Predicting the rate of progression of male balding

Male balding progresses at different rates in men

I'm often asked to help patients predict their rate of balding? How different will they look in 1 year? How different in 2 years? When will they look like their father or a specific photo they bring in?

Getting a sense of male balding rates of progression is challenging and certainly becomes more reliable as the patient ages. For example, predicting what someone will look like at 50 is easier to predict at 40 than 20.  However, with a series of carefully chose questions and a through evaluation of the scalp it is often possible to gain some understanding of the patient's rate of balding. 

The following questions are 'key' to ask when assessing the likelihood and degree of progression of male pattern balding:

1. What age did the hair loss start?
2. What is the current age of the patient?
3. How much progression has occurred in 6 months?
4. How much progression has occurred in 12 months
5. How much progression has occurred in 5 years (if hair loss started more than 5 years ago)?
6. What medications are used by the patient? What has been the results?
7. How much hair loss does the patent's father has?
8. What age (if any) did the patient's father start balding?
9. Does the patient's mother have hair loss?
10. What are the hair loss patterns of both grandfathers?
11. Are there any males in the extended family who have a Hamilton Norwood above level VI? If yes, how many?
12. What medications does the patient take now?
13. What mediations were used in the past ? (anabolic steroids, isotretinoin)?
14. Is the patient a smoker?
15. What is the patients' health?
16. What sun exposure has the patient had over the years?
17. Is the patient obese?
18. Does the patient have high cholesterol?
19. Does the patient have diabetes?
20. Does the patient have high stress?

The following items are key to evaluate when assessing the scalp in order to evaluate the likelihood and degree of progression of male pattern balding:

1. What is the current position of the frontal hairline? How much has it changed since age 12?
2. How much temporal recession due to balding (not hairline maturation) is there? How much has it changed since age 12?
3. What change have occurred in the crown?
4. What changes have occurred in the area in front of the ear (pre auricular area)?
5. Is there hair loss in the back of the scalp (occipital area)? Is the pattern of hair loss best described as 'diffuse unpatterned alopecia (DUPA)?
6. What percent of hairs are miniaturized in the frontal, mid scalp, crown and occipital scalp?
7. What changes in miniaturization have occurred in the past 6, 12 and 18 months?
8. Is their seborrheic dermatitis present in the scalp? What other scalp conditions are present?