Hair loss may be harmless, but it has a huge impact on men's self-esteem. Conor Pope reports
Going right back to biblical times, baldness has been given bad press. Everyone knows that the long-haired Samson was strong and vigorous while the shorn Samson was a weakling, but his story is not the only occasion the good book touches on the issue.
The holy man Elisha reveals himself to be a pretty touchy prophet when he orders the immediate execution of a group of children after they call him "baldy". Eziekel, for his part, warns that "[ sinners] will put on sackcloth, and horror will overwhelm them. Shame will cover all [ their] faces, and all their heads will be bald."
In the 3,000 years since then, there has been no let up in what Seinfeld and Curb Your Enthusiasm creator Larry David calls "hate crimes" against the sleek headed.
Polls, at least those ones carried out by snake oil sellers, repeatedly show that women find bald men unattractive. This antipathy appears to be borne out in real polls - no successful US presidential candidate has been thin on top since the dawn of the TV age as voters equate responsibility, trust, honour and decency with good hair.
In Britain, meanwhile, the abject failure of the last three Tory leaders to make any impression on the electorate has been blamed, in part, on their lack of hair
While male pattern baldness, or androgenetic alopecia, has been blamed on many things - excess testosterone, stress, thinking, hats, poor circulation, diet and sin - it's the genes that are mostly to blame.
There are about 100,000 follicles on the human head. These continuously produce hair for periods of two-six years. When a hair falls out, the follicle which produced it rests before growing a fresh one. At least that's what happens before male hormones start meddling with susceptible genes.
Testosterone and its more potent derivative dihydrotestosterone (DHT) are androgens which play a crucial role in the development of the male foetus and are responsible for increasing the size of hair follicles in areas such as the beard and underarm during male puberty.
Certain hair follicles in the scalp however are also genetically programmed to be vulnerable to DHT and when targeted post-puberty they shrink and begin producing thinner and shorter hair.
The growing phase of the cycle of these follicles also becomes shorter so more hairs fall out. Although they still have a sufficient blood supply, the follicles continue to be bombarded by DHT which means they shrink further and some eventually die, resulting in male pattern baldness. It is a common event and 40 per cent of men can expect to lose some of their hair before they hit 35.
Although hair loss is harmless, it has an enormous impact on some men's self-esteem. This explains why the hair-replacement industry globally is worth €1 billion annually and more money is spent on researching treatments for male pattern baldness than is spent on cures for malaria, tuberculosis and sleeping sickness.
The search for a cure has lasted thousand of years and the most bogus ones have consistently been taken seriously. Ancient Egyptians favoured pasting boiled hippopotamus fat on to the scalp, while the Greeks experimented with pigeon droppings and goat's urine. The Romans, in addition to gifting future generations the comb-over, slapped the burnt remains of mice onto their bald patches to stimulate hair growth.
There was a lull in ridiculous cures during the Dark Ages, but in the Renaissance cow spit and headstands were among the treatments hailed as wonder cures. The end of the 19th century also marked the dawn of the golden age of quackery - electric shock therapy, vibrations, electronic suction devices and scalp massagers were all employed with varying degrees of uselessness.
Throughout the last century, treatments grew increasingly scientific and sophisticated with the result that now some of them actually work. The two most popular pharmaceutical treatments are Minoxidil, marketed as Regaine in this country, and Finasteride, marketed as Propecia or Proscar.
Finasteride is a DHT inhibitor and is an FDA-approved baldness treatment. It is said to have an 80 per cent success rate at preventing hair loss. Propecia is not marketed in Ireland but Proscar is available on prescription here at a cost of €50-€60 for 28 tablets.
Minoxidil was originally developed as a drug to reduce blood pressure but in trials brought about hair regrowth in some patients, much of it as surprising as it was unwanted. It was modified and developed as a spray for the scalp and released onto the market in the late 1980s. It stops hair loss in 80 per cent of cases, according to the company, and leads to new hair growth in one in four users, although much of the regrowth is said to be downy and light in colour.
Laser therapy, now widely available in the Republic, is popular and apparently works by stimulating blood supply to the follicles and scalp leading to, it is claimed, stronger hair growth. For a six-month course, you can expect to pay €2,000-€4,000.
This therapy doesn't impress Dr Maurice Collins, who runs the Hair Transplant Surgery in the Blackrock Clinic. He says that outside of the surgical option, the only two treatments which have been shown to be effective are Minoxidil and Finasteride.
"There are a lot of lotions and potions being sold as treatments for hair loss but none of them has any scientific validity behind them. In particular, I can find nothing in the literature to substantiate the claims made for laser treatment to the scalp," he says.
Collins describes his surgical method as "the gold standard" of hair-replacement treatments. It is certainly the most costly option with one hair graft costing €10. It is difficult to say how many grafts an individual needs but more than 1,000 grafts on a patient would not be unusual.
During a transplant, hair bearing skin from the side of the head is removed and dissected to produce grafts which are then sewn onto the balding area. While it is effective, it is not a cure.
"I tell every patient I see that I cannot cure their male pattern baldness but we can certainly do a lot to help them by both medical and surgical means," Collins says. There is, he says, "nothing wrong" with going bald but some men find it unacceptable and suffer from very low self-esteem because of it.
"When you do a successful hair transplant on somebody like this, it certainly improves their self- esteem to a very large extent. I always tell my patients that the treatment costs us a lot to do and it therefore will cost the patient a lot. However, looked at in the length of time that the hair will stay on the patient's head, ie permanently, it is a costly procedure but not expensive. I do, however, warn them that if they cannot afford to have a really top class transplant carried out then they should not have any procedure done," Collins says.
A Google search reveals countless "cures", some of which are up there with boiled hippopotamus fat, are still being peddled to the desperate. Some of the advertising is very slick and convincing. The relentless sales pattern is a concern to Collins, who believes people looking for treatment "should approach a medically qualified person as opposed to a salesperson as I don't believe salesmen have any role to play in counselling somebody or advising them when they have hair loss."
