Male Pattern Baldness: Causes, Symptoms, Stages, and Treatment

Androgenetic alopecia, commonly known as male pattern baldness (MPB), is a highly prevalent and progressive hair loss condition that affects millions of men globally [1]. It is distinguished by a slow, predictable thinning of scalp hair, usually beginning at the temples and crown, which can progress to substantial balding over time. In this post, we’ll look at the causes, symptoms, phases, and evidence-based treatments for male pattern baldness.

What Is Male Pattern Baldness?

Male pattern baldness is the most common form of hair loss in men, affecting up to 50% of men by the age of 50 [1]. This progressive condition typically begins with a receding hairline at the temples and gradually progresses to thinning on the crown. Over time, hair loss can become more extensive, leading to a characteristic horseshoe-shaped pattern of hair around the sides and back of the head. MPB is primarily driven by a combination of genetics and the action of male sex hormones (androgens) [2].

Causes of Male Pattern Baldness

The causes of hair loss in men are complex and multifactorial, involving a combination of age, hormones, and genetics:

• Age: Hair loss tends to increase with age, affecting approximately one-third of men in their 30s and a majority of men later in life [1, 3].
• Hormones: Androgens, particularly dihydrotestosterone (DHT), play a significant role in male pattern baldness [1]. DHT, a potent metabolite of testosterone, causes hair follicles to shrink, a process known as follicular miniaturization [1]. This leads to the production of finer, shorter hair until the hair growth cycle ceases entirely.
• Genetics: Heredity accounts for approximately 80% of the predisposition to MPB [1]. It is considered a polygenic condition, meaning multiple genes are involved. While the gene for the Androgen Receptor (AR) on the X chromosome is a key factor inherited from the maternal side, family studies show a strong correlation between hair loss in both fathers and sons [4].

Understanding these underlying causes, particularly the role of DHT and genetics, is essential for developing targeted treatment strategies.

Stages of Male Pattern Baldness

Male pattern baldness progresses through distinct stages, which are typically classified using the Norwood-Hamilton scale (often simply referred to as the Norwood scale) [5]. Here are the stages:

• Stage 1: No significant hair loss is observed; the scalp hairline is usually preserved.
• Stage 2 (Minimal): Slight recession of the hairline at the temples becomes noticeable.
• Stage 3 (Mild/Moderate): The hairline recedes further, forming an M, U, or V shape. Stage 3 Vertex involves significant thinning or hair loss at the crown.
• Stage 4 (Moderate): More severe hair loss occurs, with a band of hair remaining between the receding frontal hairline and the balding crown area. The connecting hair is distinct but thinning.
• Stage 5 (Advanced): Larger bald areas develop, with a narrower, more sparse band of hair separating them.
• Stage 6 (Severe): The bald areas at the front and crown merge, leaving only a horseshoe-shaped band of hair at the sides and back.
• Stage 7 (Most Severe): Only a thin, sparse horseshoe-shaped band of hair remains around the sides and back of the head.
• Norwood Class A: A less common, distinct hair loss pattern where the hairline recedes uniformly from front to back without a separate, distinct bald spot on the crown (vertex).

Symptoms of Male Pattern Baldness

The symptoms of male pattern baldness are typically easily recognised and include a gradually receding hairline and thinning hair. Here are the key symptoms to look out for:

• Receding Hairline: Gradual thinning at the temples, progressively forming an “M” shape.
• Vertex Thinning: Noticeable loss or thinning of hair at the crown of the head.
• Increased Shedding: While not a primary diagnostic symptom, some individuals notice increased hair shedding before or during the process of miniaturization.

If you notice these progressive changes, consulting a dermatologist or your primary healthcare provider is advisable for a proper diagnosis and discussion of potential management options.

Diagnosis of Male Pattern Baldness

The diagnosis of male pattern baldness is primarily clinical, based on visually examining the scalp and classifying the extent of loss using the Norwood-Hamilton Scale [5]. A dermatologist will also take a comprehensive medical and family history, as MPB often has a strong genetic component. A physical examination, sometimes involving a dermatoscope (trichoscopy), helps confirm the presence of miniaturized hair follicles [6].

Your doctor may perform additional blood tests to rule out other potential causes of hair loss, such as thyroid dysfunction, nutrient deficiencies (like iron/ferritin), or other hormonal imbalances [6]. This is essential before starting treatment.

Risk Factors of Male Pattern Baldness

While genetics and hormones are the direct causes, several factors influence the likelihood and severity of MPB:

• Genetics: This remains the most important risk factor, with a significantly higher chance if close family members, such as a father or brother, are affected [4].
• Age: The risk and severity increase as men age [1].
• Ethnicity: MPB incidence and severity show racial variation. For example, the incidence is reported to be higher in Caucasian men compared to Asian men [1].
• Associated Health Conditions: Although the link is debated, some studies suggest that severe early-onset MPB (before age 30) may be weakly associated with an increased risk of certain conditions, including arterial stiffness and cardiovascular disease [1]. It is important to understand that MPB itself does not cause these conditions, but rather, the same underlying hormonal factors or genetic predisposition might be at play.

Evidence-Based Treatments for Male Pattern Baldness

Various treatment options are available for managing hair loss in men, ranging from established medications to surgical interventions. The goal of treatment is typically to halt further hair loss and stimulate new growth.

1. Medications

Medications offer a non-invasive, frontline approach to slowing down hair loss and promoting regrowth.

Always consult a Dermatologist before starting prescription medications, as they can assess suitability and monitor for potential side effects.

2. Hair Transplant

• Hair transplantation is a surgical option that offers a permanent solution for restoring hair in areas affected by balding.
• The procedure involves moving healthy, DHT-resistant hair follicles from donor sites (usually the back of the scalp) to the balding areas.
• Hair transplants offer permanent results with a natural appearance. However, they are invasive, can be costly, and do not stop the progression of hair loss in untreated areas [1]. Patients may still require medication to preserve existing hair.

3. Platelet-rich Plasma (PRP) Therapy

• PRP therapy involves drawing the patient’s blood, concentrating the platelets (which are rich in growth factors), and injecting the resulting plasma into the scalp to encourage hair growth.
• PRP is considered an emerging therapy in many clinical settings, and while research shows encouraging results and minimal side effects, it is not currently FDA-approved as a standalone treatment for MPB.
• The effectiveness and required frequency of treatment can vary widely, and its use is often considered an adjunct (supplementary) therapy alongside established medications.

4. Cosmetic/Styling Techniques

• In addition to medical treatments, styling techniques can help visually manage the appearance of hair loss.
• Using thinning shears to trim the hair or employing specific shorter cuts can create a fuller appearance.
• Applying hair-thickening products, such as volumising sprays, hair fibers, or powders, can add volume and texture to the hair.
• Choosing hairstyles that strategically cover bald spots can help minimise the appearance of hair loss.

Management and Prevention of Male Pattern Baldness

While genetic hair loss cannot be completely prevented, adopting a proactive and healthy approach can help manage the condition and support overall hair health.

• Maintain a Nutrient-Rich Diet: A balanced diet rich in protein, B-vitamins (especially Biotin), Iron (Ferritin), and Zinc is essential for optimal hair health. Addressing any nutritional deficiencies is a core part of hair loss management.
• Manage Stress: Chronic stress can potentially exacerbate or accelerate hair loss (known as Telogen Effluvium), which can compound MPB. Employ relaxation techniques like meditation, yoga, or deep breathing exercises.
• Avoid Unnecessary Hair Products: Avoid frequent or harsh chemical processes (perming, strong dyes, excessive heat styling) that can cause breakage or damage to the hair shaft. Consult your doctor or dermatologist if you suspect a product is causing scalp irritation or hair shedding.
• Seek Early Professional Consultation: Regular check-ups with a dermatologist or doctor can help in early intervention, which is significantly more effective in managing male pattern baldness than waiting until the loss is advanced.

Adopting a proactive approach, led by professional medical advice, is key to maintaining hair health and appearance for longer.

Conclusion

Male pattern baldness is a common, genetically and hormonally driven condition that affects many men. While DHT and genetics are the primary causes, various evidence-based treatment options are available to effectively slow down hair loss and promote hair growth. By understanding the causes, symptoms, and stages of hair loss and critically, by seeking professional medical advice for diagnosis and treatment, men can proactively manage this condition and maintain their confidence.

Disclaimer

This content is for informational purposes only. Do not attempt to self-diagnose or self-treat based on the information provided here. Always consult a qualified Dermatologist or healthcare provider for personalised medical guidance, diagnosis, and treatment, especially before using prescription medications like Minoxidil or Finasteride.

Frequently Asked Questions (FAQs)

Can male pattern baldness be reversed?

While MPB cannot typically be completely reversed, established treatments like oral Finasteride and topical Minoxidil can effectively slow its progression, halt further loss, and stimulate substantial regrowth in many individuals. These treatments require continuous use to maintain the effect [1].

Is balding at 25 normal?

Yes, balding at 25 is not unusual. Due to genetic and hormonal factors, male pattern baldness can begin as early as the late teens or early twenties [3]. Early onset often suggests a strong genetic predisposition.

At what age do men typically start balding?

The onset of MPB typically begins in the late twenties to early thirties, with severity and prevalence increasing with age. However, significant balding is often observed in men starting in their 30s and 40s [1].

What are the best treatments for male pattern baldness?

The two first-line, FDA-approved treatments for androgenetic alopecia are Topical Minoxidil and Oral Finasteride (1mg). These can help slow hair loss and stimulate growth. A Dermatologist may recommend a combination of these or other therapies, like hair transplantation, based on the individual’s stage of loss and health profile.

References

[1] Asfour, L., Cranwell, W., & Sinclair, R. (2023, January 25). Male Androgenetic Alopecia. Endotext. MDText.com, Inc. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK278957/

[2] Redmond, L. C., Limbu, S., Farjo, B., Messenger, A. G., & Higgins, C. A. (2023). Male pattern hair loss: Can developmental origins explain the pattern? Experimental Dermatology, 32(7), 1174–1181. https://doi.org/10.1111/exd.14839

[3] York, K., Meah, N., Bhoyrul, B., & Sinclair, R. (2020). A review of the treatment of male pattern hair loss. Expert Opinion on Pharmacotherapy, 21(5), 603–612. https://doi.org/10.1080/14656566.2020.1721463

[4] Nyholt, D. R., Gillespie, N. A., Heath, A. C., & Martin, N. G. (2003). Genetic basis of male pattern baldness. The Journal of Investigative Dermatology, 121(6), 1561–1564. https://doi.org/10.1111/j.1523-1747.2003.12615.x

[5] Ellis, J. A., & Sinclair, R. D. (2008). Male pattern baldness: current treatments, future prospects. Drug Discovery Today, 13(17–18), 791–797. https://doi.org/10.1016/j.drudis.2008.05.010

[6] Diagnosis of hair loss in men. (n.d.). American Academy of Dermatology Association (AAD). Retrieved from https://www.aad.org/public/diseases/hair-loss/types/pattern/diagnosis

[7] Studies Uncover New Approaches to Combat Hair Loss in Men and Women. (2019, June 19). Columbia University Irving Medical Center. https://www.cuimc.columbia.edu/news/studies-uncover-new-approaches-combat-hair-loss-men-and-women

[8] Irwig, M. S. (2012). Persistent side effects in men previously treated with finasteride. The Journal of Clinical Psychiatry, 73(7), 992–994. https://doi.org/10.4088/JCP.12m07916

[9] Gkini, M. A., Kouskoukis, A. E., Mourellou, O., Lykoudis, E. G., & Karamitsos, D. (2015). Platelet-rich plasma as a potential treatment for androgenetic alopecia. International Journal of Environmental Research and Public Health, 12(9), 11035–11053. https://doi.org/10.3390/ijerph120911035