Male-Pattern Baldness (MPB) is a hair loss condition that affects millions of men and women worldwide. And while the onset is different for men and women, one simple fact is the same: the earlier you catch it, the easier it is to handle.
After all, it is much harder to regrow new hair as opposed to keeping the hair you have already got.
In this article, you will learn the different causes of hair loss and how to identify the early signs of balding. You will also learn the most common ways to treat the issue before it becomes a more permanent problem.
The 8 Main Causes of Balding
Before you can understand how (and why) early balding occurs, it is a good idea to understand the different causes of hair loss.
Androgenetic Alopecia (AGA)
The exact cause of AGA is unknown, but the androgen DHT is believed to be a major culprit.
DHT is produced in three places in the body: the testicles, the prostate, and the hair follicles (2). It is a result of the interaction between testosterone (the male sex hormone) and 5AR (an androgen). The excess DHT then attaches to the hair follicles and, in individuals with AGA, this leads to inflammation and irritation (3).
As the inflammation continues, it results in a process known as hair miniaturization.
This process makes it difficult for hair to grow, as the strands become shorter and shorter until, eventually, they can no longer push through the scalp.
In recent years, another theory by which pattern baldness progresses has been “discovered:” scalp tension. It is thought that mechanical tension of the scalp can increase the presence of DHT, which then triggers the aforementioned process.
Alopecia Areata (AA)
Alopecia Areata is an autoimmune condition (4). It occurs when the immune system believes the hair follicles are foreign and attacks them.
The main symptom of AA is patchy baldness, which seems to come on out of nowhere. This balding typically happens on the scalp, though more advanced forms of the condition lead to total hair loss on the face and head (Alopecia Totalis) and hair loss on the entirety of the body (Alopecia Universalis).
While not incredibly common, this condition does affect more than 6 million men and women in the United States alone.
The foods we eat provide our bodies with crucial nutrients, such as calcium, iron, and potassium. However, a poor diet or malabsorption problems can mean your body is not receiving the vitamins and nutrients required to keep it running at its best (6).
Nutritional deficiencies are not a common cause of long-term hair loss, but they can result in temporary thinning and baldness. This is especially true if you are low on a few of hair’s most vital nutrients, including iron, niacin, biotin, and vitamin E.
Fortunately, nutritional deficiencies can be solved with an improved diet and, in some cases, vitamin supplements. With improved intake, you can then avoid the many symptoms of poor diet, such as anemia, weight loss, and hair fall.
Illness and Medications
Our bodies can be delicate in many ways, as they require balance and overall wellbeing. Unfortunately, these can be thrown off by both illness and medications which can then trigger short-term or long-term hair loss.
The two most common types of hair loss to occur from illness and medications are Telogen Effluvium (TE) and Anagen Effluvium (AE) (7).
TE is the most common, and it occurs at the very last stages of the hair growth cycle. Hair fall begins weeks to months after an illness or medication, and it can take just as long to resolve.
AE is less common but is often seen in patients undergoing chemotherapy. It occurs during the phase of active growth, and it can begin as soon as a few days after the medication is administered, and it may take several months to resolve.
Mental and Physical Stress
Stress is a problem commonly faced by people throughout the world. It can take on many forms and have various triggers including traumatic injury, surgery, or loss of a loved one.
The most common symptoms of stress include:
- Low energy
- General aches and pains
- Overall discomfort
It can also manifest as panic attacks, which include accelerated heart rate, quickened breathing, and feelings of chest tightness.
Another symptom of stress can be thinning and hair fall. It is most commonly classified as TE, and it can occur months after the triggering event.
But exactly how strongly is stress linked to hair loss? This question was answered in a 2017 study (9).
The study included 33 female college students. Eighteen of the students were in the midst of exams, while the other 15 were not.
Throughout the study, the researchers used various tests to measure stress. They include:
- Self-reported distress and coping strategies (Perceived Stress Questionnaire [PSQ]
- Trier Inventory for the Assessment of Chronic Stress [TICS]
- Cytokines in supernatants of stimulated peripheral blood mononucleocytes (PBMCs)
- Trichogram (hair cycle and pigmentation analysis)
The study was then split into three periods: T1 (before the start of the learning period), T2 (between the 3-day written exam and oral exam), and T3 (after 12 weeks of rest following exam period).
As the results showed, the stress perception of the exam students increased significantly in T2. There was further evidence of this stress, though, and that was cytokines.
Cytokines are pro-inflammatory substances that are released by the immune system in response to injury, illness, or stress (10). An increase in cytokine levels, then, is a good indicator of body-wide inflammation.
The good news is that in many cases, this form of hair loss resolves itself.
Whether due to medical treatment or illness, hormone imbalance can wreak havoc on your body and its various systems. One such system it can interfere with is the hair growth cycle.
The most common causes of hormone imbalance are Polycystic Ovary Syndrome (PCOS), thyroid disease, and hormonal birth control. If you suspect a hormonal imbalance is the cause of your hair loss, it’s best to speak with your physician.
Early Signs of Balding
Here is a closer look at the most common signs of early balding.
Excessive Amounts of Hair on the Pillow and in the Shower
Firstly, male pattern baldness is not necessarily about how many hairs you shed each day but more about how quickly you are replacing them.
Becoming paranoid and worrying about each hair that is lost will not help with your stress levels either.
Pattern Hair Loss and Receding Hairline
The other thing to take note is that common balding takes place in a pattern (that is why it is known as male or female pattern baldness) so seeing clumps of hair come out will usually mean you have a different kind of hair loss.
MPB starts at the temples and forehead and typically recedes over time. The hairs at the front become thin and wispy over time and eventually fall out due to hair follicle miniazturization. However, there is a difference between a mature and receding hairline.
DHT (the male hormone that is believed to be primarily responsible for pattern baldness) causes hair follicle miniaturization where the dermal papilla is starved on the nutrients and minerals and oxygen it needs to grow (11, 12).
DHT also causes hair to go into a ‘dormant’ or ‘resting phase’ so hair that falls out is not replaced.
Itchy, Flaky Scalp
This is not necessarily a cause or effect of hair loss, but the two are often correlated.
Hair Takes Longer to Grow
Because pattern hair loss comes from hair follicles entering a resting phase, as well as often being starved on nutrients and minerals, quite often your hair will take longer to grow after a hair cut.
There are other factors involved as well and it can be hard to tell for sure but this often an early warning sign.
Thin, Wispy Hair
Hair follicles typically get thinner, less radiant, and lose some of their shine before eventually falling out.
So if the front of your hairline around the temples and forehead seems to be getting thinner and more wispy, this is fairly typical of male pattern baldness.
Consider Your Relatives
The mainstream convention is that hair loss is genetic, and while that is true to some extent, it does not tell the whole truth. It is actually more of a ‘genetic predisposition’ which means it is more likely that you will suffer from male pattern baldness but it is not guaranteed (13).
It also means there are things you can do to prevent hair loss. Anyway, when you are looking for early signs of balding, you might want to consider your relatives (on both sides of the family tree) to see if any of them suffer from pattern baldness.
Fathers, uncles, and grandfathers will give you a good indication of the likelihood that you might be seeing the beginning stages of male pattern baldness.
What Are Your Options?
The earlier you catch pattern hair loss, the easier it is to do something about it. It is incredibly hard to re-grow hair where it has been completely lost and the dermal papilla has healed over.
If you are facing the reality of early balding, you are likely wondering what your next steps are.
Prescription and Over-the-Counter Treatments
The first line of defense against hair loss often recommended by doctors is one that involves topical and/or oral medications.
Minoxidil, more often known by its brand name of Rogaine, is a topical hair loss solution that was originally developed as a treatment for high blood pressure (14).
The exact mechanism by which minoxidil works is not yet known, though there are a few theories.
The first involves the drug’s role as a potassium channel opener (15). In short, this function can theoretically widen the blood vessels which will then improve the delivery of blood, and oxygen and nutrients as a by-product.
A second theory is that minoxidil upregulates various genes and, more specifically, vascular endothelial growth factor (VEGF) (16). As a result, the drug may support vasculature and promote hair growth.
And if those potential theories are not enough to convince you, there is also research studies to back its beneficial claims.
One such study, performed in 1990 at Duke University, followed 31 male subjects with AGA as they completed four-and-a-half to five years of minoxidil treatment (17).
The hair growth seen in the men peaked at one year of treatment, at which time it then began to slow. However, the growth results were still improved over those seen at the beginning.
But more recent studies, including one performed in 2016, has also proven these positive results (18).
The study took place in two parts.
The first part consisted of a 24-week period that included randomized, double-blind controls.
The second part took place over 80 weeks and all participants received the 5% minoxidil foam formulation.
By studying these subjects, the researchers were able to conclude:
5% MTF is effective in stabilizing hair density, hair width and scalp coverage in both frontotemporal and vertex areas over an application period of 104 weeks, while showing a good safety and tolerability profile with a low rate of irritant contact dermatitis.
Minoxidil is available over the counter, but there is also a prescription option to consider.
Finasteride, also known as Propecia, was the second hair loss drug to receive FDA approval.
However, unlike minoxidil, the way in which finasteride works is clear.
Finasteride is a 5-alpha-reductase type II inhibitor that promotes hair growth by reducing the levels of DHT in the scalp (19). This is why finasteride is so effective in treating men with AGA.
Scalp biopsies have shown finasteride to reduce DHT levels in the scalp between 60 and 75 percent (20).
And beyond just biopsies, its effects were proven in human subjects.
One such study (well, actually, two) was published in 1998 (21).
The first study consisted of a total of 1553 men from the ages of 18 to 41 with male pattern hair loss.
The men were split into two groups. One received oral finasteride 1 mg/d, and the other received a placebo.
The men in the first group (finasteride) saw a significant increase in hair count at year 1, while the men in the second group (placebo) saw continued hair loss.
And while these results were promising, the second part of the study was even more promising.
1215 of the men from the first study went on to continue with treatment, and they continued to see positive hair growth results even to the end of year two.
As the researchers concluded:
In men with male pattern hair loss, finasteride 1 mg/d slowed the progression of hair loss and increased hair growth in clinical trials over 2 years.
Low-Light Laser Therapy (LLLT)
Low-Light Laser Therapy (LLLT) is a relatively novel treatment method for hair loss. It has been used for years in dermatology, but it is only recently becoming a favorite of hair loss sufferers around the world.
As the name of the treatment suggests, LLLT is a therapy that utilizes lasers. The low-light lasers stimulate the hair follicles (in a variety of ways) to produce hair growth.
The current medications on the market treat one type of hair loss in particular – pattern baldness. One of the great things about LLLT is that it can work to treat many types of hair loss (22). Here is how.
- It stimulates epidermal stem cells
- It promotes anagen phase hair growth
- It reduces inflammation
When hair loss occurs, whether it is from pattern baldness or alopecia areata or even stress, the main cause of the hair loss is often inflammation. That is, the hair follicles become inflamed, the follicles miniaturize, and the hair strands can no longer make their way through the scalp.
This means the hair will come in shorter until, eventually, it stops coming in altogether.
You certainly want to treat the root cause of your hair loss, as this will stop the hair loss cycle entirely. But in the meantime, you want to treat the inflammation so as to reverse follicle miniaturization. It has been shown that LLLT can do just that.
How to Perform LLLT
You can practice LLLT at home, or under the care of a dermatologist or esthetician. If you are practicing at home, you will have a few devices to consider.
The most common devices for at-home laser therapy are combs and helmets. These are used on the scalp in small, regular doses to ensure the proper and efficient delivery of low-light lasers to the follicles.
The comb will be used just like a regular comb. You will place it on the hairline and then move back towards your crown very slowly. You need to make sure that the teeth of the comb are making contact with the scalp to ensure the lasers are making direct contact.
As for the helmet, it is as simple as placing it on your head and switching the device on.
While LLLT is not an FDA approved therapy, laser combs (but not helmets) have received FDA “clearance.” This simply means that the device is likely safe for human use, though its effects have not been fully proven in human subjects.
Scalp Massage and Exercises
Scalp massage and exercises boost blood flow to the scalp while also stretching the dermal papilla cells to stimulate hair follicles (25).
How to Perform Scalp Massages
If you are ready to get started, here’s a basic rundown of the daily process:
- Place your thumb, index, and middle fingers on either side of your head (just above the ears). Use your fingers to massage in a circular motion, and apply varying levels of pressure as you do so.
- From the sides of the head, move up to the crown. Continue with circular motions, and backtrack to previous places on the scalp as you do.
- From the crown, slowly move to the middle of the hairline and temples. Continue applying varying levels of pressure.
- Finally, bring your fingers from the hairline to the crown, and finally to the base of the scalp.
This entire process should take about 10 minutes, though you can extend it if you would like.
How to Perform Scalp Exercises
To further increase blood circulation, you can use using facial muscles to ‘exercise’ the scalp. Here is how to do so:
- Lift your eyebrows as high as possible, and hold them in place for 2 minutes. Return your eyebrows to the resting position.
- Furrow your eyebrows as deep as possible, and hold them in place for 2 minutes. Return your eyebrows to the resting position.
- Lift your eyebrows as high as possible and hold for 3 minutes. Then furrow your eyebrows as deep as possible and hold for 2 minutes. Return to the resting position.
You can also use your fingertips to ‘stretch’ the skin of the scalp, by placing two fingertips on the scalp and pushing and pulling them away from each other.
If you want to further increase blood flow to the scalp, you will want to take your treatments to the next level. One way to do that is with microneedling.
Microneedling is a technique that uses tiny needles to puncture the scalp. As these wounds heal, they increase collagen levels in the skin (which is important for elasticity) as well as promote the proliferation of Dermal Papilla Cells (DPCs).
And while it may seem odd to cause intentional injury to promote hair growth, there is actually proof that it works. In 2013, researchers compared microneedling and Minoxidil (26). The group to receive both Minoxidil and microneedling saw better results than the Minoxidil-only group:
How to Perform Microneedling
There are two common microneedling tools: the dermaroller, and the dermastamp. Never share microneedling products.
The dermaroller can cause damage to surrounding hair structures. The dermastamp, on the other hand, is easy to target and much easier to control.
To use the dermastamp, you will first want to clean the scalp.
You can then use the stamp to puncture the areas of your scalp with thinning and hair loss. Applying light pressure, target the areas first vertically, then horizontally, and finally diagonally.
You can perform this technique once per week.
When you first notice the early signs of balding, you may be startled and unsure of what to do. However, there are many causes and, as such, many ways to treat the problem.