Waiting rooms are tense, silent places. Nervous patients in the reception areas of GPs, physiotherapists and proctologists sit quietly wondering the same thing: whether they’re worse off than the person beside them. Usually it’s hard to tell, but sometimes there are clues. If you’re at the ophthalmologist you can watch how closely someone holds a magazine to their face. At the chiropractor observe how people are slouching.
In the waiting room at hair surgeon Russell Knudsen’s clinic in inner Brisbane Spring Hill, men discreetly judge one another’s scalps in glass reflections and self-consciously run their fingers through their remaining locks. The man in the leather jacket sitting opposite me I notice has broken a golden rule of hair loss: don’t grow it long to compensate for its absence. While we don’t make eye contact, I know he’s surreptitiously examining my head too.
When I’m called into Knudsen’s office I can’t help but notice his own promiscuously wild salty mane. It’s almost botanical, growing in vine-like licks and curls. The 54-year-old has four clinics like this in Australia and one in New Zealand, and has personally performed hair transplants on more than 4000 patients. Sitting behind me he runs a small, tube-like camera across the back of my head. “These are your hairs on your scalp,” he explains, pointing towards a small monitor, “fifty times closer.” Zoomed in like this you can see how hair grows. Some roots yield single hairs; others sprout two or three from the same spot. These, Knudsen explains, are “follicular units”, what surgeons call naturally-occurring groups of one to three hairs, growing from the same spot. When he moves the camera higher, towards the top of my head, the landscape changes a little. “Here, I’d say your hair looks normal,” he says. “The odd one’s a bit wispier, but most look healthy.”
I’m not so sure. Only a couple of years ago my hair grew like thick, weedy wire. You could give it a good pull and it wouldn’t come out. But about a year ago, when I was 24, it started dropping off in the shower, easily snapping from my scalp and leaving conspicuous black clumps on my bathroom tiles. “Is it my imagination, or is there more scalp in this area?” I ask, pointing to the video monitor. “It’s your imagination,” Knudsen says. “You’re being paranoid.” But when he moves the camera to my forehead hairline the visuals speak for themselves. Some hairs are so thin they’re barely visible. They look like cobwebs. “There’s a slight, subtle deterioration with some of those hairs,” Knudsen says slowly. Slight, subtle. Knudsen knows his role is equal parts surgeon and therapist. “It’s a mixture of the good, the bad and the ugly in there,” he says, pointing to my magnified hair. “That’s what thinning is.”
IT’S NOT until you start losing hair yourself that you notice young men everywhere going bald alongside you. My friend Nicholas Booth is 22 and already his hair is on a similar path to his late uncle’s. He points to the two peaks of scalp high on his forehead, which are conspiring to form a conspicuous M-shaped hairline. “It’ll keep going up and up,” he says, tracing his widow’s peak with two fingers, “and then it’ll start to go inwards. It used to be thick then suddenly it became flatter and flatter. When you parted it, you could see how thin the hair was.” His impending baldness began to play on his mind to an almost ridiculous extent. “You learn the areas around your home, or where you work, where certain wind gusts would come, so your hair wouldn’t behave in a certain way,” he says. “If you ran across the street too fast, it would part in a silly way, and scalp would be revealed.”
To begin losing your hair at 22 is a cruel thing. Most people associate balding with getting old, but male-pattern baldness, or androgenic alopecia, begins any time during or after puberty. For all intents and purposes this most common type of baldness is a young person’s condition. One of Knudsen’s early clients was 19, and brought in by his mother. He couldn’t look Knudsen in the eye and wouldn’t remove his baseball cap. “He locked himself in his bedroom at night, wouldn’t do anything except at university,” Knudsen says. “I wince when I see a mother coming in with a young man. I know I’m in for a very difficult half-hour. His mother will do all the talking, and it’s going be very uncomfortable.” Since then that scene – young untalkative boy, flighty concerned mother – repeats itself in his clinic almost every week.
Teenagers and young men also make up a large proportion of clients for Janne Scougall-Hunt, a Brisbane trichologist and President of the International Association of Trichologists. Trichologists take the naturopathic approach, treating scalp and hair disorders largely with herbs, minerals and dietary supplements. “Some guys are bald by the time they’re 19,” Scougall-Hunt says. “Very, very bald. It’s gradual hair loss, until they get to about 19 or 20. Then they think ‘Oh my god, I’ve lost my hair.’ But it’s been happening very steadily for that amount of time.”
It’s difficult to get a firm figure on how many men suffer male-pattern baldness. However, Scougall-Hunt says the maths is easy to remember: around 20 per cent of blokes lose their hair in their 20s; 30 per cent in their 30s; and so on. Knudsen says about 70 per cent of all men will suffer some form of hair loss in their lifetime, since male-pattern baldness is only one type.
So what causes it? All men produce a natural enzyme called 5-Alpha-Reductase. It’s there to convert testosterone into dihydrotestosterone (DHT) which literally makes you into a man, ensuring gender development happens in the womb and during puberty. For reasons we still don’t understand too much DHT in our scalps shrinks our hairs – one by one – until they eventually disappear.
Your 5-Alpha-Reductase levels largely depends on genes on both sides of your family: it’s a myth that hair loss is solely inherited from the mother. If you went through my family’s photo albums you’d find that hair loss runs rampant on both sides. My maternal uncles shed most of theirs decades ago and the front of my father’s skull resembles a freshly polished marble dome. “Generally, I like to think of it as genetic dice,” Knudsen says. “One from your father’s side, one from your mother’s side. Throw the dice, see what you get.” Take Knudsen’s family. While his hair is enviably thick his father is receded and bald in the crown. His older brother is bald through the top – an entirely different pattern altogether – and his younger brother has a receding hairline. “And I’m essentially nothing,” Knudsen says shrugging. He’s got no reason to lie: if that lush growth was the result of hair transplants he’d be a walking advertisement for his business.
While there’s a basic understanding of the root causes of male pattern balding experts all emphasise one point firmly: there is no cure. Unsurprisingly, history’s littered with failed attempts to find one: boiled snake paste in 8th century China, the urine of pregnant women for native Americans, goose dropping for the Vikings. Now there are dozens, if not hundreds of proclaimed treatments on the market, from laser therapy to detox teas, shampoos that thicken hairs to shampoos that unclog your pores. The hair loss industry is estimated to be a billion dollar one, and for young men a combination of silent shame, a confusing arsenal of products and a high disposable income makes for a lucrative market.
“Treatments are secret men’s business,” says Knudsen, who laments that men, unlike women, have not developed a shared vocabulary for discussing their anxieties about their bodies. “Men don’t want to be seen to be seeking treatment because they’re embarrassed their mates would know.”
Damon Neill, another friend of mine, agrees. He’s 27, and a classic “bloke’s bloke” – huge football fan, built like a small truck. A couple of years ago when he found himself in a bathroom fitted with harsh fluorescent lighting he realised that like the rest of the men in his family he was losing his hair. “It’s emasculating,” he says “Men aren’t supposed to show they care that much about appearance. It’s that old-school idea of masculinity. You don’t want people to know you’re taking these avenues.” A friend of his he told me, around the same age, is also thinning and has trouble discussing it. “It’s only when he’s really drunk, and it’s you and him, that you have a chat about it. It’s not a usual male thing to do.”
For many – especially those with a full set of hair – this angst might sound over-the-top for a condition that’s common, natural, and not life threatening. Yet it’s not the hair loss that bothers these men so much, but the age at which it’s happening. “I’d feel a lot better if I was in my mid 30s or 40s,” Neill admits. “I’m pissed off,” says Booth, “being the age I am now. But I’ve seen a lot of men much worse off than me who are my age. Some guys I went to school with have nothing.” Whether men are single or not is also a big factor. “When I was single, it played on my mind more,” Neill says. “It was a real big deal. You’re always looking at yourself, and thinking: ‘Is this how other people look at me?’ Now I’m in a relationship, I’m not constantly trying to pick apart myself.”
Currently there are two medically proven drugs that address hair loss, although they don’t work in the same way. There’s the prescription drug Finasteride, taken orally, which targets the production of 5-Alpha Reductase and DHT. It’s been commercially available for a decade, and $1000 will buy you about a year’s supply of Propecia, the brand-name for 1mg of the drug. However, many GPs warn patients of its potential side effects: loss of libido, erectile and ejaculation problems. One person I spoke to who’d tried Finasteride discreetly warned me about the “penile shrinkage” he’d experienced. However, studies of nearly 2000 men documented by the US Food and Drug Administration show more measured outcomes, with only 3.7 per cent of those taking Finasteride experiencing erectile dysfunction and 3.3 per cent decreased libido. Then there’s the topically applied Minoxidil, available over the chemist counter, also marketed as Rogaine or Regaine. It’ll set you back around $300 for a year’s supply. Originally taken orally for high blood pressure, doctors noticed that one of its side effects was hair growth. The effect is hypertrichosis, what Knudsen calls a “werewolf effect”, an anomalous growth of hair that can’t be explained. While its mystical quality lends itself towards miracle cure status, the resulting growth isn’t consistent or sustainable. Men who rub Minoxidil into their scalps will grow back some hair, only to eventually lose it again, because while the drug is producing hair, 5-Alpha-Reductase continues to make DHT in the scalp.
When I asked trichologist Scougall-Hunt about Minoxidil her face contorted: “I don’t like it, I don’t recommend it, I don’t suggest it. It works in a different way to Finasteride.” While Knudsen advocates its use on his website, he adds that unless you’re using it with Finasteride you are basically “flogging a dying horse”.
Assuming you still have some hair on the sides or back of your head then a transplant – surgically grafting existing hair (plus skin) to a bald spot – is an option, although not cheap nor quick. The result — hair growing in the transplanted area — is permanent, although taking Finasteride before, during and after the procedure is also necessary. When Knudsen, a former GP, saw his first hair transplant at Sydney’s Kogarah Private Hospital in 1982, “cores” of hair were taken from the back of the head, 15 or 20 at a time, and grafted to the scalp in a grid-like, checker-board fashion. The resulting look was rather unnatural, like a doll’s scalp. Now transplants look more natural with surgeons grafting one follicular unit at a time. It’s done under a “twilight anaesthetic” in a day surgery, with clients conscious but with only have vague awareness. Recovery requires putting ice-packs to your head for 48 hours afterwards. Doing 1500 individual grafts — an average amount – takes seven hours, costs $9900, and is done in a single marathon session.
Outside of hair surgeons, there’s a myriad of hair restoration companies whose techniques and approaches can be hard to decipher amid all the ®s and ™s. Ashley & Martin, one of the better known names in Australia and in business since 1964, offers three types of products for men – RealGROWTH™, RealHAIR™, and RealLOOK™ – and on its website emphasises the medical aspects of some of these procedures. Figures quoted are dizzyingly seductive: almost 98 per cent of patients in the RealGROWTH™ program regrew “an average of 113 per cent more hair”. Trying to find out more though was problematic; my repeated requests for an interview with someone at the company’s Brisbane office were refused.
Another big name is Advanced Hair Studio, the company with the ubiquitous slogans (“Advanced Hair: Yeah Yeah”) and endorsement from cricketer Shane Warne. Established in Florida in the US in 1973 it has 80 studios worldwide, with 35 of those in Australia. Trying to speak to someone in Brisbane proved an international logistical operation. I’d confirmed an interview time with AHS’s Brisbane manager Glenn Lauchlan, but then received a call from AHS’s national publicist saying he’d need to get the interview approved. Shortly after company founder Carl A. Howell rang me from London asking whether I was writing an exposé. I wasn’t exactly sure, I explained, what there was to expose? (Perhaps Howell was sensitive after last year’s ruling by the British Advertising Standards Authority that an AHS newspaper ad about its “advance hair and scalp fitness program” featuring Shane Warne was misleading).
I eventually meet up with Glenn Lauchlan in the Brisbane studio, which is tucked behind the cafés and bookshops of inner-city Milton. At 30 he looks like the blond, affable high-school jock everyone knew, all grown up. While his father didn’t shed hair at all, he wasn’t so lucky: he started losing his at 23, rapidly and severely. I’m surprised. His hair’s styled sharply and sun-kissed, giving the impression he’s a sporty, outdoors type (and he is into wakeboarding and waterskiing). It’s Advanced Hair Studio he tells me effusively that he has to thank for the hair he has now.
As we talk he warns against treatments like hair transplants (“you’ll have a scar for the rest of your life”) and Finasteride (“libido issues, sperm count reduction”). “It’s up to the individual whether they want to take those particular risks,” he says.
When we move onto AHS’s products and techniques, Lauchlan speaks almost exclusively using in-house terms. The ideal result for an AHS client is “rectification of visual impact”. How to attain “rectification of visual impact” is using a “strand by strand” approach, using a natural “unit”, which is “non-surgically grafted” onto you like a second skin or “membrane”. All this vernacular makes it difficult to discern what AHS exactly does, or how their “Strand by Strand” approach works. I’m confused so I ask Lauchlan to explain things in layman’s terms. If a unit of natural hair is non-surgically applied onto someone’s scalp, that makes it sound as though it’s removable. “That’s exactly right,” he says.
What he’s describing I say sounds like a hairpiece. He winces. “We don’t class it as a hairpiece, because obviously, with Strand by Strand, we make it permanently part of the client.” So it’s “removable” but “permanent”? Lauchlan explains further: the Strand by Strand unit is applied using a medical gel. Only AHS staff members can apply it, and only they can remove it. “Every four to six weeks, we release the medical gel we’ve made become a part of the client,” he says.
This all makes me look at Lauchlan’s hair in an entirely new way. If the hair on his head is actually a sophisticated hairpiece (“membrane”, “unit”) it’s breathtakingly realistic. Part of me wants to run my fingers through it.
So how much does this set you back? “That’s a very good question,” Lauchlan says cheerfully. “And a hard one to get an understanding of.” With that he ducks in and out of rooms within the office for a good few minutes before announcing he’s run out of price lists. Brochures at the reception offering instalment payment plans imply treatments aren’t cheap.
Pakistan born Nauman Qayyum, 27, tells me his first AHS treatment – a combination of laser therapy and the topical application Minoxidil – cost $4500 in 2006. His hair loss had been so noticeable by the age of 17 that he was socially paralysed. “I couldn’t go anywhere. You totally lose confidence,” he says. “You’re talking to someone, and you try to ignore the thought that this person is going to look at your hair and think ‘You’re 18, and you’re bald? What’s happening?’” At school, his classmates pointed out his hair loss, and asked him why it was occurring so young. It wasn’t teasing, but it was enough to make him cry every day.
After the first block of AHS treatment Qayyum agreed to the Strand by Strand system (total cost $9500), and his first treatment was credited towards it. He says the AHS videos he was given showed clients on operating tables and staff members wearing surgical masks, which gave him the impression the procedure was a surgical one. He says he was led into a room in the Milton studio resembling a suburban hairdresser’s, complete with posters of men boasting hairstyles from the early ‘90s with gel in their cowlicks. Staff took a number-one clipper to the top of his head, leaving hair on the sides on. They applied adhesive to his scalp, and glued the unit of hair on tight. “There’s your new hair,” Qayyum says they told him.
Over the next six months, he says his unit had to be reapplied regularly. Sometimes he was charged $59 for the reapplications. He then paid $7500 for a second, upgraded model, but said it smelled and peeled off at the edges. He insisted it be removed, his head shaved and he asked for refund.
WE’RE not the only animal species that balds. Other primates, like chimpanzees and macaque monkeys, experience benign frontal balding during or after adolescence. However, we seem to be the only species which frets fastidiously and loses sleep over it. Because it’s not a condition that threatens our physical wellbeing, many young men encounter a who-cares, get-over-it attitude. “If they have a sympathetic GP, that’s great,” Knudsen says. “They’ll get good advice. If they have an unsympathetic GP, go and look for someone else. Baldness is a medical condition, so steer away from people who won’t—or can’t—give you medical advice. When a woman comes to you with hair loss, is that what you tell them? ‘Don’t worry about it love’?”
While we may be able to clone entire sheep, no one has quite figured out yet how to clone hair. That breakthrough is regarded by surgeons like Knudsen as the Holy Grail with cloning providing a limitless supply of hair to replace any loss. An international race is on to crack the technology with a British team, backed by about £2 million from the UK government, recently reporting positive results in clinical trials. Researchers hope to have something on the market by 2011, but Knudsen isn’t optimistic. Even if new techniques are available by then, he says there’ll likely be teething problems. Still, pursuing that avenue could not only to help young men losing their hair, but victims of severe burns, and cancer patients undergoing radiation treatment.
As for me, my university graduation photo offers a glimpse of the future. In it my fringe is lifted up and tucked under the scholar’s hat, showing off a luxuriously long expanse of forehead. It also masks the sides, giving the impression I’m bald. I don’t carry off the look well. So I’ve taken my chances with Finasteride. To those thinking of following this route it should be noted: it’s uncomfortable asking your GP for the prescription when he’s unflinchingly bald himself. After nine months my hair has stopped shedding in the shower and, to my eyes, there’s less scalp visible. And no I haven’t experienced “loss of libido”, “erectile dysfunction”, or the dreaded “penile shrinkage”. While your DHT levels are a genetic lottery, so too perhaps your reaction to medication. My friend Nicholas Booth, who used to avoid gusts of wind, has taken a different approach. “Back when I had longer hair, I considered going to one of those clinics on TV,” he says. “Massage something on the scalp, take a tablet. But it was the liberation of shaving my hair off that wiped that clean. It felt like this entire weight—all these different layers of thought about my hair—were suddenly gone.”
Maybe one day I’ll be that brave. But not just yet.