Baldilocks and the Three Hairs


Going bald is not something we men can look forward to. Exotic ‘comb-overs’ like Donald Trump’s look a little weird. However, the shaved head look isn’t all that smart either.

Male pattern baldness is a curse bestowed upon men by their fathers. Yes, chaps, the way your hair disappears depends upon the genetic disposition you inherited from your fathers. I also fully realize that some of you will say, “My father had a full head of hair until he was 90 and I am going bald at 50.” The answer is genetic heritage. Did you study the postman’s genes? Or maybe you just had a hard life.

Jokes aside, male pattern baldness (or Androgenetic alopecia, the medical terminology) results from the presence of circulating androgens (sex hormones) in susceptible individuals. The end result is the baldness beginning at the crown of your head, and it all goes on from there. Or I should say, goes off from there.

What actually happens, is that the sensitive scalp follicles are progressively made smaller by Dihydrotestosterone (the male sex hormone DHT), so the hair becomes finer and finer and eventually falls out altogether. It is actually normal to lose between 50 to 200 hairs every day – as you get older, this rate increases.

Another strange fact is that the rest of the hair on the body does the reverse with exposure to DHT. Body hair becomes darker and coarser and more copious.

Unfortunately, our appearance is very intimately involved with our own self esteem. None of us want to get older (though it still beats the alternative!) and we certainly do not wish to be reminded of this fact every time we look in the mirror.

Consequently there are many forms of “treatment” for male pattern baldness, and the range is quite extensive (and expensive). The simplest, but most unsatisfactory method is straight out camouflage. This includes spray can hair sprays that hold the hair in place and color the scalp. Unfortunately they are messy and the dye can run in the rain.

The next form of treatment is the covering wig. These come in many forms from quite good to downright dreadful. Unfortunately, the cheaper acrylic hair models are very easily detectable. Interwoven models, where the artificial hair is entwined with natural hair looks fine for a while, but have to be re-adjusted as the normal hair growth lifts the wig away from the scalp.

There are medications that can be used. The one that has been around the longest is Minoxidil, usually sold as “Regaine” and comes in 2% and 5% solutions. These have to be rubbed into the scalp twice a day for ever thereafter. The main problem with Minoxidil is that it takes two to three months before it stops the hair shedding and another four to eight months before regrowth may be apparent. On the downside, only around 50% respond and scalp irritation from the liquid is quite common.

There is also a drug called Finasteride, taken by mouth. This drug blocks conversion of androgen to DHT and the results would seem to show that for most men, hair loss is slowed or stopped and a significant proportion actually get regrowth as well. Again it is necessary to take the medication for at least three months before any change will be observed.

Finally, there is surgery to take good hair from the back and side of the scalp and transplant it into the bald areas. Again this is time consuming, and in the intermediate stages looks most un-natural. The best is transplanting individual hairs, rather than the punch graft tufts, but it is naturally longer and more expensive a procedure.

There is now another procedure called Robotic Hair replacement which my hospital has now invested in, which is like transplants, but the replacement hair is inserted by robot, with the donor site and the recipient site being very small as to be almost unnoticeable. It is also almost painless and a safer method.

So that’s the good news, gentlemen. You don’t have to go bald, but expect your wallet to get slimmer instead. The choice is yours.