Losing your hair can lead to a rush of questions, many with potentially hasty conclusions. For one, can a daily dose of biotin supplements prevent your hair from falling out? And once your hair recedes, is it actually gone forever, or can it be resuscitated without surgical intervention? Can a hair loss shampoo live up to its claims? These are all the kinds of questions men ask themselves — and their web browsers — as they navigate the murky waters of hair loss.
The good news is that hair retention is rather straightforward. There are a handful of truly successful measures you can take to retain your hairline and density and prevent further loss (while also reviving some recently dormant follicles). However, there is a lot of misinformation out there, too. To separate truths from falsities, we spoke with Dr. Alan J. Bauman, founder of Bauman Medical hair loss treatment center in Boca Raton, Florida, about the most common balding myths; he’s the expert on this stuff, so he’s the best person to help with debunking hair loss myths once and for all.
Common Myths About Men’s Hair Loss
Here are some of the more widely spread hair loss myths that men hear. Dr. Bauman sets the record straight with some hard truths about hair loss.
1. Your Hair Fate Is the Same as Your Maternal Grandfather
Does hair loss come from your mom’s side? This is one of the most common hair loss myths: If you want to know whether or not you’ll go bald, just look at pictures of your mother’s father in his later years. Or so that’s the belief.
“We know there are hundreds of different genes that are related to hair and hair growth,” Bauman says. “Genetically, hair loss risk can come from either your mother’s side or your father’s, or both. While we can’t predict 100% if someone will go bald, we can now use genetic DNA testing to determine which treatments may work best for each individual based on their DNA. This is a critical component of a new paradigm called Personalized Precision Medicine, which takes into account the fact that each of us may respond differently to treatments based on our unique DNA and other factors.”
If you want to get ahead of hair loss and understand your odds, he suggests looking into TrichoTest™. “It is a breakthrough genetic test that looks at three variations of 16 SNPs [genes] related to certain metabolic pathways that can tell us specifically what kind of therapies and treatments might work best for your hair loss. Doing a genetic TrichoTest can save patients time, money… and follicles!”
2. The Right Supplements and Hair Loss Shampoo Are the Best Defense
I’ve heard this from a handful of friends: “I bought a hair loss shampoo for men, since I don’t want to try any medicines. Oh, and I’m taking biotin and saw palmetto supplements. It’s gonna work, right?” Sure, saw palmetto is a popular ingredient in hair retention products thanks to its ability to inhibit DHT, or dihydrotestosterone, the byproduct of testosterone that shrinks hair follicles. Ditto for biotin, known for its supposed ability to reinforce and accelerate hair growth. Are these enough to make a huge difference, or is something more medical-grade required?
“Good quality ingredients and a trusted source of supplements or hair care products are important,” Bauman says. So, yes, those products are good, in that they support the greater cause. “However, for many, DHT-blocking ingredients in a shampoo or even nutritional sources will not be enough to stop, much less reverse, hair loss. If your inherited sensitivity to DHT is high and therefore you’re prone to accelerated male pattern hair loss, you might need pharmaceutical treatment to reduce DHT (i.e., finasteride, dutasteride), or other therapies to make the follicles more resilient to the hair loss process. You may also have an underlying condition that exacerbates the hair loss situation, like poor scalp health. Therefore, it’s important to have a board-certified hair restoration physician diagnose your hair loss to determine your risks and provide a treatment plan. Oftentimes, this will include more powerful treatments such as PRP, exosomes, prescription medications and/or low-level laser light therapy.”
3. With the Right Medicine, You Can Restore Your Youthful Hairline
Speaking of the best hair loss treatments: What exactly can they restore, when it comes to the hair you’ve already lost? Here’s some heartbreaking news: Any hair you’ve lost to recession, at the temples and hairline, is likely gone for good.
“A receded hairline is usually severely depleted of density by the time it’s noticeable to the naked eye, so there’s not much hair left to ‘revive,’ if any,” says Bauman. “In the crown, the area can appear thin but still have a great deal of ‘miniaturized hair’ that can be rejuvenated. If a hair follicle is still alive, even if it’s thin and wispy and partially miniaturized, it can be typically strengthened to produce a longer, thicker, darker hair fiber again with the proper hair restoration treatments.” (Like those mentioned in the previous bullet, this includes at-home treatments like finasteride and minoxidil.)
It’s important to know that any hairs lost to this miniaturization are gone for good; those follicles are dried up or gone. “Once a hair follicle is producing a hair fiber that’s 2mm or less, it’s considered ‘vellus hair’ and beyond repair,” Bauman says. “It has no hope of rejuvenation, so only transplants will work [to fill it in].” The hair lost to recession has likely already passed this phase, hence why it’s not revivable compared to the uniform thinning you experience around the crown.
4. Guys With More Testosterone Are More Prone to Hair Loss
If you lose your hair, and if hair loss is caused by the conversion of testosterone to DHT, then guys with more testosterone must lose hair faster, right? Wrong. This is one of the biggest DHT balding myths. “DHT is the primary trigger for the miniaturization of hair follicles,” Bauman explains. “It’s the hallmark of male pattern hair loss. The extent of one’s hair loss is not the amount of testosterone or the amount of DHT, but is determined by one’s susceptibility or ‘sensitivity’ to the DHT. Most often, this is determined by genetics.” (Was it actually a competition to see who has the most testosterone, anyway?)
Funnily enough, the primary defense against DHT production (finasteride) can increase the levels of testosterone circulating in the body, Bauman says.
5. Hair Loss Treatments for Men Always Have Negative Sexual Side Effects
One of the biggest hangups men have about hair loss treatments is that they risk negative sexual side effects, like a lowered sex drive or inability/difficulty to get full erections. This isn’t a total myth, though: Bauman confirms that 2% of men using oral finasteride experience some type of sexual side effects. But, before you write off these treatments altogether, remember: That’s just 2% of users, in reference to one type of remedy, and only the oral form of that medicine. There are plenty of other treatments available, and even a topical-spray version of finasteride.
If you still gamble on oral finasteride and are one of the unlucky 2% , then Bauman offers hope: “Changing the timing of the dose resolves the side-effects 50% of the time, in our experience,” he says. “If these side effects continue to occur, then stopping the medication will typically cease these side effects in a matter of days. I then recommend using topical finasteride Formula 82F, which has minuscule systemic absorption and therefore virtually eliminates the risk of sexual side effects. I’ve never had a patient complain of sexual side effects from Formula 82F topical finasteride.”
6. Some Men Never Experience Hair Loss
If a guy has a full head of hair at 70 and has never taken measures to retain said hair, then he must have never experienced male pattern hair loss (androgenetic alopecia). But even though he’s suffered less hair loss than the next guy, he’s definitely got less hair than in his prime. “I truly believe all of us lose hair density and caliber with age. However, certain hair qualities like curl and color can help camouflage loss,” Bauman says. “Slow male pattern hair loss with a little bit of curly gray hair can go a long way to make it seem 100% full. In other words, if you’re going gray and still having some hereditary hair loss, you will maintain more scalp coverage longer because gray hair reflects more light and hides the scalp.”
7. Wearing Hats Can Cause Hair Loss
It’s a common myth that hats cause hair loss, in that the hair experiences trauma from being pushed back so frequently and for so long. The truth is, no hat (nor any such ongoing habit) will likely cause this condition, which is known as traction alopecia. Instead, it’s people with specific hairstyles who need to be wary of the condition.
“The chronic pulling of hair, which occurs in tight braids, cornrows, ponytails, long dreadlocks (because of their weight) or the attachment of hairpieces/hair systems can cause traction alopecia, resulting in permanent damage to hair follicles.” Compare it to the constant plucking of eyebrows, which leads to eventual permanent loss at the site. The same happens to your hair after constant tugging and pressure on the follicles. But that pressure isn’t so strong with hats; if the hat really is tight, then you’ll know from the lightheadedness and faint feeling.
Speaking of risky hair habits and styling, be doubly cautious before you do any coloring, processing or bleaching, warns Bauman. “Hair coloring/bleaching, no matter how professionally performed, can have a risk of chemical burns or irritation at the level of the scalp. Also, overprocessed hair fibers tend to lose their shine, become dull, rough to the touch and become more fragile and prone to breakage over time.”
8. Stress Can Exacerbate Male-Pattern Hair Loss
When you’re stressed in any way (even physically, or if you’re poorly rested), then you can experience hair shedding. This type of “shock loss” differs from male-pattern baldness, however. It’s important not to confuse the two, and to understand what happens during shock loss.
“Every man loses hair all of the time, up to 100 strands per day,” Bauman says. “They fall out during the telogen (resting) phase of hair growth before the anagen (regrowth) phase begins again. Male-pattern hair loss is when the hair does not regrow, or grows in more thinly.”
To clarify: Hair shedding is natural, and we experience it daily. When you experience stress of any kind, the body generates cortisol, the stress hormone, in response. “Prolonged exposure to cortisol is awful for hair growth, and can shut down hair follicles,” Bauman says. But the good news is that it typically grows back, particularly when the stress is mitigated. But it can take a couple of months before you notice the regrowth, since the follicles need time to regenerate the hair in the new anagen phase.
Bauman notes that he saw an uptick in the number of stress-induced hair shedding during the pandemic, both from the stress of lockdowns and as a result of getting COVID-19 — since certain illnesses also register as stress on the body. “I’ve treated over a thousand COVID hair loss patients in the past two years,” he says. “Infections with SARS-CoV-2 in addition to the vaccinations and boosters have caused significant hair shedding events (telogen effluvium) in huge numbers of patients in my practice. Many long-COVID patients continue to see shedding come in waves.”
9. Minoxidil, a Common Hair Loss Treatment, Also Causes Hair Loss
Among the many myths and facts about hair growth, here’s one regarding minoxidil, an over-the-counter remedy and one of the best hair loss treatments for men. You might know it as Rogaine (minoxidil is the generic version).
Many guys hesitate to start minoxidil, knowing that it causes hair shedding at the start. But, given what we outlined in the previous bullet, you now know that there’s a huge difference between hair shedding and hair loss. “Minoxidil is a potent anagen-promoting agent,” Bauman explains. “When the follicle is in the resting phase (telogen) there is often a hair fiber present in the follicle, even though it’s not actively growing. When follicles are triggered by strong anagen-promoting treatments like minoxidil, a Turbo LaserCap, or plasma injections (PRP), a large number of follicles enter anagen, and begin to produce new hair fibers. These new hair fibers push out the old, resting hair resulting in a synchronized shed.”
So, yes, at the start of your minoxidil use you will experience slightly accelerated hair shedding, but each of these hairs is likely to grow back stronger than before. “The good news is, typically the stronger the shed with these hair growth treatments, the more improved the hair measurements are at 90 days, so don’t give up if this is happening to you. Push through, it’s working!” Bauman says.
This shedding from minoxidil, laser, or PRP typically only lasts about a month or two, he adds. “From there, it’s upward improvement!”
10. A Hair Transplant Negates Any Need for Future Hair Retention Efforts
Let’s say you have lost enough hair that you are considering a hair transplant — and perhaps because you don’t want to take the daily treatments to restore or retain anything. Because a hair transplant is the permanent solution, no? Not quite.
When you get a hair transplant, they relocate the hairs from the sides and back of your head to the top, since the hairs along the sides and back aren’t prone to thinning and loss. (Only those originating atop the head are susceptible.) So if you suddenly have a bunch of hairs atop your head that genetically will not thin and fall, then you might feel invincible. But what about the rest of the hairs up there, the ones that have always been there and have outlasted their crown-dwelling brethren? They’re still very much susceptible to thinning and falling. And for that reason, you need to continue taking treatments to prevent their eventual loss.
“While properly harvested hair follicles transplanted from the back and sides of the scalp are generally permanent, it’s critical to continue to protect the remaining hair so it stays healthy and full,” Bauman warns. “Otherwise, you would need additional transplants to cover those newly affected areas, and eventually you may run out of available donor hair. Medical therapies to best protect your existing hair include maintaining good scalp health and scalp hygiene, proper nutrition, custom compounded medications (like finasteride and minoxidil), high-quality laser therapy, PRP and exosome therapy.”