There are two kinds of people in the baldness game: those looking for magic and those selling it.
In 400 B.C., Hippocrates - the bald father of medicine - decided he'd gone bald from thinking too much. His solution: opium, beetroot, pigeon poop and horseradish.As recently as the 1920s, a congressional committee analyzed products on the American market such as Hall's Hair Renewer (Borax and red pepper), Lucky Tiger (active ingredient: arsenic) and Hair-a-Gain (kerosene and lanoin).
How do men with receding hairlines really feel?
Some of us survive unscathed. Others, frankly, lose it. We feel neutered. We feel old.
"I might go out with a bald guy when I'm a lot older, but not now," says a winsome female at the beginning of one hair-transplant company's info-video.
A man who is worried about his hair is likely to be told not to worry. This is a double whammy. Not only is he suffering, he's being told that something is wrong with him for it. Small wonder some of us begin the search for a magic bullet.
As boys we have about 100,000 hairs on our heads - a golden age. By age 30, one-fourth of men experience some hair loss. By 40, it is up to 40 percent. By 70, two out of three men will be follically challenged.
More than 95 percent of the time, the cause is male-pattern baldness - or MPB.
MPB is an inherited condition that can't be changed any more than the color of your eyes. While some men's hair loss is nearly total, others with MPB will lose a fraction of an inch of hair over a lifetime.
Scientists don't fully understand who will go bald. Two brothers, even identical twins, may have widely varying patterns.
Contrary to popular belief, MPB can be passed on by either parent, and it often skips a generation. If either parent carries the gene, there's a 50 percent chance their son will carry it. If both parents carry the genetic code, the chances go up to 75 percent.
Myths abound. Wearing hats neither speeds nor slows the balding process. Applications of lemon juice and vinegar do not stem the tide. Dandruff doesn't cause baldness. Shampooing or blow-drying daily doesn't either. Electric shocks to the scalp won't reverse the loss.
`I'M GROWING HAIR'
There's always a miracle drug on the horizon, but only one drug, minoxidil, has been licensed for sale to regrow hair.
At one time or another all these medications have been held out as cures: Viprosotol, Cyoctol, Diazxide, Cyclosporin-A and Nocorandil. None has proven safe and effective. Several will increase the blood pressure or breast size, or even change a man's voice.
An article in a recent newsletter published by the American Hair Loss Council recounts a phone call one doctor got from a patient who had made his own cocktail of non-FDA-approved drugs obtained outside the United States.
"I can't perform sexually. I have heart palpitations and get dizzy - but I'm growing hair!" the man exulted.
Tip: If you find yourself being taken in by magic potions, remember one thing. Pharmaceutical companies know that a drug proven to grow hair without hurting health is worth billions. The minute it's found, they'll interrupt the Super Bowl to spread the news.
In 1990 the Food and Drug Administration ruled that companies could not claim that products stimulated hair growth or stopped hair loss unless they could prove it. So far, only minoxidil has passed muster.
Minoxidil was actually developed to combat hypertension. Applied to the scalp in a 2 percent solution - the rest is alcohol, propylene glycol and water - it grows hair in some of the people some of the time.
There are a lot of "buts" with Rogaine, as minoxidil is marketed. It regrows "moderate to dense" hair in 26 percent of men in clinical trials. The best candidates are men in their 20s and 30s, whose hair loss is moderate and within the past five years.
It also tends to regrow the kind of hair that's already there or close by. If that happens to be baby-fine, fuzzy "vellus" hair strands instead of thicker "terminal" ones, that's what it restores. And vellus hair, even if you've got a bunch of it, doesn't cover up much.
Because Rogaine is a treatment, not a cure, one has to apply it twice a day in perpetuity. It costs about $30 for a month's supply. If one stops, he'll lose within a month whatever he may have gained.
Last February the FDA approved Rogaine for over-the-counter sale. Rogaine is now flying off the shelves. If your local drugstore is out of the men's version, pick up the women's. Both have the same active ingredient.
Pharmacia & Upjohn, makers of Rogaine, are awaiting FDA approval of a 5 percent minoxidil solution to be sold by prescription only. It remains to be seen whether the stronger dosage will yield better results.
If you're going bald on top, a balanced hairstyle can divert attention. Avoid long hair at the sides and back. That only emphasizes the landing strip atop your head. Although the shape of one's head and facial features is a factor, a shorter cut generally works best.
For years women have used permanent waves to create the appearance of volume. The idea is that one curly hair covers twice the amount of area that a straight one does. A wave also can give hair shape, so one's head looks less like a Tootsie Roll Pop.
To achieve this, a stylist places the hair in rollers, then applies a solution to make the curl set. The solution is left on for 15 minutes to 20 minutes. Then the hair is rinsed and a neutralizing solution is put on to lock the curl in. The permanent will last three to six months.
The market is awash in mousses, gels and shampoos that promise to add volume to hair. What such products do is coat the hair, making it appear slightly thicker. But if one has really thin or thinning hair, slightly thicker isn't going to make much difference.
HAIRPIECES, WEAVES AND CLUBS
The American Hair Loss Council says that 400,000 American men will get fake hair this year, roughly enough to carpet the outside of the World Trade Center towers.
Variously called hair weaves, hair extensions, hairpieces, toupees, nonsurgical hair replacements or rugs, they consist of human or synthetic hair attached to what remains of the natural hair or scalp by clips, adhesive tape or glue.
At Hair Club for Men - the IBM of hairpiece companies with 60 offices across the country - fake hair is called a "system." This system consists of a fine nylon mesh into which human hair is woven. The mesh is then glued to one's own hair. Hair Club representatives prefer the term "bonded."
Hair Club consultants help a client choose a style and take samples of his hair to match in creating his personal rug.
Every six weeks or so, you and your system return for service, about $65. At this time the hairpiece is removed and serviced - checked for wear, restyled, the dye touched up - and your real hair is cut.
The system will last about two years, at which time you'll need to replace it with a new one.
WHAT'S NEW IN TRANSPLANTS
More than 50,000 men will get transplants this year, four times the number just 10 years ago. The surgery involves taking small pieces of scalp from a donor area - usually the sides and back of the head - and relocating them to tiny holes or slits in the balding area.
The cost is between $4,000 and $20,000, depending on how bald one is and the color, thickness and texture of the hair.
The good news about a transplant is that it's permanent. That is also the bad news. Once it's up there, it's staying.
Men who have had miniature tree farms installed often spend years and tens of thousands of dollars going from doctor to doctor in hopes of having the transplant corrected. In many cases a good hair-transplant specialist can do a lot to improve the work of a bad one. But be wary of anyone who promises the world.
A transplant requires no special maintenance. It will not detach from the head when you're swimming laps at the health club. You don't have to go to a special barber to have it cut. And it spares the anxiety of having a no-touch zone atop your head.
Almost anyone is a candidate for hair transplantation using modern techniques. Men from their 20s to their 70s have had it done.
If you've lost only 20 percent of your hair, it's fairly easy to move hair from the sides and back of the head. This is the only hair you can expect to keep a lifetime and the only place from which donor hair can be safely harvested. With this hair, the specialist goes about covering the balding area.
For a man who is three-quarters bald, there's no way to make the remaining 25 percent cover the whole desert.
Take heed: Hair transplantation is not a board-certified medical specialty. Any M.D. can hang out a shingle advertising himself or herself as a hair-transplant specialist. Plus it's a very lucrative field.
"I've never seen the climate the way it is today," says Dr. Gary Hitzig, a New York state practitioner who's been in the business 20 years. "A few years ago, you'd go to a hair-transplant conference and there would be 40 or 50 of us doing this. Now there are 500 people, and the conference is an absolute circus.
"You see doctors who go to three-day courses, get themselves a certificate, and the next thing you know they're doing transplants."
An article in Men's Health magazine last year recounted a 1993 incident in which 35 physicians met at a Pittsburgh hotel to take a one-day seminar in transplant techniques. The doctors learned how to make scalp incisions in honeydew melons with faces drawn on them.
One San Diego dermatologist was quoted as saying: "It actually feels like a scalp!"
No doubt, transplant technology has advanced considerably in the past few years. Fifteen years ago, standard procedure was to remove dime-size plugs from the back of the head and relocate them.
Today, using tiny surgical tools such as those for reattaching the blood vessels in severed limbs, doctors can move single hairs to help create that all-important front hairline, minigrafts of two hairs to five hairs to blend in behind that, and grafts of six hairs to 12 hairs to add density where hair still grows.
Word to the wise: The aftermath of surgery is that the transplanted follicles go into shock and the new hair falls out. This is normal. But the follicles remain intact and grow new hair in about six weeks. In the meantime there are scabs all over your head, which heal in about two weeks.
A man with a significant bald area will require two or three sessions, four to six months apart.
WHAT'S COMING UP
One drug that may offer even more promise than minoxidil is finasteride. It is available by prescription as Proscar currently approved only to treat prostate enlargement. Finasteride blocks the metabolism of testosterone, a side effect of which is the promotion of hair growth.
In one controlled study the drug caused at least moderate growth in more than half of the 200 men taking it - making it more than twice as effective as Rogaine. As with minoxidil, however, one loses the new hair if the drug is no longer taken.
According to Dr. Joseph Neian, a hair-transplant surgeon in Buffalo, N.Y., who is affiliated with the American Hair Loss Council, one of the problems with finasteride is that it is passed along in sperm and thus could cause birth defects.
For this reason, don't expect to see it on the drugstore shelf very soon.
Lasers are making inroads to hair transplantation too. Dr. Steven Rotter, a dermatologic surgeon in Tysons Corner, near Fairfax, Va., uses an UltraPulse 5000C Aesthetic Laser for a range of cosmetic surgery, including eye and skin rejuvenation, mole and wart removal - and hair transplants.
The precise, high-energy delivery of laser light allows for gentle, virtually blood-free preparation of graft sites with less bruising and swelling, Rotter says. But lasers work by burning tissue and can damage surrounding skin. Some physicians maintain they still get better results with surgical tools.
Lasers, like so many other treatment options, hold great potential.
But while men wait for a miracle . . . we keep losing hair.