Balding Man

What Causes Male Pattern Baldness or Hair Loss?

For many appearance-conscious men, few things rank higher on the list of concerns or cause for alarm than male pattern baldness or hair loss.  While some well-known actors, models, athletes, and celebrities definitely rock the bald look with style (we’re looking at you, Bruce Willis, Dwayne Johnson, and Terry Crews, among others), for many men it’s a scary prospect.  Hair loss doesn’t seem like something you can control, and there’s still a deep tie in many people’s psyches between a full head of hair and looking attractive. 

Male pattern baldness or associated hair loss does not need to be the end of the world, however.  First, it doesn’t change who you are – only your outward appearance.  Second, as noted above, embracing baldness can actually be a positive for many men.  Third, there are several different kinds of treatments available today, with varying efficacy, that can help you retain your hair or even grow new hair.

With all of that said, however, we come back to a fundamental set of questions that many men want answered: what causes male pattern baldness and hair loss?  Why do some people go bald, whereas others don’t?  Why do some people start losing their hair in their 30s, whereas others keep a full head of hair until their 60s, 70s, or beyond?  While the exact relationship and causes of baldness and hair loss are not fully understood, science has come a long way in the last half-century towards answering those questions.  We’ll explain in detail below.

Why Some People Go Bald, and Others Don’t

Simply put, the reason why some people go bald, and others don’t, has a lot to do with luck, and rolls of the genetic dice.  Genetics are by no means the only factor in determining likelihood of hair loss or male pattern baldness, but they do play an outsize role in influencing those outcomes.  Individual quirks in chemical sensitivities – particularly to a metabolite of the hormone testosterone – may or may not be exclusively genetic in origin.  Additional factors surrounding lifestyle, mental health, diet, and so on also come into play.  It has been argued by some that these factors don’t determine who will get thinning hair, hair loss, or male pattern baldness, but perhaps are limited to the speed or extent portion of that equation.  However, the scientific jury remains out on those contentions.

That’s not to imply that the basic mechanics of baldness and hair loss aren’t understood, as they are.  It’s just that, as with most complex systems and issues in the body, it’s not a simple or straight-line proposition from effect to cause. 

Genetic Factors

Let’s start at the macro level, and look at genetic factors associated with baldness and hair loss, before we get back into hormones and microbiology too much further.  For a long time, it’s been obvious that families in which multiple older male relatives are bald or have thinning hair or hair loss tend to have new generations of kids that also suffer from the same problem when they get older.  This immediately suggests a genetic factor at play.  Over the years, science has revealed that there are actually several genetic factors at play, and that genetics make up the largest component of determining who goes bald, who has hair loss, or who gets to remain with a thick mane of hair. 

Primarily, the key genes responsible for baldness and thinning hair appear on the X sex chromosome, which can only be inherited by males from their mother, the maternal side of their family tree.  That means if many relatives on your mom’s side are bald or are follicularly challenged, then your odds of eventually developing hair troubles have just gone up.  But even that is not so simple or clear cut.  In fact, these days, several genes have been found throughout your genome that contribute to baldness and hair loss, and plenty of them are not X-linked traits.  Therefore, the history of baldness or hair loss on your father’s side of the family tree also plays a role.  Even a family tree with limited or no history of baldness or hair loss can still produce a child who will go on to have hair loss – so there are a lot of genetic and other variables in play. 

Individual Chemical Sensitivities

Early research on baldness first proposed that testosterone was the cause, as castrated men did not exhibit hair loss.  Testosterone itself is not the direct cause, and that has been definitively shown by modern science, but it is a necessary precursor to trigger hair loss and baldness.  Even women have testosterone in their bodies, and can have characteristic thinning hair or hair loss – so it’s fairly clear that it’s not tied directly to the level of testosterone, and experiments have borne this out.  Rather than the testosterone itself, it’s been found that a metabolite – a product made from testosterone by your body – is the main culprit.

A small amount of the free testosterone in the human blood stream is converted into dihydrotestosterone, or DHT.  This metabolic conversion happens because of an enzyme known as 5-alpha-Reductase.  Individual chemical sensitivity to that DHT, and/or the amount of activity of the 5-alpha-Reductase enzyme, seem to be a determining factor in who loses their hair and who doesn’t.  These sensitivities or activity levels appear to be largely genetic, but can be triggered or modified by several other factors as well.  It is through this mechanism that many internal treatments for male pattern baldness work – by modifying sensitivity to DHT, or the activity or production of 5-alpha-Reductase. 

Lifestyle Factors

There are also several environmental or lifestyle factors, and even health factors – essentially, factors unrelated to genetics – that are fairly common causes, triggers, or, at the very least, may exacerbate the speed and severity of hair loss and male pattern baldness.  In no particular order, these include:

  • Various skin conditions can cause different types of baldness or hair loss
  • Wearing your hair in tightly-bound styles can cause what is known as traction hair loss
  • Thyroid or hormonal changes or problems can be a trigger or accelerator for baldness and hair loss
  • Poor nutrition, especially a deficiency in certain key vitamins and minerals, can result in hair loss, which can be easily reversed by treating the deficiency
  • Stress, especially emotional or traumatic experiences, can often cause sudden hair loss or baldness, which usually reverses or stops over several weeks or months
  • Long-term stress can accelerate the speed and scope of baldness and hair loss
  • Many medications have side effects that include some kind of hair loss or baldness (often referred to by the medical name, “alopecia”)
  • Certain illnesses and medical conditions may result in baldness or hair loss, often temporary, including diabetes, immune disorders, infections, and more
  • Radiation therapy for cancer, and some types of chemotherapy, are well-known to cause hair loss and baldness, also usually temporary
  • Significant and especially sudden weight loss may trigger baldness or hair loss
  • Excessive sun exposure has been shown to have an effect on hair growth and hair loss (and isn’t good in the first place due to skin cancer and related concerns)
  • Smoking has been shown in some studies to have a link with baldness and hair loss
  • Excessive hair treatments, which are less common for men but still may occur, can also damage hair follicles and create thinning hair, hair loss, or baldness – perms, hot oil treatments, rollers, curling irons, and similar should be avoided or minimized

Much Remains Unknown or Poorly Understood

The range of non-genetic factors mentioned above show that there is still much that isn’t fully understood when it comes to baldness and hair loss.  That applies for both sexes – if anything, male pattern hair loss, because it is so much more common, is more well-understood than female thinning hair or hair loss.  Those are just some of the reasons why there is no guarantee, no easy test to take that will tell you whether or not you will go bald, have thinning hair, or deal with hair loss in your lifetime; at what age it may start; or exactly what you should or shouldn’t do to avoid triggering hair loss.  However, enough is understood about the mechanics of male pattern baldness and hair loss, and the hormonal/chemical pathways that seem to cause it, that several largely effective treatments have been developed. 

There are Effective Treatments for Those Concerned about Hair Loss

If you are concerned about baldness or hair loss, there is hope.  Several popular treatments are available, with varying degrees of success.  Some may be covered by medical insurance, whereas others may require payment out of pocket.  The right treatment for you may be very different than the right treatment for someone else, especially depending on the causes and severity of the hair loss or baldness.  Typically, there are several avenues of attack for dealing with baldness or hair loss:

  • Physical transplantation of hair and hair follicles from elsewhere on the body, or from the back of the scalp to the crown; hair plugs; toupees or wigs
  • Topical treatments that aim to slow down hair loss or even regrow hair
  • Pills and chemical treatments, that seek to disrupt or stop the production or activity of 5-alpha-Reductase, and thereby reduce or stop DHT, the triggering chemical, from getting at hair follicles and causing hair loss

The latter category is often the most convenient for most men – it simply involves taking a pill, no messy creams or topical treatments.  Transplantation, wigs, and other exterior solutions don’t get at the root (pardon the pun) cause of the problem, either.  So, most men first start with a medication-based solution, such as the popular drug Propecia (finasteride), and see real results in slowing down hair loss, preventing further hair loss entirely, or even seeing their natural hair start to regrow. 

Frequently Asked Questions

Does baldness come from your mother or father’s side?

Baldness appears to have both genetic and lifestyle components.  On the genetic front, it was long believed that baldness was only a mother or maternal line-associated trait, since genes have been identified on the X chromosome, which a male can only get from their mother (the father’s sex chromosome must be a Y, absent any genetic abnormalities, because an X would mean XX for the child, and they would be born a girl).  Modern science has revealed that while the maternal line baldness gene on the X chromosome is slightly more dominant, there are also genes throughout your combined DNA that play a role in baldness.  On top of all that, factors like stress, vitamin deficiencies, illness, etc. also can contribute to the onset, severity, or progression of baldness and hair loss.  While it is true that a large portion of the genetic component comes from the mother’s side, that does not, in and of itself, mean you will or won’t lose your hair or go bald. 

Does baldness mean you have high testosterone?

As baldness is chemically dependent on testosterone, a long-standing adage about bald men having more testosterone (and perhaps being more fertile or better in bed) has circulated.  This blends some scientific truths with many mistruths.  Baldness or hair loss do not, in and of themselves, identify the level of testosterone in the body.  It’s actually a byproduct or metabolite of testosterone that acts as the chemical trigger to decrease hair growth, and the precise mechanism isn’t fully understood.  Converting testosterone into DHT (dihydrotestosterone) is the responsibility of an enzyme in the body, 5-alpha-Reductase, and very tiny amounts of testosterone circulating in the blood are actually involved in the process.  Therefore, men with both high and low testosterone levels can develop baldness, thinning hair, or hair loss.  It all depends on the level of this enzyme, and how individually sensitive a person is to the DHT.

What are the odds of hair loss or going bald?

Your likelihood of going bald or losing your hair is increased if members of your maternal lineage also have baldness or hair loss.  These odds are increased if your paternal family also exhibits male pattern baldness.  However, neither of these traits guarantee you will lose your hair or go bald.  On average, surveys reveal that 2/3 of men at age 35 report some thinning hair or hair loss, and by age 50, around 85% of men report those same conditions.  This does not mean, however, full male pattern baldness in all cases.  As yet, there is no surefire way to determine whether or not any specific individual will have mild, moderate, or severe hair loss, at what age, and to what extent.  If you are concerned, however, about the early signs of hair loss or baldness, then it’s best to take action with either prescription or over-the-counter solutions, and discussing your concerns with a healthcare professional. 

Concluding Thoughts

There are many causes of male pattern baldness or hair loss, though the biggest contributor is genetics.  You can’t control what hand you were dealt in the genetic card game of life, but can manage your health and lifestyle risk factors.  If you are concerned about hair loss, consider talking to your doctor or a healthcare provider about the treatment options available.  Since hair loss, in a minority of cases, can be a symptom of a greater underlying medical problem or issue, it’s best to get your condition checked out.  Once you know it’s nothing more serious, consider your treatment options – taking action sooner rather than later gives you the best odds of maintaining your current hair, and more effectively growing new hair. 

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