Male hair loss is one of those things that gets discussed constantly and explained poorly. The standard account is 'it's genetic, there's nothing you can do'. The other extreme is an industry full of products promising regrowth they can't deliver.
The reality is somewhere in between and worth understanding clearly, especially if you're thinking about your options.
The main cause: androgenetic alopecia
The vast majority of male hair loss is androgenetic alopecia, commonly called male pattern baldness. About 50% of men experience some degree of it by age 50, and around 85% are affected by age 70.
The mechanism involves a hormone called dihydrotestosterone (DHT), which is converted from testosterone by an enzyme called 5-alpha reductase. In men who are genetically sensitive to DHT, this hormone causes hair follicles to shrink over time. Each cycle of hair growth becomes shorter, the hairs produced get finer, and eventually the follicle stops producing visible hair.
The sensitivity is genetic, but it comes from both sides of the family. The old idea that it only comes from your mother's father is a myth. The inheritance pattern is complex and doesn't follow a simple rule.
The Norwood scale
Male pattern hair loss follows predictable patterns, which is why the Norwood-Hamilton scale exists. It maps hair loss across seven stages from a full head of hair to significant recession at the temples through to a horseshoe pattern of remaining hair at the sides and back.
Specialists use this scale to describe where someone's hair loss currently sits and, to some degree, predict where it might go. This matters for transplant planning because a good specialist plans not just for where your hair is now, but for where it's likely to be in ten years.
What makes it worse (and what doesn't)
If you're genetically predisposed to hair loss, certain things can accelerate it. A few that have actual evidence behind them:
- Chronic stress: significant, sustained stress can push hair follicles into the shedding phase earlier than they'd normally go. Stress-related shedding (telogen effluvium) is usually temporary, but it can accelerate underlying pattern loss.
- Nutritional deficiencies: low iron, low ferritin, or significant deficiency in vitamins like D and B12 can affect hair growth. These are worth checking if your hair loss seems faster than expected.
- Scalp inflammation: chronic dandruff or seborrheic dermatitis doesn't cause pattern baldness but can worsen the scalp environment and contribute to shedding.
- Certain medications: some drugs, including some prescribed for blood pressure, gout, and depression, list hair loss as a side effect. Worth checking if loss began around the time you started a new medication.
Hats, tight ponytails (for men with longer hair), and poor circulation don't cause pattern baldness. These are persistent myths worth discarding.
The non-surgical options
Two medications have genuine evidence behind them for slowing or partially reversing androgenetic alopecia.
Minoxidil (Rogaine) is applied topically and works by prolonging the growth phase of hair follicles. It's available without a prescription and works for many people, though results vary and it requires consistent, ongoing use. There's now also an oral version, which some studies suggest is more effective for some people.
Finasteride (Propecia) is taken orally and works by blocking the conversion of testosterone to DHT. It's effective at slowing progression and can produce some regrowth. It requires a prescription and has known potential side effects that are worth discussing with a doctor, including effects on sexual function that most men don't experience but some do.
PRP (platelet-rich plasma) therapy is another non-surgical option that some specialists offer. It's less well established in the evidence than minoxidil or finasteride, but some people respond well to it. It works by injecting concentrated growth factors from your own blood into the scalp.
When does a hair transplant make sense?
Medications can slow the process and, in some cases, modestly reverse it. They don't restore hair to areas where the follicles have already shut down. For significant thinning or recession where non-surgical options aren't enough, a hair transplant is the only reliable way to add density back to those areas.
The transplanted follicles come from the back and sides of the scalp, where hair is genetically resistant to DHT. Because they keep that resistance when they're moved, the transplanted hair tends to be permanent.
Timing matters. Most specialists prefer to treat people whose hair loss is relatively stable rather than still actively progressing, so the plan accounts for future loss properly.
What to do with this
If you're noticing hair loss and wondering what to do, the first and most useful step is a proper assessment. A specialist can look at your pattern, your donor area, and your history and give you a clear picture of where you are, where you're likely to go, and what the options are for your situation.
For Surrey residents and people across Metro Vancouver, that's exactly what a consultation through our service provides. No obligation, just a real conversation with a qualified specialist.