Hair Loss Treatment

Male hair loss is very common, especially in men aged 30-60. The most common type of male hair loss is balding, also sometimes known as alopecia.

Hair loss is often also called ‘male pattern balding’ because usually men lose their hair in a set pattern. Generally, hair first recedes from the hairline, then it thins on the crown and temples. This normally starts during a man’s 20’s or 30’s. For some men it may start as soon as the late teens. However, by the age of 60, most men have experienced some degree of hair loss. Whilst some men are not troubled by going bald, others find the experience very distressing. It can lead them to lose confidence, develop low self esteem and suffer with depression.

Hair loss is genetic. It is usually caused by an over-sensitivity to a hormone (known as dihydrotestosterone or DHT) found near the scalp. Your body makes this hormone out of testosterone. Over time, your body’s sensitivity to DHT means that your hair follicles shrink. Your hair grows for a shorter length of time than previously in its natural cycle. The hairs that do grow become finer. In the end, the follicles that shrink will stop growing hair altogether. So, when your hair follicles shed hair as part of their natural cycle, new hairs don’t grow back in their place. Although there isn’t a way to reverse the body’s over-sensitivity to DHT, it is possible to use a hair loss treatment to stop your body producing this hormone in the first place. Propecia is used to treat male pattern hair loss in this way.

8 million men are affected by male pattern baldness in the UK.
1.5 million women in the UK experience hair loss too.
Male pattern baldness accounts for 95% of hair loss in men.
Over 40% of men in the UK will have started balding by age 35.
Two thirds of men in the UK will have noticed significant hair loss by age 60.
The average adult has 100,000 strands of hair on their head and will shed between 40 and 120 of them as part of a normal regrowth cycle.

The symptoms of hair loss include a more pronounced hairline at the sides (also known as a receding hairline), thinning on top (on the crown or temples), and finding that there’s more hair than usual in your brush or comb after you brush your hair.

In 95% of cases, male pattern baldness is inherited. If other people in your close family have gone bald, there’s a good chance that you will too. The hair loss gene has the strongest influence on your mother’s side, but either parent can have passed the gene on to you. It is possible for men to go bald because of the effects of medication, poor diet, bad hair care techniques, major stress or illness. Normally though, it is genetic. It is not true that you can lose your hair by: blow drying it, colouring it, or washing it. It won’t grow back faster and thicker if you cut it or shave it regularly.

Hair loss is normally diagnosed by looking at the pattern of hair loss, your own medical history and also your family’s medical and/or hair loss history. A dermatologist can look to see how much your hair follicles have shrunk, or a general practitioner can advise on treatment options.

It is possible to use a chart of pictures called the Norwood Scale to assess the extent of hair loss and to work out the best way to treat it. More information on the reliability of this is available here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2938573/

You can take a medication called Propecia (or generic finasteride) to decrease the levels of the hormone that causes your hair follicles to shrink. You can try topical creams such as Regaine. You can consider surgical techniques, such as hair transplants/scalp reduction. You can also try low level laser therapy, UV treatment, and alternative lotions, but these have very mixed results.

There can be long term issues with hair loss treatment, depending which treatment you use. Severe side effects are rare. The most common side effects of Propecia and finasteride are erectile dysfunction and/or a lowered sex drive, itching or a rash, and breast tenderness. You should read the patient information leaflet for the full details of potential side effects, but the Side Effects page also has further information on this.

Propecia takes a while to build up in your system because hair growth can be a slow process. You need to take it for 9 months to a year to notice a real difference but, that said, many men notice an improvement within 3-6 months. Best results with Propecia were seen after two years. You also need to follow the prescription, because Propecia will stop working if you stop taking it.

It depends which treatment you would like to use. For Propecia or finasteride you would need to get a private prescription. Our doctors can provide this for you online.

You can get a topical cream called Regaine on the NHS. About a third of men who apply this cream see good regrowth of the hair on their bald patches.
You can’t get Propecia on the NHS though. It is only available on private prescription.

If you would like to get personalised advice on how to cope with hair loss, you can book a telephone consultation with one of our doctors.

Propecia and finasteride tablets are an effective oral hair loss treatment. Both are prescription treatments for male pattern hair loss and are taken orally once a day every day. They stop hair loss or lead to hair regrowth in 9 out of 10 men. Patients need a continuous treatment for at least 3 months for the treatment to start to take effect. Propecia can’t stop your body being oversensitive to the hormone dihydrotestosterone (DHT). There is no known way to reverse that. Instead, it stops your body producing the hormone in the first place. As your DHT levels fall, your hair will go back to growing the way it did before you started balding.

Most shampoos for hair loss contain minoxidil (i.e. Regaine), usually as a gel or foam to rub on your scalp twice daily. It often takes 3-4 months for the effects of Minoxidil to improve your hair loss problems. Minoxidil also exists in a stronger version (5%) which is somewhat more effective.

However, as we said before, the effectiveness of this hair loss treatment remains limited, in particular if you’re looking to re-grow your hair (only effective for 15% of users). Just like Propecia, the effects of Minoxidil will stop as soon as you stop the treatment. Side-effects of Minoxidil are quite rare, but include scalp irritation and skin rash. Minoxidil was originally developed for the treatment of high blood pressure, however researchers noted that a common side-effect of the medication was the slowing down of hair loss. Therefore, they eventually developed one of the most common shampoos for hair loss instead of a treatment for hypertension.

Plastic surgery ranks high among the best hair loss treatments in terms of effectiveness. Unfortunately, it also ranks high in the most expensive ones too. Even then, to achieve the best results, plastic surgeons often combine their treatments (e.g. hair transplant) with a Propecia treatment. There are three common types of surgeries for hair loss: hair transplant, scalp reduction and flap-surgery.

Hair transplants work best in cases of partial hair loss at the top of the head. The technique consists in moving some hair from the back of the head onto the top of the head. Not everyone is suitable for hair transplant as the surgeon has to take many factors into account before deciding if the technique will be effective for you, such as your age, the nature of your hair loss and the type of hair you have. A good number of patients have to undergo several transplant surgeries over time, as hair loss often reappears.

Scalp reduction is another technique recommended for early baldness on the top of the head. It consists of removing the bald scalp on your hair and covering the scalp-less area with surrounding healthy, “hairy” scalp. Obviously, this stretches the skin around the bald area, which means that in most cases it only buys you 1 or 2 more years until hair loss extends to other parts of your scalp. That's why many patients return to their surgeon to get scalp reductions one after another every 2 years or so.

Flap-surgery is a type of scalp reduction that consists in folding hairy scalp onto a small area affected by hair loss.

If you stop taking hair-loss medication, you will lose any hair you’ve gained within six to twelve months. Your hair loss will return to the same level as it was before you started the medication.

If you’re losing large amounts of hair fast, especially if you’ve also unexpectedly lost a lot of weight, have diarrhoea or a high temperature, then speak to your GP. Do likewise, if you are losing hair in clumps or if your scalp is irritated.

A very small number of men who took Propecia reported sexual side effects – they wanted sex less, found it difficult to get an erection and/or produced less semen. Most of these men also found that these side effects stopped when they stopped taking Propecia.

Even more rarely, some men reported sore breasts, depression, an allergic reaction such as a rash, itching, hives or swelling, sore or painful testicles, difficulty getting an erection even after stopping the medication, male infertility and low quality of semen, and in extremely rare cases, male breast cancer.

If you take a test for prostate cancer (a PSA or Prostate Specific Antigen test) whilst taking the hair loss treatment Propecia, it can affect the results, so tell your doctor.

There is a risk associated between men taking Finasteride (the active ingredient in Propecia) and prostate cancer, but this only applied when these men took an amount of Finasteride that was five times the dose of Propecia.

It has been suggested that men who take Propecia may end up drinking less alcohol than they would have done had they not been taking it, though findings are inconclusive: http://www.nhs.uk/news/2013/06June/Pages/finasteride-propecia-cuts-mens-alcohol-intake.aspx

If you stop taking Propecia, you’ll lose any hair you’ve gained within six to twelve months (your hair loss will go back to how it was before you started the medication).

Women can’t take Propecia. It is only for men.

Pregnant women should not touch broken or crushed Propecia tablets - this could result in abnormalities in a male foetus.