Hair in Men: Alopecia, Hair Transplantation & Beard Growth

Alopecia – Basics and Types

The term alopecia generally refers to hair loss, regardless of cause or location. In men, it overwhelmingly refers to androgenetic alopecia – the most common form of hair loss worldwide. It is not a disease in the classic sense, but a genetically programmed reaction of the hair follicles to androgens, particularly dihydrotestosterone (DHT). Less commonly, other causes are present: alopecia areata (patchy hair loss caused by autoimmune processes), diffuse hair loss due to malnutrition, thyroid disorders, iron deficiency or chronic stress, as well as scarring forms of alopecia following inflammation or trauma.

Androgenetic Alopecia

Androgenetic alopecia arises from the combination of a genetic sensitivity of the hair roots and the effect of DHT – a metabolite of testosterone formed by the enzyme 5-alpha-reductase. In genetically sensitive follicles, DHT shortens the anagen phase (growth phase) and causes progressive miniaturisation of the follicle: the hairs become finer, shorter, and eventually stop growing back at all.

The clinical picture follows typical patterns classified according to Hamilton and Norwood: starting with a deepening of the temples (receding hairline) and thinning at the crown (bald spot formation), hair loss progresses in some men to partial or complete baldness; a fringe of hair on the sides and back of the head is usually preserved, as these follicles are genetically less sensitive. The course varies greatly between individuals – from slowly progressive thinning over decades to rapid progression already in early adulthood.

Treatment Options

The first-line medical treatments are minoxidil and finasteride, whose effectiveness is supported by controlled studies. Minoxidil is applied topically to the scalp as a solution or foam and prolongs the growth phase of the hair as well as improving blood flow to the follicles; after several months of regular use, many patients show a slowdown in hair loss and, in some cases, thicker hair. Finasteride, an oral medication, inhibits 5-alpha- reductase and thereby lowers DHT levels; it requires a prescription and, taken consistently, can stop hair loss and in some cases even reverse it. Possible sexual side effects should be discussed with a doctor.

PRP therapy (platelet-rich plasma) is a complementary approach in which platelet-rich plasma is obtained from the patient's own blood and injected into the scalp to activate growth factors and stimulate the hair follicles. Evidence is growing, and the method is considered safe and well tolerated. Low-level laser therapy can be used as a supportive measure but is not a standalone treatment. Cosmetic options such as hair fibres, scalp micropigmentation, or hairpieces offer immediate visual solutions without a medical procedure.

Hair Transplantation

Hair transplantation is the only surgical, and therefore potentially permanently effective, treatment for androgenetic alopecia. It is based on the principle of donor dominance: hair from the back and sides of the head, which is genetically resistant to DHT, retains this property even after being transplanted into bald areas and continues to grow there permanently.

Two methods have become established. In the FUT method (Follicular Unit Transplantation), a strip of skin is removed from the donor area, divided under a microscope into individual follicular units (grafts) of one to four hairs, and implanted into the recipient area. This method allows a high graft count in a single session but leaves a linear scar on the back of the head. In the FUE method (Follicular Unit Extraction), individual follicles are removed directly using a special punch tool; this leaves small, dot-shaped scars that are barely visible with short hair. FUE is more time-consuming, suitable for smaller areas, and preferred by many patients.

After transplantation, the transplanted hairs typically fall out after a few weeks (shock loss) – a normal process, as the follicles enter a resting phase. Permanent regrowth begins after three to four months; the full result can be assessed after nine to twelve months. With good planning and technique, results today are usually very natural.

Beard Growth

Beard growth refers to the growth of facial hair on the upper lip, chin, cheeks and neck and is a secondary sex characteristic triggered during puberty by rising testosterone levels. Testosterone stimulates the facial hair follicles to produce terminal, i.e. coarser, hairs. How dense, how fast, and in which areas a man grows a beard is strongly genetically determined and varies considerably – from sparse fuzz to a full beard already in early adulthood.

Interestingly, there is an apparent paradox: the same androgens that cause hair loss on the scalp in genetically sensitive follicles promote growth on the face. This is because hair follicles at different sites of the body respond differently, genetically, to androgens: facial and body hair follicles respond positively to DHT, while scalp follicles with the corresponding genetic predisposition respond negatively.

Beard growth can be influenced by hormonal disorders: testosterone deficiency leads to sparse beard growth; increased androgen effects from external sources (such as anabolic steroids) enhance it. Pronounced facial hair growth in women (hirsutism) is a sign of increased androgen activity and requires gynaecological-endocrinological evaluation.