Causes

Male pattern baldness is related to your genes and male sex hormones. It usually follows a pattern of receding hairline and hair thinning on the crown, and is caused by hormones and genetic predisposition.

Each strand of hair you have sits in a tiny hole (cavity) in the skin called a follicle. Baldness in general occurs when the hair follicle shrinks over time, resulting in shorter and finer hair. Eventually, the follicle does not grow a new hair. However, the follicles remain alive, which suggest that it's possible to grow new hair.

Symptoms

The typical pattern of male baldness begins at the hairline. The hairline gradually moves backward (recedes) and forms an "M" shape. Eventually the hair becomes finer, shorter, and thinner, and creates a U-shaped (or horseshoe) pattern of hair around the sides of the head.

Exams and Tests

Classic male pattern baldness is usually diagnosed based on the appearance and pattern of the hair loss.

It is important to note that hair loss may be due to other conditions. This may be true if your hair loss occurs in patches, you shed a lot of hair, your hair breaks, or you have hair loss along with redness, scaling, or pain.

A skin biopsy or other procedures may be needed to diagnose other disorders that cause hair loss.

Hair analysis is not accurate for diagnosing hair loss due to nutritional or similar disorders. However, it may reveal substances such as arsenic or lead.

Treatment

Treatment is not necessary if you are comfortable with your appearance. Hair weaving, hairpieces, or change of hairstyle may disguise the hair loss. This is usually the least expensive and safest approach for male baldness.

Two medications are approved to treat male pattern baldness:

• Minoxidil (Rogaine) is a solution that you apply directly to the scalp to stimulate the hair follicles. It slows hair loss for many men, and some men grow new hair. Hair loss returns when you stop using this medicine.
• Finasteride (Propecia, Proscar) is a pill that interferes with the production of a certain male hormone linked to baldness. It slows hair loss. It works a bit better than minoxidil. Hair loss returns when you stop using this medicine.

Hair transplants consist of removing tiny plugs of hair from areas where the hair is continuing to grow and placing them in areas that are balding. This can cause minor scarring and possibly, infection. The procedure usually requires multiple sessions and may be expensive. Results, however, are often excellent and permanent.

Suturing hair pieces to the scalp is not recommended. It can result in scars, infections, and abscess of the scalp. The use of hair implants made of artificial fibers was banned by the FDA because of the high rate of infection.

Outlook (Prognosis)

Male pattern baldness does not indicate a medical disorder, but it may affect self-esteem or cause anxiety. The hair loss is usually permanent.

Possible Complications

• Psychological stress
• Loss of self-esteem due to change in appearance

When to Contact a Medical Professional

Call your doctor if:

• Your hair loss occurs in an atypical pattern, including rapid hair loss, widespread shedding, hair loss in patches, or hair breakage.
• Your hair loss occurs with itching, skin irritation, redness, scaling, pain, or other symptoms.
• Your hair loss begins after starting a medication.
• You want to attempt to treat your hair loss.

Alternative Names

Alopecia in men; Baldness - male; Hair loss in men; Androgenetic alopecia

References

Habif TP. Clinical Dermatology. 5th ed. St. Louis, Mo: Mosby; 2009.

Update Date: 5/13/2012

Reviewed by: Kevin Berman, MD, PhD, Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.