Hair Loss in Men

Some men never go "bald" but everyone’s hair thins out over the years. Despite much research, there’s still only a little that men can do to slow down or reverse hair loss.

I’m referring to garden-variety "male-pattern baldness." The medical term for that is "androgenetic alopecia," which means hair loss that you get when you have male hormones and a hereditary tendency to lose hair.

One myth is that you inherit baldness through your mother’s male relatives. Actually, baldness can come from either side of the family, or both. Looking at your family can give you at best, an educated guess about how you’ll turn out.

More myths: Longer hair puts a strain on roots. Wrong. And hats choke off the circulation to the scalp causing hair loss. Nope, wrong again.

Once you think you’re thinning, it’s worth a check to be sure. Even men who never lose much hair develop some receding at both temples during adolescence. Boy’s hairlines are straight across; adult men have more of an "M"-shape.

Many conditioners, shampoos, vitamins, and other products claim to help hair grow in some unspecified way. These are harmless but useless. To slow down hair loss, you have two options:

  • Minoxidil (brand name: Rogaine): This topical application is over-the-counter, no prescription is required. It works best on the crown, less on the frontal region. Available as a 2% solution, Rogaine may grow a little hair, but is better at holding onto what’s still there. There are few side effects with Rogaine. The main problem with this treatment is the need to keep applying it twice a day, and most men get tired of it after awhile. This drug also comes in a higher strength, 5%, which may be a tad more effective, but is certainly much more expensive.
  • Finasteride (brand name: Propecia): This is a lower-dose version of a drug that shrinks prostates in middle-aged men. Propecia is by prescription and is taken once a day. Propecia seems to do a nice job of retaining hair, however, it may also grow or thicken hair a little. It’s therefore the best treatment for men who still have enough hair to retain. One of the side effects is impotence, but it is uncommon and generally reversible. Taking Propecia once a day is easier that applying minoxidil, but the prospect of taking a pill daily for years doesn’t sit well with some men. There’s also the cost, about $50/month.

Stopping either Rogaine or Propecia puts you back where you would have been without them, but not worse off (except maybe financially).

There are various ways to camouflage hair that’s already gone. These include hairpieces ("rugs") or hair-weaving processes. Toupees require tape or other ways to keep the rug from sliding off, and they also stretch and oxidize. Hair weaves loosen and need periodic restyling.

There are surgical procedures like hair transplants, which have improved over the years, bringing better, more natural results. Transplant surgeons do their best to use hair, which isn’t programmed to fall out later. Taking Propecia after a transplant also helps in retaining hair.

Finally, there is fatalism. Some bald men console themselves with adages like, "Grass doesn’t grow on a busy street." That’s fine, if it works for you.

Medical Author: Alan Rockoff, MD