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In men, thinning hair and hair loss — otherwise known as hereditary hair loss, or male pattern baldness — is very common. It’s pretty much part of the gig; the invisible contract signed when a Y chromosome hooks up with an X. More than 50 million American men have some form of hair loss, nearly two-thirds of men will experience it by age 35, and almost 85% will develop it by age 50. Many guys take thinning hair in stride and adopt a smoother look—an evolution of their brand. But if thinning hair bothers you, you don’t have to accept it — there are things you can do to slow or stop it.
The good news: Unless you pissed off a vengeful warlock of some kind, you don’t just wake up bald one morning, generally speaking. Going bald is usually a gradual process that can take years, even decades. (15 to 25 years on average). So you probably have time to intervene. But the sooner in the process you take action, the more likely it will be that you can slow or stop hair loss.
But first, it’s important to know how to identify when your hair is permanently thinning, versus normal hair loss that will be replaced with new hair.
- Hair loss or thinning hair is prevalent in men — two-thirds of guys will experience it by age 35.
- Several factors can cause hair loss; the most common is male pattern hair loss (MPHL).
- Using finasteride, minoxidil, and/or DHT-blocking shampoo are the most effective ways to treat male pattern hair loss.
- Other treatments include LLLT (low-level laser light therapy).
How hair grows
Everyone loses about 100 hairs a day. That’s part of the natural hair life cycle — the hair follicles on our scalp are in the continuous process of growing and shedding hair. Healthy hair growth happens in three phases: anagen, catagen, and telogen.
- Anagen is the growth phase. Hairs remain in this phase for 2 to 6 years. About 80 to 85% of the hair on your scalp is in this phase right now.
- Catagen is when a hair stops growing and detaches from its blood supply. This phase lasts about two weeks, before the hair falls out, known as exogen.
- Telogen is the resting phase, in which the hair follicle lies dormant for one to four months. About 15 to 20 percent of the total hair on your scalp is in this phase at a given time. After this, anagen normally begins again.
But during male pattern hair loss, the follicle becomes miniaturized, producing thinner and thinner hair until hair production stops altogether.
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How to tell if your hair is thinning
Discovering a few hairs in your comb, on your pillow or in the shower drain isn’t necessarily a sign that you’re going bald. But over time, if you’re noticing that you’re shedding more and more hair, it could be a sign that hair is thinning.
Male pattern hair loss can happen in several ways:
- Receding hairline. Hair might thin at the temples, creating an M-shaped hairline, or it might thin across the hairline.
- Loss of hair at the crown (back top) of the head.
- Overall thinning. This is sometimes called “invisible balding” because the hair loss is so gradual and balanced it may be hard to notice until nearly half the hair is lost.
A good way to judge whether your hair is thinning is to take a picture of yourself now and compare it to past photos taken in similar lighting. Does your hairline or overall head of hair look sparser? Oh, who are we kidding — with the omnipresence of social media, you’ve noticed this already. That’s why you’re here.
Why is my hair thinning?
About 95% of thinning hair is caused by male pattern hair loss (MPHL), also known as androgenetic alopecia. Male pattern hair loss is caused by DHT (dihydrotestosterone), a type of sex hormone known as an androgen. Androgens contribute to typical male characteristics, such as body hair and a deeper voice. DHT is believed to cause hair follicles to miniaturize, getting smaller and smaller until they stop producing hair at all.
Less common reasons for thinning hair include:
- Breakage of the hair shaft. Damage to hair from dyeing or styling can cause the hair shaft to break off. This isn’t the same as male pattern hair loss.
- Alopecia areata. This autoimmune condition can cause hair loss in patches throughout the body. In extreme cases, all body hair might be lost. It is not the same as male pattern baldness.
- Stress or an emotional shock. According to the Mayo Clinic, some people experience a general thinning of hair several months after a physical or emotional shock. This type of hair loss is temporary.
- Medications or supplements. Hair loss can also be a side effect of certain drugs, such as those used for cancer, heart problems, high blood pressure, arthritis, and depression.
If you’re unsure about what’s causing your thinning hair, consult a dermatologist, who can evaluate what’s going and recommend treatment if necessary.
How to stop thinning hair
If you’re experiencing male pattern hair loss, there are several strategies you can take to stem the loss and increase hair growth. Hair loss treatments include:
- Minoxidil (Rogaine). This liquid or foam is rubbed onto the scalp twice a day. About 60 percent of men who use minoxidil see hair regrowth. If you stop using it, the new growth will reverse, and hair loss will continue.
- Finasteride (Propecia). This oral medication is known as a 5-alpha-reductase inhibitor. 5-alpha-reductase (5-AR) converts testosterone into DHT in the testicles and prostate. When 5-AR is inhibited, DHT can’t shrink hair follicles. Studies show finasteride can stop baldness from progressing and result in hair regrowth in about 80 percent of cases.
- A red light therapy device. Low-level laser light therapy (LLLT) is an FDA-cleared way to treat hair loss. These devices might come in the form of a wand you point at the scalp or a cap you can wear. They emit a constant red LED light that is believed to reduce inflammation and increase blood flow to the hair follicles.
According to a 2017 meta-analysis of studies published in the Journal of the American Academy of Dermatology, minoxidil, finasteride and LLLT were found to be superior to placebo in regrowing hair (Adil, 2017). However, the researchers concluded they’re all effective for promoting hair growth in men with male pattern hair loss.
Some other therapies for thinning hair include:
- DHT-blocking shampoo. Several varieties of shampoo claim to block DHT’s effect on miniaturizing follicles. They’re considered less effective than minoxidil or finasteride. Some contain zinc, vitamin B12, or ketoconazole (the active ingredient in the dandruff shampoo Nizoral). Studies have shown that ketoconazole can disrupt DHT’s effects on the scalp (Hugo Perez, 2004).
- PRP (platelet-rich plasma) treatments. Several dermatologists and hair-replacement specialists offer this treatment, in which a patient’s blood is drawn and placed in a centrifuge to extract the plasma, which is then injected into the scalp. The theory is that the growth factors in platelets can spur hair growth. A 2017 study published in the International Journal of Molecular Sciences found that PRP treatment increased the number of hairs and overall hair density versus areas treated with a placebo (Gentile, 2017).
- Cosmetic treatments, such as Toppik. The poorly kept secret of newscasters and Hollywood stars, Toppik is a form of makeup for your scalp that can help make thinning hair less noticeable. It comes in the form of a powder that’s shaken onto thin spots; the powder bonds to the hair that’s there, camouflaging spare areas. It is, of course, temporary, and has no therapeutic benefit for hair loss (other than for the connected ego).
The future of thinning hair
Hair-loss science marches on — somewhat slowly, considering that today’s most effective treatments, finasteride, and minoxidil, were approved in the late ’90s — and scientists have pointed up a new class of drugs that might be effective against male pattern hair loss in the future.
In 2019 research conducted at Columbia University, scientists found that a type of drug known as a JAK (janus kinase) inhibitor might also inhibit and reverse hair loss (Sutton, 2019). JAK inhibitors are usually used to soothe rheumatoid arthritis, an inflammatory condition. In this trial, researchers gave it to 22 men and women with androgenic alopecia, and 73% of them saw increased hair growth. The theory here is that hair follicles may miniaturize and “die” because of inflammation, and JAK inhibitors might quell that inflammation, pushing the follicle from resting phase back into the active (growing) anagen phase.
Whether these drugs will make hair loss a thing of the past remains to be seen. The good news is that you can likely make it a distant memory today, with one or a combination of current effective treatments.