# Severe male pattern baldness

> Citation bundle for Severe male pattern baldness on The Treatment Registry.
> URL: https://thetreatmentregistry.com/conditions/severe-male-pattern-baldness
> Bundle URL: https://thetreatmentregistry.com/api/citations/conditions/severe-male-pattern-baldness

## Description

Advanced androgenetic alopecia in men, typically Norwood VI-VII, with extensive crown and frontal loss and a limited donor area. Distinct from earlier-stage hair loss in that the treatment goal is realistic distribution of a limited donor resource rather than full coverage. Treatment combines medical management to preserve the donor, hair-transplant surgery, and (in some cases) micropigmentation or hair systems.

## Treatment ladder

### conservative

- **Topical minoxidil** — FDA-approved topical treatment with modest effect on density and good tolerability in most patients. Effect is lost on discontinuation.
- **Oral finasteride** — Prescription-only 5-alpha-reductase inhibitor. Effective at slowing progression but carries a small risk of sexual side effects that may persist; assess against the patient's priorities.

### procedural

- **Scalp micropigmentation** — A cosmetic tattoo that mimics shaved hair. Permanent (within touch-up cycles), avoids the limits of donor area, and is often paired with shaved-head presentation in severe cases.
- **PRP for hair loss** — Platelet-rich plasma injections into the scalp. Evidence base for severe cases is limited; effect is gradual and requires repeat sessions.

### surgical

- **Hair transplant (FUE)** — Follicular unit extraction from the donor area to the recipient site. Donor preservation is critical in severe cases; over-harvesting produces a visible donor depletion that cannot be reversed.
- **Sapphire FUE** — FUE using sapphire-blade recipient channels. Marketed claim of improved healing; evidence base is mixed. Subject to the same donor-preservation constraints as standard FUE.

## Related procedures

- https://thetreatmentregistry.com/procedures/hair-transplant
- https://thetreatmentregistry.com/procedures/sapphire-fue
- https://thetreatmentregistry.com/procedures/prp-hair-loss

## Sources

- [WHO Surgical Safety Checklist](https://www.who.int/teams/integrated-health-services/patient-safety/research/safe-surgery) — World Health Organization (accessed 2026-05-09)