Hair loss, also known as alopecia, is usually not anything to worry about or caused by something serious, but can be upsetting for some. Hair loss is normal process that occurs with ageing however, there are factors that cause this at an exaggerated rate. Depending on the cause the hair loss can be reversible or permanent.1
Hair loss in most cases is genetically predetermined and therefore there is little that can be done to prevent hair loss. However, there are many ways to treat and manage hair loss and this treatment will depend on the cause. Seeking medical attention may be decided by you on an individual basis.
Hair loss in people assigned male at birth (AMAB)
Hair loss is often distressing and may have a significant effect on your quality of life. Anyone at any age can lose. Male pattern baldness is the most common cause of hairloss and is more commonly seen in white people.2
There are 3 stages in the hair cycle, these are:
- Anagen phase (known as the growth phase)
- Catagen phase (known as the resting phase)
- Telogen phase (known as the shedding phase)
The growth phase is when 90% of hair is grown and the other 10% of hair growth is divided between the other 2 phases. Once hair dies it is then recycled.1
Non scarring alopecia:
- Alopecia areata - can affect every part of the body including: the scalp, face, torso, hands and feet (when one area is affected it is called alopecia totalis and when the entire body is affected it is called alopecia universalis)
- Androgenic alopecia - androgens are sex hormomes such as testosterone that can cause your hair follicles to shrink over time, until the follicle can not grow new hair, often called male pattern baldness (this condition is determined by your genetics and affects up to 50% of people AMAB characterised by progressive hair loss, receding hairline and a classic M shape at the top of the head)2
- Telogen effluvium - occurs when the hair cycle shifts from the growth phase towards the shedding phase (sometimes the result of diseases such as hypo/hyperthyroidism, stress or poor diet)
- Traumatic alopecia - similar to traction alopecia which happens due to forceful movements on the scalp commonly seen in people who pull their hair out repeatedly
- Anagen effluvium - hair shedding that occurs during the growth phase of the hair cycle (typically seen in people receiving chemotherapy)3
- Tinea capitis - Inflammatory condition
- Alopecia mucinosa - occurs when the hair follicles and skin glands are clogged and cause an inflammatory response which disrupts the hair growth
- Alopecia neoplastica - this is the most serious cause of hairloss and is when cancer spreads to the scalp3
What Age Does It Usually Start?
You may typically start to notice signs of slight hair loss in your 20’s but more commonly in your 30’s and 40’s with severe hair loss starting in your 60’s.2
- Gradual thinning of hair on the top of your head
- Circular or patchy bald spots
- Sudden loosening of the hair
- Full body hair loss
- Patches of scaling that spread over the scalp
Usually there is no need to worry about hair loss as the main complication is balding which isn't a medical emergency. However, this may become upsetting to some due to the change in appearance for a number of reasons.
However, hair loss may also be a sign of a more serious condition particularly if there is scarring as this can be caused by cancer. It is therefore important to book an appointment with your GP if you are worried so they can help determine the cause of your hair loss.1
How to prevent hair loss in men
Finasteride has two primary uses in medicine; for treatment of an enlarged prostate and male pattern baldness. In the UK, finasteride is only available with a prescription, to be taken once a day. It works by stopping testosterone hormone from being converted to another hormone called DHT.
It is important that this medication be kept out of the sight and reach of children and that other people you live with do not touch the tablets and the medication can be absorbed through the skin. You can expect to see results after 3 months to 6 months.
As with all medication finasteride can cause side effects, these include:
- Low sex drive
- Erectile dysfunction
- Painful ejaculation
- Breast cancer (rare)
If any of thes side effects persist and are causing you problems you should contact your doctor.4
Minoxidil is a topical treatment that comes in the form of a solution or foam used to treat male pattern baldness (though it is not effective for treating baldness in the front of the scalp or a receding hairline).
Minoxidil is applied with the applicator provided and you should follow the products instructions. This medication is also not available through the NHS and you will need to pay for a private prescription. You should not use this medication on any part of the skin that is irritated such as a cut, sunburn or rash. The medication, if it works, will normally be 4 months after regular use although there is currently no definitive answer on how this medication works.
The side effects usually appear at the area where the medication was applied and include: burning, stinging and redness of the skin.
More serious side effects include:
- Fast heart beat
- Chest pain
- Difficulty breathing
If you experience these side effects you should contact your doctor immediately.5
Other therapeutic interventions
There are two commonly used techniques for performing a hair transplant:
- Follicular Unit Strip Surgery (FUSS) - involves taking strips of skin from the back of the head, creating grafts out of them and placing the grafts on the scalp for the hairto grow over time
- Follicular Unit Extraction (FUE) - involves the surgeon shaving the back of the head and taking follicles to be transplanted onto the area of the scalp where hair is hoped to regrow 6
There are a number of hairstyles that can help combat the emotional effects of hair loss and that are suited to many individual tastes. Short haircuts are sometimes recommended to those with with receding hairlines including a buzz cut, crew cut or going completely bald to prevent the appearence of patchy hair growth.
Cognitive behavioural therapy (CBT)
Cognitive behavioral therapy (CBT) is used to help people cope and treat a number of mental health problems (for example, depression and anxiety) which could be caused by hair loss. CBT involves talking to a therapist who can help you understand your behaviors and coping mechanisms and give you tools to change behavioural and thinking patterns concerning your hair loss.
There are a number of ways to reduce stress in your day-to-day life will.In modern society it can often be impractical to eliminate every source of stress but things to practice include mindfulness, yoga and meditation or attend cognitive behavioral therapy. These are all excellent solutions to aid in dealing with stress and helping to change your lifestyle and habits in a controlled way.
Eating a well balanced diet can improve your overall health, reduce the likelihood of many diseases and correct nutritional imbalances which may be causing your hair loss. If your hair loss is being caused by insufficient protein intake then increasing the amount of meat, fish, eggs, diary or lentils in your diet can remedy this. If your hair loss is due to being iron deficient then increasing the amount of nuts, legumes, dark leafy greens and red meat can help increase your iron intake.
When To consult a medical specialist
- Sudden hair loss
- Development of bald patches
- Hair falling out in clumps
- Other symptoms with hair loss, particularly itching and burning sensations
- If your hair loss is causing you mental distress (no references?)
In conclusion, hair loss in those assigned-male-at-birth (AMAB) is usually not a cause for concern. The most common cause is male pattern baldness and can be treated with medication. However, hair loss can sometimes be a sign of a more serious condition. Either way if your hair loss is concerning you, contact a GP for further help.
- Hair loss [Internet]. nhs.uk. 2017 [cited 2022 Nov 3]. Available from: https://www.nhs.uk/conditions/hair-loss/
- Al Aboud AM, Zito PM. Alopecia. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 [cited 2022 Nov 3]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK538178/
- Cranwell W, Sinclair R. Male androgenetic alopecia. In: Feingold KR, Anawalt B, Boyce A, Chrousos G, de Herder WW, Dhatariya K, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000 [cited 2022 Nov 3]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK278957/
- McClellan KJ, Markham A. Finasteride: a review of its use in male pattern hair loss. Drugs. 1999 Jan;57(1):111–26.
- Suchonwanit P, Thammarucha S, Leerunyakul K. Minoxidil and its use in hair disorders: a review. Drug Des Devel Ther [Internet]. 2019 Aug 9 [cited 2022 Nov 3];13:2777–86. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6691938/
- Jimenez F, Alam M, Vogel JE, Avram M. Hair transplantation: Basic overview. J Am Acad Dermatol. 2021 Oct;85(4):803–14.