For many men, the first sign of hair loss – a widening part or increased shedding – can be a source of anxiety, impacting both self-esteem and overall wellbeing.While frequently enough associated with aging, hair loss affects a meaningful portion of the male population, with roughly half experiencing some degree of male pattern baldness by age 50. Despite ongoing research, the precise causes remain complex, but experts say early intervention and a clear understanding of available treatments can make a substantial difference.
The first sign can be a glance in the mirror, a widening part, or the feeling of a breeze on the crown of the head – moments many men dread as they confront the reality of hair loss. Addressing hair loss is important not only for cosmetic reasons, but also because it can significantly impact a person’s self-esteem and mental wellbeing.
By age 50, as many as half of all men will experience some degree of male pattern baldness, with that number increasing with age. While genetics and hormones play a significant role in hair loss, the precise mechanisms are still not fully understood, meaning treatments to stop or reverse it remain imperfect, according to Dr. Arash Mostaghimi, vice president of clinical trials and innovation in the dermatology department at Brigham and Women’s Hospital in Boston.
However, there are steps individuals can take both before and after noticing changes. Here’s a look at what works, what’s new, and what to avoid when it comes to managing hair loss.
What Causes Male Pattern Baldness?
The average human scalp contains around 100,000 hairs, each connected to a follicle capable of supporting one to five hairs.
“It’s basically an organ on its own,” Dr. Mostaghimi said of a hair follicle. “It has its own stem cells. It regenerates.”
Typically, hair loss in men is linked to an increase in an enzyme on the scalp that converts testosterone into a more potent form called dihydrotestosterone (DHT). The reasons why one man might have more DHT than another aren’t fully understood, but genetics play a role, Dr. Mostaghimi explained.
When DHT levels are too high on the scalp, the hormone initiates a complex process that causes hair miniaturization – meaning the hair and follicles begin to shrink. This explains why men often experience thinner hair, or even fine vellus hair, in areas experiencing hair loss.
This hair loss follows a predictable pattern, starting around the temples and then at the crown, where higher levels and activity of the enzyme responsible and its modified testosterone are detected, Dr. Mostaghimi explained. This is why it’s referred to as “male pattern baldness.”
How to Treat (and Prevent) Hair Loss
If you’re concerned about hair loss, the first step is to schedule an appointment with a dermatologist. It’s important to seek care from a specialist; Dr. Danilo C. Del Campo, a Chicago-based dermatologist specializing in hair loss, recommends finding a physician who focuses on hair loss specifically.
When should you seek help? Ideally, before you become overly concerned about your hair, dermatologists say. Medications are generally more effective at preventing hair loss than reversing it. “The earlier you start, the more likely you are to keep the hair you have,” Dr. Mostaghimi said.
First-Line Medications
Dermatologists typically recommend two medications approved by the Food and Drug Administration: minoxidil (also known by its brand name, Rogaine) and finasteride (also known as Propecia).
Minoxidil is the more widely recognized of the two. “It does work for hair growth,” Dr. Del Campo said, when applied at least once a day, preferably twice. It’s available in foam or liquid drop formulations. He recommends using a formula without propylene glycol, which can irritate the scalp.
Hair regeneration takes several months, but topical minoxidil doesn’t work for everyone, and many dislike the frequency of application. Furthermore, like any hair loss treatment, if a patient stops using it, they will lose any regrowth and the hairline will continue to recede, Dr. Mostaghimi explained.
Another option is to take minoxidil in pill form, an off-label therapy some dermatologists have used for years. However, the pills can cause indiscriminate hair growth, even on the beard or armpits, though this varies by patient, Dr. Del Campo explained.
Finasteride is approved in pill form for hair loss in men with a prescription. Studies suggest that most men using finasteride maintained or improved their hair coverage over five years.
Taking finasteride orally carries a small risk of erectile dysfunction, Dr. Del Campo explained, which usually resolves when the medication is stopped. However, he added, “It’s something I take very seriously when discussing it with my patients.”
Finasteride is also available in spray or drop formulations. These topical formulations are not FDA-approved, but have become popular through online providers who may prescribe them based on an online questionnaire. Dr. Del Campo said they have been shown to work with fewer side effects than the pill, but emphasized the importance of consulting with a dermatologist before purchasing prescription medications online.
Comparing finasteride and minoxidil is complex, as studies often measure outcomes differently. Minoxidil has shown better results in hair regrowth, while finasteride is often considered better at preserving existing hair, according to Dr. Mostaghimi.
There’s no reason to limit treatment to one option. “It’s generally accepted that combination therapy works better than any single treatment alone,” said Dr. Carolyn Goh, associate clinical professor of dermatology at UCLA Health. This is because these medications appear to work through different pathways and have distinct strengths.
Neither medication is typically covered by medical insurance. Topical minoxidil generally costs between $10 and $30 per month, according to Dr. Del Campo, while finasteride pills cost around $15 per month.
Adjunctive Therapies
Other options exist, but experts say they aren’t stand-alone therapies and should be used in conjunction with medication. One option is platelet-rich plasma (PRP) injections. This involves drawing the patient’s blood, separating the plasma, and injecting it back into their scalp.
It’s expensive, costing between $500 and $1,500 per session, and patients typically undergo three or four initial sessions, followed by maintenance sessions monthly, Dr. Del Campo said.
A recent meta-analysis concluded that PRP showed promise for some patients, but it was difficult to say for sure due to variations in study design. Experts like Dr. Del Campo don’t recommend it as a sole treatment.
Another option is low-level laser light therapy, often in the form of helmets or combs. While there’s evidence that stimulating the scalp with these devices can help with hair growth, Dr. Mostaghimi said they can be costly (up to $2,500). Additionally, it can be difficult for consumers to distinguish between legitimate medical devices and scams, he added; they should only be considered as an addition to other therapies.
Hair Transplants
Some dermatologists consider hair transplantation the gold standard in hair restoration. According to physicians, the technology has advanced significantly in the last 25 years since the days of hair plugs. During a hair transplant, hair follicles are extracted from one area and relocated to where they are needed. This can be done by removing a strip from the back of the scalp or relocating individual follicles from the head.
The process has its drawbacks. First, a transplant doesn’t offer immediate results. Additionally, the original implanted hairline continues to recede, so the surgeon’s skill is crucial. Patients will also achieve better results if they continue taking medication, Dr. Goh said. Transplants are also the most expensive option, starting around $7,000 and potentially costing much more.
Misinformation and Outright Scams
There are almost as many myths about baldness as there are false remedies. Some say wearing a hat too often can cause hair loss, while others blame a lack of hats in cold weather. Both myths are false, Dr. Del Campo said.
Some believe the problem is washing hair too much; others say it’s not enough. (Both claims are false, according to dermatologists). Some suggest a sunburn on the scalp can stimulate growth. (Don’t do it).
Rubbing onion or garlic on the scalp doesn’t stimulate growth. (And can irritate the scalp, according to Dr. Del Campo).
Rosemary oil has gone viral on TikTok in recent years. Evidence of its effectiveness is limited, dermatologists say. However, Dr. Del Campo said he doesn’t mind people trying it, noting that some products contain additional chemicals that can cause allergic reactions.
Finally, the role of heredity adds another layer of confusion. Should you look at your father or your maternal grandfather to see your future? Unfortunately, neither is a perfect predictor. While genes play a significant role in baldness, scientists say they don’t predict it with certainty.
Baldness can start at a younger age across generations, Dr. Goh added. A grandson may lose hair years before his grandfather, she explained. “It can happen at a very young age.”
Our hair is one of the ways we tell the world who we are, and it also affects how others perceive us. Therefore, its loss can cause significant distress. But by starting an open conversation with a doctor as soon as symptoms appear, it doesn’t have to be that way.
“There are so many options, and the future is very promising for those who have been suffering with it,” Dr. Del Campo said. “They shouldn’t have to deal with this alone.”
