Contribution: Dr. Aimee Paik, Dr. Daniel Lanzer & Jacqui Zyl
If you’re the guy who has animated conversations with your mates about footy, the latest Marvel movie or even politics, but when it comes to talking about your hair (or lack thereof), you’d rather hide under a rock, then this is the guide for you.
Balding is an incredibly personal experience and one that comes with an unfair stigma.
This is your comprehensive guide to hair loss with all its causes, preventions and treatments where we separate the truth from the BS (in an entertaining way) and help you take the right action for you in the most discreet way possible.
So, let’s get started.
Table of Contents:
Chapter 1: Hair Loss Causes
Chapter 2: Diagnosing Male Pattern Baldness
Chapter 3: Treating & Preventing Hair Loss
Chapter 4: How To Decide What’s Right For You
⚠️ It’s happening
Your hair is acting differently.
You’re finding it on your pillow and all around the bathroom.
When you look in the mirror, it seems finer and you can see more of your scalp.
Your ego starts speaking to you.
Hair loss is probably not something you really paid attention to, and not something you ever thought would happen to you.
Let’s be real.
How many blokes notice subtle changes in their appearance?
You tend not to notice a few extra kilos till you’ve put on about ten, and the same goes for hair loss — you don’t notice it till you’ve lost a bunch.
But here you are.
Panic has set in and you’ve decided to consult Dr. Google.
The search is broad:
Hair loss treatments, Hair loss causes, Preventing hair loss, Thinning hair solutions, Am I balding? Is being bald sexy? Do women like bald men? Is Jason Statham OK with being bald? (um, yes), and Is this the end?
The fear is palpable. It truly feels like major areas of your life are going to change without a luscious mane — your work, your relationships, your sex life, dating, your earning capacity, your social status, and the list goes on.
But like most things fear-related, getting informed, knowing your options, and taking action can be exactly what helps turn your fate around.
According to the stats and facts, you’re not alone
UNFORTUNATELY, SOME THINGS DON’T GET BETTER WITH AGE
Significant balding affects about 20% of men in their 20s, about 30% of men in their 30s and nearly 50% of men in their 40s.¹
IT BASICALLY HAPPENS TO EVERYONE
As many as 85% of men will have some sort of hair loss in their lifetime, and it can happen for different reasons.²
THE USUAL SUSPECT
Male pattern baldness (MPB), also known as androgenetic alopecia or androgenic alopecia, is the most common cause of hair loss in men.³ Up to 95% of guys with thinning hair can blame MPB.
MPB most often begins when a guy is in his 30s or 40s, but it can start earlier in some cases.⁴
Hair loss cuts deep and it’s hard to talk about
Some men view losing hair as a sign of wisdom and maturity, but for many, it can feel like they’ve lost their mojo entirely.
Hair is, after all, more than just a beauty asset. It’s very much tied to physical and emotional wellbeing. As a culture, we link hair with youthfulness, health, strength, sexual power and desirability.
According to a 2009 survey by the International Society of Hair Restoration Surgery, almost 60% of men said they would rather have more hair than more money or friends.⁵ So priority-wise, having hair on your head is right up there!
And despite being a widespread issue, balding is still a surprisingly taboo topic of conversation, which means many men suffer in silence.
In the early stages of suffering, you might have irrational thought processes and start desperately seeking solutions online.
That’s not necessarily a bad thing, but you should also be mindful that it’s the time when you’re most vulnerable to being drawn into the vicious lies of the hair loss treatment industry.
Ultimately, choosing to treat or not treat your hair loss is entirely up to you.
The hair care factor
How you choose to view your hair loss is your decision and a mindset shift might be all that’s needed to get comfortable with your new look.
When your inner critic tells you that most people (especially women) have a negative view of bald men, you might like to challenge that thought.
The truth is, balding men often find they do better on the dating scene and at work once they shave it all off.
Listen to this:
- A study⁶ out of the University of Pennsylvania found that when participants were shown pictures of different hair-blessed and hair-challenged men, they repeatedly ranked the bald men (those who had shaved their heads entirely) higher for masculinity, strength, dominance and leadership potential. In addition, baldness was found to make the men appear taller.
- Some balding men took to Reddit⁷ and gave this feedback about how shaving their head has affected their dating habits:
So yeah, embrace your baldness, but if you decide to take action to prevent or even reverse your hair loss, there is absolutely no shame in doing that either.
For many guys, feeling good requires looking good too. You may need a hairy head to feel confident and take steps to build the life you want, and that’s totally okay.
No matter what your hair care factor is, we just want to empower you to live the life you want.
Chapter 1: Hair Loss Causes
In this chapter, we’re going to cover the basics of hair loss and what causes it.
Here you’ll learn about the hair growth cycle and the multiple causes of hair loss from genetics to hormones to illness and medications.
It’s a complex area, but we’ll untangle the real causes from the myths.
If you failed year 10 science class, watch this video from US-based dermatologist Dr. Aimee Paik.
Hair growth: The science part
Like most of your favorite gadgets – your car, phone, or Xbox – they work…until they don’t. The same goes for the hair growth cycle – it follows quite a predictable pattern until something disturbs it.
The hair growth phases, which sound like names of a new group of superheroes, go like this.⁸
1. GROWTH PHASE (ANAGEN)
This is the active phase of hair growth. As many as 85-90% of the hairs on your head are growing at any given time, and each hair is in the growing phase for up to seven years.
2. TRANSITIONAL PHASE (CATAGEN)
Over the course of a few weeks, hair growth slows as follicles shrink. About 3% of all hairs are in this phase at any one time.
3. RESTING PHASE (TELOGEN)
The hair follicle is completely at rest and no longer growing. Around 6%-8% of all hair is in the resting phase at any given time and this phase typically lasts a few months.
4. SHEDDING PHASE (EXOGEN)
At the end of the resting phase, the hair will gradually detach from the follicle and fall out. This is why the average person sheds between 50-100 hairs each day.⁹
After exogen, the old hair is replaced with a new hair in the anagen phase, and so the cycle begins again.
Any disruptions in the hair growth cycle can lead to hair loss.
The causes of hair loss and balding
When you first start to notice that your hair is thinning you might be quick to blame yourself.
Is it the shampoo you’re using?
Is that new hair fudge to blame?
Have you been wearing a hat too often?
Whilst hair loss can be the result of a number of causes, the most common cause is male pattern baldness (MPB), also known as androgenetic alopecia or androgenic alopecia.
That means it’s nothing to do with your shampoo, fudge, or your hat. It actually to do with the genes you’ve inherited.
“Thanks Mum!” we hear you say. But actually, it’s not just her fault.
Contrary to popular belief, the genes from your father play a role too. What researchers are still unclear about, however, is the exact mode of inheritance and the relative importance of each parent.¹⁰
It’s these genes combined with your hormones and environmental factors that set the stage for potential MPB.
🔬 Testosterone and DHT — The major culprits of MPB
Without testosterone and DHT, you wouldn’t have any of your manly features, but in a cruel twist, they’re also the hormones that play a big part in MPB. Sux, right?
In the body, testosterone is converted to its more ‘active’ form, dihydrotestosterone (DHT), with the help of an enzyme called 5-alpha reductase.¹¹ DHT acts on different organs in the body including the hair follicles.
Essentially, the DHT shrinks the hair follicles as well as shortens the hair growth cycle we talked about above.¹³
This causes hair to grow out looking thinner and more brittle, as well as fall out faster. DHT can also make it take longer for the follicles to grow new hairs once the old hairs fall out.
Engaging in behaviors that increase DHT production, such as using creatine supplements,¹⁴ resistance and weight training exercise,¹⁵ or taking anabolic steroids,¹⁶ all have the potential to increase hair loss.
Age will get you…eventually, whether you have MPB or not, hair thinning and loss is actually a normal part of aging for everyone.¹⁷
It’s called involutional alopecia. That’s not to say you’ll lose all your hair as a result of aging, but as hormones in the body change with age, and the rate of hair growth naturally slows, the number of hair strands on your head will decrease.
Emotional stress or shock can temporarily kill your hair. We all experience some level of stress most days, such as sitting in traffic or dealing with an office worker who chews loudly, but that’s not the kind of stress that will cause your hair to fall out.
It’s periods of chronic or traumatic stress such as dramatic weight loss, illness, or death of a loved one, that can cause hair loss.
Unlike MPB, this is usually a form of temporary hair loss called telogen effluvium.¹⁸ In this instance, follicles are pushed into the shedding and resting phases. Once the stress is under control, however, the hair is likely to grow back over time.
Stress has also been implicated in a condition called alopecia areata — where the body’s immune system attacks the hair follicles causing hair loss.¹⁹ But again, once stress levels decrease, hair can grow back.
Finally, trichotillomania is a disorder in which people feel compelled to pull out their own hair as a way of dealing with negative emotions such as stress and frustration.¹⁹
All these conditions are much rarer than MPB.
Regardless of the effect on your hair, too much stress is not a good thing.
It’s important to look after your mental health by eating healthily, exercising, and getting enough sleep. If you’re feeling stressed or overwhelmed, there’s no shame in asking for help from your doctor.
🍔 A POOR DIET CAN MEAN A LACKLUSTRE MOP
You may be one of those blokes who can get away with eating anything, but if you’re starting to thin on top, it pays to look at your diet.
In the developed world, nutritional deficiencies leading to hair loss are quite rare, but if anything, it’s worth talking about protein and iron.
If you’re deficient in either of these, you could experience hair loss.20,21 Vegans and vegetarians may be especially vulnerable.
And if you’re aiming for weight loss, don’t try to get ripped too fast. Crash diets and sudden weight loss can cause telogen effluvium — the temporary form of hair loss.
The good news is that once nutritional deficiencies are corrected and you resume a normal, healthy diet, your hair can grow back.
🍎 YOUR WAISTLINE COULD AFFECT YOUR HAIRLINE
When you’re carrying a spare tyre — and we don’t mean the one in the boot of your car — it puts all kinds of added strains on your body. Your heart, your joints and your hormones to name a few.
If that’s not enough reason to lose the extra flab, this might be:
Research has shown that a higher Body Mass Index (BMI) may be associated with more severe hair loss in men who already have MPB, especially those who started to bald at a young age.²²
Ready to forgo that second Big Mac now?
🚬 SMOKING CAN CHOKE MORE THAN JUST YOUR LUNGS
We all know the cancer sticks are bad for you, but aside from them being a major risk to your health, they may also be contributing to balding and early greying.
According to epidemiological studies, the toxins in smoke can harm hair follicles and damage hormones. A report in the journal BMJ found a “significant” and “consistent” link between smoking and early greying.²³
Further research showed that in a group of 740 men aged 40–91 years, smoking at least 20 cigarettes a day was linked to an increased risk of baldness, even after other risk factors were taken into account.²⁴
Whilst the results of this research are in conflict with some other studies and more research is needed, giving up the durries will benefit so much more than your hair.
💊 CERTAIN MEDICATIONS AND ILLNESSES CAN BE TO BLAME
Popping pills for some common health conditions such as acne, high cholesterol, depression, and high blood pressure can (although very rarely) come with side effects like hair loss. And then there’s anabolic steroids. What’s pumping up your guns might be causing you to shed more hair.
The severity of hair loss depends on the type of drug and dosage, as well as your sensitivity to that drug.²⁵
The good news is that in most cases, hair loss is reversible once you stop taking the drug.
If you are currently taking any of these medications and hair loss is a concern for you, it’s best to speak to your doctor. Remember, never stop taking a medication before discussing it with your doctor.
Some illnesses can also bring on hair loss,²⁶ such as an underactive or overactive thyroid; eating disorders; iron deficiency anaemia; diabetes; autoimmune diseases such as lupus and alopecia areata; and skin conditions such as psoriasis and dermatitis.
If you’re experiencing hair loss, speak to your doctor to rule out such illnesses.
Mythbusting hair loss
For each of the hair loss facts served to us by science, the internet coughs up a bunch of complete and utter hair loss fallacies. So, let us clear the (h)air for you.
Chapter 2: Diagnosing Male Pattern Baldness
MBP is the most common type of hair loss in men. Here you’ll learn about the signs and symptoms of MPB, how to diagnose it correctly and how to determine what stage you’re at.
What to look out for
While there’s no surefire way of knowing if your hair is about to depart to greener pastures, there are certain early signs of MPB that should have you considering your options.
If it’s any comfort, MPB doesn’t happen overnight. Going bald is usually a long and slow process that can take anywhere from a few short years to several decades.
Don’t want to suffer through the process? Then noticing the signs and taking action early is the way to go.
The earlier you act, the more hair you’ll be able to save.
What stage are you at?
MPB gets its name because the hair falls out from the scalp in similar pattern in most guys. It’s one of those things in life that you wish wasn’t so predictable.
As a rule, it starts at the temples and crown of the head, and over time, the two areas eventually meet leaving a U-shaped rim of hair at the back. Think Prince William, Larry David, and Dr Phil.
Most men never lose the U-shaped section of hair as this hair is typically less sensitive to DHT,³¹ although there are rare cases of men losing all of their hair to MPB.
The Norwood scale is the leading classification system used by clinicians to measure the extent of male pattern baldness. It provides a reference point to diagnose the extent of baldness, discuss treatment options, and measure the effectiveness of treatment.³²
The take-home message is that as soon as you discover that you’re losing your hair, the best approach is a proactive one.
Chapter 3: Preventing & treating hair loss
Thinking about more serious hair loss treatments and want to know what actually works?
A healthy diet and lifestyle = healthy hair
Dadbods might be the new six-pack, but your hair might not agree.
Hair needs adequate protein, vitamins, and minerals to keep its strength and shine. Make sure you get enough of the following as part of a healthy, balanced diet:³³ ³⁴ ³⁵ ³⁶
- Protein
- Iron
- Zinc
- Vitamins C, D, E and A (but not too much A, as it can contribute to hair loss when taken in excess)
- The B-complex vitamins
- Omega-3 and omega-6 fatty acids
And then there are lifestyle habits…
Research done with balding male twins³⁷ says that while genetics accounts for most of it, the twin who leads an unhealthy lifestyle increases his risk of more hair loss compared to his brother.
So, get regular exercise, sleep 7–9 hours each night, staying hydrated, quit smoking (if you smoke), reduce your alcohol intake, and manage your stress levels.
Yoga and meditation are great ways to help reduce stress and calm your mind.
Natural treatments or just snake oil and lies?
We know you’re desperate to hold onto your strands, but be careful where you invest your hard-earned cash.
There are a host of natural treatments on the market claiming to increase scalp circulation and prevent hair loss, but only a few have been clinically proven.
Here are some popular ones:
💆♂ ️SCALP MASSAGE
Some small studies.³⁸ ³⁹ claim it can help increase hair thickness, but robust research is lacking.³³ The benefits most likely have to do with reduced stress levels as a result of having a massage!
💊 BIOTIN (VITAMIN B7)
You may have also recognized biotin (vitamin B7) as an ingredient in many hair thickening shampoos and hair loss supplements. There is, however, no clinical trials that have demonstrated that biotin supplementation can help hair loss when there’s no existing deficiency — and biotin deficiencies in the developed world are rare.²⁰
🌿 SAW PALMETTO
Of all the natural treatments on the market, saw palmetto is the most promising, although it still has limited effectiveness compared to medical treatments.⁴⁰ ⁴¹ An extract of saw palmetto berries may block the enzyme that converts testosterone to DHT, thereby reducing DHT levels (the hair loss culprit).⁴⁰ It can be taken orally, as topical drops, or in a shampoo, but the doses used in shampoos may be less effective.
Treatment: Hair Loss Shampoos
You can scrub, shave, brush your teeth and may be do a few other things in the shower (which we won’t mention here), so how about managing your hair loss?
While shampoos may offer a slight benefit (depending on what is causing your hair loss) they’re unlikely to be a game-changer for your hairline if you have MPB. Combining them with medical hair loss treatments may improve their effectiveness, though.⁴²
These are two common ingredients you’ll see in hair loss shampoos.
☕ CAFFEINE
It’s a great way to wake you up in the morning, but unfortunately, it doesn’t work to wake up your hair follicles. Currently, there is no clinically viable evidence that it improves hair growth in MPB.⁴³
👨🔬 KETOCONAZOLE
A small study⁴⁴ back in the 90s found that this antifungal drug increases hair density almost as well as minoxidil, but larger more robust research is lacking. It does, however, treat dandruff quite effectively,⁴⁵ which some men experience as part of hair loss.
Cosmetic Treatment
The Prince Charles kind of combover or a wig is probably not what you consider attractive options for your hair loss. But fear not.
There are other hairstyles, products, and procedures that can help you disguise your hair loss in a more discreet way…at least for a while.
🧴 HAIR-THICKENING PRODUCTS
The last thing your thinning hair needs are products that weigh it down, so get rid of any thick pastes, heavy conditioners or gels, and invest in lighter alternatives or hair thickening products.
Thickening shampoos, conditioners, sprays, and powders contain special polymers which plump up the hair shafts to make them look fuller. The effects are only temporary so you’ll need to use them regularly, but they can increase hair thickness noticeably.
Speak to your hairdresser about your options.
💈 MODIFIED HAIRSTYLES
Just because you’re losing your hair doesn’t mean you don’t want to look good. There are plenty of ways to create a trendy, clean, and professional look with thin hair or bald sections of the scalp. These are just some of them.
Hair Loss Medical treatments
If you’re serious about saving your hair in a cost-effective way, this is a path you’ll want to consider.
These treatments are clinically proven to work, but as with all medicines, they come with some side effects that you should discuss with a doctor. It’s important to be 100% informed and comfortable with any medications you decide to take.
💧 MINOXIDIL (TOPICAL SPRAY)
Of all the medical treatments, this one appears to be the most effective for the least side effects.⁴⁶
It’s most commonly used as a topical foam or spray and works by widening the blood vessels, allowing more blood, oxygen, and nutrients to the hair follicle to slow hair loss and promote hair growth. It won’t stop the onset of MPB, but it can be very effective in the early stages of MPB, and even more effective when used in combination with other medical treatments.⁴⁷ ⁴⁸ ⁴⁹
But here’s the thing…
When you first start using minoxidil, you’ll actually have an increase in hair shedding for some weeks before you see any benefit from the treatment. This will likely freak you out, but the hair will grow back again if you can push past that phase. Some scalp irritation is also possible.
🙊 A TREATMENT WE CAN’T MENTION
Australian law prevents us from mentioning certain treatments until you’ve spoken to a doctor, so it’s in the vault for now.
What we can say, though, is there is a clinically proven way to halt (and in some cases reverse) hair loss in the majority of men with MPB.⁵⁰ When used in combination with other products such as minoxidil, it can be even more effective.⁴⁷ ⁴⁸ ⁴⁹ ⁵¹
Low-Level Laser Therapy (LLLT)
If there was a hair loss therapy for intergalactic superheroes, this would be it.
It’s a non-surgical treatment that works by exposing the scalp to a low level of red or near-infrared light.
Researchers think it works by stimulating stem cells in the hair follicle and shifting them back into the growth phase of the hair cycle. The possible result is an overall improvement in the length and thickness of the hair.⁵²
Some studies have shown that it’s effective in the short term (when used consistently over several months), but more research is needed to determine its effectiveness compared to other more established treatments and in the long term.⁵³ ⁵⁴
The best thing about LLLT is that it can be done at home using a purchased LaserComb or wearing a laser helmet for a certain amount of time, every second day. It’s painless and has not been shown to have adverse effects.
Cost-wise, a laser comb or cap can set you back several hundreds, if not thousands, of dollars. So, while it might be an alternative to medical treatments, it’ll create a significant hole in your back pocket and it requires commitment and patience to see results.
Minimally invasive treatments
These ones aren’t quite surgery, but they do involve blood (which we only really like in movies), and they aren’t cheap.
🖊 ️SCALP MICROPIGMENTATION (HAIR TATTOO)
Tatts are in fashion, but hair tatts? You might need some time to digest that idea.
This procedure uses microneedles to tattoo pigment into the scalp. It creates the appearance of tiny hair follicles to restore the look of a fuller head of hair. A skilled practitioner works to ensure the dots look like a natural hair follicle and blend in with your complexion.
But having this procedure is not a decision you’ll want to make lightly. Treatments can cost in the thousands of dollars, and depending on the amount of hair loss you have, can take several sessions.
It’s a permanent procedure that requires you to keep your hair very short to take full advantage of the look, and the pigment can also fade over time with sun exposure.
📍 MICRONEEDLING
This one makes us squirm a little bit.
It’s a procedure that involves the use of a skin roller with small needles that cause minor skin injuries to the scalp. The process of creating tiny skin wounds is thought to regenerate the health of the hair follicles and result in new hair growth, or perhaps thicken thinning hair.⁵⁵
While it’s shown some promise for improving hair growth in some small studies, more research is needed.⁵⁶ If it’s combined with other therapies such as topically applied minoxidil, it may help the treatment be absorbed better into the scalp.⁵⁷
Microneedling can cost in the hundreds of dollars per session, and several sessions may be needed.
It can make the scalp red and inflamed for a few days following the procedure, and there is a risk of infection and scarring.
💉 PLATELET RICH PLASMA (PRP) INJECTIONS
Also known as Vampire PRP Hair Growth this is one of the hottest new treatments to become available, partly made famous by Kim Kardashian (don’t ask). It uses your own blood to help restore hair growth in thinning areas.
Essentially, a sample of your blood is collected (just like a normal blood test) and it is put in a centrifuge machine to separate your blood components. The platelet-rich plasma part of the blood is then injected into your scalp with the hope of reviving dying hair follicles.
Although PRP has a good scientific basis to support its use in hair restoration, it’s a treatment that is in its early days and the clinical (in practice) evidence is still weak.⁵⁸
You’ll typically need three treatments in a 4–6-week period, with maintenance treatments every 4–6 months.
Whilst the procedure itself is fairly quick with no downtime, it’s pricey (in the thousands of dollars) and there are risks such as infection, scarring and damage to blood vessels or nerves.⁵⁸
Surgical hair transplants
We’re not going to delve too deep into this option for three reasons:
- It’s too expensive for many men to consider,
- It carries significant risks, and
- It’s a major and personal decision that should be made only after consulting a good doctor.
But in brief…
Various hair transplant techniques are available, but they all involve taking areas of the scalp that have active hair (usually from the back and sides of the head) and grafting these pieces of skin onto bald or thinning areas of the scalp.
It’s the most invasive and expensive treatment for hair loss, and can cost in the tens of thousands of dollars. Multiple treatments are often necessary, and the procedure carries the risk of scarring and infection. The upside is that the result looks quite natural if it’s done well.
Don’t be fooled though. Hair transplantation doesn’t necessarily provide a one-off definitive treatment for MPB. Even after a successful treatment, maintenance medical treatments are often recommended in the long term to prevent thinning of the hairs that are not yet affected by MPB.
You’ll need to consult with a doctor (or a few) to determine if you’re a suitable candidate for this surgery. In general, the best candidate is someone who has had hair loss for a number of years but it has stabilized and they are not losing more hair quickly.
Chapter 4: How To Decide What’s Right For You
All this information is overwhelming right!? So, we’re going to help you make a rational decision about your next steps. Here are three factors to consider when deciding on hair loss treatments.
Is it easy to use?
There’s a mountain of hair loss treatment options that could have you umm-ing ahh-ing about what to choose, but your choice becomes a lot easier if you narrow down the ones that are the easiest or most practical for you to use and that best fit into your lifestyle.
For example, oral medication or supplement is a lot faster and easier to take than using LLLT.
If you choose a treatment that isn’t easy enough for you to use, you’re unlikely to stick with it consistently, which will affect your results.
Is it safe?
Us blokes like to take risks every now and then, but probably not so much when it comes to hair loss treatments.
Take the time to discuss all the possible side effects of the treatments you are considering, with your doctor.
Your individual medical history — and even prior experience with some of the treatments — will also help you narrow down the most suitable treatment option for you.
Is it likely to get you the desired result?
This is called efficacy and has to do with how effective a treatment is. For example, a treatment may be natural and have few side effects, but it may not be as effective at treating hair loss as the medical options. Furthermore, just one treatment alone may not be as effective as combining treatments.
We hope this ultimate guide answered all your questions around the causes of hair loss and your treatment options when it comes to treating hair loss.
Is there something we missed? A question you still have? Leave a comment below!
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