NetDoctor's Colin Brennan goes on the trail of a genuine cure for every young man's nightmare.

People have always been surprisingly gullible where their hair is concerned. Such was her vanity, Queen Victoria was driven to drink silver birch wine, made from the rising sap, because she believed it would cure her baldness. Even now in an image conscious age, when the masculine icon of the moment, footballer David Beckham, can voluntarily surrender his trademark dishevelled blond fringe for a shaven head, hair loss is refusing to become fashionable.

A heavy weight political writer went so far as to say that William Hague wouldn't get elected Prime Minister because of his baldness. Neil Kinnock, previously rejected for the post, agreed and he hasn't got much on top either. Jokes aside, consultant dermatologist Dr Andrew Messenger of the Royal Hallamshire Hospital, Sheffield, told NetDoctor: 'Although the great majority of men learn to live with it, I think everybody would prefer not to be bald. For a very small number of men, it becomes a big issue.'

It is often but not always younger men, he says, who are so alarmed by their hair thinning that they go to a doctor asking what can be done about it.

Most doctors believe that because the treatment options are so limited, balding men should think deeply before using any remedies. It isn't a life-threatening condition and it is easy to spend a lot of money unsuccessfully attempting to restore a full head of hair. But as Dr Messenger points out, it is a matter about how the man losing his hair feels, rather than how others think he ought to feel. His whole life can begin revolving around something that would be a small problem to the average bloke. Dr Messenger is quite clear about the possibilities. He says: 'There are only two ways to deal with baldness currently available in the UK which the evidence shows work to at least some extent.'

Minoxidil
Minoxidil is sold over the counter as a topical solution, to be applied twice a day, under the brand name Regaine. About two-thirds of the men who use it have some improvement in their hair growth, ranging from minimal regrowth to moderate to dense regrowth after four months of use. It depends on how bad the hair loss has been and how long it has been happening. It is not possible to forecast how effective minoxidil will be or who it will help. There is no evidence that it works better for younger men because of their age. They may get better results because their hair loss is not that severe and has only recently started but this would apply to a man in middle age too.

The regrowth of hair could be as much as 20 or 25 per cent of the existing hair. A higher strength version of the preparation, Regaine Extra Strength, has a slightly better effect. The first sign of new hair begins to show after two months and it peaks at around one year. In trials comparing the two strengths, Regaine Extra produced 43 per cent more regrowth than the regular strength after 12 months use.

Twice daily applications of minoxidil need to be continued for continued hair growth. Regrown hair may begin to disappear three to four months after stopping treatment and the balding process will start again.

'It can become a bit of a bind rubbing it into the scalp twice a day after it has stopped improving and you can't see anything happening,' said Dr Messenger. 'You also have to go on paying for it at the rate of about £25 per month.' The price depends on the strength and quantity of minoxidil being purchased. It is possible to get a triple pack, a three-month supply, over the counter for £59.95. On the Internet, it can cost as little as £10 a month when bought from the United States.

It is a safe drug and the only side effect is occasional irritation of the scalp and the growth of hair on other parts of the body which is not enough to worry men. However, it isn't known how minoxidil works. It was first used on patients with heart disease who reported an increased growth in their hair. This has led people to speculate that it may increase the blood supply to the hair follicles.

Some people have noticed that when they first use minoxidil, the loss of hair actually increases. Later, if the hair starts to regrow, it will probably be soft, downy and barely visible. However, with continued use of minoxidil, this new hair may become the same colour and thickness as the rest of your hair. It isn't known why it works for some people and not others.

Finasteride
Finasteride (brand name Propecia) is an oral treatment for male pattern baldness now available on private prescription in the UK. It works by inhibiting the action of an enzyme in the body called type II 5-alpha reductase. This enzyme is responsible for converting the male hormone testosterone into dihydrotestosterone (DHT). DHT is a hormone that can damage hair follicles and lead to hair loss in men who are genetically sensitive to it.

Propecia is effective in about 80 per cent of men, though it may take three to six months of treatment before a decrease in hair loss or increase in hair density is noticed. Continued use is recommended to obtain the maximum benefit and this can be expensive, as doctors can only prescribe the medicine on a private prescription. The cost of the treatment is around £30 per month. If you stop taking the drug you are likely to lose any hair you have gained within 9 to 12 months.

Potential side effects of Propecia include some sexual problems, such as a decrease in sex drive and temporary impotence. Women cannot take the treatment, nor should they handle any crushed or broken Propecia tablets, as the active ingredient can cause feminisation of a male foetus in pregnant women.

Hair replacement grafts
Another approach to combating baldness is to transplant the hair from the back of the scalp where it usually grows abundantly in bald men, especially younger men. It is transplanted to the bald patch where it grows in the same manner as if it were still on the donor site. The minor operation is under local anaesthetic and can be done in several stages or in one mega session where thousands of hairs are involved.

The hair is now usually moved in micrografts - small groups of hairs - to get a more natural look. This is designed to avoid it resembling a conifer plantation or the doll's head effect. 'A good result depends entirely on the surgeon's skill,' says Dr Messenger. 'The cost will be in thousands rather than hundreds. I have seen some fairly good results but I don't think it ever looks completely natural. 'The side effects are the usual surgical risks of infection and scarring. The main problem is that the man may not be pleased with the results and unfortunately, he is stuck with it. There is no known way of reversing this procedure and he won't necessarily go bald again. The hairs will grow on in the same way as the hairs at the back of the head which most men keep forever. 'I wouldn't recommend surgery hair grafts to anybody. I would let them know it's available but that's all. I certainly wouldn't have it done myself. It is pretty bloody and traumatic,' said Dr Messenger.

Dr David Fenton, a consultant dermatologist at St Thomas's Hospital, London, said he thought men worried about their hair loss should be careful to stay away from any advertised services. 'Many of these people are offering treatments which have no scientific basis. Men wishing to restore their hair should stay well clear of them and get advice from doctors. Then they will be advised by people who are highly trained in their field, not salesmen with no medical background whatsoever.' He also feels that these men should be supported, given counselling and not belittled.

Your money can follow your hair down the sink
Elizabeth Steel founded the support group Hairline International for both men and women after she lost her own hair. 'We hear of so many unsatisfactory transplants that we no longer recommend them,' she said. 'We advise our members to stay away from private clinics to avoid losing their money as well as their hair. It is just money down the drain. Some men have told me they knew the exotic and expensive remedies they were given weren't going to work but they just wanted to enjoy the temporary light at the end of the tunnel,' said Elizabeth Steel. Her organisation has given impartial advice to more than 30,000 men worried about their hair falling out. She agrees that thinning hair can leave men very vulnerable. She has known a 40-year-old man with a good job and two children kill himself after a hair transplant went wrong.

A report by the House of Commons All Party Parliamentary Group on Skin published in December 1999 unearthed examples of fraudulent practice in treatment offered for hair loss. A chain of clinics in London and 13 other UK cities was found to be charging £1300 for initial treatment and £45 per week thereafter.

Naturally, the Internet is also home to some highly dubious baldness treatments. Some Internet sites make their pitch by using phrases saying how important hair is to us in our self-confidence, our sexuality and our wellbeing. It makes a jar of herbal cream at £59.95, vitamins at £25 and shampoo at £8, seem cheap at the price. Other sites use pseudo-scientific language to encourage men, in despair over their thinning hair, to buy their services. As ever, many of these sites have a small print that promises much less than the large print, so consult your doctor before you hand over your money to anyone offering a cure for baldness.

Further information
For advice on hair loss write to:

Hairline International, Lyon's Court, 1668 High Street, Knowle, West Midlands B93 0LY.

Please enclose an A4-sized self-addressed envelope.

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