Men's hair loss deserves a proper diagnosis

Hair loss: not just a cosmetic problem - by Dr Mick Watts July 2026

Hair loss is often spoken about as if it is only a cosmetic issue.

Something superficial. Something men should either laugh off, shave off or pretend not to care about.

That is not fair.

Many men are comfortable with thinning hair or baldness. Some actively prefer the shaved look and carry it brilliantly. For others, however, hair loss can affect confidence, self-image, relationships, dating, confidence at work, mood and general wellbeing. That is not vanity. It is simply human.

Many men prefer the shaved look and carry it brilliantly

Hair is part of how we recognise ourselves. When our hair changes earlier than expected, it can feel as if age has arrived suddenly and publicly. We may still feel young, fit and capable, while the mirror seems to be telling a different story.

As a GP with an interest in men’s health, I think this deserves a calm medical conversation. No sales pitch. No miracle cure. No guesswork. Just proper diagnosis, honest discussion and sensible options.

The commonest cause of hair loss in men is male pattern hair loss.

The start of male pattern hair loss in a young man

The medical term is androgenetic alopecia. In plain English, this means genetically influenced hair loss driven by sensitivity to androgens, particularly dihydrotestosterone, or DHT.

This is why it often runs in families. It is not caused by wearing hats, washing hair too often, or using the wrong shampoo. It is a biological process in which genetically sensitive hair follicles gradually shrink. The hairs become finer, shorter and less visible over time.

The pattern is familiar: a receding hairline, thinning at the temples, loss of density on the crown and more scalp showing through.

For some men this happens slowly over decades. For others it starts early and progresses quickly. Earlier hair loss can be particularly difficult because it can arrive before a man feels ready to look older.

The first step is diagnosis.

Most male pattern hair loss can be recognised from the story, the pattern and the scalp examination. But not all hair loss is male pattern hair loss.

Hair can shed after illness, severe stress, rapid weight loss, medication changes or nutritional deficiency. It can fall out in patches due to alopecia areata. Scalp inflammation, psoriasis, fungal infection, scarring conditions, thyroid disease, iron deficiency, autoimmune disease and other medical problems can all play a part.

That is why examination matters.

Alopecia Areata

A proper consultation looks at the pattern, speed and distribution of hair loss. It looks at the scalp itself. It asks about family history, medication, stress, recent illness, diet, weight loss, skin symptoms and general health.

Sometimes the diagnosis is obvious. Sometimes the story, scalp or speed of change suggests there may be more going on.

Blood tests can help when the story or examination suggests there may be more going on. Some tests are straightforward, such as checking for anaemia, thyroid disease, inflammation or vitamin deficiency. Others are more detailed and depend on the individual case, including hormone tests or tests looking for wider medical causes.

Once the diagnosis is clear, the conversation becomes much more useful.

Male pattern hair loss can be treated, particularly when it is recognised early. Treatment is not about promising miracles. It is about slowing progression, preserving what remains and, in some men, improving thickness and density.

The two best-known treatments are minoxidil and finasteride.

Minoxidil is usually applied to the scalp. It can support hair growth and thickness, but it needs consistent use and the benefit usually lasts only while treatment continues. Side effects can include scalp irritation, itching, dryness, flaking and unwanted hair growth elsewhere if it spreads beyond the scalp.

Finasteride works differently. It reduces conversion of testosterone to DHT, the hormone most closely involved in male pattern hair loss. It can slow hair loss and improve density in some men. But it is a prescription medicine, not a cosmetic product. Side effects can include reduced libido, erectile problems, ejaculatory changes, breast tenderness or enlargement and mood changes.

That does not mean finasteride should never be used. It means it should be prescribed properly, with a clear discussion of benefits, limitations, side effects, suitability and follow-up.

Specialist hair clinics may also discuss options such as oral minoxidil, topical finasteride, dutasteride, platelet-rich plasma treatment, low-level laser therapy, or hair transplantation. Some of these options can be useful for selected men, but they vary in evidence, cost, regulation and suitability. Discussing this with an experienced doctor before embarking on treatment is sensible.

There is good reason for annual review, even after diagnosis. Treatment is long-term. Review allows us to monitor effectiveness, ask directly about side effects, check whether the diagnosis still fits, and decide when treatment should be adjusted or stopped.

Sometimes the most useful part of the review is not the scalp at all. It is the wider conversation about mood, confidence, stress, sleep, sexual health and general wellbeing.

Dr Mick Watts MBBS MRCGP is a GP in Windsor with a particular interest in men’s health, healthy ageing and lifestyle medicine.

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This blog is written for general information and encouragement. It is not a substitute for personal medical advice. Every person’s health, circumstances and risks are different. If you have concerns about hair loss, scalp symptoms, medication side effects, mood or whether treatment is suitable for you, please speak to your own GP or healthcare professional.