Male Pattern Baldness: Causes, Signs and Treatment Options

Male pattern baldness is the most common type of hair loss in men, driven by genes and the hormone dihydrotestosterone (DHT). It usually starts with a receding hairline or thinning at the crown and progresses slowly over years. There is no cure, but treatments can slow it, and a GP can confirm the cause.

What is male pattern baldness?

Male pattern baldness, also called male pattern hair loss or androgenetic alopecia, is the most common type of hair loss in men. The British Association of Dermatologists says it can affect men of any age after puberty, and that the scalp usually looks normal on examination. Mayo Clinic notes that it affects roughly half of men, so it should not be thought of as abnormal.

The typical pattern is a receding frontal hairline and thinning on the top of the head, while the hair at the sides and back is usually spared. Mayo Clinic describes the sequence: thinning around the temples first, receding backwards, eventually meeting a balding spot at the crown. There are usually no scalp symptoms, although a few men report itching.

What causes it?

Male pattern hair loss is caused by a combination of genetic and hormonal factors. The hormone DHT acts on hair follicles in a process called miniaturisation: affected hairs become gradually thinner, shorter and lighter in colour until the follicles shrink and stop producing hair altogether. Cleveland Clinic explains that androgens are necessary for male pattern hair loss to develop, and that it typically begins after puberty, when androgen levels rise sharply.

It is hereditary, and it can be inherited from either or both parents. The British Association of Dermatologists notes that over 190 genes have been identified as contributing, which helps explain why it affects family members to varying degrees and at different ages. Contrary to popular myth, it is not caused by wearing hats, washing your hair too often or other everyday habits.

How is it diagnosed?

Diagnosis is usually clinical, based on the history and pattern of hair loss and a family history of similar hair loss. A GP or dermatologist will look at the distribution of thinning, check the scalp and ask when the hair loss began and how it has progressed. Blood tests are not routinely needed, but they can help rule out other causes, such as thyroid problems or iron deficiency, when the picture is unclear.

It is worth knowing what normal shedding looks like. NHS 111 Wales says we can lose between 50 and 100 hairs a day, often without noticing, and that shedding in that range is not, on its own, a sign of a problem.

Treatment options

There is no cure, and hair loss tends to progress very slowly, over years or decades. But several options can slow it down or improve coverage. Talk to your GP or a dermatologist about what suits you, rather than buying products on promises alone.

• Minoxidil. A liquid or foam applied to the scalp that may slow progression and act as a hair growth stimulant. The British Association of Dermatologists says it needs to be used for at least 6 months, and possibly up to 12 months, before any benefit may be noted, and any benefit lasts only while treatment continues. It can cause skin reactions such as dryness, redness and itching.
• Finasteride. A tablet that lowers DHT levels, which may slow hair loss and possibly help regrowth. Continuous use for many months can be needed before a benefit is usually seen, and hair loss restarts after stopping. Decreased libido and erection problems are recognised side effects in a small percentage of men, so discuss the balance of benefits and risks with your doctor.
• Hair transplantation. Follicles are taken from the back and sides of the scalp, where hair is more resistant to DHT, and moved to balding areas. It is not offered on the NHS and is sought privately, and it is usually combined with medical treatment to protect the remaining hair.
• Other options. Low-level laser devices, platelet-rich plasma injections and microneedling are available privately, but the evidence for them is limited, and they are not a substitute for proven treatments.
• Cosmetic cover. Wigs, hairpieces and scalp colourants can disguise thinning. Some synthetic wigs are available on the NHS, though you may have to pay unless you qualify for financial help.

The NHS advises getting a clear idea of what is causing your hair loss from your GP before considering a commercial hair clinic, since not all hair loss is pattern loss. Temporary causes include illness, stress, weight loss and iron deficiency, where hair often regrows once the cause is treated.

Living with hair loss

Hair loss can have a real psychological impact, affecting self-esteem and body image. That is a valid reason to seek support: your GP may be able to help you get counselling, and charities such as Alopecia UK run support groups. Protecting bald areas from the sun also matters, since hair normally shields the scalp: use sunblock, a wig or a hat when you are out in strong sun.

Whether you choose treatment or embrace the change, it is a personal decision. As Mayo Clinic puts it, if your hair loss does not bother you, there is nothing wrong with allowing your body to change with age.

When to see a doctor

See your GP if you are worried about your hair loss, if it is affecting your wellbeing, or if you want to discuss treatment options. Seek advice sooner if your hair loss is patchy, sudden or rapidly worsening, if your scalp is red, scaly or painful, or if hair loss comes with other symptoms, since these patterns are not typical of male pattern baldness and may need a different assessment.

In an emergency call 911 (US), 999 (UK) or 112 (EU).