Question

My son is 24 and has always had quite fine hair. He has plenty of it at the back, but now he's thinning on the top quite rapidly. He's a young man and so this hair loss is starting to affect his confidence and self-esteem. I don't want to bring it up and upset him unless I have some kind of solution to offer. I've read you can ask your GP to prescribe steroids, but I worry that would have side effects. Is there anything you can advise him to do, either to encourage re-growth of hair or at the very least stop him thinning further? I would really appreciate your help.

The dermatologist
Mark Goodfield

It is highly likely your son has male-pattern hair loss (androgenetic alopecia), but a good dermatologist will want to discount other causes, such as iron deficiency (unlikely at your son's age) or thyroid disease. Taking steroids for this type of hair loss is not suitable or safe. However, the prescription treatment 'Regaine' (chemical name Minoxidil), may encourage re-growth. Response rates are low (10-20 per cent), it can take six to nine months to take effect, but it's totally safe and can be prescribed by a GP. There are also oral treatments that block male hormones (male-pattern hair loss is attributed to an oversensitivity to male hormones), the most widely known being Finasteride. Though effective, one per cent who take it suffer impotency while on the drug, so it's a serious decision to discuss with a specialist dermatologist. He can be referred through his GP or he can find a dermatologist through www.britishskinfoundation.org.uk.

· Dr. Mark Goodfield is a consultant dermatologist and honorary secretary of the British Skin Foundation

The patient
Craig Neilson

My advice to anyone losing their hair is to bite the bullet and shave it off, no matter how young they are. There's nothing more ridiculous than a man trying to hide his baldness with a comb over. I'm 33, but started going bald when I was 21. I knew I would at some point because my own grandfather lost his hair fairly young. My parents never made a big deal of my hair loss - like your son, I started thinning on top first - although I do remember my mum buying me a present from the Body Shop one year that included a shampoo. On closer inspection the shampoo was for 'thinning or fine hair'. It made me realise even Mum recognised I was going bald. I was never distraught about it, probably because I expected it, but for some time I tried to disguise the fact. In the end my hairdresser couldn't bear it and asked, 'Why waste your money? It'd look better short.' I shaved it to a number one when I was 23, and I'm so pleased I did.

· Craig Neilson, a project manager with Mother advertising agency, started losing his hair at 21

The hair expert
Marilyn Sherlock

The most obvious treatment is medical - Finasteride and Minoxidil are the two drugs clinically trialled and proven to work. 'Miracle cures' touted on the internet should be avoided, as there is no clinical evidence that they work, but there are some lifestyle changes which may slow down baldness. If your son has any scalp disorder - mild eczema for example - he should keep his hair really clean. Dirty scalps can cause irritation and can increase the amount of hair shed. A poor diet can also speed up hair loss, so check your son is eating well-balanced meals. Cosmetic solutions include a coloured hair lacquer that stains the scalp and camouflages it, and a powder with a static charge that sticks to the hair, giving each hair a thicker appearance - ask a registered trichologist for suitable brands. Transplant surgery is also an option. It can be expensive, and depends if he has enough 'donor' head hair to transplant - but it can be successful.

· Marilyn Sherlock is chairman of the Institute of Trichologists (www.trichologists.org.uk)

If you have a health question for our experts, email health@observer.co.uk