Let’s admit it: as good as all the hair on your head may look, it’s of little actual use for your health and survival, other than providing a little insulation and shading — a job any hat can do nowadays. Yes, research has shown that hair does matter for mating purposes, i.e., that it signals the potential for healthy offspring to females. However, as a man grows older and past his reproductive prime (male fertility usually starts declining in the early 40s), the body doesn’t have much real use for hair anymore.
That we try to stop the natural course of events and some men even can get depressed about hair loss reflects current cultural norms and aesthetic values. There were periods in history and other cultures were bald heads were considered chic and desirable. Even today in mainstream Western culture the perceived attractiveness of baldness is much better when it was three or four decades ago. It may also console you that a 2012 study found that men with bald or shaved heads are seen as more dominant and powerful by others.
Some 20 percent of Caucasian men escape the fate of baldness, but the other 80 percent will start losing hair sometime after the age of 40, often even earlier. This hair loss is genetically hardwired and known as male pattern hair loss (androgenic alopecia). For African Americans, Latinos or Asians the ratios are closer to 50:50.
Almost 95 percent of all hair loss observed in men older than forty can be attributed to androgenic alopecia. The chemistry at work is a hormonal conversion process where testosterone is changed into dihydrotestosterone (DHT). The hair follicles of the scalp are an important manufacturing site of DHT. Men with pattern hair loss produce too much DHT, which damages the follicles and reduces their size. This so-called follicle miniaturization then causes the follicle to shed hair and prevents it from growing new hair.
Pattern hair loss begins at the frontal hairline, i.e., right above your forehead and typically first at the temples. This is why pattern hair loss in its initial stage has a distinct V shape — balding temples while the hair in the middle remains intact and sticks out like the lower tip of the letter V.
Pattern hair loss will take many years to advance across your vertex and normally doesn’t entail any pain or itching. So, at first it’s difficult to notice pattern hair loss, at least until the V shape starts becoming visible. If you are concerned about pattern hair loss and want to notice early signs, regularly take pictures of your hairline after a haircut and compare them.
Even though androgenic alopecia is inherited, not every man who had bald ancestors will definitely go bald himself. Research efforts are still ongoing as to why this is the case.
If you want to overcome your genes though, there are drugs available that can stop the pattern hair loss and in some cases even trigger new hair growth. In the United States, finasteride tablets and minoxidil (a topical medication that comes as spray and liquid) are the two U.S. FDA approved drugs that fight androgenic alopecia and kindle new hair growth. Both are well-tolerated and can be taken at the same time as complementary drugs. Talk to your doctor to check whether finasteride and minoxidil could be options for you if you suffer from or suspect male pattern hair loss.
If you have androgenic alopecia, try to avoid chronic psychological stress, such as anxiety or excessive work pressure. This is because long-term stress can raise the body’s cortisol levels, which disrupts hair follicle regeneration and hair growth and thereby worsens effects of pattern hair loss.
One form of hair loss that is much rarer than pattern hair loss is alopecia areata. It afflicts around 2 percent of men in the United States and develops much faster than pattern hair loss. Random circular areas of the scalp lose hair and go bald (hence the name alopecia “areata”). These circles can be 2 inches or larger in diameter. The underlying trigger is an autoimmune disorder in which the body’s defense mechanisms attack and damage the scalp’s hair follicles.
There’s no consensus yet in the science community on how this disorder precisely works, but the general belief is that it can be triggered by sudden shocks, like the sudden death of a loved one or a major illness.
So far there is no medication that can reverse alopecia areata. Fortunately, for 34–50 percent of patients their hair will eventually fully regrow.
When your body experiences physiological stress it goes into a defensive mode and stops providing nutrition for non-essential body parts like nails and hair. This sort of stress includes prolonged illness, chronic sleep deprivation, and bad diet habits, such as insufficient protein or Vitamin D intake, lack of iron and/or other vitamins and minerals. If this stress lasts for several weeks or months, your hair will start thinning. This condition is called telogen effluvium and it can affect all age groups.
The chief difference from pattern hair loss is that you’ll lose hair relatively evenly across the entire scalp, not just at the hairline. This is why doctors often do a pull test to differentiate between pattern baldness and stress-related telogen effluvium. With the latter, pulling individual hairs from the scalp will take the same effort no matter where on the scalp the hair is pulled. In contrast, when a patient is suffering from pattern hair loss, hair on the hairline will come off much easier than elsewhere on the scalp.
Exposure to chemical pollution, radiation and medical treatments (like chemotherapy) can also be stress factors that lead to acute hair loss.
The good news about telogen effluvium is that it will last only as long as the underlying stress causes. So, once you improve your dietary habits, get healthy sleep or recover from illness, your hair will start regrowing fairly fast. You can also talk to your doctor to learn more about diet recommendations and supplements that could aid your hair’s recovery.