What is male pattern baldness?

Male pattern baldness, also known as androgenetic alopecia, is a hereditary condition that accounts for 95 percent of hair loss in men, according to the American Hair loss Association. It converts the hormone testosterone into dihydrotestosterone (DHT) which in turn weakens hair follicles, causing them to slow or even stop the production of hair.

It is called male ‘pattern’ baldness as it usually occurs in predictable patterns, most commonly a thinning at the crown on the back of the head, receding hairline from the front pushing the hairline back, or both.

What it’s like to have male pattern baldness

Although most of the time baldness comes later in a man’s life, it can occur earlier if an individual has the genetic predisposition. “I think I probably first appreciated that I was balding when I was 18,” says James, 29, from London. “I was definitely scared of it and self-conscious. I was growing hair a bit longer to cover up the balding. I was worried about finding out what my head actually looked like without the hair.”

John, who is also 29, noticed he was losing his hair at a similar age. “I remember being in my first year at uni and noticing my hairline looking really high, while wondering if the number of hairs I found on my pillow every morning was normal.” Experiencing hair loss at a younger age can, of course, be anxiety inducing, given it is less common. “I don't think it was really noticeable to others until I was 21-22,” John adds. “But by that point, trying to ‘fix’ my hair loss was an obsession for me.”

Coming to terms with hair loss is a serious matter, it’s not just about appearances but because of the association between hair loss and ageing, it can lead to this idea of being confronted with your own mortality. “I was genuinely convinced my life was over,” John said. “I would say it was the main factor in a period of depression and anxiety that I experienced in my early twenties. Reflecting on it now, I think the loss of control affected me very deeply.”

For James, he said he would worry about what he’d look like without hair, but he didn’t seek any treatments. Luckily he was able to come to terms with his hair loss during the first coronavirus lockdown in 2020. “After I shaved my hair off for the first time during the first lockdown I hardly worried about it again.”

John similarly took solace in taking back some control and choosing to shed what was left of his hair: “I know you won't believe me and your mind will make up a whole bunch of reasons why this won't work for you, but shave it off. Truly, my only regret is the amount of time I spent worrying about my hair loss.”

Baldness and dating

Because of the pervading negative stereotypes in society, one of the main reasons men tend to worry about going thin on top is how it might affect the way they are perceived by romantic partners. A lot of the time, men in the public eye tend to present with lush heads of hair – actors, footballers, influencers etc – which can leave men feeling like they have to live up to unrealistic beauty standards in order to be considered sexually desirable.

“I was quite convinced nobody would ever find me attractive again,” said John. “I couldn't imagine my life or identity as a bald man. It just didn't seem like ‘me’. At the time I felt like my attractiveness was much more about being ‘cute’ than being masculine, so the prospect of baldness was utterly incomprehensible. I remember people saying to me that some women like bald guys but I just kind of thought that would be so rare that I would never meet a woman like that.”

Luckily for John, his worst fears were allayed when he decided to reach for the razor. “It's bizarre how quickly the problem was genuinely, completely and utterly fixed by shaving all of my remaining hair off,” he says. “It's rare to have a problem in life that resolves itself overnight. It felt huge at the time, shaving it all off. I honestly planned how I would ‘come out’ to friends & family and what I would say to people I hadn't seen for a while. Obviously nobody gave a shit haha. I had instant positive feedback on my new look and I just never looked back. On the dating and relationships side, the years I've been bald have been way better than when I had hair!”

Treatments

There are a dizzying array of treatments for male baldness, from pills, creams and gels to wigs, hairpieces, and transplants. One treatment clinic, the Belgravia Centre in London, even offers a laser hairband, which it claims “penetrates the scalp, helping to grow fuller hair”.

“I would say I tried it all,” John admitted. “Pills, oils, supplements, special shampoos. Nothing worked, of course. I would spend hours scouring reviews online and reading about treatment regimens. I found a dodgy GP online who was willing to prescribe men across the UK with finasteride for an extortionate cost, preying on insecure and distressed young men.”

Going for a hair transplant was a step too far for John, due to its prohibitively high costs and the lack of guaranteed long-term success. But this is a route men are taking in increasing numbers. According to the International Society of Hair Restoration Surgery, the hair transplantation market grew by 64 percent from 2014 to 2021 in the US, making it one of the fastest-growing health care specialties.

“Having a hair transplant is an important decision that will affect your appearance for the rest of your life,” says Dr Greg Williams, founder of Farjo, a hair transplant clinic in Manchester. “Patients should beware of cheap clinics, pressure sales tactics, and advertised discounts,” he adds.

“We primarily offer hair transplant surgery at the Farjo Hair Institute, but unlike many clinics in the UK, we offer both the follicular unit extraction (FUE) and the linear strip excision (commonly referred to as strip FUT) donor hair harvesting methods. There are advantages and disadvantages to both techniques which are explained to patients so that they can choose what is best for their individual circumstances.”

Rali Bozhinova, a Trichologist at the Belgravia Centre, believes that the most important thing regarding the treatment of male pattern baldness is to address it as early as possible. This way, “you are more likely to be happy with the outcome” he says. “There are two medically proven treatments for this type of hair loss – minoxidil and finasteride.”

“Minoxidil increases the blood supply, which increases the nutrients delivered to the hair follicles and prevents miniaturisation of the follicles, resulting in the prevention of hair loss and regrowth of the hair in many cases. Finasteride can be used in oral or topical form. It works by inhibiting the 5-alpha reductase enzyme and therefore, significantly reducing the production of dihydrotestosterone.”

It is important to note here that official NHS advice states that the use of Minoxidil and Finasteride, while the main treatments for MPB, “do not work for everyone, only work for as long as they are used,” and “can be expensive.”

Further resources and help

When it comes to male pattern baldness it can be hard to cut through the noise online. If you are considering getting treatment, please read the official NHS advice regarding MPB and consult a GP before deciding to undergo any treatment.