A receding hairline usually is the first sign of hair loss
The slow balding that affects most men with advancing age is called pattern hair loss or, in clinical terms, androgenic alopecia. It’s an inherited disease that affects 50 percent of men, typically after they’ve turned 40, and even 80 percent of Caucasian men. Some 95 percent of all the hair loss observed in men of varying ages is caused by this hereditary pattern baldness.
It’s a very gradual process that will take many years and decades to make you completely bald, if you don’t do anything about it. Since it’s not accompanied by an itchy scalp or pain, pattern hair loss at first isn’t easy to notice unless you pay attention. The earlier you observe abnormal hair loss and see a doctor, the quicker you can do something about it, i.e., start protecting your hair.
The place to start looking is your hairline above the forehead. Usually pattern baldness will start its work at the temples, leaving the hair in between untouched for now. As the temples go bald, the hair in between will start looking like a protruding triangle. This looks like the lower tip of the letter V, and hence is called a V-shape hairline. Some doctors refer to it as an M shape, where the two outer legs of the M are the hair on both sides of your head.
An occasional look in the mirror won’t do; you’ll need to be more systematic about it. The best method is take a photo of your hairline right after a haircut and take a photo again under the exact same conditions — after haircut, same place, same lighting, same angle — in three to six months’ time. This way you can monitor your hair and within about a year would see whether the hairline receded.
Watch out for hair thinning across the entire scalp
Male pattern baldness almost always starts at the hairline, but in rare cases can affect the entire scalp, which results in a general thinning of your hair. Taking and comparing pictures of the crown of your head, similar to photographing the hairline, can be one way to track the overall thickness of your hair. But it will be more difficult to tell differences.
If you notice a general hair thinning that develops fast, that is within half a year, the root cause probably is not male pattern hair loss but stress or nutrition related. A lack of vitamins and other nutrients, chronic sleep problems, certain medical treatment and other external factors can cause the body to suddenly lose hair. Fortunately and in contrast with pattern baldness, this sort of short-term hair loss will be reverted when the underlying stress cause goes away.
Excessive amounts of hair in towel and brush
We typically lose 50-150 strands of hair a day, depending on age, gender, ethnicity, climate and other external factors. Even when you lose more than 150 for several weeks, this isn’t necessarily a reason to be concerned, as it may be triggered by short-term stress to your body like the one described in the section above. In this case your hair will recover on its own.
We normally don’t (and can’t) count the hair we lose throughout the day. It’s only when we look in the shower pan, brush or towel that we consciously perceive hair loss. We may become easily alarmed by large amounts of hair in towel or brush. However, many of the hair you see there probably loosened hours earlier — perhaps even a day earlier if you don’t wash your hair frequently or use gluey hair gels. So, it’s not like all that hair just fell out during showering or brushing, but instead it represents a good part of the day or night.
Of course, if the number of hair strands you recover from a towel or brush in one go exceeds the 150 limit for several days or weeks, your hair loss is abnormally fast and you’ll need to see a doctor to find the underlying cause.
This sort of fast-paced hair loss is likely to be stress related and not male pattern hair loss, since the latter proceeds slowly and doesn’t cause sudden changes in the towel and brush hair count.
What to do next?
Well, it’s time to see a dermatologist. He or she will be able to tell you whether you suffer from hair loss and what condition is causing it. At first, the dermatologist will examine the appearance of the hair loss, whether it’s concentrated in one area or diffuse. A pull test can be done to check whether it is stress related balding or pattern hair loss. This works on the premise that with pattern hair loss hair at the hairline will loosen much more easily than elsewhere on the head. Subsequently, a blood test may also be necessary.
If you are diagnosed with male pattern hair loss, your doctor will work with you to set up a treatment plan and discuss different medications.
In the United States, the most popular medication for male pattern baldness is finasteride, which is one out of only two drugs approved for hair loss treatment by the FDA and it’s taken orally. It has a long successful record of treating male pattern baldness and only moderate side effects. The second FDA approved drug is minoxidil, which is available as spray and liquid and applied on the hair. Minoxidil doesn’t stop balding but it accelerates hair growth. Both drugs can be taken together. Speak to your doctor to learn more about the two drugs and whether they could help you.
- Mounsey, Anne, and Sean W Reed. “Diagnosing and Treating Hair Loss.” American Family Physician, vol. 80, no. 4, 2009, pp. 356–362, www.aafp.org/afp/2009/0815/p356.html. Accessed 29 Nov. 2019.
- Cranwell, William, and Rodney Sinclair. “Male Androgenetic Alopecia.” Nih.Gov, MDText.com, Inc., 29 Feb. 2016, www.ncbi.nlm.nih.gov/books/NBK278957/.
- Chandrashekar, BS, et al. “Topical Minoxidil Fortified with Finasteride: An Account of Maintenance of Hair Density after Replacing Oral Finasteride.” Indian Dermatology Online Journal, vol. 6, no. 1, 2015, p. 17, www.ncbi.nlm.nih.gov/pmc/articles/PMC4314881/, https://doi.org/10.4103/2229-5178.148925. Accessed 29 Nov. 2019.