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No man wants to see his head of hair becoming thinner, receding or disappearing altogether into baldness. But hair loss is a reality for a large majority of men.
Studies have found that more than half of men aged between 40 and 49 experienced male pattern hair loss, while 16% of males aged between 16 and 29 also reported this type of hair loss.
It is also known that the percentage of men with hair loss ranging from moderate to extreme increases with age. What does this all mean for you?
Put simply: there’s a high chance that any man will experience some form of male pattern hair loss as he ages. But it’s not just age that can bring about this unwelcome issue, and other factors can cause hair loss to occur in males as young as in their twenties.
If you’re an anabolic steroid user, you also have an extra risk factor for experiencing male pattern hair loss at a younger age. My hair loss treatment guide has been broken down into the following sections:
Types of Hair Loss Explained – Which One Do You Have?
It’s easy to think that all hair loss is the same, but differing reasons for hair loss can cause different types of hair loss. By far the most common hair loss type is that of male pattern hair loss (and female pattern hair loss). It even has a scientific name: Androgenic Alopecia.
You might automatically assume that male pattern hair loss is what you’re experiencing. But you might want to rule out some of the other hair loss types.
The different types of hair loss that have been medically explained even have their own names. Some are caused by certain medical conditions and are rare, while the most common type can affect a large portion of the population.
Here are 6 Types of Hair Loss Conditions
- Androgenic Alopecia – This includes both male and female pattern hair loss and is the most common type of hair loss. It’s thought up to one third of American men suffer from this form of hair loss, making it extremely common. Androgenetic alopecia is caused by genetics as it’s a hereditary condition passed down through generations. Men can start seeing hair loss as early as their teens and it without treatment it can progress for many decades into old age.
- Telogen Effluvium – This condition is when some medical conditions like thyroid problems or some nutritional deficiencies or even shock or stress can cause a thinning and shedding of the hair because the follicles stop producing new hair. This is often a temporary condition and a relatively common one that can go away if the underlying cause is addressed.
- Anagen Effluvium – This type occurs after some medical treatment and brings about a sudden loss of hair. Chemotherapy is the biggest cause of this type of hair loss.
- Tinea Capitis – This form of hair loss is caused by a fungal infection and most commonly affects children. Similar to ringworm it can cause hair loss in a circular pattern. After treatment with anti-fungal medication, the hair grows back normally.
- Alopecia Areata – Caused by autoimmune conditions and can result in a rapid loss of hair and no new hair growing through. Hair loss can be patchy and can also affect eyebrows and other hair on the body.
- Cicatricial Alopecia – An uncommon type of hair loss caused by inflammation that can destroy the hair follicles and prevent any new growth of hair.
Most healthy men will only ever experience the most common type of hair loss, which is Androgenic alopecia.
DHT and Male Pattern Baldness Explained
Male pattern baldness is a dreaded condition for countless men, but one that most men have little control over particularly when it comes to a genetic predisposition for hair loss.
Balding is a slow and gradual process for most men who experience it; sometimes only noticing its true impact when comparing older photos to the current state of the hair and noticing a marked difference in the location of the hairline.
Symptoms of Male Pattern Baldness
Male pattern baldness is a gradual loss of hair on the head of males and is mostly seen at the top and sides; forming a noticeable pattern.
As the hair starts to thin on top of your head, the hairline begins to recede. This type of hair loss is common in men as they age, but can also occur in women. The hair recedes back from the forehead, especially on either side of the front of the head, forming a rough M shape. For most men this is the most noticeable form of male pattern baldness and can start occurring in genetically predisposed men as early as their late 20s.
As the hair thins on the central area at top rear of the head, the crown of the scalp becomes more visible. In some men thin hair can remain in this area, but others will see complete baldness eventually occur over time.
This type of thinning has an impact all over the head, with a general thinning of much of the hair but not necessarily causing a noticeable receding of the hairline.
What Causes Male Pattern Baldness?
Male pattern baldness can be caused by a few different factors. For many men the factor is well beyond his control: it’s his genetics. If your father or grandfather experienced hair loss, there’s a very high chance you will too. There’s a strong link between hair loss and androgens (male sex hormones.
The genetic marker that might be in your family for male hair loss is thought by researchers to be a gene that has an impact on the sensitivity of the hair follicles to the hormone DHT. This causes a shrinkage of the hair follicle over time. With a smaller hair follicle, each hair that regrows comes back at a thinner and shorter size than it previously was. Eventually the hair is so thin and short that the appearance of baldness occurs.
The amount of time it takes from first noticing thinning of the hair or the beginning of a receding hair line, until baldness, is highly variable. Not all men will experience extreme baldness, but those that do reach the more advanced stage of hair loss can have this happen over a period of up to 25 years or more.
For some it can come on much quicker, with the progress of balding in some men taking as little as five years to lose a large portion of the hair.
What is DHT?
DHT stands for dihydrotestosterone. It is an androgen sex hormone that is heavily responsible for males developing characteristics that we associate with adult men, such as the growth of body hair and a deep voice. DHT is an important hormone for males with its powerful androgenic effects.
But this can come with some unexpected downsides and this include hair loss on the head – also called male pattern baldness. DHT is able to attach itself to hair follicle androgen receptors that can bring about a loss of hair by reducing the size of the hair follicles so they’re less able to support the normal thickness of each hair that they previously could.
What are the Side Effects of Blocking DHT?
Selective DHT blocking products that target only the hair follicles are a common treatment option for male hair loss. But what about targeting DHT itself in the body and attempting to reduce levels of this hormone in an attempt to stop the progress of male pattern baldness?
Some medications known as 5alpha-reductase inhibitors are able to stop testosterone from converting into DHT, with the goal of preventing DHT from causing male pattern hair loss. These drugs are made to be selecting in the way they inhibit DHT, so that it mostly targets the effects of this androgen hormone on hair follicles.
There are side effects from using such medications though and some of these can be serious. They can include:
- Erectile dysfunction or impotence
- Loss of libido
- Enlargement of male breasts
- Hand and feet swelling
Blocking DHT using these types of targeted medications can be appealing, but most men worry about the sexual side effects, particularly with some research showing that in some men the sexual side effects seem to become permanent or lasting for the long term, rather than being reversible after stopping the medication.
Should You Block DHT?
It’s tempting to consider blocking DHT, after all it is the main hormone that causes male hair loss. It is scientific fact that blocking DHT with a target on the hair follicles will almost certainly slow down loss of hair, and potentially prevent it completely.
But when it comes to hair loss, the blocking of DHT is often done on a very targeted basis rather than on circulating levels of the hormone in the body so it can be misleading to believe that DHT is being blocked entirely. Topical shampoos or sprays with DHT blocking ability are often used to attempt to prevent or slow down hair loss as these can be directly applied to the hair follicles to prevent DHT from shrinking the hair follicles.
Whether or not you should consider blocking DHT by using a medication or a topical treatment is a decision to be made with your doctor firstly; since DHT blocking drugs can come with some significant side effects, these need to be fully understood and considered so you can weigh up both the pros and cons of using any form of DHT blocking product in an attempt to treat or prevent male pattern hair loss.
Risk Factors for Male Pattern Baldness
Not every single male will experience male pattern baldness. Some men are fortunate enough to enter their elder years with a full head of hair. But for many others, one or more factors will result in some level of hair loss. There are three primary factors that control your risk of hair loss on the head, whether it be mild or severe or somewhere in between. These are:
Many young men see their father’s lose a once thick head of hair and wonder if they too will experience this type of hair loss later in life. Unfortunately the chances are high of hereditary hair loss happening. The main gene for baldness is actually carried on the female X chromosome which is inherited from your mother.
Despite this, studies show that it’s not only the inherited gene from the mother that plays a role in genetic related male pattern hair loss, but males whose father experienced baldness is more likely to develop it themselves compared to those who’s father’s retained healthy hair throughout life.
Androgen hormones in people with a genetic predisposition to hair loss can cause a shrinkage of the hair follicles, and subsequent thinning of each hair over time. In both men and women, it is dihydrotestosterone that is the central cause of hair loss. In men it is a result of testosterone being converted into DHT.
Men who use anabolic steroids are at a much higher risk of having elevated DHT levels due to the activity of steroids in bringing about conversion of testosterone to DHT. The androgenic related side effect of hair loss is a common problem with many anabolic steroids.
Studies show that a very high percentage of men will experience hair loss starting at some point during their life. For men who reach age 70, a huge 80% will notice some level of hair loss. One study even revealed that by the age of 30, up to 30% of men are showing signs of male pattern hair loss, while potentially one in five males will see some hair loss by the ripe age of 20. Age related hair loss is related to both hormonal and genetic causes and as a man gets older, his hair loss becomes more difficult to reverse.
Is There a Link Between ED and Hair Loss?
The number of men who suffer with erectile dysfunction can just be as high as those experiencing hair loss. But is there a link between the two conditions? It’s easy to think that both of these problems could have a link to hormones and in particular, testosterone. But erectile dysfunction is in fact not often caused by testosterone related issues, with low testosterone known to have an impact on sexual desire but is not thought to be a specific factor influencing the ability to gain or maintain an erection.
ED therefore is known to be a complex condition caused by a range of other health problems like heart disease, high cholesterol, high blood pressure, obesity, depression and anxiety, diabetes, stress and other physical or mental health problems.
Both hair loss and ED can cause considerable anguish to males and both have a negative impact on quality of life self confidence. However it is important to realize that a man who experiences male pattern hair loss will not necessarily ever experience erectile dysfunction, and vice versa, as the two conditions are not directly linked by any medical condition.
Age is a major factor in hair loss occurrence, and statistics state that older men also most commonly experience ED with about 15% of men noting total erectile dysfunction at age 70 and up to 60% of men aged 60 experiencing some level of ED.
The main link that has been seen between hair loss and ED comes about when certain medications are being used to treat the hair loss. A major downside of some of the drugs men use to treat hair loss is that they can raise the risk of erectile dysfunction. Finasteride is one hair loss drug that has shown to raise a man’s chances of experiencing ED by five times.
Male Pattern Baldness Treatment and Prevention
Most treatments and prevention for male pattern baldness focus on trying to inhibit or block the hormone DHT. This can be done a number of ways: through medication that has a targeted DHT blocking action on the hair follicles, or by using a topical treatment that also aims to block DHT by being directly applied to the hair follicles.
Other people attempt natural treatments which are sometimes thought to have DHT blocking effects such as nettle, green tea or saw palmetto; although none of these have been scientifically proven to help with hair loss or have an impact on DHT itself.
The two most commonly used medications to treat male hair loss are Finasteride and Minoxidil. Dutasteride is also sometimes used. You will find these under a range of different brand names, so it’s important to be aware of the generic name and what the differences are between these drugs concerning both their potential benefits and possible side effects.
While Finasteride is a prescription drug in pill form, Minoxidil comes as an over the counter topical treatment that is easily applied to the head. Both products are relatively slow acting and you’ll need to be using them consistently and ongoing to get results, with the first noticeable results usually taking up to one year.
Finasteride (Proscar, Propecia)
This drug comes under several brand names including Proscar and Propecia as well as a generic drug. Some serious side effects can occur when using Finasteride, in particular sexual dysfunction effects as well as possible breast enlargement and depression.
Finasteride is a 5a-reductase inhibitor drug which has anti-androgenic effects and this results in a reduction in the production of DHT. It is known to reduce DHT by about 70% and this includes on the hair follicles, but also in the prostate which is why Finasteride is also often used as a prostate enlargement treatment. Finasteride is recommended only for male use.
Minoxidil is a topical hair loss treatment which is sold under dozens of different brand names which differ between countries. For those with genetically linked male hair loss, Minoxidil provides a convenient treatment option. It is applied directly to the head where hair loss is occurring, where you then massage it in.
Minoxidil is designed to reverse the shrinking of the hair follicle that causes thinning and balding, while also potentially stimulating the growth of new hair. It is only recommended for those who have a genetic cause of hair loss, with the aim being to slow down any further hair loss.
Minoxidil is a product that can be used by both men and women for a minimum of four months before expecting any noticeable results to appear. It then needs to be used consistently if you want to improve the growth of hair and maintain this over the long term.
Dutasteride (Avodart, Duprost)
Dutasteride is primarily a drug used to treat BPH (benign prostatic hyperplasia or enlarged prostate). It does not have approval as a hair loss drug but is often used to treat male pattern baldness because of its similarity in function to Finasteride and the possibility that Dutasteride can have a higher level of effectiveness than Finasteride.
Studies have shown that Dutasteride is a more successful treatment for reversing miniaturization of the hair and for hair regrowth compared with finasteride, with their potential side effect risk level being similar.
Potential side effects of Dutasteride include erection difficulties or impotence, decreased libido, enlargement of the breasts and swelling or pain in the testicles.
DHT Blocking Shampoos
Since topical DHT blockers made for treating hair loss are applied directly to the scalp, DHT blocking shampoos can provide a convenient way of applying the product. But do they work? It depends on the ingredients.
These shampoos can contain ingredients ranging from zinc to Vitamin B12, to saw palmetto, sesame oil and rosemary. Often called hair loss shampoos or hair regrowth shampoos, the quality and effectiveness of these products varies widely and with so many products on the market it’s critical that you see out the ingredients before selecting a shampoo to treat hair loss.
Hair Loss Supplements
Hair loss supplements aim to take a more organic approach to treating hair loss by using natural ingredients that can potentially slow down the loss of hair or encourage regrowth. The effectiveness of hair loss supplements is extremely variable, and once again the ingredients of each individual product should be studied.
Most supplements for hair loss contain a range of vitamins and minerals, and as such are often simply called hair vitamins. Other common ingredients include plant extracts and natural oils.
Remember that natural supplements have no regulation by the FDA, unlike prescription medications, so their efficacy has not been proven or approved for use as a hair loss treatment.
Minoxidil vs Finasteride vs Dutasteride: Do They Work?
What’s The Difference?
These three drugs have the same purpose when used for hair loss: to stop the progression of baldness and to potentially stimulate the growth of new and thicker hair.
Dutasteride is not approved by the FDA for use as a hair loss treatment but is often used off label for this purpose. Finasteride has FDA approval as a hair loss treatment, as does Minoxidil.
Minoxidil is not a DHT blocking drug like Finasteride and Dutasteride so it does not treat hair loss by inhibiting DHT but instead stimulates the delivery of extra nutrients through the blood vessels into the hair follicles which are causing hair loss. This action makes Minoxidil a different types of hair loss treatment compared with Finasteride and Dutasteride which are both 5-alpha-reductase inhibitors.
Finasteride is a treatment only used in men; women are not advised to use this drug. Finasteride is available in both oral and topical form, but the oral form is known to have a higher risk of side effects. Minoxidil is also available both orally and topically. Both drugs are favored for hair loss in topical form, because it can then directly target the hair follicles by being applied straight on to the scalp, lessening more serious side effects that oral forms of both drugs can cause.
How Minoxidil Works
Minoxidil works by being applied physically to the scalp so it can work directly on the follicles. Its goal is to promote greater oxygen, nutrient and blood flow to the follicles by vasodilation (widening of the blood vessels). When using Minoxidil you apply it topically directly to the scalp twice per day. This stimulates the blood vessels to widen so more oxygen and nutrients can circulate and reach the follicles.
At first this can cause some of the hair to fall out as the follicles enter a new phase, but new hair is then grown and this makes it important to continue using Minoxidil over a longer term before evaluating results; a minimum of six months is recommended.
How Finasteride Works
Finasteride inhibits the enzyme 5a-Reductase to help prevent the conversion of testosterone to DHT; the main hormone that brings about hair loss. When DHT levels in the scalp are reduced, the hormone’s impact on the hair follicles can be lessened or stopped. This prevents the further shrinkage of the hair follicles.
How Dutasteride Works
This drug is also a 5-alpha reductase inhibitor which results in a lowering of DHT levels. By reducing levels of DHT on the scalp, the follicle damage is reduced and hair growth can be promoted. This drug is considered more powerful than Finasteride in blocking and reducing DHT because it inhibits both 5 alpha-reductase type II and type I enzymes, while Finasteride blocks only the 5 alpha-reductase type II enzyme.
Do Minoxidil, Dutasteride and Finasteride Work?
All of these products have shown to be effective in preventing further hair loss and in stimulating the follicles to regrow hair. Each individual will see different results, and not all people will see positive results from any or all of these treatments. It is critical that when using one of these products that you give an ample amount of time for results to show; giving up early and deeming the treatment unsuccessful is a common mistake.
However reversing damaged hair follicles and encouraging new growth is not an overnight process. All products should be used for a bare minimum of three months before deciding if they are having any positive effect, but a period of six months will give you a more accurate idea if it is worth continuing with your Minoxidil, Dutasteride or Finasteride treatment.
Are Minoxidil, Dutasteride and Finasteride Safe to Take Together?
Minoxidil and Finasteride are commonly combined to treat or prevent hair loss, while promoting the growth of new hair. Studies have shown that it is safe for most people to combine these products, but this decision should be made with your doctor.
Because Dutasteride and Finasteride work similarly, they are not often used together. Some combination therapy studies using a low dose of Dutasteride combined with Finasteride have shown that men who are not seeing good results with finasteride alone who then added Dutasteride at a low dose soon saw a noticeable improvement in density of the hair.
Both these drugs can cause similar side effects, especially with their impacts on sexual function and this is something that must be kept in mind when considering a combination of the two, however studies show that the level of sexual related side effects are very similar between the two drugs.
Minoxidil, Dutasteride or Finasteride: Which is Better for Preventing Hair Loss?
All three products have their pros and cons when it comes to treating hair loss. For female hair loss, Minoxidil is commonly used with good success. Men who use Minoxidil as a topical solution or foam up to twice daily can potentially halt the progress of male pattern baldness, while possibly stimulating that growth of new hair. This makes Minoxidil a very effective solution for stopping the progression of hair loss in many people.
Out of Dutasteride or Finasteride, it is known that Dutasteride is up to three times more powerful at inhibiting the enzymes that convert testosterone to DHT. Dutasteride in oral form has also shown to decrease the level of circulating DHT by up to 90%, compared with a 70% decreased Finasteride.
On paper this certainly puts Dutasteride at a more powerful level of controlling DHT and subsequent hair loss compared to Finasteride. There is no doubt that both of these products have shown to help prevent hair loss in men, with finasteride simply having more studies and information available as it is the older of the two drugs, including about its effectiveness and its side effects.
Many people will choose to start with Finasteride, as the higher potency of Dutasteride can bring about a higher risk of side effects. While both drugs are available in oral form, they come with a level of side effects which many people can’t tolerate. Instead, topical versions are often used and most people experience fewer side effects but the same or similar benefits.
When it comes to choosing the best product between Minoxidil, Dutasteride or Finasteride – weigh up both the benefits and the possible side effects and be prepared to switch to a new product if the first one you try does not give you the results you expected within a suitable amount of time: usually at least several months.