Hair Loss in Men | Anne Marie McNeill, M.D., Ph.D

Hair loss and balding in men is largely genetic, right?
Dr. McNeill: Yes. Balding is mostly genetic. There may be environmental factors, as well, but these are poorly understood.
Hair loss in men is primarily genetic, and X-linked, which means it is primarily inherited along the maternal side. Males inherit their X chromosome from their mother, and on the X chromosome there are 2 known genes that influence balding. However, there are other genes which influence balding that are on other chromosomes which can be inherited from mom or dad. So, although baldness is usually inherited from one’s mother’s side, there are exceptions.
And, environmental factors, like stress and exercise habits may contribute as well, but this is not widely understood.
So, if a man has a family history of baldness, is there anything he can do to prevent it?
Dr. McNeill: You can’t change your genes. But, there are lots of medications that can modulate hair growth in a big way, as long as they are started before hair loss is notable.
Propecia is a safe and effective medication to treat hair loss just as it is starting. The medication is taken orally, and must be taken continually to stop loss, and maintain existing hair. It is ideal for men just beginning to notice hair thinning or loss.
So, a man would take Propecia for the rest of his life? Is it expensive? Is it covered by insurance? What are the side effects?
Dr. McNeill: It is something that would be continued for life… or at least as long as he wants to maintain his full head of hair. Patients tell me they pay ~$80 per month, but it depends on the pharmacy. So, you are wise to shop around.
The side effects of Propecia are none (identical to placebo in clinical trials). However rare side effects have been reported, including impotence. But again, this seems to be very rare.
As for insurance coverage, Propecia is generally not covered under most health insurance plans, but may be eligible as a Health Savings Account Expense.
Are there other options?
Dr. McNeill: Rogaine, or Minoxidil, is a topical solution that can be rubbed on the scalp. Results are more subtle than with Propecia, but it is a more cost effective option. It also seems to be more difficult to consistently rub a solution on your scalp twice a day, compared to taking a pill once a day.
And when nothing else works, what are hair transplants? Do they work, are they safe, and how much do they cost, on average?
Dr. McNeill: If hair loss is just beginning, Propecia will maintain what hair you have. But if hair loss has already advanced, and you want to replace hair that has been lost, hair transplantation is necessary.
Hair transplants today are drastically different than the ‘plugs’ of decades ago. They are virtually undetectable when done properly, and very safe. Search for a board-certified dermatologist in your area who does almost exclusively hair transplantation. Prices vary widely, but most consultations are free so you can be educated about the best options for you.