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Hair Loss in Men

The medical term for hair loss is alopecia. There are about 50 different types, with some more common than others.

Types of hair loss in men

The medical term for hair loss is alopecia. There are about 50 different types, with some more common than others. Male-pattern baldness, for instance, is by far the most common type of hair loss in men, and is though to affect around half of all men by the time they reach their 50th birthday. Meanwhile, another type of hair loss – alopecia areata – is thought to affect one to two in every 1,000 people in this country.

Here’s what you should know about the main types of alopecia that affect men:

  • Androgenetic alopecia
    Also known as male-pattern baldness, androgenetic alopecia is the most common type of progressive hair loss. In men, androgenetic alopecia runs in families. Many experts believe that in androgenetic alopecia, the male sex hormone testosterone converts to another hormone called dihydrotestosterone (DHT). This affects the hair follicles on the scalp, making them produce thinner hairs and eventually stopping hair production altogether.

    Men usually start to be affected in their late 20s or early 30s. The pattern usually starts with a receding hairline and thinning hair at the top and front of the head, and can progress to a horseshoe pattern of hair around the back and sides. Smoking is thought to speed up the progress of male-pattern baldness, but going thin on top isn’t usually a sign of a medical problem.

  • Alopecia areata
    Alopecia areata can affect anyone of any age, though it’s thought to be more common between the ages of 15 and 29 (six out of 10 people affected are thought to develop a bald patch before they reach the age of 20). It may also affect eyebrows, eyelashes and beards in men. Many cases of alopecia areata are caused by problems with the immune system, such as diabetes, overactive thyroid and lupus, and experts believe some people may be genetically predisposed to developing it if they have family members who are affected (one in five people with alopecia areata have a family history of the condition). It has also been linked with stress.

    Alopecia areata causes round patches of hair loss, though sometimes the hair loss can be diffused rather than in definite patches. The good news is in many cases, the hair grows back without any treatment.

  • Telogen effluvium
    Unlike the types of hair loss that cause bald patches, telogen effluvium is characterised by general shedding from all over the head. It’s believed to be the most common cause of hair loss in women, but can affect men too. It’s normal to lose 100 or so hairs a day, but this shedding can increase when your body reacts to things like intense emotional or physical stress, illness, crash dieting and certain medicines including beta-blockers (used to treat a range of conditions, including high blood pressure)and anticoagulants (blood thinning medications).

    Telogen effluvium is usually temporary, and hair starts to grow back within six months. But if the condition lasts for nine months or more, it is classed as chronic telogen effluvium.

  • Anagen effluvium
    This is the type of hair loss mainly seen in people having chemotherapy treatment. As well as affecting the scalp, it may cause loss of hair from other parts of the body and face. Like telogen effluvium it’s usually temporary, and hair grows back within a few months of finishing treatment.


How hair grows

The average hair grows by 0.3-0.4mm each day, which works out to around six inches a year. If you don’t have a hair loss problem, you should have between 90,000 and 150,000 hairs on your head, depending on your hair colour (redheads, for instance, have an average of 90,000 hairs on their head, while blondes have 150,000).

The hair growth cycle is in three stages: anagen, catagen and telogen.

  • Anagen
    Around 90 percent of the hair on your head is normally in this stage – the growth or active stage. This is when the cells in the roots of your hair are dividing and new hairs are formed. These new hairs push those in the non-active stages up the follicle, where they eventually fall out. The anagen phase lasts between two and six years.

    If your hair doesn’t grow to a very long length, it’s probably because it has a relatively short anagen phase. The hair on the rest of your body has an anagen phase of between 30 and 45 days, which explains why it only grows to a relatively short length.

  • Catagen
    This transitional stage affects around three percent of all the hairs on your head at any one time. This is when growth stops and the hair follicle shrinks. It lasts for anything from two to three weeks.

  • Telogen
    This stage – where the hair follicle is completely at rest – affects between six and eight percent of hairs. The hair on your scalp remains in this phase for about 100 days, but other hairs (such as eyebrow, eyelash and body hairs) stay in the telogen stage for longer. Hairs in this stage are normally shed at a rate of about 100 a day.

When large numbers of hairs switch from the anagen to the telogen phase, the result is the condition telogen effluvium.


What causes male-pattern baldness?

In men, the most common type of hair loss by far is male-pattern baldness. Indeed, for the majority of men, hair loss or thinning hair is an inevitable fact of life. Male-pattern baldness is thought to affect 6.5 million men in the UK, with Caucasian men the most likely to be affected. This pattern of hair loss varies, from a slightly receding hairline or hair that’s generally less thick than it used to be to a bald patch on top, advanced receding from the front of the head or generally very thin hair, including the familiar rim of hair around the back and sides of the head. Some men lose all their hair, leaving them with nothing on their scalp.


What causes it?

Hormones are involved in the changes that cause hair to stop growing. When testosterone – the main male sex hormone – is converted into another hormone called dihydrotestosterone (DHT) in the hair follicles, the affected follicles start to become smaller than normal, and the hair they produce starts to thin at the same time. In time, the affected hair follicles are so small that they only produce a fine hair that grows below the surface of the skin.

As to why some men have hair follicles that are sensitive to these hormonal changes while others don’t, it’s now accepted that male-pattern baldness is a genetic condition. At the same time, many men who lose the hair on their scalp have much more hair on their bodies than others. This again is a result of hormonal activity (though it doesn’t mean men who are affected by male-pattern baldness produce more testosterone than those who aren’t).


What can you do?

If you have a genetic predisposition for male-pattern baldness and your hair is starting to thin, there is some medication you can try.

In the meantime, making sure your diet has a good supply of certain nutrients may be a good idea to keep your hair and scalp as healthy as possible for as long as possible:

  • Don’t pass on protein
    Your body needs a good supply of protein to make new hairs (hair is, after all, made mostly from protein). So make sure you’re getting the protein you need, including fish, chicken and lean cuts of meat, as well as low-fat dairy products, eggs and beans. Eating meat, chicken, fish and beans also keeps your iron levels topped up (not having enough iron can also cause hair loss).

  • Eat more carrots
    Foods rich in beta-carotene, which your body converts to vitamin A, may help to keep your cells healthy, including those on your scalp. Red, yellow and orange fruit and vegetables are good sources, plus some dark green leafy veg.

    Similarly coloured foods, including oranges, peppers and tomatoes, are also rich in vitamin C, a nutrient your body needs to make collagen (collagen is found in your hair as well as your skin).

  • Zinc
    Zinc is a mineral that helps to keep the sebaceous glands attached to your hair follicles healthy, so make sure you’re getting enough foods that contain it, such as seafood, poultry, eggs, nuts and seeds

  • Boost your Bs
    Vitamins B6, B12 and folic acid help to carry oxygen around your body, including to your hair follicles. Low-fat protein foods such as chicken, fish, eggs and beans may help increase your levels of B6 and B12, while eating green leafy vegetables and fortified cereals may boost your folic acid intake.


Hair loss myths and facts

The subject of hair loss has more of its fair share of old wives’ tales. Here are some that are true – and some that are just myths:

  • TRUE: Steroid abuse is linked to hair loss
    Anabolic steroids are often taken illegally by athletes, weightlifters and bodybuilders to boost muscle mass. But research suggests they may also increase levels of male hormones that trigger baldness.

  • FALSE: Scalp massage can stop you going bald
    It may boost your circulation, but there’s no link between increased blood circulation and hair growth. The same goes for washing your hair in cold water and standing on your head – neither has any effect on thinning hair.

  • TRUE: Stress causes hair loss
    This is probably true, but usually only in major cases of psychological stress, such as after the death of a loved one. Physical trauma – such as a severe illness or an accident – may also cause temporary hair loss.

  • FALSE: Going bald is passed down through mothers
    Baldness does run in families, but you can inherit the hair loss gene from your mother or your father – or both (though some experts think the inheritance from the mother’s side is slightly stronger than from the father’s side).

  • TRUE: Colouring your hair can weaken your hair
    The chemicals in many hair dyes may harm your hair if you don’t use them properly, and can make your hair break more easily or even cause temporary hair loss. Treating your hair more gently can help reverse the damage.


Remedies for hair loss

There are several pharmacy and natural remedies for hair loss available, but choosing the one that will be effective for you will depend on the type of hair loss you’re experiencing:


Minoxidil

This pharmacy product for male-pattern baldness (hormone-related hair loss) is available without prescription. Minoxidil foam or lotion is available in two strengths: five percent and two percent. When applied to the scalp every day, it may slow down or reverse hair loss in some men – though any improvement may not be noticeable for a couple of months.


Iron

If your hair loss is caused by iron-deficiency anaemia – as can be the case with chronic telogen effluvium – taking an iron supplement to boost your blood level of haemoglobin may help to reverse the problem with your hair. However, this may be more a problem for women than men, as CTE is more commonly experienced by women. Since some people experience constipation when taking iron tablets, it’s advisable to take a form of iron that’s easily absorbed, such a citrate form.

Nutrients that help increase the absorption of iron include vitamin C (i) and the amino acid l-lysine. These may be useful, but again women may benefit more than men (an analysis of several studies suggests 90 percent of women with hair loss are deficient in both iron and lysine (ii)).


General hair maintenance nutrients

Taking a multivitamin and mineral supplement to support overall health may also be recommended, especially if it contains nutrients approved by the EU’s European Food Safety Authority (EFSA) for the maintenance of normal hair. These include biotin (vitamin B7), selenium, zinc and copper (the EFSA confirms that deficiencies in two of these nutrients – selenium and zinc – may result in hair problems).

 



References:

  1. Effect of ascorbic acid on iron absorption. Acta Med Scand. ;171(Suppl 376):51.

  2. Nutritional factors and hair loss. Clin Exp Dermatol. :27(5)396-404.