Male Pattern Baldness: Causes, Stages and Treatments - Medical Aesthetics & Skin Care Clinic in Singapore

Research shows that androgenetic alopecia, more commonly known as male pattern baldness, affects around 30% of men by age 30 and nearly 50% by age 50. For some, they notice a receding hairline or thinning around the crown that becomes harder to style or conceal over time.

At AURA, we take a medical approach to male pattern baldness by identifying how far the condition has progressed and what factors may be contributing to the hair loss. With early intervention, it may be possible to slow further thinning and support healthier hair growth.

What Is Male Pattern Baldness?

Male pattern baldness develops due to a combination of mainly genetic and hormonal factors that affect the hair follicles over time. The severity and rate of hair loss can vary from person to person.

What Causes Male Pattern Baldness?

Male pattern baldness develops due to a combination of mainly genetic and hormonal factors that affect the hair follicles over time. The severity and rate of hair loss can vary from person to person.

Genetics and Family History
- Genetics play a major role in male pattern baldness, particularly in determining how sensitive your hair follicles are to hormonal changes linked to thinning.
Hormonal Influence
- Male pattern baldness is caused by the circulating hormone called dihydrotestosterone (DHT). In men with a genetic predisposition, hair follicles on the top and front of the scalp are sensitive to this hormone. When DHT binds to these follicles, it triggers a process called miniaturisation, where the follicle physically shrinks.
- As DHT progressively miniaturises the hair follicles, they become fragile and prone to shedding. It leads to the signature 'M' shape along the forehead and eventual balding on top.
Age and Hair Growth Cycle Changes
- As men age, the natural hair growth cycle also changes. Hair may grow more slowly, while the follicles become less efficient at producing thick, healthy strands. This is why hair density often decreases gradually with age, even if the progression is mild.
Lifestyle Factors
- While lifestyle choices do not directly cause male pattern baldness, they can influence the rate at which it progresses. High levels of chronic stress, poor nutrition (particularly a lack of protein and zinc) and smoking can impair scalp health and blood circulation.
- Addressing these factors may not stop genetic male balding, but it can help maintain the health and strength of your remaining hair and may slow progression
Underlying Medical Condition
- In some cases, thinning may be exacerbated by underlying health issues. Conditions such as thyroid disorders, anaemia or autoimmune diseases can cause hair loss that mimics or accelerates male pattern baldness. It is always advisable to rule out these issues, especially if hair loss occurs rapidly or is accompanied by other physical symptoms.

Symptoms of Male Pattern Baldness

Unlike temporary hair shedding, male pattern baldness follows a predictable pattern that becomes more noticeable as the hair growth cycle weakens over time.

Receding Hairline
- One of the most common first signs is a change in the hairline's shape. It usually begins at the temples, where the hair starts to thin and move backwards.
- Over time, this creates an M shape as the hair at the very front and sides of the forehead recedes further than the hair in the centre. You may notice that the hair in these areas also becomes finer and shorter before it stops growing entirely.
Thinning Hair on the Crown
- Thinning can start at the vertex, or the highest point on the back of the head. It starts as a small circular patch where the scalp becomes increasingly visible under bright light.
- This area is difficult to see in a standard mirror, so it is sometimes identified when the hair becomes harder to style or appears flat. Eventually, the thinning can expand until it meets the receding hairline from the front.
Progressive Hair Loss Over Time
- Male pattern baldness is progressive. Meaning, the thinning continues over the years if left untreated. The hair follicles produce finer and weaker strands that lead to reduced hair density across affected areas of the scalp. In more advanced stages, the receding hairline and crown thinning may eventually merge, resulting in more extensive hair loss.

Stages of Male Pattern Baldness

At AURA, we measure the progression of hair loss using the Norwood Scale. It breaks down male pattern baldness into seven stages, providing a roadmap to help determine the most reliable intervention based on current density.

Image source: Adapted from Gupta, M., & Mysore, V. (2016). Classifications of Patterned Hair Loss: A Review (Norwood’s classification). Available on PubMed Central.

Norwood 1

At this stage, there is little to no noticeable hair loss. The hairline remains largely intact, with only minimal recession that is often considered part of a mature adult hairline.
Norwood 2

You will notice a slight, symmetrical recession around the temples, usually forming a small M shape. Some may also start to experience mild thinning at the crown of the scalp.
Norwood 3

The recession at the temples becomes deep enough to be easily seen. Additionally, a sub-category called Stage 3 Vertex involves thinning at the crown (the back of the head) while the hairline recession may still be relatively minor.
Norwood 4

Hair recession at the temples becomes more noticeable at this stage, while thinning at the crown develops into a more visible bald spot. Despite this, there is still a band of thicker hair separating the front hairline from the crown area.
Norwood 5

At stage 5 of the Norwood scale, the receding hairline and the thinning area at the crown come much closer together. Although they have not fully merged, only a thin strip of hair remains between them. Most of the top of the scalp will appear significantly bald.
Norwood 6

Stage 6 is reached when the strip of hair separating the receding hairline from the crown bald spot disappears completely, causing both areas to merge. At this stage, the entire top of the scalp is largely bald. It leaves a horseshoe-shaped ring of hair around the sides and back of the head.
Norwood 7

This is the most advanced stage. Only a thin horseshoe of hair remains around the back and sides of the head. This hair is finer than it was previously but it remains because these follicles are genetically resistant to the hormones that cause balding.

How Male Pattern Baldness is Diagnosed

At AURA, we perform a proper assessment to determine the stage of hair loss and rule out other possible causes of excessive shedding or thinning hair.

Medical History Review

Although male pattern hairloss is largely hormonal, there are certain factors that can exacerbate the problems. During consultation we will need to assess for:

Although male pattern hairloss is largely hormonal, there are certain factors that can exacerbate the problems. During consultation we will need to assess for:
- Past medical history
- Any current prescriptions that might be impacting your hair’s growth cycle.
- When you first noticed thinning and how it has changed over time.
- Factors like diet, stress and sleep that can influence hair health.
- Detrimental lifestyle such as alcoholism or smoking

Scalp Examination with Trichoscopy

To analyse the scalp at a microscopic level, we use trichoscopy. It is a non-invasive imaging technique that magnifies the scalp and hair follicles for closer evaluation. This allows the doctor to assess hair density, follicle health and variations in hair thickness that are commonly seen in male androgenetic alopecia. Trichoscopy can also help identify whether the pattern of hair loss is consistent with male pattern baldness or other scalp condition.
Blood Tests for Underlying Conditions

In some cases, blood tests may be recommended to rule out underlying medical conditions that can contribute to hair thinning or excessive shedding. Conditions such as thyroid disorders, iron deficiency, hormonal imbalances and nutritional deficiencies may affect hair growth and scalp health. Identifying these factors helps guide a more appropriate and personalised treatment approach.

Treatment Options for Male Pattern Baldness

Our treatment plans are tailored based on the pattern and severity of thinning, with the aim of slowing further hair loss and supporting healthier hair growth.

Medications

Topical Medication (Minoxidil)

Topical minoxidil is one of the most commonly used treatments for male pattern baldness. Applied directly to the scalp, it acts as a vasodilator that increases blood flow to the scalp and extends the hair’s growth phase.

Oral Minoxidil

Low-dose oral minoxidil is sometimes prescribed as an alternative for individuals who may not respond well to topical application or prefer a more convenient treatment option. As with all prescription medications, suitability and dosage should be assessed by a doctor.

Oral Finasteride

Finasteride is a daily pill that blocks the enzyme responsible for creating DHT (the hormone that causes follicles to shrink). It may help slow the progression of hair loss and preserve existing hair density.

As a prescription-only medication, Finasteride requires a medical consultation. A doctor will check for any conflicting health conditions and discuss the possible side effects.

Clascoterone

Clascoterone is a newer topical anti-androgen treatment currently being explored for male pattern baldness. It works by blocking DHT receptors directly in the scalp.

While it has received FDA approval in the US for other skin conditions and is in late-stage trials for hair loss, it is currently not yet HSA-approved in Singapore.

Clinical Procedures

Hair Transplant

At AURA, hair transplant is performed using Follicular Unit Extraction (FUE), a minimally invasive technique that involves taking individual hair follicles from areas of the scalp less affected by hair loss and transplanting them into thinning or balding areas.

Since the procedure does not involve removing a linear strip of scalp, FUE hair transplant generally results in minimal scarring and a shorter recovery period compared to older transplant methods.

RF Microneedling

RF microneedling uses radiofrequency energy with controlled microneedling to stimulate the scalp and support hair follicle activity. This process may help improve scalp circulation and create a healthier environment for hair growth.

Mesotherapy with Dutasteride

Dutasteride mesotherapy is a non-surgical hair loss treatment where small amounts of Dutasteride are injected directly into the scalp, focusing on areas most affected by DHT.

Patients should be aware that the use of Dutasteride for male pattern baldness is off-label in Singapore. Regulatory authorities have not formally approved it for scalp delivery or general hair regrowth, regardless of whether it is administered as a pill or an injection.

Nutritional Support and Lifestyle

Hair Supplements

Hair supplements may be recommended for individuals with nutritional deficiencies or poor dietary intake affecting hair health.

Depending on the individual’s needs, supplements may contain ingredients such as biotin, zinc, iron or amino acids that support healthy hair growth and scalp function. Keep in mind that they may be used as part of a broader treatment plan.

Lifestyle Changes

Lifestyle changes do not change your genetic predisposition to male pattern baldness, but they play an important role in maintaining the quality of the hair you have. For example, a diet rich in lean proteins, iron and healthy fats provides the necessary building blocks for hair production.

Can Male Pattern Baldness Be Prevented?

Yes, with the caveat that it is picked up early. Early intervention may help slow the progression of hair thinning and preserve existing hair for a longer period of time.

Seeking treatment during the earlier stages of hair loss can provide better outcomes than waiting until the thinning becomes more advanced. Once a follicle has completely stopped producing hair for several years, it is difficult to revive.

When to See a Doctor

Certain signs may indicate that the hair loss should be medically assessed.

Duration Hair Loss

Male pattern baldness typically develops over several years. If you notice a significant amount of hair falling out abruptly, such as seeing large clumps on your pillow, in the shower or when running your hands through your hair, it may indicate a condition other than genetic thinning.

Hair Loss Accompanied by Other Symptoms

Hair loss is sometimes a secondary sign of a systemic health concern. It is important to consult a professional if your thinning hair is accompanied by:

Persistent itching, pain or a burning sensation on the scalp.
Redness, scaling or the appearance of sores on the scalp.
Feeling unusually tired or noticing changes in your weight, which may suggest a thyroid or nutritional issue.

Rapid Thinning or Bald Spots

Male baldness is known for its predictable, slow recession at the temples or crown. You should seek an assessment if you observe:

Smooth, circular bald spots that appear suddenly (often a sign of alopecia areata). Rapid thinning across the scalp within a short period Noticeably increased hair shedding during washing, brushing or styling

FAQs

Generally, male pattern baldness (androgenetic alopecia) is not fully reversible once a hair follicle has become vellus, or what is commonly known as baby hairs, However, if thinning is addressed in the early stages, treatments may help slow further thinning, preserve existing hair and support regrowth in some individuals.

Male pattern baldness can begin at different ages depending on genetics and individual factors. In theory it can occur anytime after puberty. Some men notice early signs such as a receding hairline or thinning crown in their twenties, while others may only experience noticeable hair loss later in life.

Without clinical intervention, the thinning caused by male pattern baldness is permanent and progressive. This occurs as follicles shrink due to DHT sensitivity until they can no longer produce healthy hair.

Moreover, hair loss becomes irreversible once follicles have been inactive for a prolonged period. At that stage, only surgical procedures like a hair transplant can restore growth.

Stress does not cause genetic male baldness, but it can make the symptoms appear more rapidly. High levels of physical or emotional stress can trigger a different type of shedding called telogen effluvium, which pushes more hairs into the resting phase.

There is no single treatment that works best for everyone. The most suitable approach depends on the stage of hair loss, scalp condition and individual treatment goals.