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Thinning hair. Receding hairline. A widening bald spot. Male pattern hair loss (also known as male pattern baldness or androgenetic alopecia) affects up to 50% of men by age 50, with certain individuals experiencing significant hair loss in their 30s and 40s due to a combination of genetics, hormones and stress. Although male pattern hair loss is harmless and often considered by doctors to be a cosmetic issue, multiple studies have proven that male pattern hair loss can have a significant psychological impact, with men suffering from hair loss having lower confidence levels and higher rates of depression. Hair loss may make a man appear less youthful and less attractive, leading to challenges with career advancement and dating. Male pattern hair loss is a medical condition and should be treated accordingly.
Male pattern hair loss (also known as androgenetic alopecia) is the most common cause of hair loss in men. In a 2022 study, it was found that 63% of hair loss cases in men are because to androgenetic alopecia. Male pattern hair loss is a long-term condition, characterised by a receding hairline and diffuse thinning of the hair at the top and front of the head. Male pattern hair loss is due to a combination of hormones and genetics.
A hair follicle is a complex structure located in the skin that produces hair. The hair follicle is a tube-like structure surrounding the hair root and strand, with two main layers: the inner root sheath and the outer root sheath. The hair bulb, located at the base, contains the dermal papilla and hair matrix cells, which are responsible for hair growth.
Key components of a hair follicle:
Functions of a hair follicle:
Normal Hair growth alternates between phases of activity and rest. The growth period, known as the anagen phase, lasts for two to six years. During the anagen (growth) phase, the hair follicle is long and deep and produces thick, well-pigmented hair shafts. At any time, about 90% of all scalp hairs are in the anagen phase.
Following anagen comes a brief transition known as the catagen phase, which lasts 1–2 weeks. During the catagen phase, the dermal papilla shrivels up and stops supplying blood and nutrients to the hair shaft. Eventually, the hair shaft is disconnected from the dermal papilla.
Finally comes the telogen phase (resting phase), which lasts for two to three months. In this phase, the shrunken follicle retains the hair shaft, which may shed at any time. This is noticed by the individual as hair fall, with hairs coming out during showers or brushing.
Eventually, the next anagen phase begins, and the old hair is dislodged and falls out to make room for new hair to begin growing in its place.
Male pattern hair loss is an inherited condition, caused by a genetically determined sensitivity to the effects of the hormone dihydrotestosterone (DHT) in some areas of the scalp.
Genetic inheritance of male pattern hair loss is polygenic, meaning several genes are involved, accounting for differing age of onset, progression, pattern and severity of hair loss in family members. The baldness genes are inherited from both mother and father. Currently, genetic testing for the prediction of male pattern baldness is unreliable.
Dihydrotestosterone, or DHT, is the main hormone behind male pattern hair loss. The testosterone hormone (produced in the testicles) is converted into DHT by the enzyme 5-alpha-reductase. DHT acts by shortening the growth phase (anagen) of the hair follicle. In addition, DHT triggers the miniaturisation of hair follicles, causing them to produce fewer and finer hairs. Besides the hair follicle, DHT receptors are also present on the prostate gland and sebaceous glands.
Stress, poor sleep, smoking, medical conditions and nutritional deficiencies contribute to hair loss. Sudden hair loss, such as telogen effluvium or post-COVID hair loss, may also worsen pre-existing male pattern hair loss. Use of testosterone (eg bodybuilders, men on testosterone replacement therapy) may accelerate hair loss.
Male pattern hair loss is the most common type of hair loss in men. It's estimated that by age 50, about 50% of men experience some degree of hair loss, and by age 70, this can increase to 80%. Certain populations, such as Caucasians and Indians, experience higher levels of male pattern hair loss as compared to oriental (Chinese, Korean, Japanese) populations.
The severity of male pattern hair loss is classified based on the Norwood classification (aka Norwood Hamilton scale).
Norwood scale divides hair loss into 7 stages. Norwood stage 1-3 represents early hair loss, Norwood 4-5 represents moderate hair loss and Norwood 5-6 represents late-stage hair loss.
Stage 1. No significant hair loss or recession of the hairline.
Stage 2. There is a slight recession of the hairline around the temples
Stage 3. The first signs of clinically significant balding appear. The hairline becomes deeply recessed at both temples, resembling an M shape. The recessed spots are completely bare or sparsely covered in hair.
Stage 3 vertex. The hairline stays at stage 2, but there is significant hair loss on the top of the scalp (the vertex aka crown area).
Stage 4. The hairline recession is more severe than in stage 2, and there is sparse hair or no hair on the vertex. The two areas of hair loss are separated by a band of hair that connects to the hair remaining on the sides of the scalp.
Stage 5. The two areas of hair loss are larger than in stage 4. They are still separated, but the band of hair between them is narrower and sparser.
Stage 6. The balding areas at the temples join with the balding area at the vertex. The band of hair across the top of the head is gone or sparse.Stage 7. The most severe stage of hair loss, only a band of hair goes around the sides of the head remains. This hair is usually not dense and may be fine.
Male pattern hair loss is a clinical diagnosis, there is no single test to confirm or exclude it. Diagnosis is made based on the medical history- patients typically report hair loss over the past few years that is gradually progressive, and a strong family history of hair loss. Physical examination shows diffuse areas of hair loss affecting the hairline and crown area while sparing the hair at the back of the head. Other causes of hair loss, such as hair loss due to medical conditions such as thyroid hormone dysfunction, anaemia, iron deficiency, autoimmune causes (eg alopecia areata) or medications, need to be excluded. Trichoscopy (video scalp analysis) typically shows diffuse thinning of hair and miniaturisation of hair follicles, without significant scarring or inflammation. Trichoscopic signs of male pattern hair loss include: large variation in hair diameter, vellus hair (baby hair), perifollicular inflammation and yellow/white dots representing inactive hair follicles.
The consultation process includes:
Male pattern hair loss (androgenetic alopecia) is diagnosed when other secondary causes of hair loss have been excluded
Hair loss is a medical condition and should be treated by a medical professional in a medical clinic. Unfortunately, there is an entire industry of hair salons and hair spas that generate a significant amount of misinformation and unfounded claims, making getting appropriate and clinically backed treatment for hair loss challenging. Here’s an overview of treatments that actually work for male pattern hair loss, covering home-based to in-clinic treatments.
Minoxidil works by stimulating the hair follicles and prolonging the anagen (growth) phase of the hair cycle. Minoxidil increases the vascularisation (blood supply) around the hair follicles, promoting hair growth. Minoxidil can be used topically (2-5% minoxidil, 1 application at night) or taken orally. Regular application of minoxidil for 2-3 months is required to see hair growth, with hair loss resuming once minoxidil is stopped. Long term minoxidil treatment is safe and effective for the treatment of male pattern hair loss.
Finasteride 1mg (Propecia) is approved for the treatment of male pattern hair loss. Finasteride acts by inhibiting the 5-alpha-reductase enzyme responsible for the conversion of testosterone to dihydrotestosterone (DHT), leading to lower DHT levels and addressing the underlying cause of androgenetic alopecia.
Hair growth supplements are a useful adjunct in the treatment of hair loss, containing naturally sourced ingredients that counter the effects of DHT and promote hair growth. Miriqa Hair Extra Strength supplement contains Tocotrienol, Tripeptide Collagen, Saw Palmetto Berries, Keratin Forte, Biotin, KSM-66 Winter Cherry and Curcumin Bio-max. Nourkrin Hair Growth+ inCLINIC is a drug-free, safe, side-effect-free formulation, based on natural ingredients (fish cartilage). Hair Growth+ inCLINIC is supported by more than 100 scientific studies and clinical papers, trusted by scientists, doctors, dermatologists and trichologists worldwide.
Calecim Advanced Hair System (AHS) is a Mesenchymal stem cell regrowth serum that contains multiple growth factors and cytokines- including Vascular Endothelial Growth Factor (VEGF), Fibroblast Growth Factor (FGF), Platelet Derived Growth Factor (PDGF), Transforming Growth Factor (TGF), Insulinlike Growth Factor (IGF) and Hepatocyte Growth Factor (HGF).
The Stem Cell Hair Regrowth Treatment (Calecim Hair) at Bay Aesthetics Clinic is a proprietary treatment protocol utilising with Calecim Advanced Hair System with micro needling and Low Level Laser Therapy (LLLT). Results are typically seen in 2-3 months, with patients reporting improved hair density and reduced hair loss. Treatments are weekly, with 6 sessions recommended for early hair loss and 12 sessions for moderate-advanced hair loss.
Platelet-rich plasma (PRP) therapy is a hair loss treatment that involves injecting concentrated activated platelets from your own blood into the scalp to stimulate hair growth. This therapy is often used for androgenetic alopecia (male and female pattern baldness).
Blood Collection: A small amount of blood is drawn from your arm.
Plasma Separation: The blood is spun in a centrifuge to separate the plasma, which contains a high concentration of platelets. This is known as Platelet-rich plasma (PRP)
Injection: The PRP is then injected into the scalp, typically in areas where hair thinning is most noticeable.
PRP contains growth factors that can stimulate hair follicles and encourage hair growth, improving hair density and thickness while slowing down hair loss.
Low-level laser therapy (LLLT), also known as cold laser therapy or red light therapy, is a non-invasive treatment for hair loss that uses low-intensity laser light to stimulate hair growth. It works by delivering energy pulses to inactive hair follicles, promoting cell activity and increasing blood flow to the scalp. LLLT uses red light (around 650-670nm wavelength) to stimulate cells within the hair follicle, promoting cell metabolism and potentially shifting inactive follicles into the growth phase. The laser light can also improve blood circulation to the scalp, delivering more oxygen and nutrients to the hair follicles, which is crucial for healthy hair growth. Lastly, LLLT has an anti-inflammatory effect on the scalp.
A hair transplant is a surgical procedure that involves transplanting healthy hair from one part of the scalp (donor site) to a bald or thinning area (recipient site). During Hair transplant surgery, hair follicles are carefully extracted from the donor site (usually the back or sides of the head) and then transplanted to the recipient site. Two main techniques are commonly used: Follicular Unit Extraction (FUE) and Follicular Unit Transplantation (FUT). FUE involves extracting individual follicles, while FUT involves harvesting a strip of scalp containing multiple follicles. Hair growth in the recipient area starts gradually after the initial period of shedding the transplanted hair. The final results are typically visible within 6-12 months. Hair transplants' success rates average 90-95%, depending on various factors such as surgeon experience, patient health, technique, etc.
If you are suffering from male pattern hair loss, it pays off to take action early, as it is easier to treat the early stages of hair loss. At Bay Aesthetics Clinic, Medical Directors Dr Bernard Tan and Dr Hoe Ying Min are both experienced doctors with over 20 years of combined experience and thousands of patients. They treat patients with hair loss on a daily basis, recommending personalised treatment plans with clinically proven home-based and in-clinic treatments. To see their portfolio of before-and-after cases, please contact the clinic.
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It depends on the stage, with early hair loss typically responding better to treatment. In a nutshell, there needs to be active hair follicles for medications or in-clinic treatments to work. In advanced hair loss, the hair follicles have completely shut down and are unable to be revived, leaving a hair transplant as the only option.
Most people see improvements within 3 to 6 months of consistent treatment. Hair growth takes time and does not happen right away. You will need to be patient
Depending on the treatments involved, there may be a possibility of side effects. This will be discussed during the consultation
1) https://dermnetnz.org/topics/male-pattern-hair-loss
2) https://www.aad.org/public/diseases/hair-loss/treatment/male-pattern-hair-loss-treatment3) https://www.ncbi.nlm.nih.gov/books/NBK278957/#:~:text=Male%20androgenetic%20alopecia%20(MAA%2C%20male,scalp%20and%20leads%20to%20baldness.
