For men
Male Hair Loss: Common Causes and Solutions
Male hair loss? Learn the most common causes and effective treatments — from minoxidil to hair transplant — explained clearly.
About 8 in 10 men are affected by hair loss at some point in their lives — a problem that becomes a stressful reality for many. If you find more than 100 hairs daily in the shower or on your brush, your shedding may already exceed the ordinary limit. Especially concerning: already half of men between 20 and 30 can expect to lose hair.
In this comprehensive guide we want to help you understand hair loss and show ways to stop it. Although the market is flooded with supposed "miracle cures," only a few methods actually work. That is why we will distinguish between myths and scientifically proven facts. One thing is clear: in hereditary hair loss, which affects about 60% of all men, it is not an excess of hormones that plays the main role, but our genetic predisposition.
What is male hair loss?
Normal hair cycles vs. hair loss
Our hair goes through a natural life cycle consisting of three phases:
Growth phase (anagen phase): It lasts between 2 and 6 years [3]. About 85–90% of all scalp hairs are in this phase [4].
Transition phase (catagen phase): A short phase of about 2–4 weeks [5], in which only about 1–2% of hairs are found [4].
Resting phase (telogen phase): It lasts 2–3 months [3] before the hair falls out and a new one grows. About 10–14% of hairs are in this phase [4].
Characteristic of male hair loss is shortening of the growth phase. The follicles form increasingly finer, thinner hairs (miniaturization) [1]. This process is caused by increased activity of the hormone dihydrotestosterone (DHT) [1].
When do we speak of alopecia?
We speak of alopecia when shed hairs no longer grow back, or only sparsely [4]. The most common type is androgenetic alopecia, which in men typically begins at the temples ("receding hairline") and continues over the crown to the back of the head [1]. A characteristic M-shaped pattern develops that can eventually lead to baldness with a fringe of hair [1].
This form of hair loss affects about 80% of men worldwide [3] and is genetically determined. Several genes are involved in inheritance [1]. Symptoms can appear during or after puberty [1].
How many hairs are too many?
A certain amount of hair loss is completely normal. Daily we lose between 50 and 100 hairs [3]. In some people, up to 250 hairs can fall out when washing [3]. Only when more than 100 hairs are lost per day on a lasting basis do doctors speak of hair loss [2].
Signs of excessive hair loss include:
Unusually many hairs on the pillow, in the brush, or in the shower drain [6]
Visible thinning at the crown, the back of the head, or near the forehead [6]
The scalp showing through [4]
If over two to three weeks you suddenly lose far more hair than usual, or you see scalp in the mirror where none was visible before, you should see a doctor [7].
Common causes of hair loss in men
"The most common form in men is androgenetic alopecia, also called hereditary hair loss. It arises from a genetic predisposition in combination with male hormones." — Dr. Malte Kettler, specialist in aesthetic medicine, PRP treatment expert
Hair loss does not arise from a single cause, but from an interplay of various factors. Here are the most common triggers.
Genetic predisposition (androgenetic alopecia)
Androgenetic alopecia is the most common form of hair loss and affects up to 80% of all men worldwide [3]. This predisposition is inherited and is especially pronounced when both parents are affected [8]. It is not a disease in the narrower sense, but a normal variant [3]. Affected men can notice first signs between ages 20 and 30 [9].
Hormonal influences (DHT)
Contrary to popular belief, hereditary hair loss does not arise from a hormone excess [3]. Rather, the hair roots overreact to dihydrotestosterone (DHT), a derivative of testosterone [10]. This hormone shortens the hair growth phase and shrinks the hair roots [3]. As a result, blood vessels regress, so the follicles are no longer adequately supplied with nutrients [10]. Over time the hair roots waste away and can no longer form new hair [11].
Stress and psychological strain
Prolonged stress increases release of the stress hormone cortisol, which inhibits hair growth [12]. In addition, the number of nerve fibers around each hair follicle increases, leading to neurogenic inflammation [12]. A Korean study also shows that men with more than 40 working hours per week have a significantly higher risk of hair loss [13].
Illnesses and medications
Thyroid problems, diabetes, lupus, and anemia can also lead to hair loss [14]. Various medications can cause hair loss as well, including beta-blockers, ACE inhibitors, heparin, antidepressants, and cytostatic drugs [5]. Over 400 medications now list hair loss as a known side effect [15].
Malnutrition and diets
Hair follicle cells have high nutrient needs [16]. A deficiency of iron, zinc, vitamin B12, C, or D can worsen hair quality and impair growth [17]. Crash diets or one-sided nutrition in particular can lead to hair loss [18]. With rapid weight loss, fat cells that serve as hormone stores disappear, which leads to hormonal fluctuations and can shorten the lifespan of the hair [19].
Forms of hair loss and their features
Male hair loss appears in various forms, each with specific features. Recognizing the exact form is decisive for effective treatment.
Hereditary hair loss
Hereditary or androgenetic hair loss is with 80% the most common type in men [20]. This form follows a characteristic pattern: first a receding hairline forms; later a bald spot often appears on the crown (vertex) [20]. In advanced stages often only a fringe of hair remains [1]. The cause is genetically determined hypersensitivity of the hair roots to DHT, which shortens the hair growth phase [1]. The course is often classified according to the Hamilton-Norwood scale [2].
Diffuse hair loss
In this form the hair thins evenly over the entire head, without a specific pattern [21]. The scalp shows through more strongly, but completely bald spots do not form [22]. We speak of diffuse hair loss when more than 100 hairs fall out daily [22]. Typically, shedding begins 2–3 months after the triggering event [22]. Possible causes include hormone fluctuations, stress, infections, or nutrient deficiency [23].
Circular hair loss (alopecia areata)
Circular hair loss (alopecia areata) is characterized by suddenly appearing, sharply demarcated round or oval bald patches [7]. About 1–2% of the population is affected, men and women equally [7]. In 80% of patients, one or two individual hairless patches appear [7]. In more severe cases one distinguishes:
An autoimmune reaction in which the immune system attacks the hair roots is suspected as the cause [24].
Scarring hair loss
This rare form leads to asymmetric bald patches with scar formation [2]. The hair follicles are irreversibly destroyed, resulting in permanent hair loss [25]. Affected skin areas appear smooth and shiny without visible hair exits [26]. Besides hair loss there is inflammation of the scalp, often accompanied by redness, itching, or pain [2]. Triggers can include autoimmune diseases such as lupus, infections, injuries, or chronic skin conditions [26].
Treatment options and therapies
"Hair loss no longer has to be destiny today." — Dr. Malte Kettler, specialist in aesthetic medicine, PRP treatment expert
When looking for effective treatments against hair loss, various options are available. Not every method is equally suitable for every person, so it is important to know the different possibilities.
Minoxidil and finasteride
These two active ingredients are the only scientifically recognized medications against hair loss. Minoxidil is applied as a solution or foam directly to the scalp and promotes blood flow to the hair follicles. In 80–90% of users it stops hair loss, while in about 30–48% new hair growth begins [27]. Minoxidil only works, however, while it is used.
Finasteride, by contrast, is taken as a tablet and inhibits the formation of DHT. In 66% of users hair growth improves after two years [28]. Possible side effects such as loss of libido, erectile dysfunction, and depression must be noted, however [4].
Hair transplant: methods and costs
In advanced hair loss, a hair transplant offers a lasting solution. The FUE method (follicular unit extraction) removes individual hair follicles, while the FUT method (follicular unit transplantation) uses a strip of skin [29]. The more modern DHI method enables more precise placement of the hair follicles [6].
Costs vary widely: in Germany between €6,000 and €10,000, in Turkey from as little as €1,300 to €2,000 [30]. An important factor is the number of grafts needed.
Natural remedies and supplements
Natural home remedies can have a supporting effect. Coconut oil, argan oil, and jojoba oil strengthen the hair and promote blood flow [31]. Rosemary oil has also shown similar effectiveness to minoxidil in studies [32].
In vitamin deficiency, supplements with biotin, iron, zinc, and vitamin D can help promote hair growth [33].
Shampoos and tinctures compared
Special anti-hair-loss shampoos often contain caffeine or minoxidil. However, the short contact time of 2–3 minutes is usually not enough for the active ingredients to penetrate the hair follicles [34]. Tinctures and lotions that remain on the scalp are therefore often more effective [35].
When should you see a doctor?
A doctor visit is advisable if you suddenly lose hair in clumps, clearly demarcated bald patches appear, or your hair loss is accompanied by itching and redness [36]. A dermatologist can determine the exact cause and recommend the right treatment [8].
Conclusion
Male hair loss is a significant psychological burden for many, yet no one has to watch this development helplessly. Modern medicine offers effective solutions for almost every form of hair loss. As we have seen, genetic predisposition plays a decisive role, yet through targeted measures we can slow or even stop the process.
Whether you choose medication such as minoxidil and finasteride or prefer natural alternatives — the first step is understanding the exact cause of your hair loss. With sudden or unusual shedding you should therefore see a dermatologist, who can recommend the right therapy.
Remember that patience is essential in treating hair loss. Most therapies need several months before first results become visible. At the same time it is worth adjusting your lifestyle — a balanced diet, stress reduction, and enough sleep significantly support every treatment.
If you suffer from advanced hair loss, a hair transplant today offers remarkably natural results. You should carefully weigh the different methods and their costs, however.
Ultimately there is no reason to resign yourself to hair loss. Science continually develops new treatment options, and with the right approach you can regain your confidence and your hair.
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