The Different Stages of Baldness in Men and Treatment Process

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Baldness or androgenetic alopecia affects about 20% of men and 2 to 3% of women. This figure increases in men after the age of 65 and reaches approximately 35%. On the other hand, hair loss has strongly increased since 1990 and concerns 76% of the French people questioned by Ifop. Only 24% of French people who do not suffer from baldness say they do not lose their hair.

It is therefore a societal phenomenon that concerns 1/3 of men before the age of 50. Medical answers exist and have become essential for all those who are bothered by this loss.


The causes of hair loss in men

Androgenetic alopecia

It represents 95% of the causes of diffuse alopecia in men. Other metabolic, endocrine, dietary or drug-related causes will not be discussed.

The pathological explanation of baldness is related to the action of androgens on the hair bulb of the scalp. The action of these androgens is associated with circulating hormone levels in the blood and is linked to a genetic predisposition. Testosterone transformed into Dihydrotestosterone (DHT) by the 5 alpha-reductase decreases the growth phase of the hair and shortens its life span. The hair cycle accelerates and is exhausted more quickly than expected. The evolution of hair loss is characteristic: it begins with the frontal gulfs and the hairline and then reaches the top of the skull. These areas are the first to be affected because they are the most sensitive to DHT. This alopecia respects the occipitotemporal area, an area where the bulbs persist because they are insensitive to male hormones. This is why men who become bald keep their hair for a long time in this area, known as the “Hippocratic crown” in reference to Hippocrates, who was bald.

Hair loss in men is divided into 7 stages:

This classification includes 7 evolutionary stages and is of intermediate use mainly in the follow-up of baldness and the indication of hair transplant treatment.

Stage 1: no hair loss or very slight balding on the sides;

Stage 2: hair density begins to decrease in the frontal and temporal areas;

Stage 3: baldness clearly appears and a hole may be visible in the middle of the head;

Stage 4: hair loss becomes more severe in the forehead and temples and the hole becomes larger and larger;

Stage 5: we notice an amplification of the baldness on the different areas of the skull already affected;

Stage 6: the density of the hair decreases leaving the areas affected by alopecia clearly visible;

Stage 7: total baldness at the back of the head and in the middle as well as in the frontal and temporal areas. At this stage, treatment with a transplant is not recommended, as it cannot cover the entire area affected by hair loss.

Diagnosis and therapeutic evaluation

Diagnosis and therapeutic evaluation can be aided by the trichogram technique taken in the occipital, vertex and fronto-parietal areas: this evaluation, although imprecise in estimating hair loss, will highlight the miniaturization process that is significant in androgenetic alopecia.

The evaluation of hair loss by questioning, the clinical traction test and the trichogram will be the elements that will be taken into account before and during the treatment for its evaluation.

The photo trichogram is used in clinical studies. It is a more reliable technique to evaluate the change in density and effluvium but this technique is not feasible in the everyday clinic. It is a digitized photographic evaluation of a 1 cm2 area that has been shaved and photographed 3 days later: it allows for the precise evaluation of hair density.

Preventive solutions against hair loss in men

The treatment of male alopecia is a large family that includes preventive treatment, stopping the loss of remaining hair, and curative treatment on bald areas via hair transplantation.

Many treatments exist for alopecia, both topical and oral. Locally, we use minoxidil, mesotherapy of the scalp, light therapy and anti-hair loss lotions. Orally, finasteride is used.


Minoxidil has an effect on the life span and growth of follicular cells. It acts by increasing the duration of the anagen phase of the hair and allows for an increase in the size and thickness of the hair. This results in a fuller head of hair but without an increase in the total number of hairs. Minoxidil has no endocrine effect and therefore does not treat the cause of androgenic alopecia. The therapeutic effect disappears on discontinuation, which is why it is advisable to continue taking the treatment as long as the hair falls out and the patient is bothered by it.


In the medical sense of the term, mesotherapy is the injection of medicinal substances by means of short and very fine needles. It is a painless procedure that is performed without anesthesia in a medical office.

In the case of alopecia, mesotherapy of the hair aims to administer substances directly to the hair root that stimulate the vitality of the hair, stimulating the function of the hair bulb, and providing nutrients that are biologically essential for the proper functioning of the hair shaft. After evaluating your scalp, your doctor will propose the creation of a customized solution based on the various active ingredients you need.

The injected products are developed in pharmaceutical laboratories, controlled and contain :

  • Vitamin B5 or Bepanthene which stimulates hair growth and participates in the regeneration of the hair shaft by its action in the production of keratin (main constituent of the hair shaft).
  • Vitamin B12 which promotes cell renewal.
  • Vitamin B8 which regulates the production of sebum which, when produced in excess, “engulfs” the hair and reduces its growth phase.
  • Vitamin B6 which metabolizes amino acids, proteins essential to the creation of the hair structure and keratin.
  • Vitamin B3 or PP which accelerates blood circulation at the root of the hair and as always, the blood makes the life of the hair!
  • Amino acids: molecules that are part of the composition of proteins, essential to all cellular functions and creation.

These vitamins and minerals are provided by a balanced diet and are used for multiple cellular reactions in the body. The goal of the treatment is to increase their presence directly at the hair root over a short period of time and at regular intervals in order to increase their effects.

LED light therapy

LED (Light Emitting Diode) lights are one of the methods of phototherapy, a treatment discovered in the 1950s when treating jaundice in newborns by exposure to sunlight. In the early 2000s, NASA studied the acceleration of wound healing time in weightlessness using phototherapy and the results were conclusive.

Anti-hair loss lotions and food supplements

This is a very commercial area without statistically significant scientific evidence that will be only slightly developed. In this category, it is important to remember some common-sense rules. Hair, like all the other appendages (nails, etc.), is a reflection of an individual’s good health. A balanced diet with sufficient vitamins and iron will make your hair healthy. 

A restful sleep with a good management of stress especially in the evening before falling asleep is essential. Avoid excitants, tobacco, alcohol and coffee in excess. Women should also avoid braiding and straightening their hair, which traumatizes the hair right down to the roots, as well as using coloring products that are too toxic. For men, styling products should be used sparingly and in small quantities.

Curative solution: male hair transplantation

The existing hair transplant methods are represented by FUT (Follicular Unit Transposition) and FUE (Follicular Unit Extraction). They are the “Gold Standard” of alopecia treatments since they replace lost hair permanently. They complement anti-hair loss methods that focus on preventing the loss of the remaining hair.

FUE transplant – The FUE (Follicular Unit Extraction) technique is a non-invasive procedure performed under local anesthesia by a physician. It consists of taking follicular units, one by one, in the donor area using circular micro-punches of different diameters.

Robotic FUE transplant – The robotic FUE technique is a non-invasive FUE procedure, coupled with robotic assistance in the collection of follicular units. In our opinion, this is the most successful technique.

FUT or strip – The FUT (Follicular Unit Transplant) technique is the most widely practiced hair transplant technique in the world, introduced in 1999. It is a surgical technique with a scar performed by a plastic surgeon.

The Different Stages of Baldness in Men and Treatment Process
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