Why Men Go Bald and What to Do About It
You Can’t Fight Hair Loss If You Don’t Understand It
Interview with Sara Wasserbauer, MD
If you were to get together with six of your old high school buddies, at least three of you would likely have some form of baldness.
A study published by the National Library of Medicine found that 42 percent of men had moderate to extensive hair loss between the ages of 18 and 49. As age increases, so do the percentages, from 16 percent between 18 and 29 to 53 percent between 40 and 49.
Male pattern hair loss, technical term androgenic alopecia, impacts between 35 million and 45 million men in the United States, according to Dr. Sara Wasserbauer, who operates California Hair Surgeon in Northern California.
For the predominant culprit causing hair loss, you can blame your family and your hormones. There are things you can do can to stop or slow the process, if you start early enough. If it’s too late, there are some tried and true methods for covering up bald spots.
Why Do Men Go Bald?
Wasserbauer says that in most cases, going bald is “a really simple equation” of genetics plus a hormone called dihydrotestosterone (DHT).
“DHT is a hormone that is formed enzymatically from some of the testosterone in your body,” says Dr. Siman Patel, founder of Strut Health. “And, while it is normal to have a certain level of this hormone in your body, it can damage hair follicles.”
The presence of inherited genes for male pattern baldness makes the hair follicles more sensitive to DHT, which starts to shrink the follicles when it interacts with them.
“This shrinkage leads to the follicle producing thinner and shorter strands incrementally and may end up with the loss of growth from that follicle altogether – causing either diffuse thinning or bald areas,” Patel says.
Wasserbauer says to imagine your head as a forest. Pick an acre of your forest, bundle all the trees, and measure how wide across the bundle is. Come back later, go to the same acre, bundle the trees. The diameter is less because there are either fewer trees or the trees themselves are thinner.
“In other words, there’s less wood in your forest,” she says.
The other, much smaller percentage of balding cases are the result of rare forms of hair loss (note: links are to more detailed explanations from the National Institutes of Health). These include conditions such as alopecia universalis, which destroys all the hair follicles on your body; or alopecia cicatricial, which results in hair follicles being damaged and replaced by scar tissue.
Treatment from other diseases, such as chemotherapy for cancer, can also be the direct cause of hair loss. Telogen effluvium is temporary hair loss caused by a triggering event such as stress.
Determining If You Are Going to Go Bald
Genetics that result in androgenic alopecia can come from both parents, says Wasserbauer, who currently serves as president on the Board of Directors for the American Board of Hair Restoration Surgeons. Prevalent urban myths that claim balding skips a generation or that you inherit it from your mom’s dad are inaccurate, she says.
The best way to determine if you are going to go bald is to look at your older family members. Wasserbauer says tests that use saliva swabs to determine if you are going to go bald are unreliable. A 70 percent chance of going bald doesn’t mean you are going to go bald.
A visit to the doctor/hair restoration specialist can also help you determine balding and its eventual pattern, which are illustrated in the Norwood-Hamilton Scale. It can also help you determine if you are dealing with one of the rare conditions listed above.
Balding Impacts on Your Health
Other than needing a little extra protection from the sun in the summer and a warmer hat in the winter, there are no physical health risks with going bald.
Going bald is “not life-threatening other than our emotional state,” Wasserbauer says, noting that the impact of hair loss “is much more significant than people give it credit for.”
She says people on average get 34 chances a day to see their reflection. If baldness is impacting someone’s self-esteem, that’s “34 ego hits a day.”
What to Do If You Are Going Bald?
“The key with hair loss treatment is starting it at the first signs of hair loss,” Patel says, “since it is much easier to prevent additional damage to hair follicles immediately than trying to coax them back into growth years later.”
If you are between 17 and 34, these methods should help you regrow hair. Anybody over 35 dealing with balding “might be able to maintain but probably won’t be able to save it,” Wasserbauer says.
Feel free to skip to the next section if your primary concern is concealing a bald spot.
Propecia (Finasteride): This prescription pill has an active ingredient called finasteride that blocks DHT from being formed, thus helping to slow hair loss. “There is an enzyme that changes DHT and gives it an irreversible body hug,” Wasserbauer says.
“Finasteride mainly helps with maintaining your current hair and reducing additional hair loss, but some may find regrowth using it as well,” Patel says.
Rogaine (Minoxidil): Minoxidil, the active ingredient in Rogaine, “makes your blood vessels a little bit bigger” and has an affinity for the blood vessels of the hair follicles, says Wasserbauer. Minoxidil is available in either a pill form or topical application and can be purchased over the counter or stronger with a prescription.
Minoxidil “increases the health of the hair follicles and helps stimulate new growth by increasing blood flow to the follicles — bringing along plenty of oxygen and nutrients,” Patel says. He also notes that both minoxidil and finasteride “play well together.”
Low level light therapy (photobiomodulation): Low level light therapy is designed to stimulate cells to help promote hair growth. There are devices any consumer can purchase, or you can visit a doctor to administer.
Wasserbauer views low level light therapy in a very positive (ahem) light, but also notes that the method is “a victim of its own success.”
“When you start to grow hair, the hair blocks the light,” she says.
Shampoos: Wasserbauer listed four types of shampoos that contain active ingredients (listed in parentheses) that could help slow hair loss:
Head & Shoulders (pyrithione zinc)
Selsum Blue (selenium)
Neutrogena T-Gel (coal tar)
How to Enhance an Already Bald Head
If you are past the point of slowing measures, there are both sophisticated and simple ways to cover up or camouflage a bald head.
Hair transplants: There is one tissue line at the top of your head that has DHT and another tissue line at the bottom that doesn’t. That bottom strip of hair, called the safe zone, is about 2-3 inches high on the back and sides of your scalp. This is the healthy hair doctors use when performing hair transplants.
Wasserbauer compared a hair transplant to moving grass from a healthy section in the back of your lawn to the front lawn where there is some bare earth. The dying or dead grass in the front is not fixable but planting the existing grass from the back to the front will allow the replacement grass to grow.
Wig or hairpiece: The simplest way to hide your bald spot is to purchase a wig or hairpiece to cover a section of your hair. Wigs come in a variety of styles and fits and can be constructed from human or synthetic hair.
Scalp micropigmentation: Scalp micropigmentation is like getting a hair tattoo. The procedure, which can be permanent or temporary, is described on Wasserbauer’s website as applying a “specially formulated pigment (ink) to the scalp with micro-fine needles to create thousands of tiny impressions” to give the illusion of hair.
“Visually you can’t tell when it is done right. Hairdressers are like, ‘That’s hair,’ until they touch it,” Wasserbauer says. “When it’s done nicely, everyone looks like they just got off the set of Fast and Furious.”
Sprinkled Fibers: If you still have some hair remaining, you can carefully apply certain fibers to make hair look thicker. The fibers will attach to your hair, which is a protein made of keratin, through static charges in both your hair and the product.
The International Society of Hair Restoration Surgery (ISHRS) lists a few product recommendations on its site.
Toppik Hair Building Fibers
XFusion Keratin Fibers
Super Million Hair
Infinity Hair Fibers
Caboki Hair Fibers
Concealers: The ISHRS also lists powder cakes, creams, lotions, and aerosols as ways to camouflage a balding area on your head. Here are a few recommended products:
Powder cake: DermMatch
Advancements Ahead: Wasserbauer expressed excitement about the efficacy of advancing treatments like plasma injections and extra cellular vesicle hair loss therapy.
Forward-thinkers are also beginning to cryo-preserve healthy and active hairs to use in potential hair cloning transplants when the time comes. Click HERE to read more and view a video from Wasserbauer explaining the process.
Let it go: The last option is one that you can fully embrace as your first option: Just go bald. As you get older, there will be a lot more people joining your club.
This article is a re-print of Dr. Wasserbauer’s interview with Ed Virgin for AskMen