The list of factors that can cause male baldness is long and varied.
Ageing, genetics, hormones and autoimmune disease are the most well known. Then there’s vitamin deficiency, obesity, stress, thyroid issues, cancer treatments and alopecia. But hereditary hair loss, usually exacerbated by age, is the most common.
Throw poor lifestyle choices and stress into the mix and it follows that receding hairlines and/or bald spots are on the rise. As the American Hair Loss Association notes, by the age of 35, approximately 66 per cent of men will have some degree of hair loss.
Bald facts
“Male-pattern baldness, also known as androgenetic alopecia, is the most common cause of hair loss in men,” says Dr Rana Abdul Kadiru, a dermatology specialist at Aster Hospital, Al Qusais. “It’s primarily caused by a combination of genetic predisposition and hormonal factors.
“The hair follicles in certain areas of the scalp are sensitive to dihydrotestosterone, a hormone derived from testosterone. Over time, exposure to dht causes the hair follicles to shrink and produce thinner, shorter hair until, eventually, they stop producing hair altogether. This typically results in a receding hairline or thinning at the crown.”
Many myths exist, including that female hair loss is passed down through the male side of the family and male hair loss comes from the female side. However, evidence suggests hair loss comes from both sides.
It is also not a given that if a man's father is bald, he will be too. Baldness can skip generations and can also affect siblings in different ways.
“The first signs of male-pattern baldness can include a receding hairline where the hairline at the temples starts to move further back,” says Dr Kadiru.” Another common sign is thinning hair at the crown or vertex of the scalp, which may eventually lead to baldness in that area.”
Dr Kadiru says other things to look out for include increased hair shedding when showering and washing or brushing hair, and hair follicles producing finer, shorter hair. Balding men, she adds, may experience patchy spots, with the skin becoming itchy before hair fall occurs.
Balding can start as early as late teenage years, but there are treatment options available for those who wish to hang on to their hair.
Medication for hair loss: Foams and pills
Medicated treatments for men looking to slow early signs of baldness are divided into over-the-counter and prescription-only options.
The most well-known over-the-counter treatment is minoxidil, commonly known by its brand name Rogaine or Regaine. Available in shampoo, liquid and foam forms, it is applied to the scalp skin twice daily. It can take up to six months before results are seen.
“Finasteride (Propecia) and minoxidil (Rogaine) are the two FDA-approved medications for treating male-pattern baldness,” says Dr Kadiru. “Finasteride works by blocking the conversion of testosterone into dht, while minoxidil is a topical solution that stimulates hair growth.”
Finasteride, which is sold under the brand name of Propecia, can be obtained via a doctor’s prescription and taken daily in pill form. It works to slow down hair loss and users may also experience new growth after a few months.
“Topical minoxidil 5 per cent in a solution or foam is safe and effective when applied twice daily,” says Melissa Piliang, MD, a dermatologist and chairperson of the Department of Dermatology at Cleveland Clinic. “However, many patients find it is not cosmetically elegant or the twice-daily applications are too much.
“Oral finasteride is a once-daily pill that is effective and generally well-tolerated. There is a risk of sexual side effects, and although it is an uncommon side effect, it can be very distressing for patients and has been reported to be permanent in a subset of affected patients.”
Hair transplant: Should you fut or fue?
For those wishing to opt for surgical intervention, a hair transplant offers the chance to create a thicker head of hair using existing follicles. First performed in New York in 1952 by dermatologist Dr Norman Orentreich, the process has evolved over the decades.
“There are two main transplant surgeries: follicular unit transplantation, or fut, and follicular unit extraction, or fue” explains Dr Dimitrios Ziakas, hair transplant surgeon at Dubai’s Alborj Hair Clinic.
“Fut is the older method, whereby a piece of skin with the hair follicles is surgically extracted from the back of the head of the patient. In the newer fue, hair follicles are extracted one by one with placement of the follicles done either with handmade incisions or with the direct hair implantation method.
“With fut, there are stitches and the possibility of a big scar, but usually more hairs can be extracted in one session. With fue, extracting a large amount of hairs requires the patient’s head to be shaved very short.”
The fue process, during which between 3,000 and 4,000 hairs are extracted and placed, can take six to eight hours. Recovery is quick with marks and scabbing gone after about seven days. The cost starts at Dh10,000 in the UAE.
Dr Ziakas says not all men are suitable candidates for a hair transplant, as it depends on the amount and quality of hair they have around the nape of the neck. Hair that is thicker and coarser produces better results, he explains, while wavy hair offers a denser appearance than straight hair.
“Most of my patients cite confidence as the main reason behind their hair transplant decision,” add Dr Ziakas. “Restoring the hairline usually leads to a younger look and increases the self-confidence of the patient. There are also patients who want to cover birthmarks or scars from accidents.”
Light therapy, vitamins and quitting smoking
While most baldness is caused by genetics, experts say there are steps that can be taken to minimise hair loss on a daily basis. Gentle brushing and detangling for longer hair, especially when wet will help prevent breakage and loss.
Experts also recommend avoiding heat as much as possible, including hot-oil treatments. A hat can be worn to protect hair from heat and ultraviolet light.
“Laser lights use infrared, not UV light, to stimulate hair growth,” says Dr Piliang. “They are used three to five times a week depending on the product and studies have shown good efficacy. Because the laser is in the infrared range, these devices do not increase the risk of skin cancer.”
Some studies have shown links between smoking and hair loss in men. A February 2024 study published in the Journal of Cosmetic Dermatology found that men who are former or current smokers, and who smoke at least 10 cigarettes per day, were significantly more likely to develop androgenetic alopecia compared to those who don’t smoke.
There are also interventions available, which are positioned between non-invasive medications and more invasive hair transplants, including microneedling and platelet-rich plasma treatment.
“PRP treatment requires blood to be taken,” says Dr Piliang. “It is then processed to allow for the collection of the platelet-rich plasma that is then injected into the scalp. Treatments are every one to six months and studies show efficacy in male-pattern hair loss. There are many systems and techniques available, with some more expensive than others. In my experience, combining therapies leads to better efficacy.”
Dr Kadiru adds: “Mesotherapy, which involves injecting a combination of vitamins, minerals and other nutrients into the scalp, can also be used in conjunction with PRP to enhance its effectiveness.”
Style it out at the barber
Those experiencing hair loss who don’t wish to undergo treatments may opt to cover balding spots with products that contain hair-building fibres, or shave their hair short.
“Going short can be a tricky one to get right as the overall style has to not only suit the individual, but also not look too obvious or over-styled to cover up the thinning hair,” says Sam Carpenter, hair artist and educator at Eideal.
“Personally, I like to keep my own recession areas a little longer and the sides short. It creates a modern disconnected feel, and I think it gives a little disguise to the thinning areas.”
There are also an array of shampoos on the market that may help. Ingredients such as ketoconazole, zinc pyrithione and stemoxydine are all backed by individual studies to help thicken the appearance of hair and reduce shedding.
Carpenter suggests rosemary oil shampoo for those seeking natural remedies and says that it may, for some, be as effective as minoxidil.
“If hair loss gets to the point where you cannot hide it, there are two options,” says Carpenter. “One, let it go completely, super-short or skinned. Both are seriously cool, think Jason Statham or Dwayne Johnson. Or if you’re not ready to let it go, consider a transplant.”
Dr Kadiru notes that the psychological implications of male hair loss can vary greatly from person to person. “Hair loss can impact how men perceive themselves and how they believe others perceive them,” she says. “Seeking support from a psychologist or counsellor can be helpful for individuals struggling with the psychological effects.”
