It’s a day no man looks forward to: looking in the mirror and admitting that his widow’s prime is real. Or feel the breeze on the top of your head.
Up to half of men will suffer from some form of male pattern baldness before the age of 50, and even more after that. Although our genetics and hormones play a major role in hair loss, the exact mechanisms are not fully understood, which is why treatments to stem and reverse it remain imperfect, said Dr. Arash Mostaghimi, vice president of clinical trials and innovation in the department of dermatology. at Brigham and Women’s Hospital in Boston.
However, there are some things you can do before and after that fateful day. Here’s what you need to know about what works, what’s new, and what to avoid.
What causes male pattern baldness
The average human head contains approximately 100,000 hairs. Each is connected to a follicle that can contain one to five hairs.
“It’s basically its own organ,” Dr. Mostaghimi said of a scalp follicle. “It has its own stem cells. It regenerates.
Typically, hair loss in men is due to an increase in an enzyme in the scalp that converts testosterone into a more potent form, called dihydrotestosterone (or DHT), Dr. Mostaghimi explained. The reasons why one man may have more DMT than another are not well understood, but it has a genetic component.
When men have too much DHT in their scalp, the hormone triggers a complex process that leads to hair miniaturization, in which the hair and follicles begin to shrink. (This is why men often have thinner hair or even peach fuzz where they are bald.)
This hair loss occurs in a predictable sequence: first around the temples, then at the crown of the head, where there are increased levels and activity of the offending enzyme and its altered testosterone, Dr. Mostaghimi said. . Hence the term “male pattern baldness”.
How to Treat (and Prevent) Hair Loss
If you are concerned about hair loss, the first step is to make an appointment with a dermatologist. Dermatology is a great specialty; Find a doctor who is passionate about hair loss, said Dr. Danilo C. Del Campo, a Chicago dermatologist who specializes in hair loss.
When should you go? Ideally, before you really worry about your hair, dermatologists say. This is because medications are generally more effective at preventing hair loss than at reversing it. “The earlier you start, the more likely you are to keep your hair,” Dr. Mostaghimi said.
First-line drugs
Dermatologists generally recommend two medications approved by the Food and Drug Administration: minoxidil (also known by its brand name Rogaine) and finasteride (aka Propecia).
Minoxidil is the best known. “It works to grow hair,” Dr. Del Campo said — when patients apply it at least daily and preferably twice a day. It comes in the form of foam or drops. He recommends using a formulation without propylene glycol, which can irritate the scalp.
It takes a few months to regrow mature hair, but topical minoxidil doesn’t work well for everyone and experts said many don’t like having to apply it so often. Additionally, as with any hair loss treatment, if a patient stops taking it, they will lose all their previous gains and their hairline will continue to recede, Dr. Mostaghimi said.
Another option is to take minoxidil in pill form, an off-label treatment that some dermatologists have used for years. However, the pills cause hair to grow indiscriminately, including on the beard or armpits, although this varies by patient, Dr. Del Campo explained.
Finasteride is approved in pill form for prescription male pattern hair loss. Studies have suggested that most men who use finasteride maintain or improve their hair coverage over five years.
Taking finasteride orally carries a small risk of erectile dysfunction, Dr. Del Campo said, which usually ends when a patient stops taking it. Still, he said, “It’s something I take seriously when I discuss it with my patients.” »
Finasteride is also available in spray or drop form. Topical formulations are not approved by the FDA, but have become popular with online providers who can prescribe them using a simple online survey. They have been shown to work with fewer side effects than the pill, Dr. Del Campo said, but he stressed the importance of talking to a dermatologist before purchasing prescription medications online.
Comparing finasteride to minoxidil gets tricky because studies often measure results differently. Minoxidil got better marks for regrowing hair, while finasteride, Dr. Mostaghimi said, is often considered better for holding it in.
But there is no reason to limit yourself. “It is generally accepted that combination treatment works better than anything alone,” said Dr. Carolyn Goh, clinical associate professor of dermatology at UCLA Health. This is because these drugs seem to work in different pathways and have different strengths.
Neither drug is usually covered by insurance. Topical minoxidil typically costs between $10 and $30 per month, Dr. Del Campo said, and finasteride pills cost about $15 per month.
Secondary therapies
There are a few other options, but experts say these are not standalone therapies and should be used alongside medications. One option is to inject platelet-rich plasma (PRP). During this process, a patient’s blood is drawn, their plasma separated, and reinjected into their scalp.
It’s expensive, between $500 and $1,500 per session, and patients typically undergo three or four primary sessions, followed by maintenance sessions each month, Dr. Del Campo said.
A recent meta-analysis concluded that PRP was promising for some patients, but it was difficult to say for sure because the studies were all done differently. Experts like Dr. Del Campo have not recommended it as a stand-alone treatment.
Another option is low-level laser light therapy, often in the form of helmets or combs. While there is some evidence that stimulating the scalp with these devices can help grow hair, Dr. Mostaghimi said, they can be expensive (up to $2,500). Additionally, it can be difficult for consumers to differentiate between legitimate medical devices and scams, he said; they should only be considered as a complement to another therapy.
Hair transplants
Some dermatologists consider hair transplantation the gold standard in hair restoration. According to doctors, technology has come a long way in the last 25 years since the days of hair plugs. During a hair transplant, hair follicles are removed from one location and moved to where needed. This can be done either by removing a strip from the back of the scalp or by moving individual follicles around the head.
The process is not without caveats. First, a transplant often does not provide instant results. And the original hairline continues to recede, so the skill of the surgeon is important. Patients will also get the best results if they continue to use medications, Dr Goh said. Transplants are also the most expensive option, starting at around $7,000 and reaching several times that amount.
Disinformation and outright scams
There are almost as many myths about baldness as there are false cures. Some people claim that wearing a hat too often can cause baldness, while others blame lack of a hat in cold weather. Both are false, Dr. Del Campo said.
Some people think that washing your hair too much is the problem; others say it’s not washed enough. (Both are false, dermatologists say.) Some suggest that sunburn on the scalp can stimulate growth. (Do not do that.)
Neither rubbing onion or garlic on your head will stimulate growth. (And they can irritate the scalp, Dr. Del Campo said.)
Rosemary oil has gone viral on TikTok in recent years. The evidence for its effectiveness is thin, say dermatologists. But Dr. Del Campo said he’s OK with 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 to your father or your mother’s father to see your future? Alas, neither is a perfect predictor. Although genes play a major role in baldness, scientists say they don’t predict it with certainty.
Baldness can start at an earlier age over generations, Dr Goh added. A grandson may lose his hair years before his grandfather, she said. “It can happen very young.”
Our hair is one of the ways we tell the world who we are – and it also affects how the world perceives us. Its loss can therefore cause real suffering to a man. But by starting an open conversation with a doctor as soon as signs appear, it doesn’t have to be this way.
“There are tons of options, and the future is very, very bright for someone who has been dealing with this problem,” Dr. Del Campo said. “They shouldn’t have to deal with this alone.”
Christopher Solomon writes frequently for The Times and is working on a memoir about family and running.