Male-pattern baldness is the most common type of hair loss, affecting around half of all men by 50 years of age. It usually starts around the late twenties or early thirties and most men have some degree of hair loss by their late thirties.
It generally follows a pattern of a receding hairline, followed by thinning of the hair on the crown and temples, leaving a horseshoe shape around the back and sides of the head. Sometimes it can progress to complete baldness, although this is uncommon.
Male-pattern baldness is hereditary, which means it runs in families. It's thought to be caused by oversensitive hair follicles, linked to having too much of a certain male hormone.
As well as affecting men, it can sometimes affect women (female-pattern baldness). During female-pattern baldness, hair usually only thins on top of the head.
It's not clear if female-pattern baldness is hereditary and the causes are less well understood. However, it tends to be more noticeable in women who have been through the menopause (when a woman's periods stop at around age 52), perhaps because they have fewer female hormones.
Alopecia areata causes patches of baldness about the size of a large coin. They usually appear on the scalp but can occur anywhere on the body. It can occur at any age, but mostly affects teenagers and young adults.
In most cases of alopecia areata, hair will grow back in a few months. At first, hair may grow back fine and white, but over time it should thicken and regain its normal colour. Some people go on to develop a more severe form of hair loss, such as:
alopecia totalis (no scalp hair)
alopecia universalis (no hair on the scalp and body)
Alopecia areata is caused by a problem with the immune system (the body's natural defence against infection and illness). It's more common among people with other autoimmune conditions, such as an Down's syndrome.
It's also believed some people's genes make them more susceptible to alopecia areata, as one in five people with the condition have a family history of the condition.
Alopecia areata can occur at any age, although it's more common in people aged 15-29. It affects one or two people in every 1,000 in the UK.
Scarring alopecia, also known as cicatricial alopecia, is usually caused by complications of another condition. In this type of alopecia, the hair follicle (the small hole in your skin that an individual hair grows out of) is completely destroyed. This means your hair won't grow back.
Depending on the condition, the skin where the hair has fallen out is likely to be affected in some way.
Conditions which can cause scarring alopecia include:
scleroderma – a condition affecting the body's connective (supporting) tissues, resulting in hard, puffy and itchy skin
discoid lupus – a mild form of lupus affecting the skin, causing scaly marks and hair loss
folliculitis decalvans – a rare form of alopecia that most commonly affects men, causing baldness and scarring of the affected areas
frontal fibrosing alopecia – a type of alopecia that affects post-menopausal women where the hair follicles are damaged, and the hair falls out and is unable to grow back
Scarring alopecia occurs in both males and females, but is less common in children than adults. It accounts for about 7% of hair loss cases.
Anagen effluvium is widespread hair loss that can affect your scalp, face and body.
One of the most common causes of this type of hair loss is the cancer treatment radiotherapy – may also cause hair loss.
The hair loss is usually noticeable within a few weeks of starting treatment. However, not all chemotherapy drugs cause hair loss and sometimes the hair loss is so small it's hardly noticeable.
It may be possible to reduce hair loss from chemotherapy by wearing a special cap that keeps the scalp cool. However, scalp cooling is not always effective and not widely available.
In most cases, hair loss in anagen effluvium is temporary. Your hair should start to grow back a few months after chemotherapy has stopped.
Telogen effluvium is a common type of alopecia where there is widespread thinning of the hair, rather than specific bald patches. Your hair may feel thinner, but you're unlikely to lose it all and your other body hair isn't usually affected.
Telogen effluvium can be caused by your body reacting to:
hormonal changes, such as those that take place when a woman is pregnant
intense emotional stress
intense physical stress, such as childbirth
a short-term illness, such as a severe infection or an operation
In most cases of telogen effluvium, your hair will stop falling out and start to grow back within six months.
How is hair loss treated?
More common types of hair loss, such as male-pattern baldness, don't need treatment because they're a natural part of ageing and don't pose a risk to your health.
However, any type of hair loss can be distressing, so you should see your GP if you're worried about it.
Your GP should be able to diagnose your type of hair loss by examining your hair. They can also discuss possible treatments with you so it's advisable to visit your GP before trying a private consultant dermatologist (skin care specialist).
If you want treatment for male-pattern baldness for cosmetic reasons, two medications called finasteride and minoxidil can be used. Minoxidil can also be used to treat female-pattern baldness.
However, these treatments don't work for everyone and only work for as long as they're continued. They are not available on the NHS and can be expensive.
Alopecia areata is usually treated with steroid injections, although it's sometimes possible to use a steroid cream, gel or ointment. A treatment called immunotherapy may also be used. This involves stimulating hair growth by causing an intentional allergic reaction in the affected areas of skin.
If you have significant hair loss of any type, you may decide to wear a wig. Wigs are available on the NHS, but you may have to pay unless you qualify for help with charges.
There are also some surgical options for hair loss, including a hair transplant and artificial hair implants.
Hair loss can be difficult to come to terms with. The hair on your head can be a defining part of your identity. If you start to lose your hair, it can feel as if you're losing part of your identity. This can affect your self-confidence and sometimes lead to depression.
Speak to your GP if you're finding it difficult to deal with your hair loss. They may suggest counselling. You may also benefit from joining a support group or speaking to other people in the same situation – for example, through online forums.
A number of charities, such as Alopecia UK, have support groups and online forums where you can talk to others who are experiencing hair loss.
Treating hair loss
Although hair loss rarely needs to be treated, many people seek treatment for cosmetic reasons.
Many cases of hair loss are temporary, for example, due to chemotherapy, or they're a natural part of ageing and don't need treatment. However, hair loss can have an emotional impact, so you may want to look at treatment if you're uncomfortable with your appearance.
If hair loss is caused by an infection or another condition, such as lupus, treating the underlying problem may help prevent further hair loss.
Male-pattern baldness isn't usually treated, as the treatments available are expensive and don't work for everyone.
Two medicines that may be effective in treating male-pattern baldness are finasteride and minoxidil. Neither treatment is available on the NHS.
You may also want to consider wearing a wig or having surgery.
Finasteride is available on private prescription from your GP. It comes as a tablet you take every day.
It works by preventing the hormone testosterone being converted to the hormone dihydrotestosterone (DHT). DHT causes the hair follicles to shrink, so blocking its production allows the hair follicles to regain their normal size.
Studies have suggested finasteride can increase the number of hairs people have (hair count) and can also improve how people think their hair looks.
It usually takes three to six months of continuously using finasteride before any effect is seen. The balding process usually resumes within six to 12 months if treatment is stopped.
Side effects for finasteride are uncommon. Less than one in 100 men who take finasteride experience a erectile dysfunction (the inability to get or maintain an erection).
Minoxidil is available as a lotion you rub on your scalp every day. It's available from pharmacies without a prescription. It's not clear how minoxidil works, but evidence suggests it can cause hair regrowth in some men.
The medication contains either 5% or 2% minoxidil. Some evidence suggests the stronger version (5%) is more effective. Other evidence has shown this is no more effective than the 2% version. However, the stronger version may cause more side effects, such as dryness or itchiness in the area it's applied.
Like finasteride, minoxidil usually needs to be used for several months before any effect is seen. The balding process will usually resume if treatment with minoxidil is stopped. Any new hair that regrows will fall out two months after treatment is stopped. Side effects are uncommon.
Minoxidil is currently the only medicine available to treat female-pattern baldness.
Minoxidil lotion may help hair grow in around one in four women who use it, and it may slow or stop hair loss in other women. In general, women respond better to minoxidil than men. As with men, you need to use minoxidil for several months to see any effect.
There is no completely effective treatment for alopecia areata. However, in most cases the hair grows back after about a year without treatment. So "watchful waiting" is sometimes best, particularly if you just have a few small patches of hair loss.
Some treatments for alopecia areata are outlined below.
Corticosteroids are medicines containing steroids, a type of hormone. They work by suppressing the immune system (the body's natural defence against infection and illness). This is useful in alopecia areata because the condition is thought to be caused by the immune system damaging the hair follicles.
Corticosteroid injections appear to be the most effective treatment for small patches of alopecia. As well as your scalp, they can also be used in other areas, such as your eyebrows.
A corticosteroid solution is injected several times into the bald areas of skin. This stops your immune system from attacking the hair follicles. It can also stimulate hair to grow again in those areas after about four weeks. The injections are repeated every few weeks. Alopecia may return when the injections are stopped.
Side effects of corticosteroid injections include pain at the injection site and thinning of your skin (atrophy).
Topical corticosteroids (creams and ointments) are widely prescribed for treating alopecia areata, but their long-term benefits are not known.
They are usually prescribed for a three-month period. Possible corticosteroids include:
These are available as a lotion, gel or foam depending on which you find easiest to use. However, they cannot be used on your face, for example on your beard or eyebrows.
Possible side effects of corticosteroids include thinning of your skin and acne.
Corticosteroids tablets aren't recommended because of the risk of serious side effects.
Minoxidil lotion is applied to the scalp and can stimulate hair regrowth after about 12 weeks. However, it can take up to a year for the medication to take full effect.
Minoxidil is licensed to treat both male- and female-pattern baldness, but is not specifically licensed to treat alopecia areata. This means it hasn't undergone thorough medical testing for this purpose.
Minoxidil is not recommended for those under 18 years old. It's not available on the NHS, but can be prescribed privately or bought over the counter.
Immunotherapy may be an effective form of treatment for extensive or total hair loss, although fewer than half of those who are treated will see worthwhile hair regrowth.
A chemical solution called diphencyprone (DPCP) is applied to a small area of bald skin. This is repeated every week using a stronger dose of DPCP each time. The solution eventually causes an allergic reaction and the skin develops mild eczema (dermatitis). In some cases, this results in hair regrowth after about 12 weeks.
A possible side effect of immunotherapy is a severe skin reaction. This can be avoided by increasing the DPCP concentration gradually. Less common side effects include a rash and patchy-coloured skin (vitiligo). In many cases, the hair falls out again when treatment is stopped.
Immunotherapy is only available in specialised centres. You'll need to visit the centre once a week for several months. After DPCP has been applied, you'll need to wear a hat or scarf over the treated area for 24 hours because light can interact with the chemical.
Similar to immunotherapy, dithranol cream is applied regularly to the scalp before being washed off. It causes a skin reaction, followed by hair regrowth in some cases.
However, it hasn't been proven that dithranol cream is significantly effective in the long term. It can also cause itchiness and scaling of the skin and can stain the scalp and hair. For these reasons, dithranol is not widely used.
Ultraviolet light treatment
Two to three sessions of light therapy (phototherapy) are given every week in hospital. The skin is exposed to ultraviolet (UVA or UVB) rays. In some cases, before your skin is exposed to UV light you may be given a medicine called psoralen, which makes your skin more sensitive to the light.
The results of light therapy are often poor. The treatment can take up to a year to produce maximum results and responses vary, with a high relapse rate. It's often not a recommended treatment because side effects can include:
For many people, it's possible to replicate hair with a tattoo. This is known as dermatography and generally produces good long-term results, although it is usually expensive and can only be used to replicate very short hair.
This is usually carried out for eyebrows over a few hourly sessions and can even be used as a treatment for scalp hair loss caused by male-pattern baldness.
Wigs can be a useful treatment for people with extensive hair loss.
The cheapest wigs are made from acrylic and can cost anywhere between £60 and £300.
Acrylic wigs last for six to nine months. They're easier to look after than wigs made of real hair because they don't need styling. However, acrylic wigs can be itchy and hot, and need to be replaced more often than wigs made from real hair.
Alopecia UK also has useful information about synthetic wigs and human hair wigs, including advice about choosing the right wig and how to care for it.
Aromatherapy, acupuncture and massage are often used for alopecia, but there isn't enough evidence to support their use as effective treatments.
Hair loss surgery
Most men and women considering hair loss surgery have male-pattern or female-pattern baldness. However, surgery is sometimes suitable for a range of alopecia conditions.
Surgery for hair loss should only be considered after trying less invasive treatments, and it's not usually available on the NHS.
The success of hair loss surgery depends on the skill of the surgeon, as complications can arise. It's best to speak to your GP for advice before seeking out a surgeon in the private sector.
The main types of hair loss surgery are explained below.
Under local anaesthetic (painkilling medication), a small piece of scalp (about 1cm wide and 30-35cm long) is removed from an area where there's plenty of hair. The piece of scalp is divided into single hairs or tiny groups of hairs, which are grafted onto areas where there's no hair.
Stitches are not needed to attach the grafts because they are held in place by the clotting (thickening) action of the blood when the hairs are inserted. Fine hairs are placed at the front of the scalp and thicker hairs towards the back in a process called grading. This helps achieve a more natural result. Within six months, the hair should settle and start to regrow.
Hair transplants are carried out over a number of sessions. There should be a break of nine to 12 months between procedures. As with any type of surgery, there is a risk of infection and bleeding, which can lead to hair loss and noticeable scarring.
Hair transplantation isn't provided by the NHS. It can be expensive and take a long time.
Scalp reduction involves removing pieces of bald scalp from the crown and the top of the head to move hairy parts of the scalp closer together. This can be done by cutting out loose skin and stitching the scalp back together, or it can be done by tissue expansion.
Tissue expansion is where a balloon is placed underneath the scalp and inflated over several weeks to expand the skin in stages. The balloon is then removed and the excess skin is cut out.
Scalp reductions are not suitable for hair loss at the front of the scalp because it can cause scarring. There is also the risk of infection in the area.
Scalp reduction isn't usually used for male-pattern baldness, but it's available on the NHS to people with scarring alopecia. Surgery should only be carried out after any underlying conditions have cleared up.
Artificial hair implantation is marketed as a treatment for male-pattern baldness. It involves implanting synthetic fibres into the scalp under local anaesthetic. The technique is not available on the NHS.
Artificial hair implantation carries serious risks of infection and scarring, but clinics may be reluctant to inform people of the possible complications to avoid losing potential clients.
Artificial hair implantation isn't recommended by dermatologists because of the risk of complications such as:
synthetic fibres falling out
People considering hair loss surgery should explore more established treatments, such as hair transplantation and scalp reduction, because the advantages and disadvantages of these techniques are better understood.
The latest research into hair loss treatments is studying hair cell cloning. The technique involves taking small amounts of a person's remaining hair cells, multiplying them, and injecting them into bald areas.
Cloning is intended to treat both male- and female-pattern baldness. However, the science behind the technique is new and more trials are needed before it can be fully assessed.
If you need emotional support following hair loss, you can contact the charity Alopecia UK. An online forum is available where you can talk to other people with alopecia, and a network of support groups exists across the country.
'There is definitely life after hair loss'
Michelle Chapman was diagnosed with alopecia areata when she was just five. She now devotes her time to raising awareness of alopecia, supporting others with the condition, and designing a stylish range of wigs.
"I don't know why, but I began losing my hair when I was just five years old. It started slowly at first, just circular bald patches the size of a 10p piece. When I noticed lots of hair on my pillow, I began to ask questions. Mum took me to a dermatologist, who confirmed that I had alopecia areata. I didn't understand what was happening to me.
"Over time, the bald patches grew larger and started to join together. By the time I was eight, I was wearing a wig.
"Then, just before I started secondary school when I was about 10, my hair started to grow back for no apparent reason. But I still had the bald patches, so I'd disguise these by strategically styling my hair. Before classes, a couple of friends would help to colour my head in with eyeliner pencils, otherwise my white scalp would shine through.
"I was 21 when my hair loss happened again. I was in the shower and suddenly ankle deep in water because my hair was clogging the plughole. I pretty much lost the lot in one go. I felt devastated. Just when I thought I was over it, it got me again. That's one of the cruel things about alopecia.
"I eventually tried some wigs and chose a simple bob, just like the style I used to have. After a while, I began to get used to it and started to buy different types of wig.
"In 1996, I began my campaign to raise awareness of hair loss. When I was featured in a national newspaper, the response was incredible. Since then I was very fortunate to take part in a television documentary about Gail Porter, the television personality, who was diagnosed with alopecia in August 2005. It was wonderful meeting and working alongside Gail. Since then, the awareness for hair loss has increased dramatically.
"I've come a long way since those early years. I spend time as a volunteer for the charity Alopecia Awareness, which gives those experiencing hair loss the opportunity to communicate with others who understand the emotional trauma caused by the condition.
"To top it all off, I now work for a wig company. My time is divided between working alongside a number of NHS hospitals, where I attend specialist hair loss clinics, and designing a range of wigs. After all, I know how they should feel and what looks right.
"I now have around 50 wigs in my collection: red, brunette, blonde, black, long, short, straight, curly. The one I wear depends on where I'm going, what I'm doing, what I'm wearing and how I'm feeling. There is definitely life after hair loss."
'I hate my bald head'
Robert Murray started losing his hair at the age of 16 and, more than 10 years later, he's still coming to terms with it.
Insults like slaphead, chrome dome and baldie have made it difficult for Robert, from Cheshire, to be bald and proud.
He's not alone. Almost one-third of men are noticeably balding by the age of 30. Most try to hide their receding hairline by shaving off what's left.
Robert decided to test society's perceptions of baldness and sample some of the available treatments for a BBC3 documentary.
He tried several lotions, which promised to stimulate and nourish his hair follicles, as well as help them regrow hair. "All they did was redden my scalp, discolour the skin and leave a sticky residue," he says.
He tried an alternative treatment, which involved having his head regularly rubbed for 30 minutes by an Ayurvedic practitioner.
"While it was certainly pleasant, my hair failed to reappear," Robert says.
With the ointments and tablets having no effect, Robert tested whether a hairpiece would change how people treated him.
Wigs have come a long way since the days of TV magician Paul Daniels. It's been said that his decision to get rid of his toupée kept the Chernobyl nuclear disaster off the front pages in 1986.
"The first difference I noticed was how the wig made me feel about myself," says Robert. "Being fitted with false hair, I was surprised at how irate I felt towards the man reflected in the mirror.
"It felt like a slur on my integrity, but also made me wonder: if I hadn't lost my hair, would I be a different man?"
To put the toupée to the test, Robert took his wig to a speed dating event in Manchester. During the course of the evening, he spoke to eight women with his hairpiece on and eight women without it.
Robert felt a little self-conscious. "I couldn't stop patting my head every few minutes to ensure the toupée hadn't slipped to an awkward angle," he says.
Robert asked several women what qualities they looked for in a man. Personality and a sense of humour were among the answers.
Hair was never mentioned – until the wig came off. "I love bald men," Robert heard from two different women. "Vin Diesel is well fit," said another.
"The event ended with hugs and saucy compliments about my naked scalp, helping me realise that bald could be sexy," says Robert.
"The wig made me feel like a traitor to myself. It was time to embrace my baldness."
He remembers going to his doctor in his teens to ask for help with his hair loss. "He suggested a crew cut," says Robert.
But he now realises his GP was right. "I just needed to get over losing my hair," he says.
While surveys show that British bald men are more ashamed of their hair loss than European men, women think there's nothing to be ashamed of.
But Robert believes society has some way to go before balding men can feel at ease with their thinning hair.
"We will only walk tall when the insults fade and there are no more false promises from dodgy treatments," he says.
"In the meantime, if my confidence wavers, I just look at the shaved domes of Freddie Ljungberg and Billy Zane."
'The bald patch seemed to get bigger and bigger'
Gita Mendis was diagnosed with alopecia in 2008.
In this video, Gita talks about her experience of alopecia areata, how she felt when she noticed her hair loss, and the treatment she received.
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