No man wants to see the day when he looks in the mirror and admits his widow’s peak is real. Or feels the breeze on the top of his head.
It’s estimated that up to half of all men will experience some form of male pattern baldness by age 50, and even more following that. While genetics and hormones play a role in hair loss, the exact mechanisms aren’t fully understood, so treatments to stop and reverse it remain imperfect, said Arash Mostaghimi, vice chair 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 both before and following that fateful day arrives. Here’s what you need to know regarding what works, what’s new, and what to avoid.
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Causes of male pattern baldness
The average human head contains regarding 100,000 hairs. Each of them is connected to a follicle, which can house one to five hairs.
“It’s basically their own organ,” Mostaghimi said of scalp follicles. “They have their own stem cells. They regenerate.”
In general, 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), Mostaghimi explained. The reasons why one man may have more DHT than another are not well understood, but there is a genetic component.
When men have too much DHT on their scalp, the hormone initiates a complex process that leads to hair miniaturization, in which hairs and follicles begin to shrink. (This is why men often have thinner hair or even peach fuzz where they’re balding.)
This hair loss occurs in a predictable sequence: first around the temples and then at the crown, where increasing levels and activity of the causative enzyme and its modified testosterone are found, Mostaghimi explained. Hence the term “male pattern baldness.”
How to treat (and prevent) hair loss
If you’re concerned regarding hair loss, the first step is to schedule an appointment with a dermatologist. Dermatology is a broad specialty; look for a doctor who is passionate regarding hair loss, says Danilo C. Del Campo, a Chicago-based dermatologist who specializes in hair loss.
When should you go? Ideally, you should visit a specialist before you are really concerned regarding hair loss, according to dermatologists. That’s because medications are often better at preventing hair loss than reversing it. “The sooner you start, the more likely you are to keep the hair you have,” Mostaghimi said.
First-line medications
Dermatologists often recommend two FDA-approved drugs: minoxidil (also known by its brand name, Rogaine) and finasteride (also known as Propecia).
Minoxidil is the most well-known. “It works to make hair grow,” Del Campo explained, when patients apply it at least once a day and preferably twice. It comes in foam or drop form. Del Campo recommends using a formulation without propylene glycol, which can irritate the scalp.
Mature hair takes a few months to grow back, but topical minoxidil doesn’t work well for everyone, and experts say many people dislike having to apply it so often. Also, as with any hair loss treatment, if a patient stops taking it, they will lose all the hair they’ve gained and their hairline will continue to recede, Mostaghimi said.
Another option is to take minoxidil in pill form, an off-label treatment that some dermatologists have used for years. But pills cause hair to grow indiscriminately, including in the beard or armpits, though this varies by patient, Del Campo said.
Finasteride is approved in pill form for male pattern hair loss by prescription. Studies have suggested that most men who use finasteride maintain or improve their hair coverage within five years.
Taking finasteride orally carries a small risk of erectile dysfunction, according to Del Campo, which usually goes away when the patient stops taking it. However, he said, “it is something I take very seriously when I discuss it with my patients.”
Finasteride is also available in spray or drop form. Topical formulations are not FDA-approved but have become popular with online vendors, who can prescribe them through a simple survey. They have been found to work with fewer side effects than the pill, Del Campo said, but she stressed the importance of talking to a dermatologist before purchasing prescription drugs online.
Comparing finasteride to minoxidil is tricky because studies often measure results differently. Minoxidil has been rated higher for hair growth, while finasteride, according to Mostaghimi, is generally considered better for hair retention.
But there’s no reason to limit yourself. “It’s generally accepted that combination therapy works better than either one alone,” said Carolyn Goh, a clinical associate professor of dermatology at UCLA Health. That’s because these drugs appear to act through different pathways and have different strengths.
Neither drug is typically covered by insurance. Topical minoxidil typically costs between $10 and $30 a month, Del Campo said, while finasteride pills cost regarding $15 a month.
Secondary therapies
There are a few other options, but experts say they are not stand-alone therapies and should be used alongside medications. One option is platelet-rich plasma (PRP) injections. In this process, blood is drawn from the patient, their plasma is separated and injected back into their scalp.
It’s expensive: It costs between $500 and $1,500 a session, and patients typically undergo three or four primary sessions, followed by maintenance sessions every month, Del Campo said.
A recent meta-analysis concluded that PRP therapy was promising for some patients, but it was difficult to say for sure because all the studies had been conducted differently. Experts such as Del Campo do not recommend 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 hair grow, Mostaghimi said, they can be expensive — up to $2,500. And it can be difficult for consumers to distinguish between legitimate medical devices and scams, he said; they should only be considered an adjunct to other therapy.
Hair transplants
Some dermatologists consider hair transplants to be the gold standard for hair restoration. According to doctors, technology has come a long way in the past 25 years since the days of hair plugs. During a hair transplant, hair follicles are removed from one location and relocated where they are needed. This can be done by removing a strip from the back of the scalp or by relocating individual follicles from the entire head.
The process has its drawbacks. For one, transplants often don’t give immediate results. Also, the original hairline keeps receding, so the surgeon’s skill is important. Goh said patients get better results if they continue taking medication at the same time. Transplants are also the most expensive option, starting at regarding $7,000, rising to multiples of that amount.
Misinformation and outright fraud
There are almost as many myths regarding baldness as there are false remedies. Some say that wearing a hat too often can cause baldness, while others blame the lack of hats in cold weather. Both are false, Del Campo said.
Some believe that over-washing your hair is the problem; others say that you don’t wash it enough (both are false, according to dermatologists). Some suggest that a sunburn on your scalp can stimulate growth (don’t do this).
Rubbing onions or garlic on your head won’t stimulate growth, either. (And they can irritate the scalp, Del Campo said.)
Rosemary oil has gone viral on TikTok in recent years. Dermatologists say evidence of its effectiveness is scant. But Del Campo said it’s OK for people to try it, with the caveat that some products have additional chemical compounds 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? Unfortunately, neither is a perfect predictor. Although genes play a major role in baldness, according to scientists, they do not predict it with certainty.
Baldness can start at an earlier age across generations, Goh added. A grandson may lose his hair years before his grandfather, he 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 sees us. So losing it can cause a man real suffering. But if you start an open conversation with a doctor as soon as symptoms appear, that doesn’t have to be the case.
“There are plenty of options, and the future is very, very bright out there for those who have taken it on,” Del Campo said. “They shouldn’t have to face it alone.”
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