Male Pattern Baldness

Male Pattern Baldness: Frequently Asked Questions

The Basics: What is happening?

What actually causes male pattern baldness?

It is a mix of genetics and a specific hormone called Dihydrotestosterone (DHT), which your body creates from testosterone.

If you are genetically sensitive to DHT, this hormone binds to receptors in your scalp hair follicles. Over time, DHT causes these follicles to shrink—a process called miniaturisation. As they shrink, the hairs grow back thinner, shorter, and lighter, until they eventually stop producing hair altogether.

Is it inherited from the mother's side or the father's side?

Both. There is an old myth that you only inherit baldness from your mother’s father, but modern genetics shows it is a polygenic trait—meaning it involves multiple genes passed down from both parents. If there is a history of hair loss on either side of your family tree, your statistical risk is higher.

Diagnosis & Identification

How can I tell if it's male pattern baldness or normal shedding?

Losing hair is completely normal—the average person sheds roughly 50 to 100 hairs a day as part of a healthy hair growth cycle.

However, male pattern baldness follows a very specific, distinct structural pattern. Clinicians use the Norwood Scale to track this progression. You can spot the difference by looking for:

• A receding hairline that slowly forms an "M" shape at the temples.

• Gradual thinning at the crown (the vertex at the back of the head).

• A general thinning across the entire top of the scalp, while the sides and back remain relatively thick.

Can stress cause male pattern baldness?

Not directly. Chronic emotional or physical stress can trigger a different type of temporary hair thinning called Telogen Effluvium, which causes a large number of hairs to suddenly enter the resting phase and shed at once. However, stress does not cause the permanent follicle miniaturisation seen in genetic male pattern baldness.

If I start a treatment, do I have to use it forever?

Yes. Neither treatment provides a permanent cure; they only manage the symptoms while the active medicine is present in your system. If you stop using Finasteride or Minoxidil, your scalp DHT levels will return to their baseline within a few months, and any hair you saved or regrew will gradually shed.

Why am I shedding more hair after starting a new treatment?

This is completely normal and is actually a sign the medicine is working. Both Minoxidil and Finasteride kick-start a new growth cycle. This causes resting, thin hairs to drop out all at once to make room for new, thicker, healthier hair strands. This temporary "shedding phase" typically occurs within the first 2 to 8 weeks and resolves on its own.

Side Effects & Safety

What are the side effects of Finasteride?

The vast majority of men tolerate Finasteride very well, but like all medicines, it can carry a low risk of side effects. In clinical trials, a small percentage of men (roughly 1% to 2%) experienced temporary sexual side effects, including:

• Decreased libido (sex drive)

• Erectile dysfunction

• A reduction in semen volume

For most individuals who experience these, the symptoms resolve completely once the medication is stopped, or over time as the body adapts to the treatment.

Can I use these treatments if I am planning a family?

While small amounts of Finasteride can be present in semen, there is no strong clinical evidence to show it harms a developing foetus. However, as an absolute precaution, many men choose to temporarily pause oral Finasteride while actively trying to conceive with a partner. Note: Pregnant women must never handle crushed or broken Finasteride tablets, as the active ingredient can be absorbed through the skin and affect a male baby's development.

Other Interventions

Do caffeine shampoos or biotin supplements work?

They can support general hair health, but they cannot treat genetic male pattern baldness. Biotin will only improve hair growth if you have an actual dietary biotin deficiency (which is rare). Caffeine shampoos can temporarily coat the hair shaft to make it feel slightly thicker, but they do not stay on the scalp long enough to block DHT at the follicle level.

How do hair transplants work?

A hair transplant is a permanent surgical procedure. A surgeon extracts DHT-resistant hair follicles from the "donor site" (usually the back and sides of your head) and meticulously implants them into the balding zones at the front or crown.

Because those transplanted follicles retain their genetic resistance to DHT, they will continue to grow naturally for life. However, most surgeons still recommend using medical treatments like Finasteride after a transplant to prevent the rest of your original, non-transplanted hair from thinning out.

What clinical treatments are proven to work?

While there are countless "miracle cures" advertised online, only two medical treatments are clinically proven and licensed in the UK to successfully treat male pattern baldness: