Like Allied Forces during the Battle of the Bulge, your hairline has started retreating from your temples—creating a wicked widows peak. Worse, you can feel your hair thinning toward the back of your head.
“This is classic androgenic alopecia, or male pattern baldness,” says Adam Friedman, M.D., a dermatologist and residency program director at the George Washington University School of Medicine and Health Sciences.
Your hair is constantly growing, falling out, and re-growing, Friedman explains. Even guys with healthy heads of hair lose 60 to 80 follicles a day. But those follicles grow back, Freidman says.
The same is true for men with male pattern baldness. But unlike other men, these guys have a built-in sensitivity to a male sex hormone called Dihydrotestosterone, or DHT. Over time, this DHT sensitivity causes hair follicles to grow back shorter and shorter, and eventually to stop growing back altogether, Friedman explains.
How do you stop this vicious, hair-destroying cycle?
Friedman calls minoxidil (Rogaine) “our greatest tool.” He says it likely works by keeping your hair in the growth phase, and preventing the fall-out-and-regrow phases. Because your hair never falls out in the first place, those DHT hormones can’t do their dastardly deed.
“It’s a topical foam, and if you start using it early when your hair loss is minimal, it does an excellent job of helping you hold onto what you’ve got,” Friedman says.
That said, there are two issues with minoxidil. Number one: “You have to take it for life,” Friedman says. “Once you stop, the progressive hair loss caused by DHT will start right up again.” Number two: Minoxidil generally will not regrow hair. “It’s really intended to prevent further loss,” Friedman says. When it comes to your bald patches, he adds, “It’s extremely tough to give life to something that doesn’t exist.”
Finasteride (Propecia) prevents your body from producing DHT in the first place. This not only protects the hair you have, but can also allow hairs that have become very short to grow longer—giving the impression you’ve regrown hair, Friedman says.
Right now, he says the major drawback is that finasteride is a pill—not a topical cream—and comes with potential side effects like decreased libido and, in rare cases, erectile dysfunction.
Friedman says he often prescribes anti-fungal shampoos, especially those containing the active ingredient ketoconazole. Like finasteride, these shampoos seem to prevent those DHT hormones from messing with your hair follicles.
When it comes to all three of these anti-hair loss tools—shampoos, minoxidil and finasteride—Friedman says he often prescribes them in combination. “It’s not one or the other,” he says. “It could be all three, depending on the specifics of the patient I’m dealing with.”
Unless you dig your receding hairline, or you’re into bald domes—honestly, both can look pretty badass—then talk to a dermatologist about your options.