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Experts Share the How, Why, and What to Do About Male Pattern Baldness

Experts Share the How, Why, and What to Do About Male Pattern Baldness

While more men are becoming invested in taking care of their skin — whether it’s via a simple slathering of SPF or a full-on regimen — it’s still not the most popular grooming category. The average man’s biggest concern is losing their hair — and the issue is not just in their heads.

According to the American Hair Loss Association, two-thirds of men will experience some degree of hair loss by age 35, and by age 50, that figure turns into 85 percent of men. It’s no wonder then, that hair-loss or hair-thinning treatments have always made up the bulk of men’s grooming products. We’ll try almost anything to keep our hair.

Male pattern baldness, the most common form of hair loss in men, is a genetic issue. For many years, we believed that there was only so much one could do to “treat” it — including simply shaving it all off. But now, we know more about hair loss than ever before, and with that knowledge comes new perspectives in treatment. We consulted some key experts to break down this complicated subject, but remember: talk to your doctor before trying anything new.

Why Do We Lose Our Hair?

The most common form of hair loss in men is genetic. It’s called androgenetic alopecia or, more commonly, Male Pattern Baldness and is pretty easy to spot. “It can present in the frontal temple area as a recession in the front or it can present at the vertex, which is almost at the back of the scalp,” says dermatologist Dr. Jerry Shapiro. “The hair can also generally become thin on the top.”

These localized receding hairlines and bald spots are the first sign of androgenetic alopecia, but another good indicator of hair loss is taking a closer look at your family. Despite the common myth that hair loss is carried in the X chromosome, which men get from their mothers, it can actually be inherited from your father’s side of the family too. Take note of your cousins’ and uncles’ hair at your next holiday gathering — it could be evidence of what’s to come.

While male pattern baldness counts for the vast majority of hair loss in men, it’s certainly not the only factor. We know our bodies work holistically, so hair loss could be a sign of other internal issues. “Low iron in men and also medications can cause loss of hair,” says dermatologist Dr. Timm Golueke. “Hair loss can also follow stressful situations and internal diseases.”

Other factors like diet, hormonal balance, and environment such as aggressive haircare can play a role as well. A powerful sign that one of these factors is responsible for your hair loss — and not male pattern baldness — is if it’s in areas other than the front hairline and back of the head. The only way to know for sure, though, is to see a doctor for a consultation, so meet with yours if you are concerned.

How Do We Lose Our Hair?

The particulars of male pattern baldness are not completely understood, but we do know that it involves the relationship between a hormone called dihydrotestosterone (DHT) and an enzyme called 5 alpha-reductase, which aids in converting testosterone to DHT; a normal bodily function.

The problem appears when this relationship is compromised and there is an overabundance of DHT. With male pattern baldness, certain hair follicles are particularly sensitive to DHT. “This particular hormone is higher in balding scalp than in non-balding scalp,” says Dr. Shapiro. Those higher levels of the hormone cause the hair follicles to miniaturize (a.k.a. thin out), and the negatively affect life cycle of the hair.

In case you need a refresher, a hair’s life cycle comes in three parts: the anagen (growth) phase when the hair is actively growing, the catagen (intermediate) phase which is transitional, and the telogen (shedding) phase when the hair rests and then ultimately falls out. When a hair follicle is sensitive to DHT, the anagen and catagen phases are shortened and the telogen phase is prolonged, meaning more loss.

Stocksy United / Ania Boniecka

When Does Hair Loss Start?

The bad news is that since male pattern baldness is technically a genetic disorder, it can start early. “[Many] people start in their early 20s, but, I see it in all ages,” says Dr. Shapiro. “The most common age I see it in my office is 23.” But it’s important to know that it’s a prevalent issue regardless of age.

“If you start to experience hair loss in your early twenties, you might think something is wrong,” says Steve Gutentag, co-founder of hair-loss treatment brand KeepsTM;, whose customers are predominantly in their twenties and early-thirties. “Actually, male pattern baldness starts earlier than you think.” Gutentag knew this from his personal experience himself and learned that he was not alone.

Can Hair Loss Be Cured?

Unfortunately, “male pattern baldness can not be cured, [the condition] can only be maintained and treated,” says Dr. Shapiro. But men are starting to notice it earlier, and that’s a powerful thing. When trying to slow down or stop hair loss, you want to try to beat the clock — so talk to your doctor about developing a treatment plan that’s customized just for you.

It’s also important to know that there is a difference between a hair follicle dying and going dormant. While it’s proven that you can’t regrow hair that is completely gone, no one can tell for sure which follicles are dead and which are dormant (and why). That’s why consulting with a doctor can make all the difference. “You can sometimes get new hair back,” says Dr. Golueke. “Even if someone is half bald, [I recommend they] start with the therapy, because then they can at least keep the hair they have — and maybe they’re lucky, and [some] comes back.”

Let’s Talk Treatments

Most traditional treatments for male pattern baldness, like finasteride (a.k.a. Propecia®), require a prescription and work to regulate the unbalanced relationship between DHT and 5 alpha-reductase. By regulating DHT, the medication helps to bring the life cycle of the hair back to normal which helps to retain hair and also assist in bringing follicles back from dormancy. Companies like Keeps have recently made it even easier to get both prescription and over-the-counter treatments by offering them for purchase online.

Hair loss treatment with finasteride is not a cure, but a continuous treatment. At times, it may no longer be an appropriate medication to take, so going it alone without the recommendation of a physician is ill-advised. After all, you need to make sure what you’re using is actually the right thing for you. “You may not actually have the trait [for male pattern baldness] and you may be committing yourself to [an ongoing] treatment when you may not even have the condition,” says Dr. Shapiro. Go to your dermatologist if you think you are losing your hair, or take advantage of a company like Keeps (Dr. Shapiro is one of the company’s medical advisors) who offer online consultations with a network of doctors before the ability to purchase their products.

[Editor’s note: Propecia is a prescription drug that may increase the risk of high-grade prostate cancer. It is not intended for use by women or children. Women who are pregnant, planning to become pregnant, or nursing should not handle crushed or broken tablets. Talk to your doctor to see if it’s the right treatment option for you.]

iStock / Torwai

Hair Issues are Scalp Issues

One of the first steps to an effective hair loss treatment program is to make sure you’re giving yourself the best possible start — and that means making sure your scalp is healthy. Yes, a hormonal imbalance is the root cause of male pattern baldness, but things like diet, hygiene, and even product buildup can play a big role.

“Men have a tendency to be a little more heavy-handed when they use styling aids,” says Christyn Nawrot, Education Director of PHYTOTM;. “Detoxing and doing a full regimen that's proper and healthy first is important before we even think about getting a thinning hair treatment.” Using products like non-stripping shampoo and scalp scrubs can help make sure the canvas is primed for optimal treatment. “If you have a healthy scalp, [chances are] you're going to have healthy hair,” notes Nawroth. Learn more about how scalp scrubs could work for you here.

Customizing Treatments

Most experts agree that to get the best results out of a program, it’s all about using a combination of treatments. The only way to find the right mix for you is to consult an expert. “Everything we do for our clients is based on their individual consultation,” says Lars Skjoth, founder and head of research and development of Danish hair-loss company HarklinikkenTM;. “It’s about the way you combine ingredients into one treatment plan. We custom blend formulas for each patient.”

Experts like Skjoth now seek to treat the holistic causes of hair loss from genetics to diet. Combining topical treatments like serums, internal treatments like supplements, and product-based treatments like shampoos can help achieve optimal results.

Don’t Discount Botanicals

Botanical ingredients are popular throughout the entire beauty industry, and the hair loss category isn’t exempt from the trend. These plant-based ingredients can help protect the hair, especially against damaging oxidants, and even help stimulate new hair growth.

“Cacao can help slow down the thinning process,” says Nawrot of an important ingredient in Phyto products. Dr. Golueke’s skincare line Royal FernTM;, which features a hair thinning treatment range, also uses botanicals like “ginkgo biloba which [helps] activate blood circulation,” says Dr. Golueke.

The Treatment of the Future

You may not have heard of Platelet Rich Plasma (PRP), but your dermatologist definitely has. The buzzy technology draws plasma from your blood and, by re-injecting it into other parts of your body, delivers healing benefits via concentrated growth factors. It’s commonly used to help patients heal from surgeries and laser treatments, and now studies are being conducted to test its ability to combat hair loss.

“We don't know exactly how it works, but we do know that it helps quite a lot of people,” says Dr. Shapiro. Also excited about PRP, Dr. Golueke shares, “PRP is one of the most performed therapies here in my clinic,” he says. “It’s good because it activates the blood circulation and the cross factors do strengthen the hair roots.”

[Editor’s note: Women who are pregnant or plan to become pregnant should avoid minoxidil. Talk to your doctor before starting or stopping any new treatment, medication, or supplement.]

Most Importantly, Be Patient

Hair loss treatment is about the long game, so no matter what your personal treatment plan looks like, there is no quick fix (apart from a visit to the wig store). “You’ve usually got to give it six months,” says Dr. Golueke. “It takes [two to four] months for the hair loss to stop and maybe also some hair newly regrowing.”

It can also take a while to find the right treatment for you, since issues with diet, environment, and medications can be tricky to narrow down and even longer to adjust to. But if you are truly committed — and especially, if you start early — there is a plan that will work for everyone. If all else fails, you could always shave your head. And really, there is no shame in that.

 

Dr. Jerry Shapiro has received an honorarium for his work as an advisor to Keeps.

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