Hair is an undeniable part of a man’s image and there is a large body of literature outlining how hairloss contributes to a lower quality of life by reducing self-confidence but also increasing romantic rejections and limits your dating pool (49-51).
With androgenic alopecia (pattern baldness) being the most common cause, seeing your hairline recess slowly gives you a sense of helplessness that your attractiveness is slowly decreasing.
Bald Men Are Seen As More Masculine And Strong!
While it is true that bald men are seen as more masculine (55)
- They are perceived as less attractive by general consensus studies (56)
- Hairloss is linked to greater risk of psychological disorders such as depression (57)
- Younger men feel the effects of pattern baldness much more strongly (58)
- Men in relationships or who did not care about looks still feel the social effects of balding (54)
This leads to balding being an overall unpleasant experience that most (young) men refuse to just ‘accept.’
The Social Effects Of Hairloss
As men lose their hair, their confidence plummets and to some degree most acknowledge the importance of hair to personal attractiveness (52). In many cases, especially those of early-onset hairloss, this leads to Body-Dysmorphic Disorder. We predict that hairloss can drop a man’s attractiveness by a full 2 points on a 10 point scale.
”...irreversible changes, which occur too early in one's life, can be especially stressful.Razum Et al 2021Quality of life in young men with androgenetic alopecia: A mixed methods study.
Step 2 | Diagnosing Hairloss
How Is Hairloss Diagnosed?
Hair loss causes are numerous and it is hard to find the main cause of your hair loss condition without the help of a dermatologist. Therefore, it is highly recommended to find a dermatologist for correctly diagnosing the cause of the hair loss once you start noticing the problem (19). QOVES cannot help you truly diagnose the cause of your hairloss, we can only make an educated guess.
To diagnose the condition accurately, your doctor will perform a physical examination and ask you several questions about your diet, hair care routine, medical conditions, medications and supplements, and family history (20). The following tests may also be needed:
- Blood Test: Blood tests may reveal any medical conditions or nutrient deficiencies you may have that cause hair loss.
- Pull Test: To determine the shedding stage, your doctor may pull your hair to examine their strength and see if they come out easily or not.
- Scalp Biopsy: Scalp biopsies are gathered by scraping skin samples or pulling a few hairs from the scalp. Your doctor will then examine your hair roots microscopically to determine whether the cause of the hair loss is an infection or not.
- Light Microscopy: This is an instrument used mainly to examine hair shafts in order to discover any hair shaft disorders.
Signs and Symptoms of Hairloss
Do not ask friends or family for advice on hairloss. Most are not equipped to provide proper advice or will sugarcoat the truth.
- Full-Body Hair Loss: Certain health conditions and treatments can lead to full-body hair loss such as cancers and chemotherapy.
- Scaling Patches: Ringworm infections can lead to scaling patches spreading over the scalp.
- Visual Evaluation: In more severe cases of hairline recession or thinning, it’s quite clear to see how the hairline is moving.
- Diffuse Thinning: This type of hair loss is the most common and natural. Hair thickness will reduce with age, even with a full head of hair.
- Bald Spots: Hair loss can develop in circular or patchy bald spots on different body parts including the scalp, beard, or even eyebrows.
- Hair Loosening: Sudden hair loosening usually occurs due to emotional or physical shock.
What Are The Causes Of Hairloss?
Androgenic Alopecia (Male Pattern Baldness)
This is the most common hair loss type in men. It is also called male pattern hair loss or androgenic alopecia (3).
Androgenic alopecia is genetic. It means that you have inherited certain genes from your family that makes your hair follicles sensitive to Dihydrogentestosterone (DHT). In simple terms, as your natural male Testosterone turns into DHT, this DHT attaches to hair follicles causing them to miniaturize. Hair does not permanently ‘fall out,’ it just becomes too small to see.
- 80% of predisposition to baldness is inherited (35).
- Increased risk of baldness with increasing affected family members (36).
- If your father suffers from pattern baldness there is an ~81% chance you will too (37).
- Some regions are less sensitive to DHT than others, like the base of the head. Hair transplanted from here to the front will not miniaturize as quickly (38).
Alopecia Areata (Autoimmune Hairloss)
Alopecia Areata is an autoimmune disease in which the immune system attacks hair follicles leading to hair loss. The condition can affect hair in any body part including the scalp, eyebrows, eyelashes, and even the inside of the nose and ears.
This is the second most common type of non-scarring hairloss (after pattern baldness) but only affects around 2% of the general population within their lifetime (39). Alopecia Areata is generally seen combined with a host of other illnesses such as depression or autoimmune diseases like rheumatoid arthritis, vitiligo, psoriasis… if you have this form of Alopecia, you are likely already aware of it.
- Characterized by patchy baldspots
- No notable sex or ethnic differences in prevalence
- Treated with steroidal creams and is moderately reversible (40)
Tractional Alopecia (Friction Hairloss)
Tractional Alopecia is hairloss caused by physically pulling the hair out of its shaft openings due to tight hairstyles or headwear. This is most prevalent in African women who practise tight braiding but also applies to men, such as in Sikh practices or by simply wearing a regular hat (41).
For most males, wearing tight headphones is a relevant reason for tractional hairloss, creating a band-like thinning on the vertex from where the headphone sits on the head. As a preventative, we recommend wearing earphones instead of headphones where possible.
- Characterized by temporal recession, horseshoe or band-like thinning
- African hair is most at risk due to the asymmetrical shape of the hair follicles
- Cornrows, weaves, dreadlocks, turbans, ponytails, buns and hats mechanically pull on the hair.
Extreme stress can also cause hair loss by speeding up the hair cycle into the shedding stage. When stress triggers hair loss, the condition is known as telogen effluvium.
This can be caused by a variety of factors, including stress, hormonal changes, and certain medications. In most cases, telogen effluvium is a temporary condition and the hair will eventually regrow. However, in some cases, the hair loss may be permanent.
Step 3 | Treating Hairloss
What Are the Treatment Options for Men?
Minoxidil is a vasodilator originally made for hypertension, that is nowadays used off-label for hairloss. Formulations are available in both liquid and foam forms, although we recommend the liquid solution if you skin can tolerate it. This solution is applied to the scalp twice a day at 5% preferably.
Bottom line is that it really works, but you need to be consistent in your application and expect at least 6 months before results.
Finasteride is an enzyme inhibitor that stops the breakdown of Testosterone to Dihydrotestosterone which is the metabolite responsible for miniaturizing sensitive hair follicles. It is taken in topical or oral forms with 1mg/day being shown to be optimal and nearly as efficacious as 5mg with less side-effects (45).
- Once started, Finasteride must be taken for life or the hair will continue falling out
- No significant difference between oral (1-5mg/day) vs topical (1% solution) (46)
- Finasteride is prescription only, but can be bought through an online-prescription
Platelet Rich Plasma (PRP)
Platelet rich plasma is an injectible procedure of separating the platelets (growth factors) from extracted blood and injecting it back into the scalp to promote hair growth. This procedure does need to be done in a licensed clinic, making it a less attractive but effective option. It has shown to be highly effective at increasing hair counts with a recommended protocol of 4 monthly visits with quarterly maintenance applications (47)(48).
- Works like Minoxidil to encourage hair growth
- Needs ongoing maintenance
- Does not slow down hairloss (like finasteride)
Step 4 | Your Next Steps
So... What Now?
Get Your Hairline Assessed
Whether by us, your local practitioner or the most qualified dermatologist in the country, if you have concerns about pattern baldness, get a second opinion now.
Prevention is far more effective than any treatment today.
Things you should probably know
To prevent or slow down hair loss, follow these tips:
- Avoid Excessive Touching: Pulling, twisting, and rubbing your hair make it loose. Try to avoid touching your hair as possible.
- Use a Loose Hairstyle: Braids, buns, ponytails, and other hairstyles put a lot of pressure on your hair. Try to use a loose hairstyle.
- Dry Your Hair Gently: When your hair is wet, gently pat it dry. Rubbing or twisting your hair with a towel may make it weaker over time.
- Consume Nutrient-Rich Foods: Nutrient-rich, balanced diets will prevent hair loss due to nutrient deficiencies. Consume foods that contain iron and protein regularly.
- Avoid Styling Tools and Products: Blow dryers, heated combs, hair strengtheners, coloring products, bleaching agents, relaxers, perms, and other hair styling products and tools may weaken your hair over time and accelerate hair loss. Many men use heated tools to style their hair. These tools should be used when the hair is dry and with the lowest settings.
If you are experiencing hair loss, baby shampoos are the best option to wash your hair. In addition, people with extremely oily hair should wash their hair a few times per week.
- Do I have at least 3 months of hair loss progression photos?
- Frontal hairline and crown
- Does my dermatologist need a referral from another doctor to see them?
- What will I get out of my first consultation with them?
- If they prescribe Finasteride, am I ready to start it…for life?
- Is my hairloss bad enough to see a dermatologist yet?
- Does my hairloss affect my looks?
- Hairloss Evaluation Report
- Does pattern baldness run in my family?
- Take a look at your family members closely before you go… many people forget!
If you have unexplained hair loss, you should see a dermatologist. He/she can find out the underlying cause and outline the best treatment approach for your condition.
During the history-taking and examination phase, mention any unusual symptoms you are experiencing such as:
- Weight loss
- Limb problems such as swelling or pain
- Bowel movement changes
- Skin changes such as rashes
Try to mention your entire medical history during the appointment including your past medical conditions, operations, medications you take, and family history. Any piece of information can help determine the main cause of your hair loss condition.
Minoxidil is the active ingredient in many hair loss treatments. Its topical use stimulates hair growth in men but it is not clear how exactly it works (26).
It is essential to use minoxidil-based products properly and exactly as directed. It is a direct vasodilator. Therefore, it affects the heart and blood vessels and can lead to many unwanted effects.
The timing of minoxidil really matters. Here are a few tips that must be followed:
- Applying other skin and hair products on the same area where minoxidil is applied must be avoided.
- Wash your scalp before using relaxer, or hair coloring products and make sure that minoxidil no longer exists on your scalp.
- Do not use minoxidil for at least 24 hours before or after hair treatment procedures.
- Avoid using a double dose of minoxidil to make up for missed doses.
- The hair and scalp must be completely dry before applying minoxidil.
- After applying minoxidil, you should not shampoo your hair for at least 4 hours.
- After applying, you should leave it to dry completely for 2 to 4 hours.
Ask your doctor about how and when minoxidil should be applied to avoid any unwanted effects. Also, if you noticed any unusual symptoms, call your doctor immediately.
Platelet-Rich Plasma or PRP therapy for hair loss is a medical procedure that involves drawing blood from the person, processing it, and then injecting it into the scalp.
Many studies say that PRP therapy can enhance the natural hair growth process and maintain the hair over the scalp since it increases blood supply to the hair follicles while leading to increasing the thickness and strength of the hair shaft.
Moreover, PRP can be used along with other medical procedures or medications to enhance hair regrowth (27, 28).
On the other hand, more research is needed to confirm the effectiveness of PRP for hair loss in men. It has been around since the 1980s but the research is not enough, especially as a hair treatment. Ask your doctor whether PRP can benefit your hair loss condition or not.
Scalp micropigmentation aims to make the scalp look fuller, even though it is not. The procedure is done using a tattoo device to penetrate the thick skin of the scalp (29).
The small, layered dots look like a shadow on the scalp and create a natural-looking fullness of the scalp. These dots must look like natural hair follicles.
The process is recommended for nearly all cases of hair loss such as:
- Cancer patients
- Hair thinning
- Male pattern baldness
Hair cloning or hair multiplication is one of the trending hair loss treatments for androgenic alopecia. The process depends on multiplying hair follicle stem cells and re-implant them into the scalp.
It is a promising treatment. But it is still not available for clinical application (30).
Less Common Causes Of Hairloss
Chemotherapy and radiation therapy usually lead to losing almost all body hair within the first few weeks of treatment. After finishing the treatment, the hair usually grows back. Besides, many treatments can stimulate the hair re-growth process. Furthermore, hair loss can be prevented during chemotherapy by wearing a cooling cap (6).
Stress is one of the main reasons for hair loss in men. If you are under a lot of pressure or experiencing a stressful time, you may notice significant hair loss while brushing or on your pillow.
Once the stress is relieved, the hair loss usually stops. Your hair will be back to its usual fullness in 7 to 9 months (7).
Excessive Hair Care
Coloring, perming, or relaxing your hair can lead to severe damage over time, which may lead to hair loss. Unfortunately, once the hair follicle is damaged, hair cannot come out of it. In other words, excessive hair care can lead to permanent bald spots.
Hair re-growth is possible. Change your hair care routine once you notice the problem to prevent hair loss (8).
Scalp infections usually create inflamed, scaly areas over the scalp. They usually develop hair stubs and bald spots. Treating the infection stops hair loss. The hair grows back once the infection is completely treated (10).
Hair loss can be a side effect of many medications. If you notice hair loss after taking a certain medication, consult your doctor and see if there is a way to stop it. Do not stop taking your medications until your doctor prescribes a new drug since the sudden stoppage can lead to serious problems. Hair re-growth usually occurs once you stop taking the medication (11).
Plaque psoriasis is a common chronic autoimmune condition that leads to an itchy, inflamed scalp. Plaque psoriasis leads to the development of scalp psoriasis if ignored. Scalp psoriasis leads to hair loss.
Once the condition is treated, hair regrows. However, the process usually takes time (12).
Severe scalp inflammations cause severe damage to the hair follicles, which leads to the development of scarring alopecia. Hair strands cannot come out of destroyed hair follicles. This sequence of events is called cicatricial alopecia.
Unfortunately, hair regrowth is not possible in most cases. Therefore, discovering and treating this condition as early as possible prevent significant hair loss (13).
Sexually Transmitted Diseases (STDs)
Untreated sexually transmitted diseases can lead to severe hair loss. For example, untreated syphilis can lead to losing hair on the scalp, beard, eyebrows, and other body parts. Once the condition is treated, hair regrowth occurs on its own (14).
Thyroid diseases can lead to hair thinning. People with thyroid diseases usually notice clumps of hair coming out while brushing it. Once the condition is treated, hair loss can be reversed (15).
If you have zinc, biotin, protein, or iron deficiency, hair loss is usually one of the first and most common symptoms. Once you find out what nutrient is deficient and get enough of it, hair regrowth occurs (16).
Certain poisons can lead to hair loss such as mercury, arsenic, and lithium. Besides, the long-term usage of certain medications and supplements such as warfarin, vitamin A, and selenium can lead to hair loss. Once you stop being exposed to the poison, hair regrowth occurs.
Most hair loss causes can be treated efficiently. However, to treat the condition successfully, you need to find out the main reason for the condition. An accurate diagnosis is the main key to effective treatment (18).
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