It’s not remarkable to see a man with thinning hair, or no hair at all. It’s practically expected as a man ages. Are men okay with that? Rarely. Despite celebrities like Bruce Willis, Vin Diesel and Michael Jordan serving as handsome, vital bald men, most would much rather have a full head of hair. No man wants to have to get creative with deceiving cuts or, dare we say it, comb-over options.

Why does baldness in men happen?

Dr. Elaine Cook, M.D., explains that hair grows in a cycle. “The growth phase (anagen) lasts approximately 2-8 years followed by a transitional phase of 10-14 days, then a resting phase (telogen) lasting 3-5 months, and finally a shedding phase. When hair is shed, it is replaced by a new hair, starting the cycle again” says Dr. Elaine. Normally 85% of hair is in the growing phase, and 15% is resting and falling out. It’s normal to lose up to 100 hairs per day.

Okay, so it’s normal but why does it happen? For men, the most common cause of hair loss in men is hereditary. You can blame dear old dad, or mom. According to Dr. Elaine, “It is caused by an inherited tendency combined with exposure to male hormone, which causes follicles to shrink and grow thinner, shorter hairs, then finally produce no hair.”

What can be done for male pattern baldness?

Treatment options for male pattern baldness include Finasteride (Propecia) which costs about $40 per month. The pill decreases one form of male hormone in hair and follicles. It has to be continued indefinitely or any of the hair regained will be lost. Side effects in less than 2% of men include difficulty achieving erection and decreased sexual interest, which resolve when treatment is discontinued.

Another option is Minoxidil (generic Minoxidil 2% or 5%, Rogaine 2% or Rogaine Extra Strength 5% for men). The cost is approximately $35 per month and is sold over the counter. Minoxidil is applied to the scalp twice a day, indefinitely. “Improvement, if seen, is usually noted by 8 months with the 2% solution, or by 4 months with the 5% solution. The 5% solution usually gives quicker and more improvement. If discontinued, all hair gained is lost, usually within 2 months. Infrequent side effects include dizziness, fast heartbeat, local redness, itching or dryness,” explains Dr. Elaine.

Hair Transplantation, the surgical transplantation of hair follicles from area of scalp with hair growth to the area of balding, is a non-medicated option many men choose.

What else causes baldness in men?

Beyond hereditary factors, other less common conditions that lead to hair thinning and hair loss in men include things with daunting names like Telogen Effluvium (when more than the normal 10% of hairs are shed during the telogen, or resting, phase); Acute Telogen Effluvium which starts a few months after a triggering event such as surgery, general anesthesia or illness; and Chronic Telogen Effluvium which can last more than 6 months. Multiple triggers for this condition include various diseases, nutritional problems, significant aerobic exercise, psychological stress and certain medications, both prescription and over the counter.

Alopecia Areata is another condition that causes hair loss that, several years ago, was unheard of by the average man, but is now talked about more openly. The autoimmune form of hair loss is unpredictable and recurring. The body’s immune system rejects the hair follicles, causing them to go dormant. “Hair loss may vary from a dime size bald area of complete hair loss,” says Dr. Elaine. “Much less likely, it can mean total baldness or loss of body hair.” Some people have an inherent trait for AA but others get it after periods of severe stress.

A commonly-known cause of hair loss is caused by cancer treatments and is referred to as Anagen Effluvium. Hair typically regrows once treatment has stopped but can return with different texture and different color.

With so many conditions, reasons, treatments and possibilities, it can be confusing for men to know where to turn for help. Contact Dr. Elaine for a consultation to learn about more options for fighting hair loss.