Hair Loss in Men: 13 Causes, DHT Explained & What Actually Works

Quick Comparison: What Type of Hair Loss Is It?

Male Pattern Baldness (The Primary Driver)

The most common reason men lose hair is androgenetic alopecia — often called male pattern baldness. It typically shows up as temple recession, a thinning crown, or both. Some men progress slowly, while others move through stages quickly. The difference is partly genetics, partly timing, and partly whether you start a consistent routine early.

Male pattern baldness is strongly linked to genetic sensitivity in follicles to DHT (dihydrotestosterone), a hormone derived from testosterone. In susceptible follicles, DHT contributes to a gradual process called miniaturisation.

What DHT Actually Does

DHT binds to receptors in genetically sensitive follicles (typically on the hairline and crown). Over time, those follicles produce hairs that are thinner, shorter, and less pigmented. Eventually, the follicle can become so weakened that it stops producing a visible hair.

Miniaturisation means:

• Each growth cycle produces a thinner strand
• The growth phase shortens, so hair can’t reach the same length
• Hair diameter shrinks (less coverage even with “the same number” of hairs)
• Terminal hairs convert into fine “vellus-like” hairs

Early warning signs men often miss:

• A subtle change in temple shape (early “M” pattern)
• More scalp visible under harsh lighting
• Hair feels harder to style or “doesn’t sit” like it used to
• Fine wispy regrowth in thinning areas instead of thick strands

The key principle: once follicles miniaturise for long enough, reversal becomes harder. That’s why early action matters so much.

How Male Pattern Baldness Progresses

Male pattern baldness usually progresses in stages (often mapped by the Norwood scale). The crown and hairline are commonly affected first because those follicles are more genetically sensitive in many men.

Year 1–2: Subtle miniaturisation begins; styling starts to feel different.

Year 3–5: Visible recession or a developing crown spot becomes noticeable in photos.

Advanced stage: Larger areas of scalp show; donor hair planning becomes important for transplant candidates.

Not all men progress at the same rate. Many stabilise significantly with early, consistent treatment.

The 13 Causes of Hair Loss in Men (Complete List)

Male pattern baldness is the #1 cause, but it’s not the only one. Below are the 13 most common causes of hair loss in men, with what each one looks like and what the smartest first move tends to be.

1. Male Pattern Baldness (Androgenetic Alopecia)
   Temple recession, crown thinning, gradual miniaturisation.
   First step: Start an evidence-based routine early (growth support + DHT strategy + scalp care).
2. DHT Sensitivity / Androgen Sensitivity
   Looks like MPB; progression speed varies by genetics and androgen response.
   First step: Discuss options with a clinician; support scalp environment consistently.
3. Telogen Effluvium (Stress/Illness Shedding)
   Diffuse shedding 6–12 weeks after illness, fever, surgery, grief, or sustained stress.
   First step: Identify the trigger, stabilise sleep/protein, avoid panic-switching treatments.
4. Thyroid Disorders (Hypo/Hyperthyroidism)
   Diffuse thinning, slower regrowth, sometimes dry/brittle hair.
   First step: Medical evaluation and blood work.
5. Alopecia Areata (Autoimmune)
   Round or patchy bald spots; may come and go.
   First step: Dermatology assessment; early management matters.
6. Scalp Inflammation (Seb Derm, Psoriasis, Chronic Irritation)
   Itching, burning, flaking, tenderness; shedding can increase.
   First step: Treat the scalp first — inflammation can cap progress.
7. Nutritional Deficiencies (Low Ferritin, Vitamin D, Zinc, Low Protein)
   Diffuse shedding, weak regrowth, brittle hair quality.
   First step: Diet review + blood markers (especially ferritin and vitamin D).
8. Rapid Weight Loss / Crash Dieting
   Shedding 6–12 weeks after significant calorie deficit.
   First step: Stabilise intake, prioritise protein, restore recovery.
9. Medications
   Increased shedding after starting or changing certain prescriptions.
   First step: Never stop a prescription without advice; discuss alternatives.
10. Smoking
    Slower growth, poorer hair quality, accelerated thinning over time.
    First step: Smoking cessation + supportive scalp routine.
11. Anabolic Steroids / Androgen Use
    Accelerated pattern thinning if genetically predisposed.
    First step: Discontinue and seek medical guidance; stabilise follicles.
12. Chronic Sleep Deprivation
    Poor recovery, hormone disruption; can worsen existing thinning.
    First step: 7–9 hours target, consistent sleep schedule.
13. Traction / Breakage (Tight Styles, Harsh Grooming, Heat/Chemicals)
    Broken hairs, thinning at tension points, hairline fragility.
    First step: Reduce tension + heat + harsh chemicals; focus on shaft protection.

What Actually Works: Evidence-Based Treatments

Treatment only works when it matches the cause — and when it’s used long enough to judge. Most plans need 3–6 months before you assess results, and combination routines tend to outperform single tools.

Medical

• Topical minoxidil: supports the growth phase for many users.
• Oral finasteride (Rx): reduces DHT via 5α-reductase inhibition (discuss suitability/risks with a clinician).
• Ketoconazole shampoo: supports scalp health and can be a useful adjunct 2–3× weekly.

Adjunct Therapies

• Microneedling: often paired with topical routines.
• Low-Level Laser Therapy (LLLT): devices may support follicles in some users.
• PRP therapy: in-clinic protocols vary; consistency matters.
• Hair transplant: best for stable pattern loss with adequate donor hair.

Foundational

• High protein intake and stable calories
• Optimised vitamin D and ferritin
• 7–9 hours sleep + stress reduction

Starter Routine (Early Stage Thinning)

Morning: Apply minoxidil (if suitable for you).

2–3× weekly: Ketoconazole shampoo.

Weekly: Microneedling (as part of a broader plan).

Daily: Nutritional support + protein-rich diet + sleep consistency.

Assess changes after 3–6 months using consistent photos and lighting.

When to See a Doctor

• Sudden round bald patches
• Itchy, painful, inflamed, or scaly scalp
• Rapid shedding with systemic symptoms
• Hair loss before age 18

References

• NHS – Hair loss overview
• American Academy of Dermatology – Male pattern hair loss
• British Association of Dermatologists – Alopecia guidance