Medically reviewed & verified by: Prof. Dr. Naci Karacaoğlan
Written by: ClinicAdvisor
What is male pattern baldness?
Androgenic alopecia is a type of hair loss that is inherited from either the father or the mother or both. Also known as male or female pattern baldness, it is the most common cause of hair loss in the world.
Male pattern baldness occurs when the growth (anagen) phase of the hair growth cycle becomes increasingly shorter.
Genetic sensitivity to androgens, a type of hormone, causes hair follicles, where hair growth begins, to shed hairs that are finer and shorter than normal. Over time, hair follicles stop producing hair.
In men, hair loss occurs in the frontal hairline and on the forehead, and on top of the head. Bald patches are notorious.
In women, hair loss occurs with the hair becoming overall thinner on the top of the head. Women tend to retain their frontal hairline and generally do not have bald patches.
What causes male pattern baldness?
Male pattern baldness (Androgenetic alopecia) results from two factors: a genetic predisposition and the action of androgens, the male sex hormones (but nevertheless present in small quantities in women).
The genes predisposing to androgenetic alopecia have been identified, one of which is carried by the X chromosome (transmitted to men by their mothers).
Thus, in men, the probability of suffering from baldness is higher when it is present on the mother’s side.
So there is usually a direct family history, although its absence does not exclude the possibility of this type of alopecia appearing.
In the presence of favorable genetic background, the hair follicles on the top of the skull are particularly sensitive to the action of androgens, and in particular to a substance derived from testosterone (DHT, dihydrotestosterone).
Under the action of this hormone, the hair growth cycle is accelerated and shortened. The hair becomes finer, less dark, and falls out faster. The 20 to 25 growth cycles that are supposed to last a lifetime are exhausted in a few years.
The hair follicles located on the sides of the skull are less sensitive to the action of the hormone and their growth cycle is less disturbed.
In women, other hormonal factors can promote androgenetic alopecia: oral contraceptives or hormonal treatments for menopause.
In addition, stress and excess blood cholesterol could also be risk factors for alopecia in women.
Can male pattern baldness be treated?
To date, there is no curative treatment for male pattern baldness ( androgenic alopecia). That is, the available topical and oral treatments can help slow down baldness and show some improvement over the time they are used.
However, these results will usually stop as soon as the treatment is stopped.
The goal of treating androgenic alopecia is first to stop the progression of alopecia. However, most patients also achieve an improvement in capillary density, in some cases very significantly.
The most common androgenic alopecia treatments include:
Nonsurgical Treatments
Antiandrogen drugs (dutasteride, finasteride)
These treatments are usually the most effective for male pattern baldness. These are medications that act selectively on the follicular root, slowing down alopecia. They are well-tolerated drugs and the patient can lead a normal life during treatment.
They are medications that are usually used orally, although they can be administered in the form of microinjections or topically.
Nonetheless, they do have some common side effects such as disruptions in sexual functions in men. So, it is worth discussing with your doctor before starting the treatment.Minoxidil:
- Topical minoxidil: this is a liquid or foam treatment that is applied to the skin of the scalp and stimulates hair thickening. By carrying an excipient with alcohol, slight skin irritation may be noted at the beginning of treatment, which is usually temporary. It can be applied once or twice a day. It can be combined with oral minoxidil.
- Oral minoxidil: in selected cases of male pattern baldness, especially in the more diffuse forms or in those patients who do not tolerate topical application. Discuss with your doctor the recommended dosage for your case.
Dutasteride Microinjections:
It is an innovative treatment in which the dutasteride antiandrogen molecule is infiltrated directly into the scalp, allowing a high concentration of the drug to reach the follicular root.
The procedure is performed in a doctor’s office, local anesthesia is applied to the scalp to avoid pain, it lasts about 30 minutes, and does not require any prior preparation or special care afterward.
The molecule has a prolonged effect, so it is usually enough to carry out 2-4 sessions a year to improve density. This procedure can be used as a complement to oral antiandrogen treatment, or even as sole therapy.Platelet Rich Plasma:
It consists of extracting blood from the patient in a similar way to a blood test, centrifuging it, and isolating the portion rich in growth factors derived from platelets.
Afterward, it is infiltrated into the scalp after the application of local anesthesia. Like dutasteride microinjections, it does not require any prior preparation or special aftercare.
Other medical therapies:
There are other treatments that may be useful in selected cases of male androgenic alopecia, such as low-power laser, micro-needling, or stem cell treatments for hair like Regenera Activa which are still in the early stages and do not yet provide conclusive results.
Surgical Treatments:
Hair Transplant:
To this date, the only really effective ‘treatment’ for male pattern baldness is a hair transplant.
This is a minimally invasive surgical procedure that aims to relocate some of the remaining DHT (dihydrotestosterone) resistant follicles in the back of the head to the bald areas.
Hair transplantation using the micrograft technique can be used as a complement to medical treatment to significantly improve hair density in areas where it has been lost. With the current technique, the result is totally natural.
It can be done using the FUT technique or using the FUE technique. It is performed in the operating room, does not require hospital admission and recovery is usually complete within a week after the intervention.
Results of hair transplants start to be seen about 6 months after the operation, but the final results are usually visible within a year.
Am I suffering from male pattern baldness?
Diagnosis of male androgenic alopecia is made at the clinical level and thorough analysis with the digital microscope.
Thanks to this non-invasive diagnostic technique, an early diagnosis of androgenic alopecia can be made, allowing the patient to benefit from early treatment to stop its alopecia.
Regarding complementary tests, given that male androgenic alopecia is not usually associated with other concomitant diseases, in the case of men it is not usually necessary to request periodic analytical studies.
The Norwood-Hamilton scale for self-diagnosis
The Norwood-Hamilton Scale is the most widely used classification and grading system for male pattern hair loss.
It has become a standard in the dermatology sector thanks to its almost unanimous adoption by medical professionals. 
This is a 7-stage classification system used to classify male pattern baldness by analyzing it based on the pattern of hair loss. The purpose is to determine the appropriate treatment.
FAQ's
Can male pattern baldness be stopped? Medical treatment may be offered; it slows down the evolution but does not stop the process. A 5 alpha-reductase inhibitor, also called minoxidil, can be offered as a local treatment. Only surgical treatment allows hair regrowth. It consists of a transplant of hair follicles. | Can male pattern baldness grow back? Androgenic alopecia (male pattern baldness) does not normally grow back. However, depending on the stage of baldness, the patient can either use some topical/oral medication or can have a hair transplant surgery for more permanent results. |
How to reverse male pattern baldness? Some existing medications such as Minoxidil and finasteride can help slow down the progress of male pattern baldness, although they don’t totally reverse it. The most radical and only method to reverse male pattern baldness is a hair transplant, provided the patient has enough healthy donor hair in the back of the head. |
