Hair Loss Men
- Best Results6-12 months+
- Treatment RecoveryVariable
- Procedure TimeVariable
- Skin SpecialistDermatologists
- Duration of ResultsVariable
- Back to WorkDepends
Hair Loss Men
Hair Loss Men affects the majority of the male population. It can start as early as the late teens to early 20s & is progressive. Early medical management with minoxidil, finasteride or dutasteride will markedly slow down the course of baldness. Microneedling combined with growth factors & PRP can improve early to moderate cases of hair loss. FUE hair transplantation can be useful for moderate to end stage baldness.
FactsFacts on Hair Loss Treatments for Men
- The most important step is to halt progression of hair loss as soon as possible
- Medical therapy with lotions & medications are successful in 90% of cases
- Dermatologists also prescribe PRP injections & microneedling
- Hair transplantation can repurpose follicular units to cover up bald areas
- FUE or follicular unit extraction is the most popular method of transplantation
- A dermatologist can guide you as to the correct timing of treatments & intervention
- Androgenic alopecia or male pattern baldness affects all men at some stage of their lives
- The degree of hair loss varies individually
Hair Loss Men
Androgenic alopecia or AGA, also known as male pattern hair loss/baldness is the most common cause of hair loss in males. This affects 85% of males & can occur as early as in the teenage years. AGA is progressive & should be treated early.
Note: Rare causes of hair loss such as alopecia areata, folliculitis decalvans, acne keloidalis nuchae, & others are not discussed in this page. Review information written on other pages on this website.
What causes male pattern hair loss?
Genetics modified by hormonal input. Most often there is a family history of hair loss (take for example Prince Charles & his son William). The flipside is that your sibling may ‘skip’ the hair loss gene (Harry).
Hormones play an important part, namely androgens. This is why males are more susceptible to hair loss than females. The most important hormone is known as DHT or dihydrotesterone. This is a by-product of testosterone conversion. DHT accounts for the majority of hair fall, hence why many treatments are aimed at reducing DHT.
Why is early treatment essential in managing hair loss?
Fact- the earlier the treatment the more follicles you save. If you have bald or near bald areas, it is unlikely hair density will ever return to normal. In this case, FUE hair transplantation is the only way back.
Simple medical treatments like minoxidil & finasteride can effectively halt recession in 90% of cases. Slowing down hair loss is the first step in actively managing male pattern baldness.
What are simple DIY home treatments that can slow down hair loss in men?
A simple home solution (I personally have been on this for the past 25 years) is minoxidil 5% applied twice a day. You can get this from most pharmacies. It costs 50 to 80 cents a day to help maintain hair follicles from dropping out prematurely.
Other treatments that can reduce DHT include saw palmetto. There are a few studies demonstrating the efficacy of this natural product. It is not as effective as finasteride or dutasteride, but it is side effect free. The next step involves management by a medical dermatologist.
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Can the extent of hair loss be predicted in men?
To a degree, yes. The current classification is known a the Norwood scale & is categorised as follows:
- Stage 1. No significant hair loss or recession of the hairline.
- Stage 2. There is a slight recession of the hairline around the temples. This is also known as an adult or mature hairline.
- Stage 3. The first signs of clinically significant balding appear. The hairline becomes deeply recessed at both temples, resembling an M, U, or V shape. The recessed spots are completely bare or sparsely covered in hair.
- Stage 3 vertex. The hairline stays at stage 2, but there is significant hair loss on the top of the scalp (the vertex).
- Stage 4. The hairline recession is more severe than in stage 2, and there is sparse hair or no hair on the vertex. The two areas of hair loss are separated by a band of hair that connects to the hair remaining on the sides of the scalp.
- Stage 5. The two areas of hair loss are larger than in stage 4. They are still separated, but the band of hair between them is narrower and sparser.
- Stage 6. The balding areas at the temples join with the balding area at the vertex. The band of hair across the top of the head is gone or sparse.
- Stage 7. The most severe stage of hair loss, only a band of hair going around the sides of the head remains. This hair is usually not dense and may be fine.
- Norwood class A. The class A variation of the Norwood scale is a slightly different and less common progression of hair loss. The main differences are that the hairline recedes back uniformly, without leaving an island of hair in the middle, and there is no bald area at the vertex. Instead, the hairline progresses directly from front to back.
What do dermatologists prescribe for hair loss in men?
We all start with topical treatment, namely minoxidil. Consider this as the first step. The algorithm goes something like this-
Step one: Minoxidil 5% to 7% compounded solution. Option for foam.
Step two: Option for minoxidil orally 1-2.5 mg capsules & DHT blocker, ie. finasteride 1 mg orally or 0.1 to 0.25% topically with or without minoxidil 5 to 7%.
Step three: Option for dutasteride orally in pulsed manner with finasteride topically or orally.
Step four: PRP or platelet rich plasma. Three sessions over three months then maintained every 4-8 months. Low level laser therapy, or option for 1927 thulium laser. Microneedling can be considered, with or without growth factors.
Step five: FUE or FUT Follicular unit extraction & or transplantation to stable areas.
Looks confusing? It is. The reason is that there are many options, depending on the stage of hair loss, genetics, the risk-benefit ratio of medications & your aims. Be guided by your medical dermatologist.
Disclaimer: I do not prescribe medications for hair loss as my work is procedural, namely I perform surgical procedures including FUE & FUT hair transplantation.
What is finasteride?
Finasteride is one of the mainstays of treating male pattern hair loss. This drug has been FDA & TGA approved for nearly three decades. It works by inhibition of 5 alpha reductase, the enzyme that converts testosterone to the more potent dihydrotesterone or DHT.
Finasteride can be taken orally as a tablet (usually 1-2 mg per day) or as a topical lotion, most frequently prescribed with minoxidil. The decision as to which one is best for your hair loss is a conversation you should have with your dermatologist.
The most talked about side effect is sexual dysfunction. Most specialists agree that the risks are minimal, namely 1.5 times the age matched normal population not on DHT blockers. If you are risk averse, the topical formulation of 0.1 to 0.25% finasteride may be a better opinion.
Disclaimer: I am a procedural dermatologist. I do not medically manage hair loss, please see a medical dermatologist.
What is dutasteride & is it better than finasteride?
Firstly, finasteride is FDA & TGA approved, hence treatment with dutasteride is considered off label. Dutasteride is a more potent inhibitor of 5 alpha reductase. This results in more inhibition of DHT. Some papers have given the edge to dutasteride, but the outcomes are marginal at 5 years (controversial).
I know for a fact that most dermatologists will prescribe finasteride due the fact that more robust studies have been conducted over a longer period of time. The TGA/FDA bit also helps medicolegally. A sensible option is to pulse dutasteride over the week, namely one to two tabs. This is at the discretion of your dermatologist.
Disclaimer: I am a procedural dermatologist. I do not medically manage hair loss, please see a medical dermatologist. These medications require follow up with PSA levels.
How does minoxidil work?
Minoxidil has been proven without doubt to maintain & in some cases regrow hair in both male & female pattern hair loss. It is FDA & TGA approved with over 40 years of research.
It works by vasodilation & modulation of potassium channels. This allows more blood flow to the hair follicles, in turn pushing them from a dormant sleeping stage known as telogen to the active phase of the hair cycle known as anagen.
This shift from the dormant to the active phase of hair growth accounts for the transient shedding of hair, which commonly occurs when you start minoxidil. Minoxidil requires long term treatment for best results. If you stop this medication your hair loss regresses back to pre-treatment levels within 4-6 months.
Which formulation of minoxidil is best for male pattern hair loss?
If you can remember to use topical lotions, the 5% minoxidil solution is best. Ideally it is applied twice a day to areas of early recession or potential hair loss.
Oral minoxidil is another option. The dose ranges between 1-2.5 mg. Side effects such as hypertrichosis (hairy areas on the cheeks, temples, trunk), lower limb swelling & potential reduction in blood pressure is higher with oral medications.
For minimal side effects a lotion formulation consisting of minoxidil 5% & finasteride 0.2% is probably the best. There are many variations with this theme, you should have a conversation with your prescribing dermatologist as to the correct formulation for you.
Note: Minoxidil is best used to slow down/prevent hair loss. Regrowth in bald areas is marginal at best.
Disclaimer: I do not prescribe medications for hair loss as my work is procedural. Please book a consultation with one of my medical colleagues at Clinic Cutis.
What is PRP & does it work?
PRP is a concentration of cell growth factors derived from platelets. These include growth factors & chemokines. This mix gives PRP the power to repair damaged cells including miniaturized hair follicles, as found in male pattern hair loss. PRP helps to activate hair growth, increasing the number of follicles as well making the hair shaft thicker. PRP also increases the lifespan of hair follicles.
A standard regiment is monthly injections of PRP for three months. This, followed by a maintenance phase of approximately a treatment every 6 months. In most patients we also combine another proven method for hair-regrowth, namely microneedling.
PRP should be combined with medical management, namely minoxidil & finasteride.
Yes. This is a good adjunctive treatment for hair loss. This is most frequently combined with platelet rich plasma. Clinical microneedling is conducted using 1.5 to 2.5 mm needles every month (for six months).
At home microneedling can increase topical absorption of growth factors, & minoxidil. This is performed using 0.2 to 0.25 mm microneedles. Refer to DIY on microneedling covered in this site.
What is scalp micropigmentation?
This is a cost-effective way of giving the illusion of hair. It involves tattooing of the scalp to simulate 1-2 mm hair shafts. Scalp micropigmentation can also be used in combination with FUE transplantation to hide the donor site & to give the illusion of increased hair density in the recipient zones.
The downside of micropigmentation is that you will require a saved head to pull this one off.
Can lasers grow hair?
Lasers & LED therapy can be useful to stop hair loss, & in most cases increase the hair density. The lasers that I most frequently use include thulium fractional, as well as low-level lasers in the 600 to 650 nm range.
Laser therapy involves weekly visits for a period of ten to twelve weeks. They are best employed for mild & early androgenetic alopecia.
Can vitamins & supplements help?
There are numerous claims that supplements can cure or reverse male pattern hair loss. These compounds work by inhibiting the conversion of testosterone to DHT.
- Saw palmetto
- Green tea extract
- Procyanidin B-2
My viewpoint: these supplements are cost effective & harmless. The most promising (& controversial) studies are based on saw palmetto. If you want to try them out, they can be purchased from most pharmacies. Ideally they should be combined with topical minoxidil.
What does hair transplantation involve & when to consider?
Hair transplantation, as the name suggests, takes hair follicles from one area of the body (mainly the back of your scalp) & places them in areas of balding. Contrary to popular belief, this procedure does not ‘regrow’ or multiply hair follicles, it repurposes them from one area to another.
Medical therapy including lotions, tablets, PRP, microneedling & lasers can only go so far in the management of hair loss disorders. For areas of recession or low hair density, hair transplantation is indicated.
What forms of hair transplantation are there?
Don’t worry, hair plugs are the look of the past. Today’s hair transplants, pioneered by dermatologists & plastic surgeons use a follicular unit. Each unit consists of 1 to 3 individual hair follicles. These follicles are harvested from the back of the head using one of two methods.
- Traditional strip method or follicular unit transplantation (FUT). This procedure uses the donor site from the occipital scalp. Essentially a strip of scalp measuring ¾ to 1.3 inches is excised. Individual units are dissected by a team of specialists & then transplanted to the areas of recession.
- FUE or follicular unit extraction is a more discrete & less invasive method, however it takes more time to perform. This involves punch excising small (0.8 to 1.2 mm) areas from the scalp, leaving every 2nd to 3rd follicle alone. The individual units are then transferred to bald or thinning areas. FUE is the preferred method of hair transplantation, as it is less invasive.
How successful is hair transplantation?
In the context of male pattern baldness / hair loss, it is very successful. The caveat is that everyone on the hair transplant team has to be meticulous with harvesting, processing & implantation of the grafts.
Graft survival at 12 months is in the order of 90% +. It is essential that medical therapy, either topically or orally is combined with surgical techniques of transplantation. This gives a better prognosis- especially for the remaining hair follicles.
What is the recovery following hair transplantation?
2 to 12 days. Using the FUE method, the donor site heals up within a few days, as compared to strip FUT harvesting.
The recipient site will have swelling for 2 to 3 days (depending on the extent of transplantation). Scabs will fall off within 8 to 12 days.
How many units are transplanted in one sitting?
Between 500 to 2500. It really depends on the extent of hair loss. Limited number of hair follicles are transplanted for the frontal hairline & temples. A high number of units are transplanted for extensive areas of balding on the vertex & frontal areas.
Will I need to be on hair loss medications after hair transplantation?
Yes, if you would like to keep the remainder of your hair. Medical therapy such as minoxidil & finasteride (either topically or orally) can halt progression of hair loss, & in many cases increase growth. You will require lifelong management for best results.
Davin’s Viewpoint on Male Pattern Hair Loss
Hair loss in males can be devastating, especially in young adults. There is no ‘cure’, however dermatologists can markedly slow down this process with medical treatments and early intervention. The most important aspect to understand is early management & mitigation. This means get a move on to preserve your hair follicles at the earliest sign of hair fall.
Over the past two decades, the use of minoxidil & finasteride has been the foundation of medical management. My viewpoint is that topical formulations markedly reduce the side effects of oral medications. Compounded formulations will vary according to your medical dermatologist. Possibly the addition of dutasteride in a pulsed manner (once or twice a week), can improve outcomes whilst minimizing side effects. More research is required.
For more advanced cases of hair fall, PRP with microneedling is indicated. Our medical dermatologists normally perform 3 sessions over 3 months followed by a maintenance phase. These treatments should be viewed as adjunctive with mainstream medical intervention as discussed. The whole idea is to slow down the requirement for FUE or FUT hair transplantation.
FUE is the end of the road. Depending on the patient, I perform either shaven FUE or unshaven. The latter is preferred if I transplant a small amounts of grafts, (less than 1500). The advantage of FUE unshaven is coverage of the donor area. The recipient area still requires 9-12 days to heal. The downside of unshaven FUE is that it requires extra time to perform.
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