Overview

Male Pattern Hair Loss

Male pattern hair loss (MPHL), also known as androgenetic alopecia, is the most common form of hair loss in men. It is a progressive condition influenced by genetic predisposition, androgen activity, and age.

This page provides general information about the biology, clinical features, and management options for MPHL. It is for educational purposes only and is not medical advice. Treatment decisions require an individual assessment by a registered medical practitioner.

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Male Pattern Hair Loss Diagram

Pathophysiology

The biological mechanisms behind Male Pattern Hair Loss

Dihydrotestosterone (DHT)

The term androgenetic alopecia reflects interacting androgenic and inherited factors. Testosterone is converted to dihydrotestosterone (DHT) by 5-alpha reductase. In genetically susceptible scalp follicles, DHT is associated with a shorter anagen (growth) phase and progressive follicular miniaturisation. Successive cycles may therefore produce shorter, finer, less pigmented hairs until visible growth is reduced.

The frontal and vertex scalp are relatively androgen-sensitive. MPHL therefore typically presents with bitemporal recession, vertex thinning, or both, and can be described with the Norwood–Hamilton scale (Norwood, 1975).

Genetic factors

MPHL is polygenic. Genome-wide association research has identified multiple loci associated with male-pattern baldness, and susceptibility may be inherited through either parental line (Heilmann-Heimbach et al., 2017). A family history of early hair loss can be associated with earlier onset or greater severity, but does not determine an individual outcome.

Male Pattern Hair Loss Progression and Follicular Miniaturisation Diagram

Clinical Features

Diagnosis is principally clinical and may consider:

  • Age of onset, usually after puberty
  • Family history of pattern hair loss
  • Pattern of recession or thinning, including Norwood–Hamilton stage
  • Hair-shaft calibre variation and follicular miniaturisation on trichoscopy, where indicated

The rate and extent of progression vary substantially between individuals.

Other Causes to Consider

Not all hair loss in men is androgenetic alopecia. Assessment may need to consider:

  • Seborrhoeic dermatitis
  • Alopecia areata
  • Telogen effluvium after illness, surgery, physiological stress, weight loss, or medication exposure
  • Nutritional contributors, such as inadequate protein or iron status
  • Medication- or supplement-related shedding, including anabolic androgenic steroids
  • Systemic or endocrine disorders, including thyroid disease and autoimmune disease

Do not stop prescribed medication without medical advice.

Clinical Assessment

A hair-loss consultation may include:

  • Medical, medication, dietary, lifestyle, and family history
  • Scalp and hair examination, including Norwood–Hamilton staging
  • Trichoscopy to document density, shaft diameter, and miniaturisation when appropriate
  • Targeted blood tests when history or examination suggests nutritional, endocrine, or systemic contributors

Establishing the diagnosis matters because management differs across the various causes of hair loss.

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Management Options

The following describes potential approaches and the evidence base relevant to MPHL. Suitability, expected benefit, risks, and the need for medical supervision differ between individuals. No intervention guarantees a particular outcome.

Other Management Options

  • Minoxidil

    Topical minoxidil is used to support anagen-phase activity and follicular growth. A randomised clinical trial reported greater hair-count improvement with 5% topical minoxidil than with 2% minoxidil or placebo in men with androgenetic alopecia (Olsen et al., 2002). Potential adverse effects and contraindications require medical assessment, and benefits generally depend on ongoing use.

  • Hair transplantation

    Hair transplantation relocates follicular units, usually from the occipital donor area, to areas of thinning. Suitability and outcome depend on donor supply, the extent and future trajectory of hair loss, recipient-site characteristics, surgical technique, and individual healing. Risks include bleeding, infection, scarring, and variable graft survival, which should be addressed in pre-operative consultation.

  • Scalp micropigmentation

    Scalp micropigmentation (SMP) is a cosmetic camouflage procedure in which pigment is placed in the superficial scalp dermis to create the appearance of follicular stippling or greater visual density. It does not regrow hair. It may be considered for selected patients, including scar camouflage or advanced hair loss when surgical donor supply is limited.

  • Holistic Hair and Scalp Wellness Programme

    Personalised care combining assessment, appropriate investigations, scalp care, and lifestyle guidance to support long-term scalp health and address early hair thinning or shedding.

References & Further Information

If you are concerned about hair loss, consult a registered medical practitioner for assessment. This page is for general education only and does not constitute medical advice, diagnosis, or a treatment recommendation. No treatment described here guarantees a specific result.

References

  • Alessandrini AM, Bruni F, Piraccini BM, Starace M. The effectiveness and tolerability of preformed growth factors vehiculated through iontophoresis on patients with androgenetic alopecia and telogen effluvium: A clinical study. Dermatology Practical & Conceptual. 2021;11(3):e2021082. doi:10.5826/dpc.1103a82.
  • Avci P, Gupta GK, Clark J, Wikonkal N, Hamblin MR. Low-level laser (light) therapy (LLLT) for treatment of hair loss. Lasers in Surgery and Medicine. 2014;46(2):144–151.
  • Cedirian S, Pampaloni F, Quadrelli F, et al. Efficacy of skin patting and iontophoresis with dutasteride gel in male and menopausal female androgenetic alopecia: A pilot study. Dermatology and Therapy. 2025;15(11):3419–3424. doi:10.1007/s13555-025-01532-w.
  • Heilmann-Heimbach S, Hochfeld LM, Paus R, et al. Meta-analysis identifies novel risk loci and yields systematic insights into the biology of male-pattern baldness. Nature Communications. 2017;8:14694.
  • Jimenez JJ, Wikramanayake TC, Bergfeld W, et al. Efficacy and safety of a low-level laser device in the treatment of male and female pattern hair loss: A multicenter, randomized, sham device-controlled, double-blind study. American Journal of Clinical Dermatology. 2014;15(2):115–127.
  • Kaufman KD, Olsen EA, Whiting D, et al. Finasteride in the treatment of men with androgenetic alopecia. Journal of the American Academy of Dermatology. 1998;39(4):578–589.
  • Mella JM, Perret MC, Manzotti M, Catalano HN, Guyatt G. Efficacy and safety of finasteride therapy for androgenetic alopecia: A systematic review. Archives of Dermatology. 2010;146(10):1141–1150.
  • Norwood OT. Male pattern baldness: Classification and incidence. Southern Medical Journal. 1975;68(11):1359–1365.
  • Olsen EA, Dunlap FE, Funicella T, et al. A randomized clinical trial of 5% topical minoxidil versus 2% topical minoxidil and placebo in the treatment of androgenetic alopecia in men. Journal of the American Academy of Dermatology. 2002;47(3):377–385.

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This page is intended for general educational purposes only. It does not constitute medical advice, diagnosis, or treatment recommendation, and does not create a doctor–patient relationship. For assessment of your individual condition, please consult a registered medical practitioner.