'Hair loss can devalue your sense of being'

Male hair loss is often regarded as a joke - but for sufferers, it is no laughing matter, writes Ciarán Brennan.

Male hair loss is often regarded as a joke - but for sufferers, it is no laughing matter, writes Ciarán Brennan.

IT BECAME the case of the grannies who never died. When Republic of Ireland footballer Stephen Ireland withdrew from the squad before last September, he said it was because his maternal grandmother had died, then changed that to his paternal grandmother, before saying he had made up the stories so that he could be with his girlfriend who had suffered a miscarriage.

Reports later emerged that Ireland was unhappy at the reaction of some other squad members to what appeared to have been a hair transplant. On the night before a match against Slovakia, a small number of players had apparently held him down and tugged at the hair, severely upsetting Ireland in the process.

Whether or not this was the reason for Ireland's withdrawal from the squad, it demonstrates how hair loss - and doing anything about it - is treated as a joke.

Although hair loss and male-pattern baldness is an affliction suffered by thousands of men, jokes and jibes about "slapheads" have abounded for years. There is a tendency to ignore the fact that it can be a real source of insecurity and embarrassment for those not ready to lose their hair or shave their head.

While some men aren't troubled by baldness or hair loss, others suffer great emotional distress associated with a lack of self-confidence and sometimes depression. They can experience real anxiety and stress over excessive hair loss, according to Dr Conor Kiely, who heads Kiely Healthcare, a medical hair replacement clinic.

"Around 40 per cent of men, by the age of 40, will have significant hair loss - that's a big figure, and causes a lot of self-esteem problems. Often hair loss makes people look older and accentuates the wrinkles on their faces and so on. I would have encountered circumstances where men were very upset by it."

Clinical psychologist Armien Abrahams agrees that it can have a devastating impact on men's feelings of self-worth.

"If there is a predisposition towards lower self-esteem or lower self-confidence, baldness would aggravate it," he says. "Some men would really feel as if their whole sense of being is being totally devalued because of baldness making it worse."

The issue is not helped by a world which is becoming more image-conscious, with men feeling greater pressure to look their best at all times.

"You can get away with being a little overweight but you won't get away that easily with hair loss," says Kiely.

Male pattern baldness is the most common form of hair loss and usually starts in the late 20s or early 30s. It is hereditary and thought to be due to over-sensitivity of hair follicles to dihydrotestosterone (DHT), a derivative of the male hormone testosterone. This causes the hair follicles to generate thinner and thinner hair until they eventually stop completely.

A quick perusal of the internet will throw up a multitude of cures and treatments for baldness.

"The majority of guys are upset about it and some guys are so upset that they are willing to spend money on it, and I would see my job as to steer them away from the snake oil merchants and be honest about the likely success," says Dr Mel Bates from the Irish College of General Practitioners (ICGP).

"I'm not trying to minimise the psychological upset, because I do understand that some people feel very strongly about it, but what I'm really saying is don't spend lots of money on this because whenever conventional medicine hasn't got a clear answer to something, then lots of other people step in and say they have the answer for it."

The most common hair loss treatments are Minoxidil and Finasteride, which largely slow hair loss and may lead to some small regrowth. Minoxidil is a lotion which is available from the pharmacist that you rub on to the scalp. Finasteride is a prescription-only medicine that comes in a pill or tablet form. However, the effects of either treatment wear off if the treatment is stopped.

"You have to realise you're on this for life, the moment you stop you go backwards," says Bates.

Medication can be helpful in conjunction with surgery, but on its own it tends to be very limited, says Kiely.

"Medical treatment is available to try to slow down hair loss but it won't actually cause hair replacement and the difficulty about trying any medical treatment for hair replacement or hair loss is the secondary effect on sexual characteristic."

However, Bates says side effects are quite uncommon, with research showing that two out of 100 men may suffer a loss of libido from taking hair-loss treatments.

"I think it is important that people are aware that this can happen, but it happens rarely," he says.

Hair transplant surgery has come a long way from its beginnings in Japan in 1939 when the end result was the "doll's head effect", with the transplant obvious to even casual observers.

"That is gone and now every single hair individually is transplanted," he says. "We remove hair follicles from the back of the head and these follicles have no receptors to DHT and these will stay forever and that is passed on to the front of the head and it takes root and grows forever for the rest of the person's natural life.

"It's about a five-hour procedure done under a local anaesthetic."

At a cost of about €8,000, would balding men not be better off shaving their heads instead?

"It is a very dismissive attitude," says Kiely. "I get loads of people who come into me and say their GP has said things like, 'just shave your head', and they feel very upset by that sort of comment because it just doesn't work for them, they don't want their head shaved."