The Bald­ness Busi­ness

For many bald­ing men, male sto­icism and other cop­ing strate­gies – from hats and wigs to dark hu­mour – of­ten mask deep distress. Will mod­ern medicine ever find a ‘cure’ – or does the so­lu­tion lie else­where?

Reader's Digest Asia Pacific - - Front Page - BY RHODRI MARS­DEN

When I was a teenager, my mum re­as­sured me that I wouldn’t go bald in my 20s like my fa­ther had. “Look,” she said, brightly, push­ing back her hair from her fore­head, “you’ve got my hair­line, not your dad’s.” At the time, I bought her ar­gu­ment, but within ten years her rea­son­ing had been re­vealed to be mag­nif­i­cently wrong. My hair­line had be­gun its slow march north, a clear sign that I’d in­her­ited malepat­tern hair loss from one of my par­ents, if not both of them. I pre­tended not to be both­ered at the time, and as the years went by I per­suaded my­self that my ever-shorter hair­cuts might make me look bet­ter than I used to. But deep down it felt un­fair, a ge­netic quirk I didn’t de­serve. I’d wince as the bar­ber held up the mir­ror be­hind me, re­veal­ing an ever-widen­ing bald patch. The ad­vent of so­cial me­dia gave me an ex­cit­ing new pas­time: un­tag­ging my­self from pho­tos that gave an un­flat­ter­ing per­spec­tive on my gleam­ing fore­head, which was pretty much all of them. I pre­tended not to be both­ered, but it was a pre­tence, and that pre­tence con­tin­ues to­day, in my 40s; while sto­ically ac­cept­ing hair loss as my destiny, I don’t like it. I’ve found my­self turn­ing to clas­sic cop­ing mech­a­nisms such as wear­ing hats and grow­ing a beard, fee­ble at­tempts at mis­di­rec­tion that fool no­body, least of all me.

“Hair are your aeri­als,” says Danny, the hir­sute drug dealer in the film With­nail and I. “They pick up sig­nals from the cos­mos and trans­mit them di­rectly into the brain. This is the rea­son bald-headed men are up­tight.” Danny’s con­clu­sion – that all hair­dressers are in the em­ploy­ment of the govern­ment – was drug­in­duced para­noia, but in one sense he was right: bald­ing men are of­ten up­tight, about their bald­ness, if noth­ing else. As cop­ing mech­a­nisms go, my hat and my beard are pretty be­nign ex­am­ples. But while hats and beards tend not to pro­voke any ad­di­tional anx­i­ety, it would seem that trans­plants, drugs and wigs cer­tainly do.

An­dro­ge­netic alope­cia is the med­i­cal term for this in­her­ited form of hair loss, and while it af­fects both men and women, it’s men whose anx­i­eties tend to be tar­geted by the hair­loss in­dus­try, and they are be­com­ing in­creas­ingly adept at per­suad­ing them to part with money. It’s es­ti­mated to be worth at least US$1.5 bil­lion a year world­wide, ser­vic­ing the needs of mil­lions of men. An in­ter­net search re­turns a dis­ori­en­tat­ing ar­ray of op­tions that prom­ise to al­le­vi­ate

the mis­ery of the bald­ing man: from herbal reme­dies to sur­gi­cal pro­ce­dures, from magic foams to fancy hair­pieces, from restorative sham­poos to nanofi­bre sprays for ‘colour­ing in’ bald patches. Some of them work, in that the hair loss might be less ap­par­ent (no mir­a­cle cures ex­ist), but what works for one per­son might pan out dis­as­trously for an­other. The re­sult­ing ar­gu­ments play out daily be­tween thou­sands of voices across dozens of web­sites, help­ing to gen­er­ate a smoke­screen of con­fu­sion be­hind which snake-oil sales­men can op­er­ate freely.

Spencer Steven­son started losing his hair at a young age, and he’s spo­ken widely in the me­dia and on­line about the trauma it has caused him. To as­suage his mis­ery he ended up hav­ing treat­ments cost­ing thou­sands of dol­lars, in­clud­ing 11 hair trans­plants, many of which fell way short of his ini­tial ex­pec­ta­tions. Fol­low­ing that hor­rific ex­pe­ri­ence, he’s be­come a vo­cal men­tor for those suf­fer­ing from hair loss, of­fer­ing ad­vice and de­tail­ing his suf­fer­ing at the hands of what he con­sid­ers to be a bru­tal, cut-throat in­dus­try. “It’s gov­erned by money, and there are only a few

or­gan­i­sa­tions that have the pa­tient’s best in­ter­ests at heart,” he says. “The in­dus­try has a rep­u­ta­tion for prey­ing on the vul­ner­a­ble.”


This vul­ner­a­bil­ity is rarely ac­knowl­edged, but it’s wide­spread. A 2005 study found that 43 per cent of men with hair loss were con­cerned about its ef­fect on per­sonal at­trac­tive­ness, with 22 per cent wor­ry­ing about its im­pact on their so­cial life and 21 per cent link­ing it with feel­ings of de­pres­sion. The wide­spread con­di­tion of male-pat­tern hair loss has caused distress since the year dot but is hardly talked about. His­tory tells us of men will­ing to try all man­ner of bizarre reme­dies to thwart it. In the Old Tes­ta­ment, the prophet Elisha is taunted for his bald­ness by a group of boys as he heads to Bethel; he’s suf­fi­ciently touchy about this to call on the as­sis­tance of God, who promptly sum­mons two bears to maul the boys to death. Harsh, cer­tainly – but it’s worth not­ing that God chose to ex­ter­mi­nate the taunters rather than tackle the hair loss. You can’t re­ally blame him, though: male-pat­tern hair loss is a very tricky prob­lem in­deed.

Ac­cord­ing to the UK’s Na­tional In­sti­tute for Health and Care Ex­cel­lence (NICE), the con­di­tion af­fects 30 per cent of men under 30, in­creas­ing to around 80 per cent of men over 70. Its causes are well-es­tab­lished, but poorly un­der­stood by those of us who have it. We might blame blocked pores, over-sham­poo­ing, over-brush­ing, the wa­ter sup­ply or even the reme­dies we’ve bought, but the truth is that it’s a cruel trick played by na­ture on the ge­net­i­cally sus­cep­ti­ble. Di­hy­drotestos­terone (DHT) is thought to be the hor­mone re­spon­si­ble; it’s syn­the­sised from testos­terone by an en­zyme, 5-al­pha-re­duc­tase, that’s found in the der­mal papilla, a small com­part­ment at the base of the hair fol­li­cle. This kicks off a process of minia­tur­i­sa­tion in hor­mon­ally sen­si­tive ar­eas such as the fore­head and the crown. The der­mal papilla cells re­duce in num­ber, the fol­li­cles shrink and, as the Amer­i­can Hair Loss As­so­ci­a­tion puts it, they stop pro­duc­ing “cos­met­i­cally ac­cept­able hair”.

The first con­se­quence of this is pro­gres­sive bald­ness. The sec­ond, and ar­guably more im­por­tant, is the psy­cho­log­i­cal re­sponse to it: it could be “a sense of loss of at­trac­tive­ness, a loss of youth, a loss of viril­ity, or even emas­cu­la­tion,” says An­thony Bew­ley of the Bri­tish As­so­ci­a­tion of Der­ma­tol­o­gists. He ar­gues that al­though a phys­i­o­log­i­cal change, that is, some­thing that hap­pens as you get older, “to dis­miss it as some­thing that isn’t a dis­ease, or some­thing that doesn’t mat­ter, or some­thing that’s just your hair – that’s ut­terly un­help­ful for peo­ple whose con­fi­dence is com­pro­mised.”

A bald­ing Bruce Wil­lis is widely con­sid­ered to be sexy, but this isn’t enough to re­as­sure most of us. For

ev­ery re­la­tion­ship that breaks down, fal­ters or fails to be­gin, bald­ness is fre­quently used as a scape­goat. “If only I had a full head of hair,” goes the train of thought, “things would be dif­fer­ent.” The logic is hi­lar­i­ously flawed – but it’s a seed that can grow quickly if it isn’t kept in check, and it is fer­tilised by a cul­ture that en­cour­ages bald men to con­ceal their con­di­tion, of­ten lead­ing to re­pressed anger, un­hap­pi­ness and re­sent­ment. Most health­care pro­fes­sion­als would agree that com­ing to terms with hair loss would be the best op­tion for most men, but this av­enue is rarely ex­plored by those in distress; most see the prob­lem to be tack­led is hair loss, rather than our at­ti­tude to­wards it.

“I’d say that the most des­per­ate emails, the peo­ple who sound like they’re at their ab­so­lute low­est ebb, tend to be from men,” says Amy John­son at Alope­cia UK, a char­ity of­fer­ing sup­port and ad­vice to men and women with all types of alope­cia. “They’ve not felt they’ve been able to speak to any­one else about their feel­ings, so it’s an out­pour­ing to an anony­mous per­son. But when peo­ple say it’s much harder for women, and for men it’s all right, I say ac­tu­ally, no, that’s not what I find.”

Jay Pa­tel, the co- founder of MH2Go, a wig sup­ply and fit­ting busi­ness, sits in his of­fice in cen­tral Lon­don, fid­dling with a pen as he re­counts his tale of hair loss. “About four or five years ago I tried to com­mit sui­cide,” he says, adding that this state of mind was wors­ened by body dys­mor­phia. “I was in hospi­tal for three weeks, and I got a lot of sup­port. Af­ter that I told ev­ery­one that I wore a wig, and the whole bur­den just lifted. I stopped feel­ing em­bar-


rassed, I stopped feel­ing ashamed.” I can’t help but glance up at Pa­tel’s hair­line; you’d never tell that it’s a wig. He’s a good-look­ing chap, and he’d look great with or with­out hair. But hav­ing told me about his wig, he forces a smile. He knows that I know. “I’ve turned some­thing that was an is­sue into my liveli­hood,” he says. MH2Go grew from a bed­room-based mail-order ser­vice. From the street the premises look like a reg­u­lar sa­lon, but inside Pa­tel of­fers ad­vice to peo­ple look­ing to buy wigs, while his busi­ness part­ner, Egita Rogule, styles and fits them. The price list is, by wig

stan­dards, very rea­son­able: $800 for the first and $ 400 for each sub­se­quent ‘sys­tem’, each of which should last be­tween four and six months.

Now it’s Pa­tel’s turn to look at my fore­head. “You see,” he says, “you wouldn’t be a good hair trans­plant client be­cause of the larger area to cover. It’s just not fea­si­ble.” He picks out a hair­piece from a box. “Do you want to try one? You prob­a­bly should, as you’re here.” I’d al­ready de­cided be­fore my visit that I didn’t want to have a fit­ting, that I didn’t want to em­u­late El­ton John or, for that mat­ter, Burt Reynolds. But I bite the bul­let and sit down in front of a mir­ror. “So, this isn’t made for your head shape, or any­thing,” he says, “and it’s black hair, so it’s not your colour. Just imag­ine that it’s grey.” Pa­tel puts it into po­si­tion and stands back. “Ac­tu­ally,” he says, “it looks quite good.” I’m in­clined to agree with him – but at the end of the day, it’s a wig. I’m wear­ing a bloody wig.

“I do my con­sul­ta­tions in a way that makes peo­ple aware of what they’re get­ting them­selves into,” says Pa­tel. “I say, look, it’s a wig. It’s never go­ing to be your own hair. We’ll make it look the best we can, but you’re still

wear­ing a wig.” His hon­est ap­proach stems from a bit­ter ex­pe­ri­ence he had in his early 20s, when he paid a com­pany many thou­sands of dol­lars for a se­ries of wigs that lasted just a few weeks. “I ran out of money, I was only 23,” he says. “But I was locked in with them. It’s like a drug, they were my sup­pli­ers.” The na­ture of wig fit­ting, which re­quires the top of the head to be shaved be­fore it’s glued or taped, means that once you’re in the game it’s not easy to get out.


Nadeem Ud­din Khan, di­rec­tor of the Har­ley Street Hair Clinic, knows how pain­ful the ex­pe­ri­ence of hair loss can be. “I’m just look­ing for a pic­ture of my­self,” he says, flick­ing through his phone. He turns it around to show me: it’s a pic­ture of a bald­ing guy, good-look­ing, per­haps slightly self-con­scious. Again, I in­stinc­tively look back up at his cur­rent hair­line: it’s neat, buzz-cut and very dif­fer­ent from the photo. “That was about ten, 12 years ago,” he says, putting his phone face down on the ta­ble. “When I lost my hair it was just ter­ri­ble. A year of not go­ing out. So I un­der­stand what th­ese guys go through.”

Khan was one of the first peo­ple in the UK to un­dergo the FUE (fol­lic­u­lar unit ex­trac­tion) method of hair trans­plan­ta­tion, which his clinic now spe­cialises in. FUE is re­garded, par­tic­u­larly by younger men, as a suc­cess­ful, mod­ern sur­gi­cal pro­ce­dure with min­i­mal stigma. This may be largely down to English foot­baller Wayne Rooney’s two hair trans­plants, both per­formed at Khan’s clinic. “He’s been a great am­bas­sador for us, and for hair trans­plan­ta­tion in gen­eral,” says Khan. “It’s led to a mas­sive spike of in­ter­est from all around the world.”

Af­ter don­ning some pro­tec­tive cloth­ing, I’m led into a surgery, where a man is ly­ing on his back as a doc­tor uses a tool to make in­ci­sions in his fore­head. He spent the morn­ing ly­ing on his front as fol­li­cles were ex­tracted from the back of his head; later they’ll be popped into their new lo­ca­tion. He con­fesses that he’s a bit bored, but he’s look­ing for­ward to the re­sults. It’s his sec­ond op; he was so de­lighted with the re­sults of the first that he’s come back for an­other. Rooney, again, turns out to have been the cat­a­lyst.

All hair trans­plants are based on the prin­ci­ple of donor dom­i­nance, de­vel­oped in the 1950s by New York der­ma­tol­o­gist Nor­man Oren­tre­ich: a trans­planted fol­li­cle doesn’t know it’s been moved; it just con­tin­ues to grow as if it had been left where it was. Fol­li­cles taken from the back and the sides of the head – ar­eas that aren’t sen­si­tive to the minia­tur­i­sa­tion caused by the hor­mone DHT – ‘re­mem­ber’ their lack of sen­si­tiv­ity when trans­planted into bald ar­eas. By the 1980s, ex­per­i­ments with graft­ing had de­vel­oped into a pro­ce­dure known as FUT (fol­lic­u­lar unit

trans­plan­ta­tion) or strip surgery. A strip of the scalp is re­moved and cut into very small seg­ments, which are then in­serted into small holes in the af­fected area. It’s a quicker pro­ce­dure than FUE, and is con­sid­ered by some to be the best way of har­vest­ing high-qual­ity hair. How­ever, it leaves a long scar where the strip has been re­moved. This scar­ring, along with a num­ber of poor-qual­ity pro­ce­dures un­der­gone by high-pro­file celebri­ties, has given FUT a bad rep­u­ta­tion, which may not be en­tirely de­served.

FUE clin­ics tend to be quick to den­i­grate FUT, but FUE also has its draw­backs. As I wit­nessed at the Har­ley Street Hair Clinic, it’s a gru­elling process that re­quires great con­cen­tra­tion and stam­ina on the part of the physi­cian, and enor­mous pa­tience from the pa­tient. Thou­sands of in­di­vid­ual fol­li­cles are se­lected from across the donor area, ex­tracted with a spe­cial tool, kept chilled, and later trans­planted into tiny in­ci­sions. “The pro­ce­dure for me – around 3000 grafts – was so labour-in­ten­sive that it took all day,” says one man who re­cently un­der­went an FUE trans­plant in Aus­tralia.

Ex­per­tise is the key to a good FUE trans­plant, ac­cord­ing to Khan. “The trans­plants should be done by a physi­cian who knows what they’re do­ing,” he says. “The right fol­li­cle has to go in the right place. Mother Na­ture doesn’t work in straight lines. Th­ese lit­tle de­sign de­tails are crit­i­cal.” Khan shows me the first post-op pho­to­graphs of the man whose pro­ce­dure I just wit­nessed. They’re great.

Sadly, not ev­ery­one per­form­ing th­ese op­er­a­tions pays close at­ten­tion to de­tail. “There are tens of thou­sands of clin­ics,” says Spencer Steven­son. “Of­ten you have nurses per­form­ing surgery in the back of a den­tist’s! It’s un­be­liev­able. In Turkey there’s a con­veyor belt of pa­tients be­cause it’s so cheap, but money and ge­og­ra­phy should be the last con­sid­er­a­tions. As dif­fi­cult as it is to go and have surgery, it’s a thou­sand times more dif­fi­cult once you be­come a re­pair pa­tient.”

Given the risks as­so­ci­ated with dodgy clin­ics, why do men put them­selves through this? The sense that a head of hair be­stows us with greater mas­culin­ity and sex­ual ap­peal is ev­i­dently very deep-seated, and it’s not some­thing the in­dus­try has ever rushed to dis­pel. In June 2016 the Farjo Hair In­sti­tute, an ac­claimed Bri­tish FUE trans­plant clinic, re­leased the re­sults of an ex­per­i­ment it had done with a pa­tient us­ing the dat­ing app Tinder. The re­sults, breath­lessly re­ported by the me­dia, showed that the pa­tient’s post-trans­plant pic­tures re­sulted in 75 per cent more matches than pre-trans­plant. There was lit­tle sci­en­tific rigour in this, but men only seem to re­quire a small amount of anec­do­tal ev­i­dence to re­in­force their be­lief that male-pat­tern hair loss is in­her­ently unattrac­tive.

“I used to have re­ally thick hair,” says Jay Pa­tel, wist­fully. “Es­pe­cially in

our cul­ture, South Asian cul­ture, if you don’t have hair, you’re not go­ing to get mar­riage pro­pos­als. You see all your friends and your cousins, they all have amaz­ing hair, but you’re suf­fer­ing from hair loss.” Pa­tel tells heart­break­ing sto­ries of clients who ar­rive at his shop who are clearly trau­ma­tised. “One guy spent half an hour stand­ing out­side be­cause he was too scared to come in and even dis­cuss hair loss,” he said. “He even­tu­ally came in, wear­ing a ban­dana, which he was re­ally re­luc­tant to re­move. He wanted to make sure the door was closed. Then he asked who was go­ing to style his hair. I said it would be my col­league Egita, and he said that he didn’t want a woman to see him like this.”

Clin­i­cal psy­chol­o­gist Paul Gil­bert ar­gued in a 1997 pa­per that our drive to be per­ceived as at­trac­tive is in­nate, and feel­ings of shame and hu­mil­i­a­tion re­sult from neg­a­tive re­ac­tions, par­tic­u­larly in the mod­ern age, when those neg­a­tive re­ac­tions are eas­ily ex­pe­ri­enced via dat­ing apps and re­in­forced by the me­dia, who of­ten re­fer to the ‘mis­ery’, ‘suf­fer­ing’ and ‘hope’ of those with the con­di­tion. “The re­al­ity of West­ern cul­ture,” says con­sul­tant der­ma­tol­o­gist An­thony Bew­ley, “is that young is beau­ti­ful, more suc­cess­ful, more at­trac­tive. Sadly, if you are older, uglier, scarred and bald, it’s not just about what that means in terms of your abil­ity to suc­ceed or be at­trac­tive; it’s also, sadly, marked out as be­ing less wor­thy.”

Faced with three op­tions that all have dis­ad­van­tages – the stigma of wig-wear­ing, in­va­sive sur­gi­cal pro­ce­dures or do­ing noth­ing what­so­ever – a com­par­a­tively easy way of treat­ing male-pat­tern hair loss might seem to be drugs. From the reams of sales pitches and glow­ing tes­ti­mo­ni­als for var­i­ous foams, sprays, creams and tablets, you’d think that among them there would be at least one drug, one magic so­lu­tion, that would make hair mirac­u­lously re-sprout from a bald pate. But this isn’t the case. There are just two ap­proved drugs on the mar­ket, mi­nox­i­dil and fi­nas­teride, and it’s gen­er­ally agreed that nei­ther can re­verse hair loss but merely de­lay the in­evitable.

The link be­tween mi­nox­i­dil and hair growth was first no­ticed in the 1960s, and the US Food and Drug Ad­min­is­tra­tion ap­proved it as a hair-loss


treat­ment in 1988 with the pro­viso that it “will not work for ev­ery­one”. Tri­als have shown some form of re­growth in as many as 80 per cent of pa­tients, but a 2015 sys­tem­atic re­view of the ef­fi­cacy of mi­nox­i­dil stated that “cos­met­i­cally ac­cept­able re­sults are present in only a sub­set of pa­tients”. Mi­nox­i­dil is avail­able as an over-the­counter top­i­cal med­i­ca­tion under such promis­ing-sound­ing names as Hair Grow, Hair-A-Gain, Hair­way and Splen­dora; in the UK, US and Aus­tralia it’s usu­ally known as Ro­gaine or Re­gaine. “It’s a bit of a bandaid,” says Steven­son. “It’s a good add-on as part of your regime, but on its own it’s not go­ing to get you too far.”

Fi­nas­teride, mean­while, has been avail­able for hair growth under the name Prope­cia since 1997. Its work­ings are bet­ter un­der­stood than mi­nox­i­dil’s ( it’s thought to in­hibit the 5-al­pha-re­duc­tase en­zyme in the der­mal papilla) but some of the side­ef­fects listed by the US Food and Drug Ad­min­is­tra­tion ( FDA), in­clud­ing erec­tile dys­func­tion, li­bido dis­or­ders, ejac­u­la­tion dis­or­ders and or­gasm dis­or­ders, can put men off. “There are mil­lions of peo­ple tak­ing fi­nas­teride with no side-ef­fects,” says a dis­grun­tled Steven­son, “but you don’t hear from them. All you hear is the mi­nor­ity of peo­ple who have, and they put the fear of God in ev­ery­body.”

No other med­i­ca­tions for malepat­tern hair loss are li­censed by the FDA or its Euro­pean and Aus­tralian equiv­a­lents, but there are many di­etary sup­ple­ments with med­i­cal-sound­ing names that claim to pro­mote healthy hair growth. While there may be a link be­tween poor nu­tri­tion and some forms of hair loss, there’s no men­tion of di­etary sup­ple­ments in the NICE guid­ance on an­dro­ge­netic alope­cia. Nev­er­the­less, the rel­a­tive mer­its of sup­ple­ments such as TRX2 and Vivis­cal are vig­or­ously de­bated on­line.


While those ar­gu­ments con­tinue, the pur­suit of a won­der drug con­tin­ues, with dozens of com­pa­nies keen to reap the fi­nan­cial re­wards. One such com­pany, Al­ler­gan, has two po­ten­tially promis­ing drugs un­der­go­ing tri­als: a top­i­cal one, bi­mato­prost, which was orig­i­nally a treat­ment for glau­coma and was ap­proved by the FDA in 2008 to as­sist with the growth of eye­lashes; and an oral med­i­ca­tion, setip­iprant, which in­hibits a com­pound (prostaglandin D2) that’s found to be el­e­vated in bald­ing scalps. An­other com­pany, Sa­mumed, has re­cently picked up a huge amount of press in­ter­est for an­other po­ten­tial treat­ment, SM04554, but some ex­perts have found their clin­i­cal data to be less im­pres­sive than their mar­ket­ing acu­men.

Dif­fer­en­ti­at­ing bold claims from promis­ing av­enues can end up be­com­ing a full-time job, ac­cord­ing to Su­san Holmes, a hair-loss ex­pert at the Bri­tish As­so­ci­a­tion of Der­ma­tol­o­gists. “If we’re asked to com­ment

on th­ese things,” she says, “it’s weeks of re­search to go through the lit­er­a­ture. What we want to see is good ev­i­dence in a re­search pa­per, re­search that’s been done prop­erly, that’s been peer-re­viewed. A lot of the lit­er­a­ture is in small jour­nals where it’s dif­fi­cult to know who’s re­viewed it and what process it’s gone through. There’s a lot of re­search be­ing done, and a lot of av­enues look in­ter­est­ing, but it’s a ques­tion of whether they come through all the rig­or­ous tests to be­come an ef­fec­tive treat­ment. Hair is just a dif­fi­cult thing to make grow.”

Hair is just a dif­fi­cult thing to make grow. This should be the dis­claimer on ev­ery medicine, ev­ery ‘nat­u­ral’ sup­ple­ment, ev­ery web­site that claims to of­fer treat­ments for hair loss, but in­stead they choose to sell false hope. “A cure is al­ways five years away,” says Steven­son, with a laugh. “In five years, it will be five years away – in ten years it’ll be five years away. It’s the Holy Grail. But I think cloning will be a mas­sive in­dus­try.”

Suc­cess­ful cloning of hair fol­li­cles could give trans­plant pa­tients a more plen­ti­ful source of hair; cur­rently that source is re­stricted to their very valu­able but very lim­ited donor area. “Hair

cloning, neo­ge­n­e­sis, in­duc­tion, it’s all the same thing,” says Claire Hig­gins, a lec­turer in the Depart­ment of Bio­engi­neer­ing at Im­pe­rial Col­lege Lon­don, “but it’s re­ally hard to do.” In a 2013 pa­per, five sci­en­tists in­clud­ing Hig­gins de­scribed how they man­aged to ini­ti­ate neo­ge­n­e­sis in hu­man skin with­out last­ing re­sults. “I think it will work, long-term, but in our lab we’re try­ing to map out the ge­netic changes that are oc­cur­ring be­fore try­ing in­duc­tion again.”

Hair re­growth may not be the spe­cific fo­cus of her re­search, but Hig­gins be­lieves that the psy­cho­log­i­cal is­sues caused by male-pat­tern hair loss make that work more valu­able. “Peo­ple won’t leave the house,” she says. “It’s not life-threat­en­ing, but it is life-chang­ing.” It cer­tainly changed Jay Pa­tel’s life, al­though he now feels that he’s pulled things around. “I’m 37 now,” he says. “I was 23 when I started losing my hair, so it took me a long time. I wasn’t a con­fi­dent per­son. I went through a lot of hard­ship to get where I am.”

Su­san Holmes mourns the lack of psy­cho­log­i­cal sup­port avail­able. “There are many peo­ple with many dif­fer­ent dis­or­ders who re­quire the in­put of a clin­i­cal psy­chol­o­gist. We know we can’t cure hair loss, we know that what men need is help to come to terms with it.” But given our poor track record, is there any like­li­hood that bald­ing men like me will ever rel­ish our slow shed­ding of hair?

Mi­lan Stolicny hopes so. His web­site, bal­dat­trac­, of­fers a joy­ous, up­beat ap­pre­ci­a­tion of bald­ing heads, and be­seeches men with re­ced­ing hair­lines to re­claim their bald­ness and rel­ish the new per­spec­tive it gives them.

“Bald is very at­trac­tive!” he says. “Bald can wildly suc­ceed in this world! It’s time to kick ass and wildly suc­ceed as a bald man!” Stolicny of­fers no quack­ery, no reme­dies, po­tions or bal­sams – just en­thu­si­asm. “The true bald­ness cure,” he says, “is to be­come an at­trac­tive bald man!” In other words, be­lieve in your­self. It looks so easy, writ­ten down. If bald­ing men were able to do such a thing, a huge in­dus­try would col­lapse overnight. But that in­dus­try knows only too well that Stolicny’s so­lu­tion, while beau­ti­fully sim­ple, is per­haps the hard­est of all to achieve.

Hair loss usu­ally be­gins at the tem­ples, with the hair­line grad­u­ally re­ced­ing

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