All the Stages of Male Pattern Hair Loss

Male pattern hair loss is one of the most common form of hair loss that affects men worldwide. Like female pattern hair loss, it is due to androgenetic alopecia which causes progressive loss of hair. However, male pattern hair loss has a distinct appearance and usually involves the temples and crown. Recognising the stages of male pattern hair loss is essential for early identification and better management. In this article, we’ll explore the stages in male pattern hair loss and the best treatments for each of these.

What is Male Pattern Hair Loss?

Commonly known as androgenetic alopecia, male pattern hair loss is primarily a genetic condition linked to the hormone dihydrotestosterone (DHT). This is a derivative of testosterone. In genetically predisposed individuals, hair follicles become highly sensitive to DHT which leads to their progressive miniaturisation. In men this sensitivity primarily affects the hair follicles at the front, temples and crown of the scalp. As such it results in characteristic receding hairlines and baldness in men.

Although both are forms of androgenetic alopecia, male pattern hair loss distinctly differs from female pattern hair loss in appearance. Female pattern hair loss generally presents as diffuse hair thinning across the scalp without significantly affecting the frontal hairline. More interestingly, whilst male pattern hair loss predominantly affects men, it can in rare cases occur in women also. This is especially likely in women experiencing hormonal imbalances with higher androgen levels. Conversely, some men with androgenetic alopecia can experience a female pattern of hair loss with diffuse thinning rather than distinct bald areas or pronounced hair line recession. That’s why proper clinical assessment is crucial to distinguish these patterns clearly and allow targeted treatments.

Causes of Male Pattern Hair Loss

Male pattern hair loss is a complex condition with contributing causes. Although genetics and hormones are the core drivers of androgenetic alopecia, there’s a number of external and lifestyle factors that can trigger or worsen the condition. Identifying and addressing these early can significantly can slow the progression of hair loss. The key factors influencing male pattern hair loss include:

• Genetics: A strong family history increases the likelihood and severity of male pattern hair loss. If your male relatives experienced significant hair loss (especially at a younger age) then you have a higher risk of developing it.
• Hormonal Sensitivity: Male pattern hair loss is closely tied to increased sensitivity of hair follicles to dihydrotestosterone (DHT). This sensitivity causes the follicles to shrink over time leading to thinner and shorter hair growth then eventually loss.
• Ageing: As men age, the natural growth cycle of hair slows down. Follicles become less active, making thinning and hair loss more pronounced with each passing decade.
• Lifestyle & Diet: Inadequate nutrition, particularly deficiencies in protein, iron or vitamins can trigger hair loss. Habits like smoking and chronic stress can also hasten hair loss and weaken existing hair.
• Health & Medications: Underlying medical conditions such as thyroid disorders or autoimmune diseases can cause hair loss. Additionally, medications like anabolic steroids or chemotherapy agents can also impact hair growth and accelerate loss.

Accurate diagnosis is essential for effectively managing male pattern hair loss and finding the most appropriate treatment. It typically begins with a detailed history and examination by a qualified healthcare professional to evaluate the extent and pattern of hair loss. This may also involve blood tests if there is suspicion of underlying health conditions driving the hair loss.

Stages of Male Pattern Hair Loss

The Norwood Scale is the most popular clinical tool for classifying the stages of pattern hair loss. This is due to its ease of use, accuracy and universal applicability. It simplifies the older more complex Hamilton classification system and is hence sometimes called the Norwood-Hamilton Scale. The Norwood Scale provides a framework for diagnosis, treatment planning and tracking changes over time. The stages of male pattern hair loss on the Norwood Scale are:

• Stage 1 (Minimal or No Hair Loss): At this initial stage, there’s very minimal or no visible hair loss. The hairline remains largely unaffected and any thinning or recession is barely noticeable.
• Stage 2 (Noticeable Recession at Temples): In stage 2, the hairline begins receding subtly at the temples, forming a mild “M” shape. Hair loss remains mild and typically goes unnoticed apart from on close inspection.
• Stage 3 (Significant Hairline Recession): This marks the first clear signs of noticeable hair loss. In stage 3, the hairline is receding deeply at the temples clearly defining the characteristic “M” or “V” shape. Its at this stage that most people tend to worry and start to seek medical help.
• Stage 4 (Advanced Hairline Recession with Crown Thinning): In stage 4, hair loss becomes more extensive. There is noticeable thinning at the crown which starts to form a bald spot. The temples also recede further and there is increasing visibility of the scalp.
• Stage 5 (Extensive Hair Loss with Connecting Bald Areas): By this stage there is extensive recession at the temples and substantial hair thinning at the crown. Only a narrow band of remaining hair separates these bald areas. Stage 5 marks a clear progression towards significant baldness.
• Stage 6 (Severe Hair Loss): Hair thinning is severe at this stage with the crown and temples merging into one large bald area. The remaining hair typically forms a horseshoe shape around the sides and back of the head. There is very sparse coverage across the top.
• Stage 7 (Complete Baldness): This represents the most advanced stage of male pattern hair loss. The scalp is almost entirely bald with hair remaining only at the sides and back.

Treatments for Each Stage of Male Pattern Hair Loss

The most effective approach to managing male pattern hair loss depends largely on the stage of hair thinning. Most interventions work best in the early phases to halt progression and promote regrowth which is why early detection is key. There are however a few that can also help with moderate to more advanced stages when hair loss. Below are the best treatments for male pattern hair loss which may be used alone or in combination depending on the stage:

• Medications: In the early stages (Norwood 1-3), several medications can help slow progression and stimulate hair regrowth. Minoxidil, which is available as a topical over the counter treatment in up to 5% strength, improves blood flow to the hair follicles and prolongs the growth phase. Oral Minoxidil and compounded topical solutions are also available by prescription for more stubborn cases. Finasteride is a DHT blocker which is licensed as an oral medication for male pattern hair loss but is controversial due to rare but serious side effects. Topical Finasteride and the more potent DHT blocker Dutasteride are also available as unlicensed compounded treatments. Lastly, Spironolactone is also sometimes prescribed unlicensed either orally or topically as an alternative androgen blocker to Finasteride or Dutasteride.
• Platelet-Rich Plasma (PRP) Therapy: This is an injectable treatment that is typically used in combination with other therapies for mild to moderate stages (stages 2 to 4). PRP involves injecting concentrated platelets from your own blood into the scalp to promote healing and stimulate hair regrowth. It can be effective for men who are experiencing thinning but still have a significant number of active follicles.
• Low-Level Laser Therapy (LLLT): LLLT uses red light lasers to stimulate cellular activity in hair follicles. This enhances blood circulation and energy production to promote hair growth. LLLT is best for early to moderate stages (1 to 4) as an adjunct to other treatments.
• Microneedling: This involves using a device fitted with fine needles to create micro-injuries on the scalp to stimulate vascularisation. It can also help enhance the absorption of topical treatments like Minoxidil. Microneedling is most effective in the early to moderate stages of male pattern hair loss alongside other therapies.
• Hair Transplant Surgery: For more advanced stages (Norwood 3 to 6) where hair loss prominent and follicle activity is minimal, hair transplant surgery may help. This procedure involves harvesting hair follicles from donor areas (usually the back or sides of the scalp) and transplanting them into balding areas. Results are usually permeant but maintenance with medication may be recommended.

Preventative Measures

Whilst you can’t stop yourself from developing androgenetic hair loss, there are some proactive strategies to slow down its progression and encourage regrowth. The below can help reduce the severity and speed of hair loss alongside targeted treatments :

• Food: Eat a balanced diet rich in essential nutrients.
• Stress: Regular physical activity and mindfulness practices ca help to reduce stress.
• Hair Care: Avoid tight hairstyles and harsh hair treatments that can damage hair follicles or cause breakage of strands.
• Seek Help: Early medical in put can help provide effective treatment and stop progression of hair loss.

Male pattern hair loss can be a manageable and treatable condition if there is prompt detection and intervention. Recognising the early stages of male pattern hair loss will maximise your chances of stopping shedding and regrowing hair. Remember that your hair is also affected by your overall health and wellbeing so any assessment of hair loss should also try to identify and treat any contributory factors.

We believe in a personalised approach to hair care which is why we offer personalised topical hair loss and regrowth treatments through our online skin clinic. Our doctors create custom hair growth treatments using actives such as Minoxidil, Finasteride, Dutasteride, Spironolactone, Melatonin, Caffeine and Tretinoin where appropriate for each and every patient. Start your virtual consultation and begin your journey to great hair today.