Male-Pattern Hair Loss: Can It Be Prevented, and How Is It Treated?
Androgenetic alopecia affects up to 80% of men by age 70. A board-certified Seoul dermatologist explains the DHT mechanism, diagnosis, the two FDA-approved drugs, and the wider treatment toolkit.
This is an English adaptation of a clinical article Dr. SangYoul Yun — board-certified dermatologist and Medical Director of Delight Dermatology in Gangnam, Seoul — originally published in Korean. Read the Korean original on Naver. It has been restructured and translated for international readers; all references are the author's own.
Today I'll give a full round-up of male-pattern hair loss — one of the most universal concerns there is — based on current knowledge.
What is male-pattern hair loss (androgenetic alopecia)?
Androgenetic alopecia (AGA) — known as male-pattern hair loss or female-pattern hair loss — is the most common form of hair loss worldwide, and it arises from an excessive response to androgens. By age 70 it affects 80% of men and 50% of women.
What causes it
Genetic factors are strong, but it also develops through interaction with environmental factors such as body mass index (BMI), metabolic syndrome and severe COVID-19.
Normal hair cycles repeatedly through anagen (growth) → catagen (regression) → telogen (rest), after which the exogen hair is shed. In androgenetic alopecia the follicle spends only a short time in growth, so anagen hairs progressively enter the terminal phase, the hair thins, and hair loss follows.
The core cause is excess secretion of DHT (dihydrotestosterone). In the follicle, the male hormone testosterone is converted into DHT by 5α-reductase; DHT then makes the hair thinner and lighter in color.
Pattern of presentation
Male-pattern loss thins the hair at the crown and front, the hairline recedes, and the sides and back are relatively preserved (Norwood scale). Female-pattern loss shows progressively diffuse thinning across the front of the head and the crown.
Diagnosis
Diagnosis is based on family history and clinical presentation, after excluding causes such as medication use, thyroid hormone abnormalities, iron deficiency and anemia. In the pull test, 40–60 hairs are grasped between thumb and index finger and gently pulled; if 6 or more come out, hair loss is diagnosed.
Treatment options
As interest in preventing and treating hair loss has grown, so have the questions — so here is a round-up. You can also see the overall approach on our hair loss treatment page.
The two FDA-approved drugs
- Topical minoxidil — supplied at 5% for men and 3% for women; a foam formulation (Rogaine foam) is also available. It generally needs to be applied for at least 4 months before an effect appears.
- Oral finasteride — the original product, Propecia, is taken as one tablet daily and must be taken for at least 3 months; many generic versions are also available.
Other oral medications
- Oral minoxidil — dilates arterioles to induce cell proliferation. Watch for dizziness and hypertrichosis (excess hair).
- Dutasteride (Avodart) — a type 1 and 2 5α-reductase inhibitor that blocks DHT formation in the follicle. Watch for reduced libido, mood changes and gynecomastia.
- Spironolactone — an anti-androgen that effectively lowers testosterone; taken at 12–200 mg once daily, with caution for low blood pressure. Combining 0.25 mg oral minoxidil with 25 mg spironolactone has been shown to improve shedding and increase density in female-pattern hair loss.
Injectables
- Botulinum toxin A
- PRP (platelet-rich plasma) — growth factors and concentrated platelets that support hair regeneration, injected every 1–6 months. Because the growth factors are drawn from the patient's own blood, allergic reactions and side effects are minimal, and studies have shown it to be effective.
- Exosomes — cytokines and growth factors that help hair regeneration.
Supplements
- Vitamins — vitamin C, vitamin D, iron, folate, selenium.
- Nutrafol — 21 botanical compounds that support hair growth (ashwagandha, saw palmetto, curcumin, palm extract, amino acids, and others).
- Viviscal — a marine-complex supplement of vitamins and minerals that supports hair growth; across 30 years of research, safety and efficacy assessments showed an increase in hair-shaft diameter.
Low-level laser therapy (LLLT)
- Smartlux — uses mainly 660 nm laser light reaching the follicle, inducing cell proliferation and vasodilation to nourish the hair. Treatment three times a week, 15 minutes each, for 6 months produced higher hair density and greater average hair-shaft diameter.
Beyond the two FDA-approved treatments there are many other options. For oral drugs, many people weigh up "the classic Propecia vs. the potent Avodart" — I'll cover that comparison in a future post.
References
Medical disclaimer. This article is general information and does not replace individual consultation. Prescription drugs such as minoxidil, finasteride, dutasteride and spironolactone carry side effects and contraindications and require a doctor's evaluation and prescription; the type of hair loss and the treatment that suits you should be decided after an in-person consultation with a dermatologist.
ご案内: この記事の情報は一般的な教育目的であり、医学的助言に代わるものではありません。個別の施術計画は皮膚科専門医の相談を通じて決定されます。
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