Monthly Archives: April 2018

Receding Hairline

Receding Hairline: Stages, Causes & Treatment

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Receding Hairline Hair Loss
Receding Hairline Progression.

A receding hairline is the main reason that most men visit this blog. Women usually suffer from a more diffuse pattern of hair loss, although some of them also get hairline recession. In younger people, receding hairlines can cause tremendous stress due to making one look much older.

This is an informational post that was required in order for me to summarize some general information and links to past posts in one place. If you suffer from hair loss, make sure to check out my page on the best hair loss shampoos for your needs.

Receding Hairline Stages in Men

Receding Hairline Stages
Male Receding Hairline.

A receding hairline is typically used to describe the progressive nature of male pattern hair loss. The latter is also known as male pattern baldness (MPB) or androgenetic alopecia (AGA).

The hair loss usually starts with the temples slowly receding backwards with time. This often leaves one with a prominent widow’s peak. The actual stages of hair loss in men are classified under the Norwood Scale (or Hamilton-Norwood scale). In MPB, anagen phase hair follicles go through shorter and shorter cycles before reaching telogen phase and shedding.

For women, female pattern baldness is usually seen in a much more diffuse and spread out pattern. However, there are some types of hair loss disorders such as frontal fibrosing alopecia and traction alopecia that can cause receding hairlines in women too.

What Causes a Receding Hairline?

The average man has around 90,000-150,000 hair follicles on his head depending on hair color. Most men will slowly start losing some of these follicles starting in their late teens and early 20s after the end of puberty. The pace of this permanent loss of hair will vary tremendously depending on person. Note that it is common to shed 50-100 hairs per day without the hair loss being permanent.

The main cause of receding hairlines in men is genetics and family history. If you have been cursed with the problematic hair loss gene(s), your hair follicles are much more susceptible to the ravages of dihydrotestosterone (DHT).

Some people will lose hardly any hairs permanently until they are in their 50s or 60s, while others will become bald as a cue ball by age 20. Nevertheless, most men will have a visibly receding hairline by middle age as the adverse combined influence of hormones and aging diminishes follicle regeneration capacity.

Receding Hairline Treatment Options

You have a number of options to treat your receding hairline, with each of these having significant advantages and disadvantages. Many people opt for a combination of the below treatments. None of them represent a true receding hairline cure.

Medications

There are two main FDA approved medications to treat male pattern hair loss (androgenetic alopecia):

  • The first of these is Finasteride, which is FDA approved to treat hair loss in men. The oral drug works by reducing dihydrotestosterone (DHT) levels significantly, but it must be taken forever or else the hair loss will restart. Finasteride drastically reduces the 5α-reductase enzyme’s ability to convert testosterone into DHT. Some people who take the drug do get significant side effects, although the majority seem to tolerate it well. Women should not even come into contact with the drug when trying to get pregnant.
  • The second of these is Minoxidil, which is a topical product to treat hair loss via an entirely different mechanism (see how Minoxidil works) from Finasteride. It must be applied daily (ideally twice per day) on a permanent basis

A third option is a powerful drug called Dutasteride that has been approved to treat hair loss in some countries, but not in the US. Dutasteride is essentially a much stronger version of Finasteride with greater potential for hair regrowth as well as for side effects.

A fourth option is anti-androgen therapy that entails taking drugs that can sometimes significantly feminize you. Note that some hair loss shampoos can also improve your hair quality.

Hair Transplants

If you do not want to use either of the above medications, there are other options out there. The most popular choice of all is getting a hair transplant surgical procedure to fix a receding hairline. Hair transplants are especially effective when a person’s hair loss is largely limited to the frontal region of the scalp (with the crown area not being too thin). For example, see Elon Musk’s hair transplant results for one such example. The presence of thicker and plentiful donor hair also makes hair transplant end results look much better.

The main limitations of hair transplants are the lack of unlimited donor hair in all people, and the fairly significant cost of hair transplants. Moreover, most people will need at least two such procedures over their lifetimes. Permanent scarring is also a potential side effect when getting a hair restoration procedure, even in the hands of the best surgeons out there.

Hair Systems or Toupees

Another option is getting a hair system, hairpiece or toupee. Modern day customized hair systems are fairly unnoticeable and long-lasting. In fact, I did a survey on this blog in the past on whether people would be willing to wear a hairpiece. Almost half of people responded with a “yes” or “maybe”. The main disadvantages of hairpieces are that they must be regularly maintained; are fairly costly; and can still be noticeable in certain situations such as on very windy and rainy days, or when swimming.

Other Hairline Receding Treatments

  • Scalp Micropigmentation procedures can make you look like you have a full head of hair that has just been shaved down all the way via a buzz cut. Looks better on certain hair and skin types.
  • If you still have a substantial quantity of hair left on your scalp, you can cover the few in-between balding and thinning areas with a hair loss concealer.
  • For those who prefer the natural route, there are some natural treatments that will reduce hair fall and regrow some hair. However, usually these do not work as well as the proven FDA approved medications.

The Top 5 Hairstyles & Haircuts for Men with Receding Hairlines

If you do have a receding hairline, you must make sure to go for a hairstyle that suits your particular facial and bone structure. When getting a haircut, make sure to ask your stylist for his or her opinion on the best hairstyle for your thinning hair. A combover is a complete no-no for hiding your hair loss recession and belongs in the dustbins of fashion history.

Among the most popular haircuts for a receding hairline include:

  • Clean Shave. The best option if you are willing to go through with it and forget about your hair loss once and for all. Often works well in tandem with a goatee or beard.
  • Buzz Cut. The cleanest and most popular haircut for receding hairlines, although not everyone likes such short hair. Works best on certain hair and face types. One popular version of it is the crew cut.
  • French Crop. A modern low maintenance men’s hairstyle for those with short hair. Best for those with few visibly thinning balding areas.
  • Spiky Hair. A range of options in this style where the spiky hair with gel in it can hide or camouflage problematic balding areas. Requires you to have at least a moderate amount of thick remaining hair that can be spiked.
  • Comb-It-Forward. A hairstyle in which the hair on top is combed forward (rather than to the side or to the back or spiked upwards). One popular version of this is the Caesar Cut that was popular with the balding Julius Caesar.
George Cotsarelis

Two Decades of Quotes from Dr. George Cotsarelis

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University of Pennsylvania’s Dr. George Cotsarelis is a legend in the hair loss world. He has been among the three most quoted hair loss researchers in the world over the past two decades (with the other two being Dr. Angela Christiano and Dr. Ken Washenik). I have covered all three of these US-based researchers numerous times on this blog in the past.

Dr. Cotsarelis’ first hair related study that I could find is dated all the way back from 1990. Since then, the doctor and his lab (sometimes in collaborative efforts) have been responsible for a number of groundbreaking discoveries in relation to androgenetic alopecia. These include crucial findings related to progenitor cells, prostaglandin D2, skin regeneration, Wnt signaling, wounding and more.

Dr. Cotsarelis is a co-founder of Follica, a company of paramount importance to us. I therefore thought it would be of interest to find some important quotes and thoughts that Dr. Cotsarelis has given in interviews over the past two decades to major newspapers and scientific publications.

George Cotsarelis Quotes

The quotes below give a good indication about the overall progression of hair loss research in the US during the past several decades. They also suggest major revisions in Dr. Cortsarelis’ prognostications about when a hair loss cure will finally arrive.

1998

Science News (need subscription)

“Ideally, you would like to turn on beta-catenin just in an adult and see if you have the same effect: production of hair follicles.”

1999

CNN

“If someone thinks this is going to lead to a baldness cure in a year or two, that’s completely unrealistic. I think seven to 10 years is more realistic.” 

2000

BioScience (need subscription)

“The discovery of the human homologue of the mouse hairless gene defect beautifully shows that the hair follicle in the mouse is very similar to the human, and that’s heartening because a lot of people are working on mouse and assuming that it’s going to be relevant to humans.”

“It’s not crazy by any means. At some point in the future, I wouldn’t be surprised if there were some type of gene therapy for hair loss.”

2004

The Guardian

“I think this or something like it will be available in the next five to 10 years” said George Cotsarelis, a dermatologist at the University of Pennsylvania school of medicine who led the research.”

2007

Reuters

“Dr. George Cotsarelis, a dermatology professor at the University of Pennsylvania School of Medicine in Philadelphia who led the study, said the findings dispel the dogma that hair loss is permanent in people and other mammals, and that once they are lost new hair follicles cannot grow. Cotsarelis said the findings could pave the way for remedies for male-pattern baldness and other types of hair-loss. He said the idea would be to apply compounds to get epidermal cells to turn into hair follicles. Cotsarelis is involved with Follica Inc., a privately held start-up company that has licensed the patent on the process from the University of Pennsylvania. He said it probably would be more than five years before a treatment was possible.”

2007

Scientific American

“For this to become therapeutic, you’d probably have to find ways to activate the Wnt pathways with a topical agent,” Cotsarelis says. He notes that he and his colleagues have founded a small start-up company called Follica to create a product that could be applied to injured skin as it heals to “activate the right pathways … [that trigger] follicle formation.” Cotsarelis says the for-profit venture is now only doing preclinical experiments, but if all goes perfectly, there could be a product on the market in two to three years.” 

2008

Penn Medicine

A great overview of Dr. Cotsarelis’ work through 2008 can be found in the above publication and is worth a complete read. Key quote:

“When cells move in to close a wound, they are trying to make a decision: Should I make epidermis or should I make a hair? If there is a lot of Wnt around, they choose to become hair follicles.”

My Note: Besides an instructive summary of how the lab’s hair research has developed and progressed every few years, I was very surprised to read about how important Dr. Mayumi Ito’s work has been in some of the key findings, especially wounding. Dr. Ito now works at her own lab in New York and has been covered on this blog a number of times in the past.

2011

BBC

“This implies that there is a problem in the activation of stem cells converting progenitor cells in bald scalp. The fact that there are normal numbers of stem cells in bald scalp gives us hope for reactivating those stem cells.”

2011

Daily Mail

“Dr Cotsarelis, a dermatologist, whose work was part-funded by the US government and by L’Oreal, believes a treatment could be on the market within a decade.”

2012

NY Times

“Dr. Cotsarelis, who describes himself as enamored with the hair follicle, has been hard at work on balding scalps since he identified hair follicle stem cells in mice in 1990, when he was a postdoctoral fellow. We were able to show that when we isolated the cells and injected them into another mouse, he said, the mouse made new hair follicles.”

2013

WSJ

“George Cotsarelis, professor and chair of dermatology at the Perelman School of Medicine at the University of Pennsylvania, in Philadelphia, is skeptical of product claims. Topical products can change the hair’s appearance but not the follicle itself, he cautions. It’s like throwing gasoline on your car and expecting it to go.”

My Note: Maybe he forgot about topical Minoxidil and topical Finasteride?

2014

CNN

“Cotsarelis was adamant about it because male pattern baldness isn’t related to the immune system.”

My Note: It is therefore a bit strange that Follica (Puretech) classifies androgenetic alopecia to be an immune system related problem per recent presentations.

2016

CNN

“In the end, I think there are going to be multiple ways to treat male pattern baldness, and some will work fabulously well in some people and not so well in others.”

2017

The Telegraph

“Essentially, we can manipulate wound healing so that it leads to skin regeneration rather than scarring.”

2019

In June 2019, Dr. George Cotsarelis made an interesting presentation titled “Two Decades of Riding the Hair Wave”:

2023

In 2023, Dr. Cotsarelis was interviewed by the ISHRS and said that despite advances in hair regeneration, he does not thing that hair transplant surgeons “need to be worried about going out of business”.