Saturday 24 August 2019

There's hope out there for balding men

Pills and creams offer hope for men who will try anything to avoid hair loss...

Why go Bald sign
Why go Bald sign
Ross McDonagh before and after his hair treatment.
Ross McDonagh's hair before and after treatment.
Ross McDonagh's hair before and after treatment.

Ross McDonagh

'I'M AFRAID your condition is incurable." I'm sitting in the doctor's office, and the devastating bombshell has just been dropped.

Because my dad is bald, and my mam's dad is bald, it's extremely likely I'm headed that way, too.

I've come to Hair Restoration Blackrock today to learn of the wonders of hair transplantation. As I've just been regaled, long gone are the days of dreadful 'Elton John' style hair plugs; Dr Maurice Collins – one of the world's foremost hair specialists – has a veritable army of scalp surgeons who literally take individual hairs from the back of your head and replant them lovingly in the front. They remove single hairs one at a time, root to stem, and give it a new home, spacing the normally thick mass of hair at the back and distributing it more evenly across the more arid areas. The trick to keeping the hair alive is that each strand is never more than a few hours out of your head.

Of course, terraforming on such a grand scale is inevitably expensive. So when he tells me there is also a pharmaceutical route, I am naturally sceptical. My spam box is inundated on a daily basis with similar pill miracle cures for fat bellies and floppy penises.

"Does it work?" is obviously my first question. He proceeds to show me a series of 'before and after' pictures of previous patients, and at first look they seem to look more like 'after and before' pictures: each person looks a good deal younger in the later photos. Apparently around 86pc of patients who tried it showed positive results.

Why go Bald sign

According to Dr Collins, only two medicines have individual lab-proven results, and they work even better when used together: Finasteride and Minoxidil.

Finasteride isn't a hair pill at all. It's actually a prostate pill, taken to reduce the swelling of enlarged prostate gland; the hair growth bit is really just a side-effect. To that end, you don't take whole ones, rather one quarter of a pill per day. If you are one of the very rare women suffering from male pattern baldness, well, unlucky because UNDER NO CIRCUMSTANCES should females ever ingest them, the box pretty dramatically warns. Besides the fact women don't have prostates, the pill can cause serious birth defects, and pregnant women or those at risk of becoming pregnant (read: women who have sex) should avoid even coming in contact with the dust from the pill splitter.

What the drug does is prevent testosterone in the body from converting into the hormone Dihydrotestosterone, or DHT. DHT is very important to male fetuses, because it is crucial in the formation of testes. But once you've got those, DHT actually becomes more of a hindrance in the body, causing prostate growth and affecting the hair follicles. It shortens the growth lifespan of individual hair follicles, causing them to shrink until fewer hairs are visible, hence your thinning hair. But because Finasteride (also known by the brand names Proscar or Propecia) blocks DHT from forming, follicles can either cling to whatever life they had before a patient starts taking the drug, or if they're lucky allow the follicles to reinvigorate and grow stronger and thicker again.

Ross McDonagh before and after his hair treatment.

Remember, the whole 'essential for growing a penis' thing should be big enough hint as to why it should be kept away from pregnant women. Indeed, some males born with intersexual lack of genitalia also lack DHT, and thus do not suffer from male pattern baldness (although that is probably the least of their problems).

Minoxidil, meanwhile, is the active ingredient in products like Rogaine/Regaine. It comes in liquid or foam format and must be applied twice per day: when you wake up and before you go to bed. I had heard it stinks, it's sticky, it ruins your hair gel, it gets all over your pillow.... It is none of these things. It is a practically odourless, colourless water that you forget about the second you rub it in. It has a little application pump, you squirt a few drops on the danger spots (temples, crown, top of the head) and Bob's your uncle.

Perhaps somewhat disconcertingly, no one really knows for sure how or why it works. But on the guys it does work for, no one really cares. Unfortunately, its effects are temporary; using it on its own may help for a few years, but you are only delaying the inevitable – you will eventually return to your pattern of male baldness. Though for some men, these few years of stalling is priceless (and if price is a concern for you, you can get much, much cheaper generic and store brand minoxidil solutions online, or in US supermarkets and pharmacies). Like finasteride, Minoxidil works by increasing the diameter of already shrunken hair. Bizarrely, it generally doesn't have much affect on frontal baldness, but works better on the crown.

Ross McDonagh's hair before and after treatment.

Of course, for greatest effect, both Minoxidil and Finasteride should be taken together.

But most importantly, there needs to be at least some hair there: the drug combo cannot regrow hair that is not there any more. The bad news, even if it is successful and halts your hair loss, or even better regrows the dying stuff, it only lasts as long as you are taking the drug. The good news, if you do stop taking them, your head will only revert back to the state it would have normally been in had you not done anything; ceasing will not make you lose 'extra' hair.

And sometimes, the drugs' effectiveness simply wears off. It is different for every patient. For some the drugs are effective for a year, for some it's seven years, for some it doesn't work and for some it is still going indefinitely. The only way to know is to try.

Crucially, this is what many men don't realise: looking into baldness treatments when you are completely bald is like locking the stable after the horse has had a full body waxing. It is too late.

"See these wispy bits along the border?" Dr Collins asks.

I cringe – I suddenly realise it's not the receding hairline that bothers me, rather the horrible sickly, thin, uncontrollable hairs along the borders that make my head look crap.

He summarises: while the drug combination cannot regrow completely AWOL hair, it reinvigorates and restores those dying ones... and it really makes a world of difference.

I've been on the drugs for exactly a year now, but I noticed the difference within a matter of weeks. Brutally honest family members insist my hair is much thicker and healthier. My ruefully bald uncle who hadn't seen me in a while asked me if I was dying my hair.

Are there any side-effects? Because Finasteride's raison d'être involves the prostrate, it can – and does on a very small number apparently – affect sex drive and can reduce libido. Dr Collins assures me this is very rare, and even if it happens, simply stopping the course will restore everything to factory default.

Ross McDonagh's hair before and after treatment.

Frighteningly, a quick Google brought up the case of one Kevin Malley, a US 30 years old who attempted to sue the makers, Merck – even going on hunger strike in protest outside their headquarters – because he claimed the pill completely destroyed his sex drive, and in his own words 'ruined his life'. Since then, similar lawsuits have been mounting.

But according to Dr Collins, libido is heavily influenced psychologically. While 'not being able to get it up' can of course have a physical or medical cause, the vast majority of times it is stress, relationship or just plain situation related.

Unfortunately, from a legal point if view, it is like whiplash – impossible to prove and equally impossible to deny – which can be problematic for companies trying to stave off legal suits.

Indeed, Dr Collins – who really doesn't have anything to gain by promoting the pharmaceutical route, he makes a lot more money if you hire his hair transplant team – tells me of a recent clinical trial, in which subjects were warned of the sex drive inhibiting side-effect ... but half the subjects were given placebos.

The results? A very small proportion reported suffering loss of libido, with an almost exact split between the real pill and the placebo. And while the numbers were marginally higher for those who took the real drug, Dr Collins is convinced that the biggest killer of sex drive is the thought of something potentially killing your sex drive.

As for me, I've been on the drug for well over a year now and – touch wood (pun intended) – I haven't yet run into that problem. And even if I ever do, I have lots of offers in my spam folder to sort it out.

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