Even with all the ribbing by comedians and ex-wives, the majority of the 40 million bald men in the United States eventually accept their shiny pates.
But some 10 percent apparently think they must look like chopped liver: Collectively, they will spend more than $1 billion a year on shampoos, hair pieces, lotions, pills and follicle transplants to cover up their exposed craniums.
Baldness Treatments Cost Money
Men spend the most on hair transplants, to the tune of $800 million a year, according to Mary-Fran Faraji, spokeswoman for Pharmacia Consumer Health Care, in Peapac, N.J., which manufactures Rogaine, an over-the-counter lotion for baldness. That’s because each transplant can cost from $3,000 to $20,000.
Next come hair systems, also known as toupees and hairpieces, which bring in $250 million annually.
Medical therapies, including Rogaine, Merck & Co.’s Propecia and private label brands, add up to $225 million.
Men also will spend some $60 million on vitamins and nutritional supplements in a bid to grow back hair.
The typical guy who wants to do something about his baldness, according to Dr. Bobby Limmer, a dermatologist with the International Hair Institute in San Antonio, usually goes through a series of more and more aggressive steps before he will proceed with the most invasive procedure — a hair transplant.
They first try the grooming agents, the shampoos, lotions and conditioners that promise to “grow hair.”
“They don’t work,” says Limmer, who has been in practice for 32 years, but some give the illusion of a thicker head of hair. Products that contain degreasing agents, such as polysorbate 40 and 80, make the hair look fluffier.
The next approach, Limmer says, is personal grooming: growing the ponytail, combing over the remaining hairs or getting a permanent wave, which curls the hair to give a fuller appearance.
When the three hairs across the top no longer create a sufficient illusion, men will then venture into medical remedies. Rogaine, a lotion of minoxidil, is sold without a prescription in two strengths.
Putting on Creams and Wigs
Rogaine keeps hair from falling out if someone starts using it early in his hair loss, says Limmer. Only about 5 percent in his practice have been able to grow cosmetically beneficial hair; the other 30 percent will grow a peach-fuzz type of covering.
The downside to Rogaine is that men don’t find it easy to use, Limmer says. They have to apply it two times a day. Although women are used to putting on creams and lotions in the morning and the evening, men aren’t. The vast majority, Limmer says, may try it for a year, but then give up.
Somewhere between Rogaine and more aggressive treatments is when men might start with a hair system, or essentially a wig to cover their balding.
“Hair systems have improved and look more natural now,” Limmer says, but they can be costly to keep up. The pieces themselves vary in price, from $600 to $2,000, but maintenance can cost up to $100 to $200 a month. Men need two pieces, one to wear and one that gets cleaned.
If the hair system gets too complicated or the Rogaine is too annoying, some men might consider going even further — taking a prescription for Propecia, a drug that inhibits the enzyme that converts testosterone to 5 dihydrotestosterone, or 5 DHT.
Most male pattern baldness is due to the accumulation of 5 DHT in the hair follicles preventing the hair from growing, explains Dr. Gary Hitzig, a hair transplant surgeon from Rockville Centre, N.Y. The cause is genetic, with genes from both mom and dad contributing to the way a man becomes sensitive to 5 DHT.
Popping a Pill
Propecia is a drug that blocks the formation of 5 DHT. At 1 milligram it is used for hair loss treatment; at 5 milligrams, doctors use it to treat prostate conditions.
Before a doctor would give a prescription for Propecia, he or she would take a medical history, says Hitzig. Certain drugs, for example, can cause hair loss, such as certain high blood pressure medications and diuretics. After ruling them and other diseases out as factors, Propecia might be recommended.
The problem with Propecia is that some men of the men who take it — less than 2 percent — experience some sexual dysfunction, such as impotence or reduced sperm volume. “That is too high a price to pay to treat baldness for some men,” Hitzig says.
Chris Fanelle, a spokeswoman for Merck & Co of West Point Pa., says any sexual side effects go away in men who stop taking the drug. They also disappeared in most men who continue taking Propecia.
Doctors suggest men also must take a prostate specific antigen test before they start taking Propecia to obtain a baseline level of this diagnostic marker for prostate cancer. The drug cuts the PSA levels in half.
Propecia is effective in growing good hair, doctors say. In Limmer’s practice, 66 percent get good coverage, compared to 5 percent for Rogaine. But Hitzig does not recommend that men who are trying to get their wife pregnant use the drug, even though there is no evidence that it does damage. The packaging on the drug says pregnant women should not touch the pills, he says. “It concerns me,” he says.
Going Under the Knife
Finally, if impotence scares the guy away, then he may be willing to go under the knife and needle for follicle transplants. “Don’t go to a surgeon or dermatologist that still uses plugs,” says Limmer. The state-of-the art is follicular transplants, in which groups of one-, two-, three- and four hairs from hairy areas on the head are implanted into tiny holes in the balding area. Single hairs are used to create a hairline.
The extent of the baldness determines how many grafts need to be performed. The “chrome-dome” may need about 4,000 to 10,000 grafts, while a receding hairline only 1,000 to 3,000. Each procedure requires a seven-day healing period, with hair not showing up for 90 days. Groomable hair usually sprouts in six months, with the full benefit accruing in nine months to 12 months.