying medical condition. If you notice a sudden or dramatic change in your hair, it's important to speak to your doctor.

Many men believe hair loss is simply a fact of growing old and some men even embrace it. While hair loss is completely normal, a sudden and dramatic loss of hair can be distressing.

What causes hair loss in men?

There are many factors that could cause hair loss such as stress, diet, tight hairstyles, diabetes, heart disease and cancer.

Your doctor will be able to discuss with you the specific cause of your hair loss, and provide advice catered to you on managing your condition.

Research has determined that the hormone dihydrotestosterone (DHT) plays a considerable role in male pattern hair loss.

DHT is the result of an enzyme (5-alpha reductase) which converts testosterone in the cells of the hair follicle to promote the growth cycle. When too much dihydrotestosterone is created, it shortens the growth cycle and inhibits the growth of new hair. The resting period, during which the hair is shed to allow new hair to grow from the follicle, remains the same.

Alopecia areata is an autoimmune response which attacks the hair follicles and causes hair to fall out.

If caught early, male pattern hair loss can be treated with medication.

How can I treat hair loss?

For some people, it is simply a matter of making changes to their lifestyle. For others, it may be more complicated than that.

Eating healthily and exercising regularly can reduce your risk of hair loss while also helping to reduce stress levels and improve your overall well-being.

However, androgenic alopecia is not caused by, nor can be treated with, lifestyle changes.

Androgenic alopecia is caused by hormones in the body which promote the growth and maintenance of hair. As such, it requires specific treatments which target the biological mechanisms which control the growth of hair.

Medicines for hair loss

Regaine (Minoxidil)

There are over-the-counter products available for hair loss, such as minoxidil (sold under the brand Regaine).

Minoxidil is available as a spray or solution which is applied directly to the scalp. When absorbed, it dilates blood vessels in the head, increasing blood flow to the hair follicles and promoting hair growth.

There are special formulations of minoxidil for women, such as Regaine for Women.

You can buy Regaine from most pharmacies without the need of a prescription.

While minoxidil (Regaine) acts fast and produces noticeable results in just a few months, it has a lower efficacy (50%) in studies. 33% of men using minoxidil saw no improvement in their condition.

If minoxidil (Regaine) has been ineffective, you can speak to your doctor about other possible treatments.

Propecia (Finasteride)

One treatment your doctor might suggest is Propecia.

Propecia is a brand of finasteride - a drug which is used to treat benign prostatic hyperplasia (BPH) and hair loss in men. When taken daily, the drug halts the production of DHT in the body, which causes enlargement of the prostate and hair loss.

Clinical trials have shown that, after 2 years of use, 83% of finasteride users experienced no further hair loss.

If you stop taking finasteride abruptly however, your rate of hair loss will return to the levels before starting treatment. The drug is only effective so long as it's being administered daily.

Surgical Procedures

Hair transplants

If you have exhausted all other avenues of treatment, you may consider a hair transplant.

This is a surgical procedure in which follicles are extracted from areas with lots of hair and implanted into areas of the head with fewer hairs. These implanted hairs will then produce hair in the area where there was none previously. The procedure is conducted under local anaesthetic.

The results of a hair transplant are fully realised after a year. While the procedure may cause scarring, particularly at the back of the head, the scars are typically small and are usually hidden by the surrounding hair.

The procedure is not available on the NHS and can be very costly, costing anywhere between £1k to £30k. Furthermore, the procedure isn't suitable for men with patchy hair loss known as alopecia areata.

Before considering any cosmetic surgery, it is important to speak to your doctor to ensure it is suitable for you.

Scalp micro-pigmentation (SMP)

Also referred to as "hair tattooing", the procedure involves dying individual hair follicles on the head with a pigment. This gives the impression of a shaven head.

Unlike a hair transplant, scalp micro-pigmentation does not promote hair growth and is purely an aesthetic procedure.

Non-medical options for hair loss

Aside from medication and surgery, there are other methods of concealing hair loss. While they may not help you regrow hair, they can improve your confidence.

Wigs and toupees

Whether made from synthetic or real, donated hair, wigs, toupees and extensions can help conceal thinning or bald hair. Generally, synthetic wigs are more affordable and easier to look after than wigs made from real hair, though may be more noticeable and don't last very long.

Toupees are generally small and cover a small amount of hair, while a wig can be worn over existing hair to disguise it. You can find wigs and toupees in a range of sizes, styles and colours to match your own hair.

Despite their simplicity, wigs and toupees can be itchy and uncomfortable, particularly ones made with synthetic hairs.

Wigs are available on the NHS under certain circumstances, but can also be bought from a range of stores, as can extensions and toupees.

Shaving

While it sounds counter-intuitive, some men may embrace their hair loss and simply shave their hair off.

First, shaving your head will not make your hair grow back any denser than before. This is a common myth. Hair growth occurs beneath the surface of the skin, so shaving it will not have a direct effect on the hair growth cycle.

If you suffer from dandruff, greying or thinning hair, shaving your head can indirectly make these conditions easier to manage.

Embracing your hair loss by shaving your head is the most cost-effective solution, but it isn't for everyone. You may not feel comfortable going bald or be self-conscious about the way you look without hair.

Much like SMP, shaving your head is a purely aesthetic solution to hair loss and does not promote new hairs to grow.

If you are considering shaving your head, you should still speak to your doctor about your hair loss, especially in the case of alopecia areata and sudden or dramatic hair loss, as it could be a sign of an underlying health condition. Your doctor will be able to determine the cause of your hair loss and provide you a range of options available to you.

Shaving your hair can be combined with other treatments, such as wigs and toupees. A shaven head can make the adhesion of wigs easier.

Future hair loss treatment

A recent study into finding an alternative hair loss treatment showed promising results. They found that the drug Cyclosporine A (CsA), which is used to treat osteoporosis, had an adverse side effect of hair growth. CsA reduces SFRP1, a protein that inhibits hair growth. Another compound, WAY-316606, was also found to suppress SFRP1 when applied to follicles in a lab. Furthermore, the result was greater than either minoxidil (Regaine) or finasteride.

Future studies into this potentially revolutionary treatment are needed, but Dr Hawkshaw of Manchester University is hopeful about his breakthrough saying:

"The fact this new agent, which had never even been considered in a hair loss context, promotes human hair growth is exciting because of its translational potential: it could one day make a real difference to people who suffer from hair loss."

What is the best hair loss treatment for me?

Your hair loss recovery should start with a consultation with your doctor. Your doctor will be able to discuss your condition and offer other practical advice on managing your hair loss.

In most cases, hair loss is temporary and reversible. Lifestyle changes such as eating a balanced diet, exercising regularly and taking care of your hair can help to keep your hair healthy. Other times, hair loss is hereditary trait passed on through genetics. Regardless of the cause of your hair loss, there are a range of treatments and options available to you.

Regaine (minoxidil) and Propecia (finasteride) are two medicinal treatments for hair loss which have shown positive results in studies. You can buy Regaine over the counter from pharmacies, while Propecia is only available on prescription.

Surgical procedures, such as hair transplants and scalp micro-pigmentation, are also viable options. These can produce a more permanent solution to hair loss, though they can be expensive.

If hair loss medications aren't suitable for you, and surgery isn't the route you wish to go down, there are other options available, such as wearing wigs or toupees, or shaving your head. While they won't treat the underlying condition or help grow your hair back, they can help with the appearance of your hair loss and help to boost your self-esteem.

Losing your hair can be distressing for anybody, but it can be especially difficult to manage if you are suffering from stress, anxiety or depression. It is important to tell your doctor if your hair loss is affecting your mental health.