Hair Loss in Men, What to Do?

Published: 15 January, 2024 | 7'

Let's tackle the root issue: what is alopecia?

Hair loss or alopecia is an uncontrolled decrease, either permanent or reversible, of hair specifically located on the scalp. Hair loss has a significant social and image impact and is more common in men. According to recent studies, Spain is the second country in the world with 43% of male alopecia cases. ²

What causes hair loss in men?

There are multiple factors that influence the growth and regeneration cycle of hair follicles: hormones, stress, aging, weather conditions, and an imbalanced diet, among others. However, the likelihood of developing this condition in men is mainly due to the action of male sex hormones.

When to be concerned about hair loss in men?

Hair loss is part of the normal cycle of metabolic phases of hair follicles, with losing 50-100 hairs per day considered normal. However, when this number exceeds 100 hairs per day over a period of several weeks, it can be considered a disruption of the hair cycle. In these cases, it is recommended to seek professional advice to evaluate the cause and provide guidance on the most appropriate treatment.

Types of alopecia

There are various types of alopecia that are determined by factors involved in the hair growth and renewal phases, with the most common types in men being the following:

Androgenetic alopecia

Androgenetic alopecia (AGA) is the most common cause of hair loss in men, with genetic factors and age being the main components involved in its development. Statistical studies indicate that this type of alopecia affects 80% of men, with rates of 50% at the age of 50 and 70% in older stages.^1,3

AGA is caused by the action of the enzyme 5-alpha reductase, which is involved in the conversion of testosterone into dihydrotestosterone (DHT). The male pattern is characterized by hair loss in the frontal areas (initial stage) and on the sides of the head (later stage).

Alopecia areata

Alopecia areata (AA) is the progressive hair loss of autoimmune origin caused by significant shortening of the proliferative phase (anagen). It can present as isolated patches or extensive areas without hair. The follicles do not permanently disappear, so it is reversible with proper treatment.⁴

Alopecia universalis (AU)

This alopecia is a severe and progressive form of alopecia areata (AA), characterized by complete loss of facial, body, and scalp hair.

Frontal fibrosing alopecia (AFF)

Frontal fibrosing alopecia (AFF) is mainly characterized by intense hair loss in the frontal area, causing a receding hairline. Sometimes, it can extend to the temporal and posterior regions of the scalp.

Diffuse

Diffuse alopecia is progressive hair loss due to reduction in the size of the hair follicles without specific localization.

Scarring

Cicatricial alopecia (CA) is based on the replacement of hair follicles by scar tissue, resulting in permanent hair loss. There are two types:

Primary (PCA) where the hair follicle is directly affected.
Secondary (SCA) due to external factors such as damage caused by chemical products applied to the scalp.

Causes of hair loss in men

There are multiple factors that contribute to hair loss, with the most important ones in men being the following:

Genetics

Genetic factors regulate the hair growth cycle, determining aspects such as thickness, volume, curliness, and hair color, among others. These factors are more significant in androgenetic alopecia (AGA).

In a study conducted by Yeo in 2011, it was found that, in a sample of 3114 people, male patients with a family history of AGA had an earlier age of onset than male patients without a family history.⁵

Hormones

Hormones play an important role in regulating the hair cycle, such as thyroid hormones, glucocorticoids, prolactin, among others. However, androgens are the most relevant. These hormones have an impact on the hair growth and regeneration cycle.

Stress

The negative effect of stress on our body, especially on hair, is well-known. Cortisol is known as the "stress hormone" and acts by stimulating the involution phase (catagen) and inhibiting the production of hyaluronic acid and proteoglycans that are part of the hair follicle, resulting in hair loss.

Autoimmune factors

Autoimmune factors, in general, increase the degree of inflammation in tissues, causing changes in their metabolic cycle and structure. In alopecia areata and primary scarring, the autoimmune inflammatory component is the cause of hair loss.

What should I do if I'm experiencing significant hair loss?

Identifying the cause of hair loss is essential, and for this, changes in daily life can be made to help maintain the normal function of the hair follicle growth cycle. Limiting the use of heat styling tools and including foods rich in vitamins (biotin) and minerals (zinc) in the diet are some of these changes.

If hair loss is severe, it is recommended to consult a specialist for an assessment and to determine the most appropriate course of action.

Alternatives for alopecia

There are various solutions that can help reduce hair loss. Some of them are as follows:

Natural solutions for hair loss in men

A varied and balanced diet that provides the necessary micronutrients, such as proteins, minerals, and vitamins, in appropriate proportions, helps maintain the integrity of the normal hair follicle growth cycle. Additionally, the diet can be supplemented with nutritional supplements that contain some of these micronutrients. Some natural ingredients that can help maintain hair volume are as follows:

Biotin: is essential in the production of proteins involved in hair growth, such as keratin and collagen.

Zinc: some enzymes involved in hair follicle proliferation and growth depend on this mineral. It is also key in the antioxidant system.

Cysteine: along with methionine, these are amino acids involved in the formation of proteins characteristic of hair structure, such as keratins.

Hyaluronic acid: is part of the hair structure and contributes to maintaining the hair follicle's structure.

Light therapies

Light therapies are non-invasive options that can be used to help the normal function of hair follicles safely and effectively.

Low-level laser therapy (LLLT) based on the use of red light is one of the most prominent light therapies for people with alopecia. This type of therapy stimulates follicular growth at a cellular level, improving hair density.⁸

Hair transplants

Hair transplantation involves extracting hair follicular units from a donor area and implanting those units into the recipient area characterized by hair loss. However, this method is not applicable to everyone, and there are specific criteria that the individual must meet for a satisfactory outcome:

Density of the donor area: > 70 FUs/cm².
Hair caliber: > 80 microns.
Recipient area with severe alopecia.

Additionally, hair transplantation does not prevent existing hair (that which has not been transplanted) from continuing to fall out, so it is not recommended for young people.^9,11

Therapeutic solutions

Some medications can be administered to patients experiencing hair loss. However, it is essential that the use of these medications is implemented and monitored by a specialist.

Lifestyle changes

There are multiple lifestyle factors that have a significant influence on hair loss, including the following:

Smoking: certain chemicals present in tobacco reduce blood circulation in the scalp, which can lead to alopecia. Some studies have shown that smoking doubles the risk of developing alopecia areata compared to non-smokers. This risk is determined by the duration of smoking as well as the amount consumed.¹⁰

Nutrition: a balanced diet is essential for maintaining good hair health. Foods rich in zinc (shellfish and cereals), biotin (vegetables and eggs), sulfur-containing amino acids (red meats and fish such as salmon), and omega-3 fatty acids such as EPA and DHA (fish oils) promote hair growth.

Stress: practicing yoga, tai chi, or any other sport, meditation, listening to music, and spending time with family and friends are some activities that can help reduce stress levels, thereby reducing cortisol levels in the body.

Limiting heat usage: devices such as hair dryers and straighteners can weaken hair follicles.

Conclusion: Living with alopecia

The high percentage of men experiencing alopecia in our country has made hair loss the main aesthetic concern for this population group. Changes in hair loss frequency can occur due to various factors, including stress, genetics, and diet. Learning to manage stress, supplementing the diet, getting enough sleep, maintaining a good exercise routine, and reducing heat usage on the scalp are some of the alternative approaches that can contribute to the normal function of hair growth and repair cycle.

References

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Baldness by Country 2024.” Worldpopulationreview.com, https://worldpopulationreview.com/country-rankings/baldness-by-country. Accessed 9 Jan. 2024.
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Lintzeri, D. A., et al. Alopecia Areata – Current Understanding and Management. Journal Der Deutschen Dermatologischen Gesellschaft [Journal of the German Society of Dermatology], 2022, 20 (1), 59–90
Yeo, I. K., et al. An epidemiological study of androgenic alopecia in 3114 Korean patients, Clinical and Experimental Dermatology, 2014, 39 (1), 25–29,
Thom, E. Stress and the hair growth cycle: Cortisol-induced hair growth disruption. Journal of Drugs in Dermatology: JDD, 2016, 15(8), 1001–1004.
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Minokawa, Y. et al. Lifestyle factors involved in the pathogenesis of alopecia areata. International Journal of Molecular Sciences 2022, 23.3: 1038.
Jimenez, F. et al. Hair transplantation: Basic overview. Journal of the American Academy of Dermatology, 2021, 85(4), 803–814.
Tamashunas, N. L., & Bergfeld, W. F. Male and female pattern hair loss: Treatable and worth treating. Cleveland Clinic Journal of Medicine, 2021, 88(3), 173–182.
Anastassakis K. Androgenetic alopecia from A to Z. Vol. 2: Drugs, herbs, nutrition, and supplements. Athens: Springer Nature 2014. ISBN 978-3-031-08056-2.
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Adelman MJ, et al. Clinical efficacy of popular oral hair growth supplement ingredients. Int J Dermatol. 2021 Oct;60(10):1199-1210.
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Content written and reviewed by specialists from the Scientific Information department at MARNYS. This article is for informational purposes only and does not replace consultation with a specialist.