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You lose up to 100 hairs from your scalp every day. That's normal, and in most people, those hairs grow back. But many men -- and some women -- lose hair as they grow older. You can also lose your hair if you have certain diseases, such as thyroid problems, diabetes, or lupus. If you take certain medicines or have chemotherapy for cancer, you may also lose your hair. Other causes are stress, a low protein diet, a family history, or poor nutrition.

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Treatment for hair loss depends on the cause. In some cases, treating the underlying cause will correct the problem. Other treatments include medicines and hair restoration.

Male pattern baldness affects over half of men to some extent over the age of 50 and most men at some stage in their lives. Most affected men do not wish to have any treatment. If required, treatment can usually prevent further hair loss and often cause hair regrowth.

What is male pattern baldness?

Male pattern baldness is the common type of hair loss that develops in most men at some stage. The condition is sometimes called androgenetic alopecia. It usually takes 15-25 years to go bald. However, some men go bald in fewer than five years.

Typically, at first the hair begins to thin (recede) at the sides (temples). At the same time, the hair usually becomes thin on the top of the head. A bald patch gradually develops in the middle of the scalp. The receding sides and the bald patch on the top (the crown) gradually enlarge and join together, leaving a patch at the front. The patch at the front eventually thins as well.

A rim of hair is often left around the back and sides of the scalp. In some men, this rim of hair also thins and goes to leave a completely bald scalp.

Who gets male pattern baldness?

Nearly all men have some baldness by the time they are in their 60s. However, the age the hair loss starts is variable. About three in ten 30 year-olds and half of 50 year-olds are quite bald. Some women also develop a similar type of hair loss, mainly at the crown. Baldness in women is much more common after the menopause. About 13 in a 100 women have some baldness before the menopause, rising to 75 in a 100 over the age of 65.

What causes male pattern baldness?

Hair is made in hair follicles which are like tiny pouches just under the skin surface. A hair normally grows from each follicle for about three years. It is then shed and a new hair grows from the follicle. This cycle of hair growth, shedding and new growth goes on throughout life. The following is thought to occur in men as they gradually become bald:

Affected hair follicles on the scalp gradually become smaller than normal.

As the follicle shrinks, each new hair is thinner than the previous one.

Before falling out, each new hair grows for much less time than the normal three years or so.

Eventually, all that remains is a much smaller hair follicle and a thin stump of hair that does not grow out to the skin surface.

Male hormones are involved in causing these changes. The level of the main male hormone, testosterone, is normal in men with baldness. Hair follicles convert testosterone into another hormone called dihydrotestosterone. For reasons that are not clear, affected hair follicles become more sensitive to dihydrotestosterone, which causes the hair follicles to shrink. It is also not clear why different hair follicles are affected at different times to make the balding process gradual.

The condition is hereditary (genetic); the location of the gene was identified in 2008.

It is also not clear why only scalp hairs are affected and not other areas such as the beard or armpits.

Are there any complications from male pattern baldness?

Although male pattern baldness is a common and harmless condition, it can be linked to metabolic syndrome (the combination of obesity, diabetes, raised blood pressure and raised choleterol), resulting in an increased risk of heart disease. This link is most often seen in men who develop baldness at a relatively young age.

Women with male pattern baldness should be checked for causes of raised male hormone levels, such as polycystic ovary syndrome (a condition in which cysts develop in the ovaries).

What are the treatment options for male pattern baldness?

No treatment

To become gradually bald is a normal part of the ageing process for most men. No treatment is wanted or needed by most affected men. For some men, baldness can be distressing, particularly if it is excessive or occurs early in life.

Treatment may then help.

Medication

Currently there are two medicines that help - finasteride (trade name Propecia®) and minoxidil (trade name Regaine®). Neither is available on the NHS, so you need to pay the full price for them.

Finasteride was launched in the UK in 2002, although it has been available in the USA since 1997. It works by blocking the conversion of testosterone to dihydrotestosterone. The hair follicles are then not affected by this hormone and can enlarge back to normal.

Some hair regrowth occurs in about 2 in 3 men who take a finasteride tablet each day. In about 1 in 3 men there is no hair regrowth but most do not have any further hair loss whilst taking finasteride. It has no effect in about 1 in 100 men. So, if you take finasteride, you have a good chance that hair will regrow, or at least stop any further hair loss.

Some points about finasteride include the following:

It takes about four months for any effect to be noticed and up to 1-2 years for full hair growth.

The balding process returns if treatment is stopped. Therefore, if successful, you need to carry on treatment to maintain the effect.

Side-effects are uncommon. The most common is that about 2 in 100 treated men report loss of sex drive (libido).

It does not work in women with male pattern baldness.

You need a private prescription to get it from a pharmacy.

Minoxidil lotion is a rub-on treatment that you can buy at pharmacies without a prescription. It is not clear how it works. The higher-strength solution (5%) is for men only and is more effective than the 2% solution. The 5% strength is now also available as a foam.

There is debate as to how effective it is. Probably about half of men who use minoxidil delay further balding. About 15 in 100 users have good hair regrowth. There is continued hair loss in about a third of users. However, some reports claim much higher success rates. It seems that it is best used to prevent further hair loss but hair regrowth occurs in some users.

Some points about minoxidil include the following:

It needs to be rubbed on the scalp every day.

It usually takes four months or more for any effect to be noticed.

Treatment needs to be continued indefinitely. Any new hair that does regrow falls out two months after treatment is stopped.

It is quite expensive.

It may work in some women who have male pattern baldness.

Side-effects are uncommon - for example, skin irritation or a rash sometimes occurs.

Wigs

A wig is the traditional option for baldness.

Scalp surgery

Techniques such as hair transplantation, scalp flaps and other procedures have been used for a number of years. Success rates vary and an opinion from a doctor who is a specialist is needed if surgery is considered. It is expensive and not available on the NHS.