Hair Loss in Men: Causes, Treatments, and What Actually Works

Androgenetic Alopecia (Male Pattern Baldness)

The overwhelming majority of male hair loss is androgenetic alopecia, commonly called male pattern baldness. It accounts for approximately 95 percent of hair loss in men, according to Healthdirect Australia.

The mechanism is hormonal. Testosterone is converted into dihydrotestosterone (DHT) by an enzyme called 5-alpha reductase. In men with a genetic predisposition, DHT binds to receptors in the hair follicles of the scalp, causing them to miniaturise over time. The follicles produce thinner, shorter hairs with each growth cycle until they eventually stop producing visible hair altogether. This process typically follows a recognisable pattern: a receding hairline at the temples and thinning at the crown, gradually progressing over years or decades.

The genetic component is significant. If your father or maternal grandfather experienced pattern baldness, you are more likely to as well. However, the inheritance pattern is complex and involves multiple genes, so family history is not a perfect predictor.

Telogen Effluvium (Stress-Related Hair Loss)

Telogen effluvium is a form of temporary, diffuse hair shedding triggered by a significant physical or emotional stressor. This can include major illness, surgery, severe psychological stress, rapid weight loss, or nutritional deficiency. The hair loss typically appears two to three months after the triggering event and usually resolves on its own once the underlying cause is addressed.

Alopecia Areata

Alopecia areata is an autoimmune condition in which the immune system attacks hair follicles, causing patchy hair loss that can appear suddenly. It affects roughly two percent of the population and can occur at any age. The patches are usually round and well-defined. Treatment options exist, and a GP can provide referral to a dermatologist for management.

Other Contributing Factors

Several other factors can contribute to or accelerate hair loss in men. These include iron deficiency, zinc deficiency, vitamin D deficiency, thyroid disorders (both hypothyroidism and hyperthyroidism), certain medications (including some blood pressure medications, anticoagulants, and antidepressants), and chronic scalp conditions. A comprehensive clinical assessment can identify whether any of these are playing a role.

The single most important thing to understand about treating hair loss is that earlier intervention produces better outcomes. The treatments with the strongest clinical evidence work by slowing further loss and, in some cases, promoting regrowth. They are most effective when hair follicles are still active rather than permanently miniaturised.

If you are noticing a gradually receding hairline or thinning at the crown, that is worth a conversation with a GP. You do not need to wait until the loss is advanced. In fact, waiting is the one decision most men later regret.

Sudden or patchy hair loss warrants a more prompt assessment. Rapid shedding, bald patches that appear over days or weeks, or hair loss accompanied by other symptoms such as fatigue, weight changes, or skin changes may indicate an underlying condition that requires investigation.

A GP consultation is the appropriate starting point. Your doctor can assess the pattern of loss, review your medical history and medications, and order blood tests to check for nutritional deficiencies, thyroid dysfunction, or hormonal imbalances. In some cases, referral to a dermatologist may be appropriate for further assessment, including scalp biopsy or trichoscopy.

Hair loss is not something you need to simply accept. But it is something that benefits from a clinical conversation rather than a Google search and an impulse purchase.

There are two medications with strong, well-established clinical evidence for treating male pattern baldness. Beyond those, a handful of other options have varying levels of support. Here is an honest overview.

Minoxidil (Topical)

Minoxidil is an over-the-counter topical treatment available as a solution or foam, applied directly to the scalp. In Australia, it is classified as a Schedule 5 medication and can be purchased from pharmacies without a prescription.

Minoxidil works by increasing blood flow to the hair follicles and prolonging the growth phase of the hair cycle. It does not address the underlying hormonal cause of androgenetic alopecia but can help slow hair loss and, in some individuals, promote modest regrowth. A Cochrane systematic review found that topical minoxidil was more effective than placebo at promoting hair regrowth, with the five percent formulation generally showing greater effect than the two percent formulation.

Results are not immediate. Clinical trials suggest that consistent daily use for at least four to six months is needed before meaningful changes become visible. If minoxidil is stopped, any hair maintained by the treatment will typically be lost within a few months. Common side effects include scalp irritation and, less frequently, unwanted facial hair growth from inadvertent transfer of the product.

Finasteride (Oral, Prescription)

Finasteride is an oral prescription medication that works by inhibiting the 5-alpha reductase enzyme, thereby reducing the conversion of testosterone to DHT. By lowering scalp DHT levels, finasteride slows follicle miniaturisation and can, over time, lead to some degree of regrowth.

The evidence base for finasteride is robust. A landmark study published in the Journal of the American Academy of Dermatology demonstrated that finasteride at a dose of 1mg daily significantly increased hair count compared with placebo over a two-year period. Long-term follow-up studies have shown sustained benefit over five years of continuous use.

Your GP may prescribe finasteride after a thorough clinical assessment. It is important to discuss the full side effect profile, which includes a small but documented risk of sexual side effects such as decreased libido, erectile difficulty, and reduced ejaculate volume. These side effects are uncommon, affecting a small percentage of men in clinical trials, and are generally reversible upon discontinuation. However, reports of persistent side effects in a small number of individuals have been noted in the medical literature, and this is something your GP can discuss with you in the context of your individual circumstances.

Finasteride is a Schedule 4 prescription medication in Australia. It requires ongoing GP monitoring, which is an appropriate part of responsible treatment.

Combination Therapy

Clinical evidence suggests that using minoxidil and finasteride together may produce better outcomes than either treatment alone. A study published in Dermatologic Surgery found that combination therapy resulted in greater improvement in hair density compared with monotherapy. Your GP can advise whether this approach is suitable for you.

Low-Level Laser Therapy (LLLT)

Low-level laser therapy devices, including laser combs and caps, are marketed for hair loss treatment. Some clinical studies have shown a modest improvement in hair density, but the evidence remains limited and the quality of many studies is variable. LLLT is not considered a first-line treatment and is generally viewed as a potential adjunct rather than a standalone option.

Platelet-Rich Plasma (PRP) Therapy

PRP therapy involves injecting concentrated platelets from your own blood into the scalp. Early research has shown some promise, but the evidence base is still emerging. Study designs vary widely, and there is no standardised protocol. PRP is not a first-line treatment and is not typically covered by Medicare. If you are considering it, discuss the current evidence with your GP or dermatologist.

Hair Transplant Surgery

For men with stable, advanced hair loss who have not responded adequately to medical therapy, surgical hair transplantation is an option. Modern techniques, including follicular unit extraction (FUE), can produce natural-looking results. This is a specialist procedure, and your GP can provide a referral to an appropriately qualified surgeon. Medical treatment is often recommended alongside transplantation to help maintain non-transplanted hair.