What is male pattern baldness?

Male pattern baldness is a type of hair loss and thinning that is common in adult males. It is also known as androgenetic alopecia. While it is commonly seen in older people, male pattern baldness can affect young adults as well.

Male pattern baldness typically progresses gradually over time. It involves hair loss that starts at the hairline above the temples and leads to a receding hairline. This is followed by hair loss on the top or 'crown' of the head, leaving behind a horseshoe-shaped pattern of hair.

How does hair loss occur?

Hair loss occurs because of changes to the normal hair growth cycle.

Hair follicles go through cycles of growth, rest and shedding (falling out). In the normal hair-growth cycle, most hair stays in a growth phase (known as the anagen phase). This phase lasts for about 3 to 6 years before it falls out and new hair grows in its place.

In male pattern balding, hair follicles become more sensitive to some male hormones. Hair follicles in affected areas of the scalp develop a much shorter growth phase. This means that they fall out after weeks or months instead of years. Male pattern baldness also causes less hairs to grow from each follicle, and your hairs become shorter and finer. This process results in patches of hair thinning and baldness.

What are the symptoms of male pattern baldness?

Male pattern baldness usually starts after puberty and develops gradually.

The hair loss usually occurs in a specific and recognisable pattern. Here are some signs that you may notice:

• Your hair is gradually thinning at your temples.
• Your hairline is slowly receding.
• The hair on your crown (the top of your head) may thin.
• You may eventually develop a bald patch on the top of your head, which gets bigger over time.
• If hair loss continues, you may develop a horseshoe pattern of hair growth around the back and sides of your head.

Males shows specific pattern of hair loss starting at the temples and gradually moving back across scalp.

Male pattern baldness doesn't usually affect your eyebrows, eyelashes or the hair at the sides and back of your hair. Hair loss in these areas is usually caused by other medical conditions. If you aren't sure, or you're concerned about your hair loss, see your doctor for information and advice.

What causes male pattern baldness?

Male pattern hair loss is an inherited (genetic) condition that affects how some of the hair on your scalp responds to certain male hormones. There is no genetic test currently available to predict whether you will experience male pattern baldness.

Most males will experience male pattern hair loss to some extent. It is more common as you get older.

Male pattern baldness is especially common among Caucasian males. It affects about 1 in 5 males in their 20s, 1 in 3 males in their 30s and nearly half of males in their 40s. Other population groups, such as Japanese and Chinese males, are generally less affected. If affected, males in these groups generally experience a milder and more general pattern of hair thinning or loss.

Other types of hair loss can be caused by:

• hormone imbalances
• autoimmune conditions
• infections
• radiation therapy
• emotional stress
• tight hairstyles

These factors don't usually cause male pattern baldness, but if they occur together with male pattern baldness, your hair loss may be more extensive.

When should I see my doctor?

It is normal to lose around 100 hairs a day. You may see hairs in your brush or when you wash your hair. Talk to your doctor if hair loss is causing you worry or distress.

Talk to your doctor if you:

• are losing more hair than usual
• see a receding hairline
• are balding at the crown
• have a history of male pattern baldness in your family

Also see your doctor for signs that might indicate other health issues, including if you:

• are losing more hair than usual and feeling unwell
• are losing hair from other parts of your body
• notice changes in the skin under the hair loss

How is male pattern baldness diagnosed?

Male pattern baldness can be diagnosed by your doctor. They will ask you questions about your general health, your hair loss and any hair loss in your family. They will then examine your head and scalp, especially areas of hair thinning or baldness.

Most of the time, you won't need any special tests to diagnose male pattern baldness.

In some cases, your doctor might refer you to a dermatologist (specialist skin doctor) for a detailed examination (dermatoscopy) or skin biopsy to rule out other conditions and confirm the diagnosis.

Your doctor may suggest extra tests if they think that your hair loss may be due to causes other than age-related baldness.

How is male pattern baldness treated?

Male pattern baldness is not a disease, and it is usually treated for cosmetic reasons. You may choose to embrace your new look, or to think about treatment options.

The main aim of treatment is to slow or stop hair loss. Treatment might also aim to stimulate hair growth, but results vary between people. Talk to your doctor about your expectations and discuss possible benefits and risks.

Taking photographs before, during and after treatment can help to keep track of progress.

Choices of treatment may differ depending on:

• how severe your hair loss is
• your preferences
• the risk of adverse effects
• the costs involved

The simplest and safest solution for male pattern baldness is to wear a hairpiece, such as a wig or toupee. Other people choose to fully shave their head.

If you choose not to wear a hairpiece, and are interested in treating your hair loss, there are a few medical treatments that have shown to be effective:

• Minoxidil is a liquid solution or foam applied daily to areas of the scalp affected by hair loss. It increases blood flow to the scalp and stimulates hair growth. It may also be prescribed in oral (tablet) form. It may irritate underlying skin conditions on the scalp.
• Finasteride and dutasteride are daily tablets that lower hormones causing male pattern baldness.
• Hair transplant surgery surgically removes hairs from the back of your head and implants them into areas of the scalp affected by hair loss. It's quite effective but can be expensive, and may lead to complications including scarring and infection.

You will usually notice improved hair growth after about 4 months of taking finasteride or minoxidil. Stopping these medicines usually brings back hair loss.

There are many other treatments advertised to improve hair loss, including laser treatment and plasma injections. Many of these lack evidence to prove that they are effective, and may be expensive.

It's important to have realistic expectations when deciding to try a particular treatment for male pattern baldness. Although some treatments have good success rates, no treatment will completely reverse the process, and not all treatments will work for everyone.

Your doctor can help you decide on which treatment might be best suited for you. They can also tell you about the potential side effects of your medicines or risks associated with the different treatments.

Living with male pattern baldness

Many people accept male pattern baldness as a normal part of ageing.

Taking a positive view of ageing may help you embrace your new pattern of hair growth. You may also like to take this opportunity to try a new hairstyle, hat or headwear. Alternatively, you may choose to shave your remaining hair and celebrate your new look.

If you are experiencing hair loss or baldness, it's important to make sure your scalp is protected from the sun. Apply sunscreen to your head regularly, or wear a hat, to reduce the chance of developing skin cancer.

You may also wish to wear a hat or beanie during colder months, since less hair means that you will lose more heat from your head.

What are the complications of male pattern baldness?

Some people, especially those experiencing hair loss at a younger age, find that hair loss affects their confidence and makes them feel less attractive.

If you are struggling to come to terms with male pattern baldness, you might wish to share your feelings with someone you trust, such as a friend, your partner or a professional counsellor or psychologist.

Some hair loss treatments have documented side effects. Finasteride may cause mental health problems or sexual dysfunction in some people. It is important to discuss these risks with your doctor before starting treatment.

Can male pattern baldness be prevented?

Male pattern baldness is hereditary (genetic), so it can't be prevented. However, looking after your diet and lifestyle can help maximise your general health, including the health of your hair.

Some treatments for male pattern baldness work better when hair loss is still mild. If you're worried about hair loss, consider talking to your doctor for advice and information as soon as you notice it.

Resources and support

For some people, hair loss can be distressing and affect their mental health. If your hair loss is upsetting for you, it might help to talk to your doctor or to see a psychologist for counselling.

• Beyond Blue can help if you feel anxious or depressed because of hair loss. Call 1300 22 4636 anytime.
• MensLine Australia is a telephone and online counselling service for men with emotional, health and relationship concerns. Call 1300 78 99 78 anytime.