A man’s scalp is covered by about 100,000 hair follicles, which pass through continual cycles of growth, rest and occasional death. Normally the scalp loses roughly 100 hairs a day and sprouts 100 new ones. But the sex hormone testosterone can upset this break-even dynamic. Testosterone–in the form of DHT, or dihydrotestosterone–stimulates hair growth on the face and the body. But in men who carry a certain common gene, the same hormone gradually defoliates the scalp, causing their aging heads to grow shiny even as their ears, noses and shoulders sprout more hair.
Some men turn to scalp surgery and hair transplants to reverse this tide, others to wigs and toupees. But the holy grail is a pill or potion that will restore natural hair growth. In 1989, the Food and Drug Administration cleared the shelves of many worthless products that had been foisted on gullible men for generations. Only two medications–minoxidil (Rogaine) and finasteride (Propecia)–have been left standing. And though either can help, neither is miraculous and both are expensive.
Minoxidil is sold in pill form as a treatment for high blood pressure. When applied topically as Rogaine lotion, it can prolong the hair follicles’ growth phase. Unfortunately it works only on follicles that are still active, and it works only when used regularly. Rogaine is more effective for bald spots than for receding hairlines, but even then the benefits are usually modest. In one study, only 36 percent of men who had used the product for several years thought it was worth the time and money.
Finasteride is the active ingredient in Proscar, an oral medication that eases benign prostate enlargement by reducing the production of DHT. Propecia is simply a low-dose formulation of the same drug (1mg instead of 5). Several studies have found that it can help alleviate baldness, but no one would call it a cure. In one trial, men taking Propecia had an average of 876 hairs in a one-inch circle on the scalp, while those taking a placebo had 769 hairs. In another trial, 50 percent of men taking Propecia–and 30 percent of those taking a placebo–thought their appearance had improved. Like Rogaine, Propecia requires continual use, and it won’t help men who are already bald. It is generally safe, but 1 percent to 2 percent of men experience diminished libido and potency, which rebound when the drug is discontinued.
Medically, there is no need to treat male-pattern baldness. So before you embark on any regimen, take a look in the mirror and think it over. And before you decide, try to imagine how Michael Jordan would look with a full head of hair.
