Pattern baldness, the unwanted crown of inheritance, occurs in about one man in three by the time he reaches 35. By the age of 45, as aging joins heredity in the conspiracy, nearly one man in two is noticeably losing his hair.
Those unwilling to accept their fate often turn to a panoply of treatments and procedures that promise to retard or reverse the balding process -- from inexpensive concoctions of wheat germ oil and vitamins to hair-transplant surgery that can cost more than $10,000.
Maurice Mann didn't have to wait until midlife to get desperate. He was well on the way to losing his hair before he finished college. During the next few years, he tried dermatologists, potions, hairpieces, and hairweaving -- all with no noticeable success. Finally, in 1970, Mann founded Hair Again Medical Group in New York City, and developed, with the help of two doctors, a process for permanently attaching a blend of real and synthetic hair to the scalp. Today his patented cosmetic surgery suture process -- a mainstay of the business -- is done by Hair Again's staff, together with private physicians.
Mann's one-day suturing process costs from $3,000 to $3,500 and has been used on about 11,000 men. First, a doctor puts sutures into the anesthetized scalp. Then he attaches little strips of synthetic and replacement hair to the suture to match the client's own hair. "We do this in overlapping tiers," explains Mann, "like shingling a roof."
After the synthetic hair is attached, it is cut and styled. According to Mann, the person can swim and shower, and, as long as the scalp is kept clean, he suffers no ill effects. Mann offers his own testimony: 12 trouble-free years.
Mann says his suturing process differs from fiber implantation, which involves inserting synthetic, hairlike fibers into the scalp and is now illegal, according to the Food and Drug Administration.
But to dermatologist Marvin I. Lepaw and many of his medical colleagues, the distinction between the suturing process and fiber implantation is irrelevant. Dr. Lepaw, an assistant professor of dermatology at the State University of New York at Stony Brook, opposes any procedure that leaves permanent holes in the skin. "When you leave open the portal of entry and portal of exit created by a suture," he says, "there's high risk of infection."
When Dr. Lepaw evaluates a man's hair loss, he looks first for conditions that may cause or contribute to the balding, such as fungus infection, high fever, iron deficiency, hormonal imbalances, heavy metal poisoning, and malnutrition caused by crash dieting. If hair starts falling out suddenly, disease is probably responsible.
Dr. Lepaw also believes that severe dandruff (seborrheic dermatitis) aggravates hereditary hair loss. As a preventive measure, he advises as many as three scrubbings and rinsings in a minute's time, on a daily basis.
Shampooing also washes away some of the male hormone dehydrotestosterone that surfaces on the scalp along with natural oils. If the hormone accumulates and gets reabsorbed, it acts on the hair follicles to slow or halt hair growth. Deposition of male hormone, says Lepaw, "is the precipitating factor in genetic hair loss." It's the male in male-pattern baldness.
To counter this effect, doctors apply low doses of female hormones directly to the scalp, which thereby neutralizes the male hormone. Dr. Lepaw reports a 50% success rate: "I have not been able to grow hair back," he says, "but I have been able to arrest rapid hair loss -- for an indeterminate period."
Another drug that has many dermatologists excited is minoxidil, introduced nearly three years ago to treat severe hypertension. Patients who took minoxidil complained of hair growth, ofter in undesirable places. Although no one has figured out how the drug makes hair grow, researchers think an increased blood flow in the skin may be the reason.
Some dermatologists immediately saw the drug's potential use for victims of baldness. They applied a 0.007% to 1% solution of minoxidil every 12 hours to bald areas and discovered that hair grew within three months. The drug is now being studied in cases of pattern baldness.
Alleged hair growers and baldness preventives sold over the counter came under the scrutiny of the FDA recently. An FDA-appointed panel of doctors and scientists evaluated such drugs and found them ineffective. The FDA is moving to ban all over-the-counter restorers, an order that could come by the end of the year, according to FDA spokesman Edward Nida.
Of all the cosmetic methods of coping with baldness, hair transplant remains the one most widely accepted by doctors. They have been moving hair from where it is to where it isn't for about 30 years. Done in the doctor's office, transplantation involves anesthetizing the donor and recipient areas and cutting out cylindrical plugs of skin measuring 3/16 of an inch wide and 1/4 of an inch long. Each donor graft taken from hairy sections of the scalp contains about a dozen of the follicles from which hair grows. Cylinders of tissue the same size are punched out of the bald scalp and a hairy plug is inserted into each hole. No sutures are needed because blood clots around the plug and holds it in place while the skin grows. The donor sites also heal and disappear.
Doctors usually do 40 or 50 grafts in a two-hour session and wait a month between sessions. A balding crown or moderately receding hairline requires about 150 plugs, while a Phil Silvers -- type pate may need 400 to 600, depending largely on the width and thickness of the remaining fringe.
Although some doctors have transplanted 600 plugs or more, the most Dr. Lepaw has done is 440. "You can't keep borrowing from Peter to pay Paul without eventually bankrupting Peter," he says. At his price of $20 to $25 a graft, the cost of an extensive job could reach $11,000. Cosmetic treatment is only sometimes tax deductible or covered by medical insurance.
Dr. Lepaw, who has done more than 6,500 transplants over the past 17 years, says the procedure isn't for everyone. When a transplant is requested, Dr. Lepaw first determines whether the patient is still losing hair rapidly. Transplanting before baldness has stabilized increases the chance of a bad result. There must also be enough hair in donor areas.
Dr. Lepaw takes a careful medical history of each patient in order to exclude people who have such conditions as diabetes, cardiovascular problems, and psoriasis, as well as those who bleed excessively or scar badly. He turns away more than 25% of the people who request a hair transplant.
If the prospect of tangling with all these options makes your head spin, you could just learn to grin and bear your bareness. "Bald is beautiful!" proclaims the Bald-Headed Men of America, a steadily growing 9,500-member organization based in, of all places, Morehead, N.C. "If you don't have it," the group says "flaunt it."
The Bald-Headed Men of America seem to have settled on a highly effective remedy for coping with hair loss -- a dollop of humor. Parodying all the hair treatments on the market, the association offers its favorite, a tart concoction of alum and grapefruit juice. "Applying this mixture will not make hair grow," admits the group's headstrong founder and executive director, John T. Capps III, "but it will shrink your head to fit whatever hair you have left."