Why Do Men Go Bald? And Is There Anything You Can Really Do About It?

Baldness is a hot topic in research. Androgenetic alopecia (AGA), or male pattern baldness, is the most common type of progressive hair loss disorder in men.

Half of the men in the world experience hair loss by age 50. About 70% of men will lose hair as they get older. And 25% of bald men see first signs of hair loss before age 21.

“Recent advances offer a lot of hope in both treating and preventing different types of baldness,” says dermatologist Amy Kassouf, MD. For example, researchers can now grow hair follicles in a lab. Some are even studying new cancer treatments that make hair grow instead of falling out.

But if you’re thinking about waiting for these trials to conclude final findings in the near future, there’s still a way to go.

Until then, here are some facts and common questions about male pattern hair loss that can help clear up any misconceptions you might have.

How baldness happens

You inherit the genes for baldness. The occurrence and development of androgenetic alopecia depends on the interaction of endocrine factors and your genetic predisposition. So if your dad or uncle are bald, chances are good you can’t escape a similar fate.

You reach puberty and produce androgens (sex hormones). If you’re genetically predisposed, these interact with your genes to miniaturize the hair follicles. Your normal hair then falls out. It is replaced by tiny, non-pigmented hairs (barely visible fuzz). This process occurs across your scalp until it’s run its course. Eventually, the follicles go dormant and stop producing even fuzz.

The baldness pattern

Male pattern baldness begins at the temples, front of the scalp and crown of the head. Over the course of months or years, bald areas of the scalp meet and conjoin. The result is the familiar “crown of laurel” shape.

Why don’t the hairs below your ears fall out?

Have you ever noticed that men who are bald still have tufts of hair below their ears? For some reason, this section of hair is genetically programmed not fall out.

What are the current treatments available for baldness?

There are pharmaceutical, surgical and cosmetic treatments treatments for baldness.

Topical minoxidil (Rogaine) and finasteride (Propecia) are the only drugs approved by the FDA to treat pattern baldness.

Minoxidil is a vasodilator that is also used to treat high blood pressure. When used to treat hair loss, it widens blood vessels and provides more blood flow to the hair follicles. This is applied directly to the scalp.

Oral finasterides (FNS) are synthetic compounds that block the conversion of testosterone to dihydrotestosterone (DHT). These are the most common treatments for male pattern baldness and general alopecia.

But, keep in mind and your doctor should discuss with you the side effects associated with finasterides such as:

• Weight gain.
• Itchy skin.
• Confusion.
• Back pain.
• Abdominal pain.
• Diarrhea.
• Decrease in semen.
• Testicular pain.

One recent study also shows a possible effectiveness of treatments containing quercetin — a component found in Houttuynia cordata extract. It’s one of the important markers in hair follicle and cell survival.

A new 2020 study also suggests that botulinum toxin type A (BTA) may show promise to be effective in treating AGA. It has been studied and shown to be a safe and effective therapeutic strategy for the treatment of AGA without adverse effects.

The most reliable and effective treatments are provided by doctors or under doctor supervision in a healthcare setting, so talk to your doctor to see if any are right for you.

Other treatments for hair loss

These are the most common solutions for balding that deal directly with cosmetically or physically altering your appearance:

• Hair Transplants. Anesthesia is given during this surgery where healthy hair follicles from a particular body part called the donor site are moved to the balding parts. This process is surgical, it can take many procedures before results become permanent, because hair loss still occurs several times before the skin grows more hair permanently. And the recovery time can be extensive. It’s also expensive, but results can be done quickly.
• Wigs. These are a more temporary solution but less expensive and versatile. Wigs that are synthetic are generally cheaper when compared to human hair wigs. Human hair wigs look more natural and are easier to style and maintain because polymers hold the structure longer and better under natural fibers.
• Hats. Many men tend to wear hats as the most comfortable, versatile and least expensive way to manage their hair loss with zero side effects.

Male pattern baldness and disease

Baldness affecting the crown of the head (vertex) is associated with an increased risk for coronary heart disease, so talk to your doctor about the link between the two.

There have also been many studies that question if baldness is also associated with a higher risk of prostate cancer. However, recent studies suggest that baldness is not a consistent biomarker for prostate cancer risk or progression.

Embrace what works now

Research is still underway about prevention and treatment, so there’s hope for the future. But until then Dr. Kassouf recommends shifting your focus to working with the resources you’ve got.

“Instead of wasting your money on products that claim to but don’t work, focus your efforts on finding a new style that suits you — with less hair. The best strategy is to embrace your hair loss,” says Dr. Kassouf.

“While it’s true there are pharmaceutical and cosmetic developments that can help you address your physical appearance concerns, each comes with its own set of positives and negatives. Always talk with your doctor before you consider any treatments.