How to know if you will go bald

All men worry about losing their hair at some point in their lives.
For some, this can start in their late teens or early twenties, whereas hair loss hits pretty much all males as they age. Nine out of ten men in their 90s have significant male pattern balding.
But how do you know if you will go bald? Crown Clinic’s consultant hair transplant surgeon Asim Shahmalak details the key factors.

When balding starts and how much hair we will lose is largely based on genetics. The baldness gene can run on either side of the family – both the mother’s and the father’s.

We now have scientific means for predicting hair loss. Your doctor can take a swab of DNA from the saliva inside your cheek and it will show how sensitive you are to Dihydrotestosterone (known as DHT, which is the hormone created by the body’s testosterone). This swab will also tell you your odds for balding, and how quickly, and can predict how you might react to hair loss medications such as Finasteride, which is prescribed to some patients by Dr Shahmalak at Crown Clinic.

For some men balding can start as soon as puberty ends, depending on their sensitivity to DHT. What is important to remember is that it is not DHT production which causes hair loss, it is the inherited sensitivity to DHT that causes the loss.

Those with high sensitivity will be the first to experience a weakening of the follicles. This shows itself in the thinning around the crown and hairline and the lighter pigment in the hair. Certain lifestyle choices can increase DHT production and lead to accelerated hair loss. These include smoking, stress, taking anabolic steroids or testosterone hormone replacement.

How hair loss can start and get worse

One fifth of men will already be going bald by the age of 20 and that percentage grows as we get older.

By the age of 30, 30% of men will be losing their hair; by 40, it is up to 40% and half of men will be balding by their 50s. Reach the 90s and 90% of men will have significant hair loss.

The good news is that if you have kept most of your hair by the time you hit middle age then your sensitivity to DHT is probably on the low side and you should keep most of your hair for the rest of your adult life.

Hair loss can be slow and hard to detect at first. It typically starts with a thinning in the temples and hairline recession. There can be a steady slow shedding which is also sometimes called ‘invisible balding’. The hair becomes gradually less dense until suddenly it is obvious to the naked eye.

Because some degree of hair shedding is natural, finding a couple of hairs on your hairbrush or a pillowcase doesn’t necessarily mean that you’re going bald.

However, when you start noticing a lot of hair around the house or stuck inside the plughole of the shower, it is a good sign that it is time to start looking at ways of combating hair loss – either with a clinically proven drug such as Finasteride or a hair transplant.

At Crown Clinic, Dr Shahmalak will not operate on a patient until they have reached the age of 25. That is the age when an expert such as Dr Shahmalak can detect a pattern to the hair loss. He will be able to detect how that patient’s hair loss is likely to proceed and the best treatments for it.

One option is Finasteride. This will not help the patient to grow new hair but it should slow down or halt the natural loss of hair.

The only long-term cure to male pattern baldness is a hair transplant.

At Crown Clinic, 80% of our patients chose FUE (follicular unit extraction). This is where individual grafts are extracted from the back and sides of the scalp and then replanted in the balding areas. Celebrity patients of Dr Shahmalak who have had FUE transplants include Jack P Shepherd from Coronation Street and the model Calum Best. The advantage of this method is that the scarring is minimal, and FUE is particularly suited to men who like to wear their hair short or shaved.

Dr Shahmalak also offers FUT (follicular unit transplantation) – the more traditional method of transplantation, a technique which has been used for decades. With FUT, a strip of skin is cut from the scalp to obtain the donor grafts. These grafts are removed from the strip by technicians and then replanted in the balding areas by Dr Shahmalak in the same way as FUE. The scarring is more noticeable than FUE, but FUT works well if you like to wear your hair long because the hair covers up the scar left by the removal of the strip. The TV doctor Christian Jessen has had two FUT transplants with Dr Shahmalak at Crown Clinic.