Reviewed by Vicky Davis, FNP
Written by Julianne
As men age, it is common for their hair to become thinner and more sparse. But what if it’s falling out altogether? That can be a total blow to your confidence.
In this article, we’ll take a comprehensive look at hereditary hair loss. We’ll dive into the symptoms, causes, telltale signs, and treatment options for baldness. Because that’s why you’re here, right?
Hereditary hair loss, or Male Androgenetic Alopecia (MAA), is a common form of hair loss affecting 30 percent to 50 percent of men by the age of fifty. In fact, MAA is the most common and prevalent form of hair loss in men.
Based on your heritage, there may be some surprising differences in the timing and occurrence of male pattern baldness. According to research, alopecia has been reported to be more common in Caucasian men than in any other ethnicity or nationality.
Black, Asian, Native American, and African-American men are more likely to preserve their front hairlines. These populations also experience less extensive and late-onset baldness overall than Caucasian men. Chinese men are reported to have a lower incidence of male pattern baldness than any other population. In Japanese men, the onset of androgenic alopecia occurs a full decade later than in Caucasian men.
Male pattern baldness typically begins with a thinning or receding hairline. As time goes on, male pattern baldness happens in a very predictable pattern, with seven stages.
The most popular baldness scale is called the Norwood scale. While there are other baldness scales out there, the Norwood scale is the one typically used to help men and healthcare providers assess the level of hair loss.
Stages I and II: Hair loss starts slowly and consists of a slightly receding hairline without major changes to the crown of the head. Stage I begins with light thinning around the temples and a slight hairline recession that often goes unnoticed or ignored. Stage II is marked by balding near the temples, which has moved further inward, creating the “M” shaped hairline that is commonly seen.
Stage III: Recession in the temple area continues to grow to the point that there’s little or no hair in the temporal regions. At this stage, it becomes more difficult to conceal your hair loss.
Stage IV: By the time you reach this stage, you will start to develop noticeable bald spots. The hair on your crown will thin out and you may start losing large patches of hair in the front of your head.
Stage V: This stage marks the beginnings of the horseshoe-shaped hairline. By this point, your hair loss is entering a severe stage and is difficult to treat with medications.
Stage VI: At this stage, your hairline is now on the top of your head. What little hair remains on your crown is thin and provides minimal coverage of your scalp.
Stage VII: This is the classic horseshoe or cul-de-sac pattern which leaves the top of the head completely bald. Unfortunately, if you make it all the way to this stage without taking any form of action, your chances of recovering your hair are slim.
Read more about the stages of hair loss in this blog post.
Genetics and hormones both play a role in male pattern baldness.
According to research conducted on twins, genetics accounted for around 80 percent of the predisposition to baldness. This is due to genetic factors predisposing the response of the follicle to androgens in the body.
Men with a strong predisposition may go bald in their teenage years, while men with a weak predisposition may not go bald until they are in their 60s or seventies. Overall, fewer than 15 percent of men have little or no baldness by the age of seventy.
In men, a gene test can predict the chances for MAA. This test reports the presence or absence of a specific variation in the androgen receptor (AR) gene found on the X chromosome. This variation causes changes in the follicle’s response to dihydrotestosterone (DHT), resulting in changes in the hair growth cycle.
A positive test result indicates a 70 percent chance of developing MAA—whereas a negative test result indicates a 70 percent chance of not developing MAA.
A study that assessed different hormonal levels in MAA measured elevated levels of cortisol and androstenedione in those experiencing MAA. Further, this study suggested a broad range of hormones may influence androgenetic alopecia.
If you don’t think you can confidently pull off a bald head like Bruce Willis or The Rock, keep reading for hereditary hair loss treatment options.
Scalp concealers can be a helpful and non-invasive way to camouflage thinning hair. Keep in mind that this is not a permanent solution to this condition, however. Scalp powders and concealers may drip or shed in certain weather conditions or after a workout.
Wigs and toupees are another treatment option. Some toupees are incredibly realistic and are adhered to the scalp with glue. This type of customized toupee can last for months if properly cared for.
“I tried several different options before but Hims combined approach of all four methods by far created the best results.”
“Hims has been the greatest confidence boost, no more bald jokes! I look and feel so much younger!”
“When I show my barber my progress, he is always in disbelief. I have to recommend Hims to any guy who’s experiencing thinning.”
“Cost effective and affordable. My hair keeps growing thicker, fuller, and at a fast rate.”
“I noticed a huge change in the overall health and fullness of my hairline.”
“Now after 5 months I’m able to style waves first time in 10 years!”
“I decided to jump right in and I'm so glad I did. I definitely feel ten years younger!”
“In just as little over two and half months, I can really see the difference in thickness and in color.”
“4-months strong and my confidence boosted back up to 100% using Hims, future me really does thank me.”
“I’m a 34-year-old father of two and have been using Hims for over a year now. My hair is back to what it was in my mid-twenties.”
Minoxidil is an FDA-approved topical medication used for a patient with MAA, or male pattern baldness.
The most common side effect of minoxidil on scalps is irritant contact dermatitis. Typical symptoms include itchy and scaly skin.
DHT is the primary hormone responsible for androgenic alopecia. If you’re genetically sensitive to DHT, the small amount of DHT that’s produced by your body can have a serious negative impact on your hair over the long term.
Research shows that finasteride can lower serum DHT levels by more than 70 percent, helping to reduce the effects of DHT on your follicles. It works by inhibiting the production of 5α-Reductase, the enzyme that converts testosterone into DHT within your body.
It typically takes about six months before seeing the results of finasteride on hair growth.
We offer finasteride online, following a consultation with a healthcare provider who will determine if a prescription is appropriate for you.
Hair transplants are a surgical alternative to male pattern baldness. Keep in mind it is a very complex and technical surgery, and can cost thousands of dollars.
The good news is that the results are typically very good and patient satisfaction is high. Side effects of a hair transplant can include infection, epidermal cysts and scarring.
Generic for Rogaine®, this FDA-approved over-the-counter version of topical minoxidil is used for regrowth on the crown of the head.
This is the FDA-approved dynamic duo. When used together, men saw better results in clinical trials compared to using either alone.
If you’re looking for something effective but don’t want too many steps in your routine, this once-a-day pill could be right for you.
Clinically proven to regrow hair in 3-6 months, no pills required.
If male pattern baldness is affecting your self-confidence, there are treatment options available. Speak to your healthcare provider about the hair loss treatment options that may be right for you.
Hims & Hers has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references. See a mistake? Let us know at [email protected]!
Dr. Vicky Davis is a board-certified Family Nurse Practitioner with over 20 years of experience in clinical practice, leadership and education.
Dr. Davis' expertise include direct patient care and many years working in clinical research to bring evidence-based care to patients and their families.
She is also an active member of the American Academy of Nurse Practitioners.