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For most guys, facing hair loss can be one of the most difficult pills to swallow. But the fact is, it happens to all of us in varying degrees. According to the American Hair Loss Association, two-thirds of men will experience some form of hair loss by the time they’re 35, with 25% of men beginning to show male pattern baldness before the age of 21. But as natural as hair loss is, that doesn’t make it any easier to accept and often leads to low self-esteem and a less-than-helpful view of ourselves and our potential.
The good news is, there’s plenty you can do to treat hair loss if it bothers you—from lotions and potions to surgical options. Before we jump right in, let’s get to the root causes of hair loss in men to better understand what’s going on. We talked to leading specialists: Robert Finney, MD, FAAD, a board-certified dermatologist based in New York City, and the team of trichologists at Philip Kingsley to get the long and short of the causes of hair loss in men and what you can do about it.
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What are the main causes of hair loss in men?
The causes of hair loss in men range from genetic pattern baldness to stress and trauma-induced conditions and even dietary and lifestyle-related elements. Here, we’ll tackle the top four:
Androgenetic Alopecia (AGA): Also known as male pattern hair loss or male pattern baldness, AGA is the most common cause of hair loss in men. It’s a slow process by which your hairs grow back thinner and shorter over several years, through many progressive hair growth cycles, until they stop growing altogether. According to the trichologists at Philip Kingsley, androgenetic alopecia happens to men whose hair follicles are sensitive to certain androgens (male hormones), specifically a form of testosterone called dihydrotestosterone (DHT). While this sensitivity is genetic, Finney explained that it can’t be traced back to just one family member, as it’s common for certain siblings to be affected while others are not.
Androgenetic alopecia tends to set in at some point after puberty once the body has begun to produce testosterone; however, the degree to which the hair thins and the age at which it starts depends on how sensitive you are to androgens.
To get a clearer sense of how androgenetic alopecia looks, Finney recommended consulting the Norwood Scale, which was developed to classify male pattern baldness stages.
Telogen Effluvium: Also known as “stress-induced hair loss,” Finney explained that it could be caused by a variety of scenarios, including certain medications, underlying medical conditions, traumatic events, or hospitalization for illness. He even pointed out that he’s seen several cases in patients who have recovered from Covid-19. Telogen effluvium occurs when an internal disturbance disrupts the hair cycle's growth phase (anagen) in the body, which causes more hairs than usual to move into the shedding phase (telogen), resulting in a substantial shedding. The trichologists said while it’s normal to lose up to 100 hairs each day, those afflicted with telogen effluvium may lose as many as 300.
The good news is that telogen effluvium is not permanent; however, whether it’s short-term (acute) or chronic (recurring) depends on the underlying cause and the severity of your system's disturbance. It may also take a while to notice it. “Due to the nature of the hair growth cycle, hair loss usually takes place six-to-12 weeks after the event, illness, or medication that triggered it, so you may not always connect the two,” the trichologists say, “If you notice excessive hair shedding, look back two or three months for possible causes.”
Scarring Alopecias: These, Finney explained, are many conditions in which bald patches are caused by destroyed hair follicles, boiling down to three main culprits. The first: traction hair loss occurs when tension or traction is placed on the hair follicles, such as by certain hairstyles like cornrows, heavy dreadlocks, or religious headwear like turbans. Another: Lichen planopilaris, an inflammatory condition in which immune cells attack the hair follicles, leads to hair loss and ultimately scarring. And last: Rare conditions such as folliculitis decalvans and acne keloidalist nuchae, which cause inflamed bumps on your scalp that can permanently damage hair follicles.
Imbalanced Diet and Lifestyle: Diet and nutrition play an important role in hair health for both men and women, the trichologists explain. “Being a non-essential tissue, hair is the last part to benefit from nutrients we ingest and the first to be withheld from.” As a result, they advise all clients to eat a healthy, balanced diet containing proteins (what hair is made of), complex carbohydrates (to provide energy to rapidly growing hair cells), healthy fats (important for scalp health), iron, zinc and vitamin B12 – and to supplement their diet when necessary with a nutritional supplement. Not skipping meals is also important.
The trichologists were quick to point out that a stressful lifestyle can be a major factor in hair loss. When we’re stressed, it sends a cascade of cortisol (the “stress hormone”) through our bodies which can affect the growth cycle of our hair and make our scalp itchy and flaky. And because stress can affect our eating habits, our body’s ability to digest and absorb essential nutrients can impact hair growth overall.
When Hair Loss is More Severe
Because normal hair loss such as androgenetic alopecia tends to be gradual, it’s unlikely you’ll wake up one day and notice you’ve got a receding hairline or that your scalp is suddenly visible through your hair. But if you do notice and don’t have a problem with it, even better. However, if you do decide you want to take action, Finney recommends acting early, “I always tell patients it’s much easier to keep the hair you have than to regrow a hair that left a few years ago.”
However, if you notice you’re rapidly shedding hair out of the blue, that’s all the more reason to seek medical attention, as you may require a blood test to rule out an underlying medical condition such as a thyroid disorder.
Now that we’ve covered hair loss causes in men let’s look at the various treatment options available. Both Finney and the trichologists at Philip Kingsley were adamant that there is no “one-size-fits-all” approach to treating the causes of hair loss in men. Tackling hair loss comes down to metabolic and genetic profiles and lifestyle and dietary factors that can all impact hair growth—and loss.
Consult a Trichologist: Trichology is the scientific study of the hair and scalp, and seeing a trichologist can help you form a well-rounded, effective plan to battle hair loss using various products, treatments, and procedures. “In all instances at our clinic, we try to optimize each possible factor that can affect the hair growth cycle, such as health, follicle sensitivity, nutrition, stress levels, thyroid function, and scalp health, as well as the condition of the hair itself,” the trichologists say.
Topical Medications: Anti-androgen scalp treatments such as minoxidil (the active ingredient in Rogaine) added to your daily hair care routine can help offset the symptoms of androgenetic alopecia. Ironically, there is a typical shedding period during the first few weeks of usage; however, Finney said the biggest caveat with these is that, since androgenetic alopecia is so progressive, once you start treatment, you must continue with it if you want to see results. “There is no treatment that is a one-time fix,” he said. In addition to the OTC Rogaine, which’s on the shelf of every drugstore, there are also several topical compounded medications available in stronger formulations that may increase the chances of efficacy. Still, to get your hands on these, you’ll have to talk to your doctor.
Oral Medications: If slathering your scalp up twice a day isn’t your thing, finasteride (sold under the brand name Propecia) may be up your alley. Finasteride works by blocking DHT hormones by up to 70%, reducing the shrinkage and shortening of hair follicles, and targeting male pattern baldness on the crown of the head and middle part of the scalp. Finney points out that oral finasteride has great long-term data, and most people who responded to treatment still retained their hair five years later, making it ideal for maintenance. However, it’s not without side effects, ranging from sexual dysfunction to lower PSA levels.
Hair Transplant Surgery: If all else fails, you may want to consider hair transplant surgery. Procedures range from taking entire strips of hair (usually from the back of the head) and transplanting it where it’s needed with individual hair follicles (“hair plugs”) to create a crop of new growth. Overall, hair transplant surgery can help restore a fuller head of hair; however, Finney points out a few cons. For one, surgery won’t stop the underlying male pattern hair loss, so if you don’t have a plan to keep the hair you have, the long-term benefit won’t be as great. Also, most people don’t have enough “safe” donor hair to cover the entire crown of their scalp with enough density to appear as though they’re not balding, meaning you could come out looking as though your hair is perpetually thinning. Also, it's not cheap, costing anywhere from $1000 to $30,000 or more, depending on how many passes are required.
Hair Pieces: The old “fake it ‘till you make it” method works especially great nowadays, with a wide variety of well-constructed wigs and hairpieces that look like the real thing. While they can be an instant confidence boost, the trichologists warn that improper or prolonged use could damage the scalp environment, which may exacerbate the hair loss problem you were trying to cover up in the first place.