Receding Hairline: Early Signs, Causes and What You Can Do

Short answer: a receding hairline is often the first sign of male pattern hair loss, the most common type of hair loss in men, which runs in families and is caused by genes and a hormone called DHT (British Association of Dermatologists' leaflet, June 2024). Dihydrotestosterone (DHT) is derived from testosterone by the enzyme 5-alpha reductase. It comes on gradually, at the temples and the front first, and may later thin the crown, in the stages of the Norwood scale. Hair loss that is patchy or sudden, or comes with a red, sore or flaky scalp, needs a GP first. These signs point to a cause other than male pattern hair loss. Two medicines are licensed for male pattern hair loss in the UK: finasteride 1mg tablets, a prescription-only medicine supplied after a GPhC-registered pharmacist reviews your request, and minoxidil 5%, a pharmacy medicine you apply to your scalp (UK product information, SmPC section 4.1 of each). Male pattern hair loss usually carries on slowly over time. Treatment works for as long as you keep taking it.

This guide is for men aged 18 and over, and every fact in it comes from the NHS, the British Association of Dermatologists or the UK product information.

What is a receding hairline?

A receding hairline is a hairline that moves back from the forehead, and in men it is most often part of male pattern hair loss. The British Association of Dermatologists describes the usual pattern as a receding hairline at the front and loss of hair from the top of the head, while the hair at the sides and back of the head is spared. Male pattern hair loss is also called androgenetic alopecia, and it can affect men of any age.

Not every change is hair loss that needs treatment. The NHS says most hair loss does not need treatment, because it is either temporary or a normal part of getting older. On the Norwood scale, which describes male pattern hair loss, the first stage reads: "No noticeable hair loss, or a very slight change at the hairline".

How can you tell if your hairline is receding?

The early signs are a hairline that sits further back at the temples than it used to, so the front starts to form an M shape, and hairs in that area that grow finer and shorter than the hair elsewhere. The British Association of Dermatologists says hairs in the affected areas are at first smaller in diameter and shorter than the hairs around them, before they go altogether, and that the scalp itself usually looks normal, with no symptoms, although some men notice an itch.

Finding hairs on your pillow or in the shower is not on its own a sign: the NHS says we can lose between 50 and 100 hairs a day, often without noticing. Because the change is slow, comparing your hairline with photos taken a few years apart, in similar light, can help you see it.

Why do men go bald?

Men go bald mainly because of male pattern hair loss, which is caused by a combination of genes and hormones. The British Association of Dermatologists explains that a hormone called dihydrotestosterone (DHT) changes the hair follicles on the scalp, so the hairs they produce become gradually thinner and lighter until the follicles shrink completely and stop producing hair. Doctors call this miniaturisation.

It is inherited. The leaflet says it can come from either or both parents, and that over 190 genes have been found to play a part, which helps explain why it affects members of the same family to different degrees and at different ages. The finasteride product information adds that hair follicles contain the enzyme that turns testosterone into DHT, that the balding scalp of men with male pattern hair loss has shrunken follicles and more DHT, and that men who lack the enzyme because of a genetic condition do not get male pattern hair loss (SmPC section 5.1). The hair at the back and sides of the head is spared, and the dermatologists note that hair there is typically more resistant to the effect of DHT.

Finasteride reduces the conversion of testosterone into DHT, the hormone behind male pattern hair loss. That is the step finasteride acts on.

What age do men start to go bald, and how common is it?

Male pattern hair loss can start at any age after puberty: the British Association of Dermatologists says men can become aware of hair loss on the scalp or a receding hairline at any time after puberty, and that it is the most common type of hair loss in men. It tends to progress very slowly, over several years or even decades, and an earlier start may lead to quicker progression.

So a hairline that starts to move back at 21 can be male pattern hair loss: one that has come on gradually, with a scalp that looks normal, fits the pattern the dermatologists describe. Neither the NHS page nor the dermatologists' leaflet gives a percentage of men who go bald, so this guide does not quote one. Hair loss treatment through this service is for adults aged 18 and over.

What are the stages of a receding hairline?

Male pattern hair loss is described in seven stages, from stage I, with little or no change, to stage VII, where only a rim of hair is left at the sides and back. This is the Norwood scale, the standard way of describing male pattern hair loss.

The receding hairline is the early part of the scale: recession at the temples in stages II and III, then thinning at the crown, on the top of the head, from stage IV, and larger areas of loss from stage V. The stages describe how far hair loss has gone. Stage I needs no treatment: if you choose stage I in our finasteride consultation, it tells you: "You do not seem to have male pattern hair loss, so you do not need treatment. If you are worried, please speak to your GP."

When is it not male pattern hair loss?

Hair loss that is patchy or sudden, or comes with a red, sore or flaky scalp, is less likely to be male pattern hair loss and needs a GP to look at your scalp first. Our finasteride consultation asks every man: "Is your hair loss patchy or sudden, or is your scalp red, sore or flaky?" These signs point to a cause other than male pattern hair loss. A yes means we do not supply finasteride and ask you to see your GP so your scalp can be examined. Conditions such as alopecia areata, fungal infection and scarring alopecia need different treatment.

The minoxidil product information draws the same line: it is only for male pattern hair loss and should not be used for other types, for example when there is no family history of hair loss, the loss is sudden or patchy, or the reason for it is unknown (Sons SmPC section 4.4). The NHS adds that some hair loss is temporary and can follow an illness, stress, cancer treatment, weight loss or a lack of iron. If your hair has thinned while you were losing weight, read does Mounjaro cause hair loss?

The NHS says a GP may be able to tell what is causing your hair loss by looking at your hair, and advises seeing a GP before going to a commercial hair clinic.

Can you stop a receding hairline?

There is no cure for male pattern hair loss, but treatment may slow it down for as long as you use it. Male pattern hair loss usually carries on slowly over time. Treatment works for as long as you keep taking it. The NHS says the treatments do not work for everyone and only work for as long as they are used. Finasteride 1mg is licensed to increase hair growth and prevent further hair loss (its UK product information), and the British Association of Dermatologists says minoxidil may help slow it down and acts as a hair growth stimulant.

Both take months. For finasteride: Generally, three to six months of daily treatment are needed before hair loss stabilises. For minoxidil, its product information says a 4-month course may be needed before any signs of hair growth appear (Sons SmPC section 4.2), and the dermatologists say it needs at least 6 months, and possibly up to 12, before any benefit may be noticed. Individual results vary.

Stopping lets the hair loss carry on. For finasteride: If you stop taking it, the benefit begins to reverse by six months and is lost by 9 to 12 months. For minoxidil, its product information says hair goes back to how it was before treatment within 3 to 4 months of stopping (Sons SmPC section 4.2).

What treatments are there for a receding hairline?

Two medicines are licensed in the UK for male pattern hair loss: finasteride 1mg tablets and minoxidil 5% applied to the scalp. These are the two hair loss medicines we supply.

Finasteride 1mg tablets

Finasteride is a daily tablet for men, licensed "to increase hair growth and prevent further hair loss" in male pattern hair loss (SmPC section 4.1). Finasteride reduces the conversion of testosterone into DHT, the hormone behind male pattern hair loss. It is a prescription-only medicine: at Solira you complete an online consultation, and a GPhC-registered pharmacist reviews every request before it is supplied. If the pharmacist cannot approve it, you are refunded in full. Our guide to finasteride explains it in more detail.

Uncommon side effects (fewer than 1 in 100 men): lower sex drive, low mood or depression, difficulty getting an erection, and changes in ejaculation, including less semen. In some men, sexual side effects have carried on after they stopped taking finasteride. Sexual side effects have also been linked to changes in mood, including thoughts of suicide. If you have any sexual side effects, ask our pharmacist or your GP for advice. More on each is on our finasteride page.

Minoxidil 5% spray

Minoxidil 5% is a solution you spray onto your scalp twice a day, licensed for moderate male pattern hair loss in adult men (Sons SmPC section 4.1). This product is licensed for men aged 18 to 65. It is a pharmacy medicine, supplied after a pharmacist consultation, no prescription required. Unlike finasteride it does not affect hormones. It is not suitable if you have high blood pressure, treated or not, or a scalp that is broken, inflamed, sunburnt or shaved (Sons SmPC sections 4.3 and 4.4). Some men shed more hair when they start: the product information says this usually happens 2 to 6 weeks after starting and settles within a couple of weeks (section 4.4). How long it takes is on our minoxidil page.

What about the hairline itself?

Neither product information separates the hairline from the crown in what it is licensed for. The finasteride product information describes trials in men aged 18 to 41 with mild to moderate hair loss at the crown and at the front and middle of the scalp, and the results it sets out are from the studies of hair loss at the crown; it gives no separate result for the temples (SmPC section 5.1). Minoxidil is applied to the whole affected area of the scalp, and its product information names no area (Sons SmPC sections 4.1 and 4.2). Individual results vary.

Can you use both?

There is not enough evidence to recommend using finasteride and minoxidil together, so we do not supply the two together as a plan. If you already use minoxidil, tell our pharmacist during your consultation so they can advise you.

Other options

Some men choose a wig or hairpiece, or a hair transplant, in which hair follicles are moved from the back and sides of the scalp to the thinning areas; the British Association of Dermatologists says surgery is not offered on the NHS. The two medicines are compared side by side in hair loss treatment in the UK.

Does washing, a hat or styling cause a receding hairline?

Washing does not. You can wash your hair as often as you like. It will not make hair loss worse. The NHS and the British Association of Dermatologists put male pattern hair loss down to genes and hormones, and neither lists hats or styling among its causes. In fact the dermatologists advise a hat, a wig or sun cream to protect any bald areas of your scalp from the sun.

How can you look after your hair and yourself?

Stopping smoking, keeping alcohol within recommended limits, eating a balanced diet rich in protein and avoiding stress where you can may all help your hair.

A receding hairline can affect how you feel. The British Association of Dermatologists says hair loss can lower self-esteem and cause worries about body image, and that it is important to talk about your emotional wellbeing with a healthcare professional. The NHS says that if your hair loss is causing you distress, your GP may be able to help you get some counselling.

For support, Alopecia UK (alopeciaonline.org.uk) can help, and the British Association of Dermatologists has a patient leaflet.