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The Battle Against Male Pattern Baldness - 2003-06-25

At some point in their lives, half of all men will confront a medical condition that's not life-threatening but that many treat as if it were disfiguring. It's male-pattern baldness, the steady erosion of the hairline around the temples and on the crown of the head. Women confront hair loss, too. Anxious, balding men are the prime target of a $3.5 billion industry promoting hair restoration.

But what if there's no hair to run your fingers through? Nobody writes romantic songs about the wind wafting across a bald scalp.

Chris Webb, publisher of the National Hair Journal, a five-year-old print and online magazine for the hair-management industry, says that for men in American culture, a full head of hair is a personal statement, a mark of identity.

"It's what teenagers use to assert their individuality. They grow their hair to make their parents mad, or they shave their heads to show that they can do it. But it's traditionally been a form of personal expression," Mr. Webb said.

Thick hair on a man is associated with virility and power, going back to the biblical story of the Israelite Samson, whose superhuman strength was embodied in his hair.

But baldness is equated, if only in the mind of the man experiencing it, with aging, meekness, and unattractiveness to the opposite sex.

There are exceptions, men who are bald or who shave their heads because it looks sexy. Tennis star Andre Agassi, actors Sean Connery and Bruce Willis, and basketball legend Michael Jordan come to mind. Movie idol Yul Brynner, too, among an older generation.

But by and large, baldness is something American men dread and spend billions of dollars to fight. Therapists see balding men who report diminished self esteem, even depression, and an obsession over their perceived loss of vitality and sex appeal.

Dermatologist Diane Hoss, who specializes in treating hair loss at the University of Connecticut Health Center, says, contrary to popular belief, the genetic condition of baldness is inherited from either side of the family. And in almost all cases, despite appearances, people are not truly bald at all. There is hair there, difficult though it may be to find.

"Two things are happening," Ms. Hoss said. "A single hair follicle will produce a growing hair for about three to five years. And then the follicle will rest for about three months. And then it sheds. And then a new hair grows up behind it."

But in male-pattern balding, the growth, resting, and shedding cycle lasts just months. And all the while Ms. Hoss said. "The follicle is actually miniaturizing, becoming smaller," she said. "And a smaller follicle produces a smaller hair. The hair will become so small that you can't see it. It's like what's on a woman's cheek. If you did a biopsy, there's a similar amount of follicles as to a man who has hair, but every follicle is just really tiny and producing hair that's cosmetically insignificant."

And a balding man, too, can feel less significant. Just ask 38-year-old Spencer David Kobren. When he was 22, working for his father in the clothing business, he noticed strand after strand of hair sticking to his hairbrush. Soon, he says, he was suffering from what he calls "a disease of the spirit" brought on by his hair loss.

"I was devastated to say the least. I was mortified," he said. "And, you know, people have been hiding it [hair loss] from their wives, hiding it from their girlfriends, hiding it from their brothers and their cousins, hiding their pain. It's silent suffering. You should try it one day: shave your head in a male-pattern baldness pattern, not completely bald. See what kind of reaction you get. You know, if you're 18 years old or 21 years old, and you walk into a bar, and your hair is thinning, you don't even have a chance [of attracting women]. You are done! All of a sudden, they're 'the bald guy.' People make comments, jokes. It's why people are buying rugs and plugs and drugs and getting butchered by doctors."

"Rugs," meaning hairpieces, or "hair systems," as they're now called. When poorly made or applied, these can look like dead animals plopped atop one's head. By "plugs," Mr. Kobren refers to hair transplants. For those who can afford them, the procedure can involve the surgical move of individual hairs from one part of the head to the other.

And there are two widely accepted hair-rejuvenating drugs. One is minoxidil, which in solution, rubbed on areas where a peach-fuzz growth still exists, has been shown to arrest hair loss, at least for awhile. The other medication, taken in pill form, is a version of Proscar, a drug prescribed to treat an enlarged prostate. It has been shown to grow some thin hair by blocking enzymes called androgens that play a role in balding.

Magazine editor Webb says that just about every other elixir is little more than snake oil.

"You'll find everything from extract of sap from trees in the Amazon to herbal formulae discovered by monks high in the Himalayas. So it's extremely confusing for the consumer to know who to trust," Webb said.

Early-on in hair loss, many men also try cosmetic approaches, from sprinkling colored fibers throughout their existing hair to fluffing up what's left with thickening shampoos.

Hair-loss sufferer Spencer Kobren went to work as a medical administrator for a health-care system, but his obsession with hair, if not his hair itself, grew. He wrote a best-selling paperback book called The Bald Truth and began a weekly radio program of the same name, devoted just to baldness. Now living in Los Angeles, he makes his living from that show, selling advertisements to companies and hair-transplant providers whom he trusts. On the radio show Mr. Kobren, who has regrown some thin hair but has a receding hairline, rails against what he calls "quacks" who sell overpriced and worthless drugs and offer treatments that can permanently disfigure men and women.

"It's like the Wild West," Mr. Kobren said. "And I was the first person to come in here and try to regulate it. And you know what? I'm resented for it. The doctors don't like me for it. The industry itself despises me because of it."

But some men have come to terms with their balding. Jim Karpen, 53, a writing teacher in Fairfield, Iowa, for instance, is, as he puts it, "pretty thin on top." He believes this has actually improved his appearance, accentuating his large, blue eyes.

Karpen: You can kind of pretend that you're not aging, but once the hair starts to go, baldness is so clearly associated with being old that I think it's a shock for a lot of people.

Landphair: Do you think it makes you seem older than you really are?

Karpen: Well if it does, I really don't mind.

Landphair: You're real mellow about all this, aren't you?

Karpen: Yeah, I guess I just feel comfortable with who I am. I think it's better not to hide it, or not to try to hide it.

The same goes for a man half Mr. Karpen's age. David Doughty, 25, a recent college graduate who is working here at the Voice of America this summer, was surprised to find his hairline receding, since both his mother and father have full heads of hair. He says he has caught himself looking at late-night programs called "infomercials" for hair treatments and felt, "this is really pathetic."

Doughty said, "But ultimately, to me, it's sort of vanity. And in the end, that's a trivial matter. What lands successful relationships is a matter of personality and not what's on the outside. It's not the end of the world. But, at the same time, yeah, it's disappointing. It's not the best thing in the world. I think the 'don'ts' of baldness, if I might, are simple: Don't grow your hair long on the sides. And whatever you do, don't grow your hair long on the sides and then comb it over. 'Cause that looks ridiculous."

Noam Dromi, 27, who runs a video-game company in Los Angeles, had a bald spot by age 16, when a young man's fancy often turns to girls. "I felt like a freak," he says. He could not afford a hair transplant but says he tried supplements, shampoos, pills. Nothing worked. By his early twenties, he says, he accepted the inevitable. Now he shaves his head and reports success on the dating front.

"I've come to a place in my life where I don't feel lacking," Mr. Dromi said. "I don't look at them and draw a comparison between me and them. I've met plenty of women with whom I've been romantically involved who have said that character in men who aren't stereotypical, good-looking guys is more interesting to them."

This is not entirely wishful thinking. Women like 30-year-old Meredith Radow, who's single, selling television advertising in New York City, and actively dating men, say they find bald or balding men intriguing.

"The men I know who are in the process of losing their hair, have already, or who choose to shave their heads, it seems like they are funnier and more self-assured," she said. "I don't know if that's come from, I don't know, having to overcompensate for that, or, you know, if a person feels very secure in who they are."

But here's what Spencer David Kobren of The Bald Truth radio show says to people like Noam Dromi and Meredith Radow.

He said, "Get the exact same guy who has the exact-same personality, a clone, but one has hair and the other doesn't have hair; one has a male-pattern baldness pattern and one has a full head of hair, who would you pick? They always go for the guy with the hair."

While balding men face three choices, try to regrow hair using, supplements, hide their hair loss with weaves or transplants, or accept their vanishing hairlines, scientists are at work on two fronts. They are attempting to isolate the gene or genes responsible for hair loss. And they are attempting to grow follicle cells from a balding man's own healthy follicles.

But there are no miracle cures yet for male-pattern baldness and all of the psychological scars that go with it.