Usually, most men lose hair because of genetics, or a history of baldness in the family. Studies shows that androgenic alopecia is associated to the male sex hormones identified as “androgens”, which control hair growth among other functions.
Hair loss
Although hair loss rarely needs to be treated, many people seek treatment for cosmetic reasons.
Many cases of hair loss are temporary, for example, due to chemotherapy, or they’re a natural part of ageing and don’t need treatment. However, hair loss can have an emotional impact, so you may want to look at treatment if you’re uncomfortable with your appearance.
If hair loss is caused by an infection or another condition, such as lichen planus or discoid lupus, treating the underlying problem may help prevent further hair loss.
The various treatments for hair loss are outlined below. You can also read a summary of the pros and cons of the treatments for hair loss, allowing you to compare your treatment options.
Male-pattern baldness isn’t usually treated, as the treatments available are expensive and don’t work for everyone.
Two medicines that may be effective in treating male-pattern baldness are finasteride and minoxidil. Neither treatment is available on the NHS.
You may also want to consider wearing a wig or having surgery.
Finasteride is available on private prescription from your GP. It comes as a tablet you take every day.
It works by preventing the hormone testosterone being converted to the hormone dihydrotestosterone (DHT). DHT causes the hair follicles to shrink, so blocking its production allows the hair follicles to regain their normal size.
Studies have suggested finasteride can increase the number of hairs people have (hair count) and can also improve how people think their hair looks.
It usually takes three to six months of continuously using finasteride before any effect is seen. The balding process usually resumes within six to 12 months if treatment is stopped.
Side effects for finasteride are uncommon. Less than one in 100 men who take finasteride experience a loss of sex drive (libido) or erectile dysfunction (the inability to get or maintain an erection).
Minoxidil is available as a lotion you rub on your scalp every day. It’s available from pharmacies without a prescription. It’s not clear how minoxidil works, but evidence suggests it can cause hair regrowth in some men.
The medication contains either 5% or 2% minoxidil. Some evidence suggests the stronger version (5%) is more effective. Other evidence has shown this is no more effective than the 2% version. However, the stronger version may cause more side effects, such as dryness or itchiness in the area it’s applied.
Like finasteride, minoxidil usually needs to be used for several months before any effect is seen. The balding process will usually resume if treatment with minoxidil is stopped. Any new hair that regrows will fall out two months after treatment is stopped. Side effects are uncommon.
Minoxidil is currently the only medicine available to treat female-pattern baldness.
Minoxidil lotion may help hair grow in around one in four women who use it, and it may slow or stop hair loss in other women. In general, women respond better to minoxidil than men. As with men, you need to use minoxidil for several months to see any effect.
There is no completely effective treatment for alopecia areata. However, in most cases the hair grows back after about a year without treatment. So “watchful waiting” is sometimes best, particularly if you just have a few small patches of hair loss.
Some treatments for alopecia areata are outlined below.
Corticosteroids are medicines containing steroids, a type of hormone. They work by suppressing the immune system (the body’s natural defence against infection and illness). This is useful in alopecia areata because the condition is thought to be caused by the immune system damaging the hair follicles.
Corticosteroid injections appear to be the most effective treatment for small patches of alopecia. As well as your scalp, they can also be used in other areas, such as your eyebrows.
A corticosteroid solution is injected several times into the bald areas of skin. This stops your immune system from attacking the hair follicles. It can also stimulate hair to grow again in those areas after about four weeks. The injections are repeated every few weeks. Alopecia may return when the injections are stopped.
Side effects of corticosteroid injections include pain at the injection site and thinning of your skin (atrophy).
Topical corticosteroids (creams and ointments) are widely prescribed for treating alopecia areata, but their long-term benefits are not known.
They are usually prescribed for a three-month period. Possible corticosteroids include:
These are available as a lotion, gel or foam depending on which you find easiest to use. However, they cannot be used on your face, for example on your beard or eyebrows.
Possible side effects of corticosteroids include thinning of your skin and acne.
Corticosteroids tablets aren’t recommended because of the risk of serious side effects.
Minoxidil lotion is applied to the scalp and can stimulate hair regrowth after about 12 weeks. However, it can take up to a year for the medication to take full effect.
Minoxidil is licensed to treat both male- and female-pattern baldness, but is not specifically licensed to treat alopecia areata. This means it hasn’t undergone thorough medical testing for this purpose.
Minoxidil is not recommended for those under 18 years old. It’s not available on the NHS, but can be prescribed privately or bought over the counter.
Immunotherapy may be an effective form of treatment for extensive or total hair loss, although fewer than half of those who are treated will see worthwhile hair regrowth.
A chemical solution called diphencyprone (DPCP) is applied to a small area of bald skin. This is repeated every week using a stronger dose of DPCP each time. The solution eventually causes an allergic reaction and the skin develops mild eczema (dermatitis). In some cases, this results in hair regrowth after about 12 weeks.
A possible side effect of immunotherapy is a severe skin reaction. This can be avoided by increasing the DPCP concentration gradually. Less common side effects include a rash and patchy-coloured skin (vitiligo). In many cases, the hair falls out again when treatment is stopped.
Immunotherapy is only available in specialised centres. You’ll need to visit the centre once a week for several months. After DPCP has been applied, you’ll need to wear a hat or scarf over the treated area for 24 hours because light can interact with the chemical.
Similar to immunotherapy, dithranol cream is applied regularly to the scalp before being washed off. It causes a skin reaction, followed by hair regrowth in some cases.
However, it hasn’t been proven that dithranol cream is significantly effective in the long term. It can also cause itchiness and scaling of the skin and can stain the scalp and hair. For these reasons, dithranol is not widely used.
Two to three sessions of light therapy (phototherapy) are given every week in hospital. The skin is exposed to ultraviolet (UVA or UVB) rays. In some cases, before your skin is exposed to UV light you may be given a medicine called psoralen, which makes your skin more sensitive to the light.
The results of light therapy are often poor. The treatment can take up to a year to produce maximum results and responses vary, with a high relapse rate. It’s often not a recommended treatment because side effects can include:
For many people, it’s possible to replicate hair with a tattoo. This is known as dermatography and generally produces good long-term results, although it is usually expensive and can only be used to replicate very short hair.
This is usually carried out for eyebrows over a few hourly sessions and can even be used as a treatment for scalp hair loss caused by male-pattern baldness.
Wigs can be a useful treatment for people with extensive hair loss.
The cheapest wigs are made from acrylic and can cost anywhere between £60 and £300.
Acrylic wigs last for six to nine months. They’re easier to look after than wigs made of real hair because they don’t need styling. However, acrylic wigs can be itchy and hot, and need to be replaced more often than wigs made from real hair.
Read about NHS wigs and fabric supports for information on who is entitled to free wigs and who can get help with costs.
Some people prefer the look and feel of wigs made from real hair even though they are more expensive, costing anywhere between £200 and £2,000.
Real hair wigs last for three to four years, but are harder to maintain than synthetic wigs because they may need to be set and styled by a hairdresser and professionally cleaned.
A human hair wig is only available on the NHS if you’re allergic to acrylic, or if you have a skin condition made worse by acrylic. You may wish to buy your wig privately.
Read about NHS wigs and fabric supports for more information about how much a human hair wig costs on the NHS.
Alopecia UK also has useful information about synthetic wigs and human hair wigs, including advice about choosing the right wig and how to care for it.
Aromatherapy, acupuncture and massage are often used for alopecia, but there isn’t enough evidence to support their use as effective treatments.
Most men and women considering hair loss surgery have male-pattern or female-pattern baldness. However, surgery is sometimes suitable for a range of alopecia conditions.
Surgery for hair loss should only be considered after trying less invasive treatments, and it’s not usually available on the NHS.
The success of hair loss surgery depends on the skill of the surgeon, as complications can arise. It’s best to speak to your GP for advice before seeking out a surgeon in the private sector.
The main types of hair loss surgery are explained below.
Under local anaesthetic (painkilling medication), a small piece of scalp (about 1cm wide and 30-35cm long) is removed from an area where there’s plenty of hair. The piece of scalp is divided into single hairs or tiny groups of hairs, which are grafted onto areas where there’s no hair.
Stitches are not needed to attach the grafts because they are held in place by the clotting (thickening) action of the blood when the hairs are inserted. Fine hairs are placed at the front of the scalp and thicker hairs towards the back in a process called grading. This helps achieve a more natural result. Within six months, the hair should settle and start to regrow.
Hair transplants are carried out over a number of sessions. There should be a break of nine to 12 months between procedures. As with any type of surgery, there is a risk of infection and bleeding, which can lead to hair loss and noticeable scarring.
Hair transplantation isn’t provided by the NHS. It can be expensive and take a long time.
Scalp reduction involves removing pieces of bald scalp from the crown and the top of the head to move hairy parts of the scalp closer together. This can be done by cutting out loose skin and stitching the scalp back together, or it can be done by tissue expansion.
Tissue expansion is where a balloon is placed underneath the scalp and inflated over several weeks to expand the skin in stages. The balloon is then removed and the excess skin is cut out.
Scalp reductions are not suitable for hair loss at the front of the scalp because it can cause scarring. There is also the risk of infection in the area.
Scalp reduction isn’t usually used for male-pattern baldness, but it’s available on the NHS to people with scarring alopecia. Surgery should only be carried out after any underlying conditions have cleared up.
Artificial hair implantation is marketed as a treatment for male-pattern baldness. It involves implanting synthetic fibres into the scalp under local anaesthetic. The technique is not available on the NHS.
Artificial hair implantation carries serious risks of infection and scarring, but clinics may be reluctant to inform people of the possible complications to avoid losing potential clients.
Artificial hair implantation isn’t recommended by dermatologists because of the risk of complications such as:
People considering hair loss surgery should explore more established treatments, such as hair transplantation and scalp reduction, because the advantages and disadvantages of these techniques are better understood.
The latest research into hair loss treatments is studying hair cell cloning. The technique involves taking small amounts of a person’s remaining hair cells, multiplying them, and injecting them into bald areas.
Cloning is intended to treat both male- and female-pattern baldness. However, the science behind the technique is new and more trials are needed before it can be fully assessed.
Alopecia
Losing your crowning glory can be particularly difficult for women. But there are ways to cope.
Losing your hair as a woman, especially if you’re young or at a vulnerable time in your life, can badly affect your confidence.
Jackie McKillop, Alopecia UK spokesperson and junior nursing sister at Addenbrooke’s Hospital in Cambridge, says society considers hair to be an important part of how you look:
“For women, there is a social stigma attached to going bald,” she says. “Hair loss can affect your sensuality and how you perceive yourself. There are usually emotional trials and tribulations when it happens.
“Some women question whether their partner will still love them. I’ve known others become socially reclusive and give up enjoyable activities like swimming and going to the gym, because they can’t bear using the communal changing rooms for fear of their hair loss being discovered.”
Hair loss, known medically as alopecia, is common. It’s estimated, for instance, that around 50% of women over the age of 65 experience female-pattern baldness – the most common type of hair loss, which is thought to be inherited.
There are lots of different types of hair loss. It can take the form of “thinning” or involve a total loss of hair. It can be gradual or sudden; it can affect the old and the young.
Hair loss can be genetic, or as a result of extreme stress, a medical condition or treatment.
Hair loss is a well-known side effect of chemotherapy, and around 50% of women lose more hair than usual after they’ve given birth.
Jackie McKillop, who has herself lost all her hair, says it can help to address the physical aspects of hair loss. Try to find out everything you can about hair loss and the treatment options available to you.
A proven treatment for female-pattern baldness is a hair lotion containing minoxidil. After using it, most women see improvements, including a slowing or stopping altogether of balding, as well as thicker hair. Up to 25% of women experience hair regrowth while using it.
Always contact your GP or dermatologist for advice before starting or finishing any treatments or medication for alopecia.
Find out about hair loss treatments that work.
It’s also important to address the psychological impact of hair loss. If you’ve lost your hair, even temporarily, life will be easier if you can accept what’s happened and learn to live with your altered appearance.
“How well you cope with looking at yourself in the mirror depends on your coping strategies, personality, self-esteem and the support around you,” says Jackie. “It’s really important to try to promote positivity in your life.”
Here are some useful self-help tips:
Share stories: It helps to know you’re not alone. Watch this video of a woman’s personal experience of alopecia, read this real-life story of Michelle Chapman who was diagnosed with alopecia when she was five. Read the comments at the end of this article to see how others cope.
Join a support group: There are groups around the country where you can meet and socialise with other people with alopecia. Find your nearest Alopecia UK support group.
Go online: If you prefer to go online to talk to others, join Alopecia UK’s discussion forum.
Accept it: It’s not easy, but try to come to terms with your hair loss. One way to do this is to make a list of all your good qualities and focus your energy on celebrating these attributes.
Talk about it: Discuss your hair loss with your friends, family and loved ones, preferably early on. Let them know how you feel about it and what kind of support you need. If hair loss is affecting your relationship with your partner, going to therapy or couples counselling may help.
Cover up: Look into disguising and covering up your hair loss with things like wigs, hair extensions, scarves and make-up. Persevere until you find a product and style that suits you. “Equally, you may prefer not to cover up at all. Whatever works best for you,” says Jackie.
If you have hair loss that you find difficult to cover up (around 50% hair loss or more), or your hair loss is a result of cancer treatment, you could be eligible for a wig on the NHS. Find out about NHS wigs.
Be patient: many cases of hair loss in women are temporary. That said, regrowth is unpredictable and can take years. Remember that your new hair can be any texture and colour.
Avoid miracle cures: don’t be taken in by claims for wonder products. There are no cures for female hair loss.
“There are lots of snakeoil products out there. Usually the greater the claim, the greater the letdown,” says Jackie McKillop. Her advice is to stick to products recommended in the British Association of Dermatologists’ clinical guidelines (PDF, 85kb).
You can read more articles on all aspects of hair loss, including the different types, its diagnosis and treatment.