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Why Do Men Go Bald?

We all know someone who has lost their hair, and perhaps you’re one of those men witnessing the disappearance of your once-thick mop. But why do men go bald? When does it start? And importantly, is it the same as alopecia?

To answer these questions, we’ll delve into topics such as male pattern baldness, the average age of onset, the biology behind baldness, and its evolutionary implications.

Primary Drivers of Baldness

The primary reason men go bald is due to a genetic condition known as androgenetic alopecia, or more commonly, male pattern baldness. According to the American Academy of Dermatology (AAD), this condition affects an estimated 50 million men in the United States, with about half of all men experiencing some hair loss by age 50.

bald man wearing sunglasses sitting by the beach

The condition is fueled by a hormone called dihydrotestosterone (DHT), a derivative of testosterone. Men who are genetically predisposed to baldness have hair follicles that are overly sensitive to DHT. As a result, these follicles shrink over time, leading to shorter and thinner hair.

Is This Due to Your Father’s Genes?

While many people believe that baldness is inherited from the mother’s side of the family, the reality is that genes from both parents contribute to the likelihood of baldness as we discussed here.

In one study, researchers analyzed the genomes of over 52,000 men, concluding that the X chromosome (inherited from the mother) does carry the main baldness gene. However, other genes scattered throughout the rest of the genome, which a man can inherit from either parent, also contribute to male pattern baldness. The researchers identified a total of 250 genetic regions linked to hair loss, underpinning the complexity of this trait.

What About Stress?

The link between stress and baldness isn’t as clear-cut, but research suggests that chronic stress can indeed accelerate hair loss. In a study published in the American Journal of Pathology, researchers found that stress can lead to inflammation in the body, which can cause hair to enter the “shedding” phase prematurely.

So, while stress may not be the root cause of baldness, it can exacerbate the situation in men who are already genetically predisposed to losing their hair. An interesting note to add is that there are three types of hair loss linked to high-stress levels, namely telogen effluvium, alopecia areata, and trichotillomania. These are different from androgenetic alopecia, however, which is primarily a genetically-driven process.

Average Age of Hair Loss

While male pattern baldness can commence at any age after puberty, in their early twenties to late thirties is when most men begin to notice a changeAccording to one extensive study, nearly 16% of men aged between 18 and 29 show moderate to extensive hair loss, increasing to over 53% for men in their 40s.

Independently, the American Hair Loss Association found that two-thirds of American men will experience some degree of appreciable hair loss by the age of 35, and by the age of 50 approximately 85% of men have significantly thinning hair.

So while there is some difference in the age of onset data – largely due to factors such as ethnic and genetic diversity, lifestyle, and health conditions – the key takeaway is that male pattern baldness is common and can begin at any age post-puberty.

Is Male Pattern Baldness the Same as Alopecia?

Although the words “baldness” and “alopecia” are often used interchangeably, they are not entirely the same. According to the National Alopecia Areata Foundation, alopecia means “bald” and areata means “patchy.”

Alopecia areata is a specific type of hair loss that occurs when your immune system mistakenly attacks hair follicles, leading to unpredictable, usually circular patches of hair loss. It can affect anyone regardless of age and gender, and the hair may grow back or fall out again over time. While it’s also called ‘baldness’, it differs from male pattern baldness.

Male pattern baldness, on the other hand, is a predictable, patterned hair loss condition affecting only men, primarily due to genetic predisposition and the hormone DHT, as mentioned above. The hair loss in male pattern baldness is gradual and typically starts with a receding hairline followed by thinning on the crown.

So, alopecia areata and male pattern baldness are both forms of hair loss, but they have different causes, progression patterns, and even possible treatments.

Is There an Evolutionary Reason for Balding?

The evolutionary perspective for balding is a topic of much speculation among scientists. Some theories suggest that balding has persisted because it may signal maturity, wisdom, or higher social status, which could be attractive traits to prospective mates. Some theorize that an association between age and leadership could explain why baldness, seen as a sign of age, could be perceived positively.

However, another claim published in NewScientist states the following:

“As our prehistoric ancestors moved north, they lost their skin pigmentation to compensate for the diminishing UVB levels that they found at higher latitude. Baldness would have become an advantage due to the greater capacity to synthesise vitamin D in the skin of the bald pate.”

This may explain why balding is so common and widespread, even though it might seem disadvantageous at first glance.

Are Current Environmental Factors Making it More Common?

Environmental factors are believed to contribute to the onset of baldness and accelerate the process in those who are genetically predisposed. Various elements of our modern lifestyle, including diet, pollution, smoking, and even certain hairstyles or treatments, can negatively impact hair health.

Additionally, more men are opting to shave their head completely , as this look has come to be seen as more socially acceptable and even stylish in recent times. Emerging research suggests that men with shaved heads are perceived as more dominant and, in some cases, taller and stronger than those with thicker hair, which could partly explain this trend.

Preventative Measures

For those concerned about hair loss, a variety of treatment options exist. The most widely recognized treatments are pharmaceutical and include minoxidil (Rogaine) and finasteride (Propecia). These are the only two hair loss treatments currently approved by the U.S. Food and Drug Administration (FDA), and they work by slowing hair loss and promoting hair growth.

man inspecting hair for signs of hair loss

Minoxidil is a topical solution or foam that you apply directly to your scalp, and it has been shown to effectively slow hair loss and even regrow hair in some men. On the other hand, finasteride is an oral medication that reduces the levels of DHT in your body, thereby minimizing hair thinning and loss.

Just recently the FDA approved Pfizer’s LITFULO oral medication, a JAK3 inhibitor, for the treatment of alopecia areata.

For more advanced stages of male pattern baldness, surgical treatments like hair transplants could be considered. In this procedure, a dermatologist transfers hair from a part of your scalp that still has hair to the areas that are bald or thinning. Modern hair transplant techniques can achieve a natural look, but they can be costly and require multiple sessions.

Additionally, lifestyle changes can also potentially reduce the rate of hair loss. For example, a well-balanced diet rich in proteins, Vitamin D, and certain minerals like Iron and Zinc can support hair health.

Biotin shampoos and supplements have gained popularity as a non-pharmaceutical option. Biotin, also known as Vitamin B7, plays a crucial role in hair growth, and a deficiency can lead to hair loss. However, bear in mind that unless you’re actually deficient, additional biotin may not improve your hair growth.

The AAD recommends reducing the usage of hair styling products and accessories that pull tightly on your hair, as they can cause ‘traction alopecia,’ which is hair loss due to pulling on the hair.

Remember, though, that all effective treatments require time to work, and no treatment restores all the hair you’ve lost. As each individual’s hair loss pattern and response to medication differ, consulting a dermatologist for personalized treatment is always a good idea.

Adam Williams

As the lead editor of Tools of Men, Adam loves men's grooming products. Particularly of interest is managing facial hair and perfecting the art of the modern man's skincare routine. His work has been featured or quoted in several publications, including New York Magazine, Vice, Sharpologist, MIC, Elite Daily, and more. When Adam isn't working, he enjoys spending time with his two little kids who keep him both on his toes and young at heart.

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