Male pattern baldness affects two-thirds of men but treatments on the horizon

Overcome with anxiety and poor self-esteem, Jay Massey, then 24, decided to have a heart-to-heart with his dad, former Crystal Palace footballer Stuart Massey.

During the course of that conversation in 2020, father and son found they had an unexpected shared bond: both had suffered premature hair loss that had really hit their self-confidence.

‘I started to lose my hair aged 18, and by 22 I had lost a considerable amount along the sides and front of my scalp,’ says Jay, now 26, a sales manager from Croydon, South London.

‘It badly affected my confidence. I always used to stay out of photos and I would constantly worry about the hair I had left being in the right place or that the wind was blowing in the wrong direction.’

Stuart, 58, who also played for Oxford United FC, had been through a similar experience when he was younger.

After his footballing career ended in 1998 at the age of 33, Stuart had started to feel down, and he confided to Jay that this was in part due to his hair loss, which had also started around his late teens.

Male pattern baldness, which typically begins with a receding hairline or bald spot on the top of the head, eventually affects two-thirds of men. The good news is that there are some promising new treatments on the horizon, and fresh surgical techniques available.

Male pattern hair loss occurs when excessive amounts of the sex hormone dihydrotestosterone are produced, which interferes with the hair’s growth cycle; there will be longer ‘resting’ phases, where hair remains dormant, and reduced growth phases.

Women also experience hair loss, though generally it’s in older age groups, with just 3 per cent of under-35s suffering from alopecia, which often takes the form of thinning. But by age 70, 30 per cent of women have female pattern hair loss, usually leading to gradual loss around the parting.

The good news is that there are some promising new treatments on the horizon, and fresh surgical techniques available

Hair loss in both sexes can also be the result of stress, or as a side-effect of treatments such as chemotherapy.

Although very common, male hair loss can have a devastating effect on men’s mental health, according to a 2015 survey for the Brandwood Clinic, a hair loss clinic in the West Midlands.

One-third of men with hair loss reported feeling depressed as a result, and 20 per cent of those surveyed had even considered ending their lives because of it.

One in five said it had affected their confidence in the bedroom, and 30 per cent thought it made them less attractive.

Yet the psychological impact of male hair loss is often overlooked.

‘It can lead to a range of psychological and psychiatric symptoms,’ says Dr Sohom Das, an NHS psychiatrist in London.

‘Some people are so embarrassed, they can become isolated and withdrawn, avoiding social contact. In extreme cases, it can lead to depression and anxiety.

‘But the issue is often dismissed or ignored by others because it’s so common.’

There are two main non-surgical treatments for male hair loss: finasteride, which suppresses the production of dihydrotestosterone, and minoxidil, which stimulates hair to move from the resting to the growth stage and increases the amount of time hair spends in the growth phase.

Both can be taken in oral or topical form. Neither is available on the NHS and results last only as long as they are used. Another option is hair transplant surgery, taking a graft of hair from an area of the head not affected by male pattern baldness and transplanting it to where it is needed. It is only available privately and costs between £4,000 and £6,000.

New surgical techniques are being introduced privately, too, such as follicular unit transplant (FUT), where a strip of the scalp is cut out and transplanted to an area of hair loss.

‘Transplanted hair initially sheds after surgery, then starts regrowing from month four,’ explains Ismail Ughratdar, a consultant neurosurgeon at Queen Elizabeth Hospital in Birmingham, who also works as a hair transplant surgeon at the Wimpole Clinic in London.

‘Full results [of FUT] are seen 12 to 18 months after surgery. Overall, there is a less than 1 per cent complete failure rate, and just 2 to 3 per cent of outcomes do not meet expectations.’

There is, however, a small risk of bleeding or infection, or an allergic reaction to the anaesthetic.

Meanwhile, new research raises the prospect of other treatments for baldness. The Food and Drug Administration in the U.S. recently approved the arthritis drug baricitinib for alopecia areata, where the immune system attacks hair follicles.

And last October, for the first time, fully functional mouse hair follicles were grown in a laboratory and produced 3mm hairs. The hope is that human cells can be used in the future.

The University of California also claimed progress last June after researchers were able to prevent the production of a protein — called TGF-beta — which can kill hair follicles.

They hope that its levels can be manipulated to stop hair loss occurring.

After confiding to each other their distress at losing their hair, Jay and Stuart decided to have hair transplant surgery. Stuart went first, having the operation in December 2020, at age 56.

Encouraged by the new growth of hair on his father’s head and its effects on his self-confidence, Jay followed with his surgery in 2021.

‘The procedure was really easy,’ says Jay. ‘The anaesthetic injections numb the affected part of the scalp and just feel like little pinpricks, and then you have three or four hours to just sit while the surgeon transplants the hair.

‘The day after there was no pain. The scalp was red, but within a few weeks I don’t think people would have even been able to notice that I’d had the surgery.’

Jay, who’d just started a new romance before his transplant, was concerned about telling his girlfriend. ‘I was really nervous,’ he says. ‘I thought maybe she wouldn’t be attracted to me — but she said it was no problem at all.’

After the procedure, his confidence ‘shot from zero to 100 within weeks’, he says.

‘All the negative thoughts disappeared,’ he adds. ‘My brother and my uncle have also now had it done. It’s a joke between us, but at the end of the day we all love it so much and feel better for it.

‘It’s about confidence — you get such a buzz. For me there have been no downsides to the surgery.’

Mr Ughratdar, who treated both Stuart and Jay, first became interested in treating hair loss through his work as a surgeon removing brain tumours. ‘I could see how my patients struggled to hide their scars when they were missing hair,’ he says. ‘It stopped their lives returning to normal.’

So in 2016 Mr Ughratdar added hair transplant surgery to his workload. The intricate scalp-cutting skills he had used as a neurosurgeon gave him a unique skill set.

‘It is hugely rewarding to be able to transform people’s lives and their personal confidence,’ he says. ‘I gain huge satisfaction from what I do.’

Jay believes there needs to be greater openness about the psychological impact of male hair loss. ‘Men are not as confident as people think,’ he says, ‘and we, too, face pressures about our appearance. Mental health is so important, and being able to be open about how losing your hair makes you feel is vital.

‘If only men could speak up, say they don’t like the way their hair looks and they want treatment, that would be so much better.’