For some it lies in wait for decades, for others it hits them a knockout punch in the late teens. Then there are gentlemen who live long into old age without ever losing a lock in their life. Urban myths and snake oil treatments exist in abundance. Old wive’s tales that speak of baseball caps causing baldness, hair needing room to breathe, and expensive shampoos that cause miracle growth – such claims are totally false. Yet sadly there is big money in false cures for hair loss and unfortunately there is no shortage of desperate men out there that are ready and willing to believe anything that claims to interrupt their hair loss.
As a young man affected by hair loss my own experience and research led me to discover a lot about the commonplace presence of male pattern baldness (MPB). Medically known as androgenetic alopecia – the stone cold facts of male pattern baldness are as such:
It is almost always hereditary and if one’s genes are programmed to trigger hair loss in adulthood nothing (except for medication) will act against it; no amount of healthy dieting, miracle cures nor designer shampoos will change a thing.
Contrary to what some people believe MPB has no link to low fertility, ill health or impotence. MPB is in fact linked to dihydrotestosterone (DHT) – a hormone produced by male testosterone. DHT can accumulate within the hair follicles on the top of a man’s head, causing the hairs to wilt and fall.
Hair follicles around the sides and back of the head are not affected by DHT hence why they are often immune to MPB and therefore viable to produce growth via a successful hair transplant.
Approximately 20% of men in their 20’s experience some degree of MPB, as do 30% of men aged 30+ and 60% of men aged 60+. Most men who live beyond 50 years will experience some degree of MPB. Some men lose all the hair on top of their head between their teens and 20’s. Others slowly start receding and thinning over the space of many years later on in life. Characteristics such as the amount of hair one loses, age of onset and speed of progression are generally determined by genetics. Therefore if Mother Nature says you’re to coif your doo like Dr Phil at age 22, nothing will change that outcome except maybe medication and/or surgery.
MPB is a progressive condition meaning once it starts it often continues with longevity, although in some people it can speed up or slow down at different intervals throughout life.
It generally follows one of two patterns; the most common pattern being recession at the temples and hairline followed by thinning of the crown. There is a scale that measures the progress of MPB. This scale is known as the Norwood Scale (see photo) and it recognises 7 stages that encompass the classic patterns of MPB.
The hairline of an adult male is usually slightly different to that of a teenager. Mild recession of the hairline is a feature of most mature men and it doesn’t necessarily indicate large-scale hair loss.
Some men respond to hair loss with indifference, some wrestle with it for a brief period before accepting it and moving on. However many men find the experience of losing their hair to be deeply distressing, depressing and profound. It can have a very blunt effect on a man’s confidence, self-esteem and general well-being. It can dramatically disrupt one’s ambitions and mental health. The terrible impact it can cause should not be understated.
Most young women find a full head of hair more attractive than a balding appearance. This can make the experience of MPB all the more upsetting for young men with romantic ambitions.
To this day the only known effective treatments of MPB are finasteride, minoxidil (Regaine) and hair transplant surgery. All three treatments are often used in conjunction with each other and all three treatments carry the risk of undesired side effects.
My own personal journey with hair loss started when I was about 19 (I’m in my early 30’s now) and it was quite upsetting to say the least. In hindsight I was not a developed adult back then, but more so an ageing adolescent. It was hard to cope with the growing prospect of baldness, and the fact that I already had confidence issues did not make it easier.
I first noticed my temporal recession when a friend pointed it out to me. Although the first moment of recognition was not visually colossal, it was mentally acute, because I immediately assumed that it would worsen – and I was right.
Like many young men that experience MPB I quickly became obsessed with it. Every time I looked in the mirror I could not help but draw my eyes towards my forehead. I would look at myself from different angles; always looking for the best and worst viewpoints of my hair problem, studying my own reflection in artistic depth. I’d pull at my hair to scrutinise the density of it and examine it under bright lights.
For some time I battled painfully with denial and reality. At times I told myself it would stop receding, or it would reverse itself. I devoured buckets of hair loss content on the internet; some of it factual and informative, some of it ridiculous, some of it exploitative and cruel. Over the years I discovered a cosmic galaxy of (online and offline) material pertaining to MPB. I had no idea that there could be such a deep web of forums, podcasts, blogs, medical professionals, con artists, snake oils and scams all revolving around the global hair loss industry, an industry worth billions of dollars every year. One of the only positive things that I felt in my earliest days of hair loss was the realisation that I was not alone. I very quickly learned that all around the world there was other young men going through the same traumatic hair loss problem as me.
What I can also say is that as a man of hair loss one can become hyperaware of all the hair around them. When my eyes became fine-tuned for hair analysis I began to notice lots of guys wrestling with the same problem as me. The ubiquity of strategic haircuts and strategic headwear struck me. I personally took to the occasional hat, and I wore hairstyles that helped minimize my balding features. I also fell envious of men with fantastic hair and I wondered why I was dealt a hand that seemed so desperately unfair.
The rollercoaster I went through from MPB was immense. For years – from my late teens to my mid 20’s – the distress it caused me was sharp. The self-consciousness around it was deep. One way to describe how it made me feel was that it felt like I was being robbed of my youth. I worried deeply that I couldn’t be who I wanted to be if I was suffering from hair loss. I felt like all I could hope to be was an ugly baldy loser with lesser chance of ever having an attractive girlfriend. The experience was robbing me of my identity and it was traumatic. I looked for every cure I could find; cosmetic products were everywhere but research led me to find that they were all a scam except for minoxidil and finasteride. The side effects of finasteride frightened me therefore I avoided it in my early 20’s.
Finasteride side effects include impotence, low libido, and growth of breasts. Most people who experience such side effects are a minority and in most cases the side effects subside if treatment is stopped, yet nevertheless the risk turned me off trying it at first, as it does for a lot of patients. Minoxidil which is commonly sold as Regaine did not appeal to me, mostly because it is often ineffective unless used in conjunction with finasteride.
When I first came upon the titillating sphere of hair transplant surgery I became transfixed. I thought to myself here is the answer, the solution to all my problems. Seemingly wondrous results that beautified men at the magic wave of a surgeon’s wand. To me it was astounding, and thus began my lengthy vocation of searching for hair transplant solutions. To my dismay most legitimate hair transplants were very expensive when I first started searching for them. In my early 20’s I knew of places like HRBR in Dublin, but they were out of my price range and furthermore many decent hair transplant clinics don’t operate on men under 25 for scientific reasons. While it was a relief to know that somewhere down the line improvements could be made, it was discomforting to know that I might need to wait many years before I would be old enough and rich enough to avail of surgery. Clinics such as HRBR can charge €20,000 for a procedure.
As the years rolled by and I came into my mid 20’s my hair loss was still active but thankfully quite slow. Around this time I underwent some alleviation of the negativity that I associated with my hair loss. I started experiencing a thought process that was more tolerant of my hair loss and less stressed about it. I don’t know if it was something that came with maturity or psychological development, and I can’t speak for all men, but I can say that for me at least the most severe psychological angst weakened with age and I started learning to look at the possibility of being more confident even if hair loss would be with me for life. I would like to emphasize this point for young men who suffer from hair loss – as hard as it may seem one can come to be more tolerant and accepting of their own hair loss over time.
As all this was happening however strange things were taking place in the world, more precisely the world of MPB. Celebrities like Wayne Rooney were going public about their hair transplants and hair transplants were popping up all over the internet. The phenomenon of cheap transplants in foreign countries started booming, and my curiosity grew more and more hungry. Eventually in 2018 I flew to Poland for a hair transplant from a cheap clinic called MD MEDMIX. They were located in Bielsko-Biała. I found them via a widely used website called Qunomedical. They were going to charge about €1,700 for 1,700 grafts but as luck would have it they refused to operate on me when I arrived because I had a minor dermatological problem on my scalp. So I went home with my thinning barnet in the same state as it was before I had booked my transplant. In hindsight this was a blessing in disguise because it allocated me more time to continue researching hair transplants, and more time to save for a higher quality transplant. I came to learn that I had probably dodged a bullet because it transpired that there are high risks attached to many cheap clinics.
Delving deeper and deeper into my studies I discovered some terrifying things about the hair loss industry. I learned that hair transplants are not always successful and every potential patient should know this. A detailed web search will uncover innumerable examples of botched transplants which can leave patients with absolutely devastating results, and often no recourse to seek compensation ( https://www.thesun.co.uk/news/11874197/brit-left-horrific-scars-botched-1250-hair-transplant-turkey/ ). Out there in the world are plentiful men who feel totally destroyed and disfigured as a consequence of bad hair transplants. The amount of dodgy clinics is scary, the ones I found most frightful are referred to as hair mills. Hair mills are clinics – like factory mills with conveyer belts – where multiple patients are operated on at the same time, often by bogus individuals with no official medical credentials. The risk of a botched job is of course high in these outlets. Many patients go home absolutely butchered.
However it’s not all doom and gloom because my obsession with hair loss information also brought me to very helpful sources, which ultimately led to me making a fulfilling decision on my hair loss. I found a great forum – https://www.hairrestorationnetwork.com/ – where people can post about their knowledge and experience of hair transplant surgery. I would recommend spending ample time on this forum for anyone who might consider medical intervention. There are lots of patients and doctors sharing content and communicating via private messaging on this forum, so it really is a good shout. I would also recommend anyone curious of transplant surgery to check out the ISHRS (International Society of Hair Restoration Surgeons) as members of this society must have demonstrated experience of successful transplant procedures.
I can’t stress the importance of research when it comes to weighing up options regarding medical intervention for hair loss. Also it is wise to be wary of Instagram and Social Media advertisements. Always delve way deeper than what is seen on the surface of marketing tactics. The hair loss industry is a minefield of dreadfully unethical marketing operations.
Each transplant surgeon has a different approach to surgery, each surgeon has different nuances. Although there are only two methods of transplant surgery (FUE and FUT) it is important to know which method best suits each individual. FUT can leave a perceptible linear scar across the back of the head whereas FUE tends to yield a less dense result. A decent surgeon will weigh up characteristics such as hair texture, patient age and level of hair loss when advising patients on which protocol to follow.
It should be known that most patients will need a few transplants in a lifetime, and most patients really should be committed to using finasteride and minoxidil for optimal results with a transplant. Unfortunately not everybody is a good candidate for surgery, decent doctors do reject patients for a variety of reasons, and even the most skilled surgeons can have patients that yield poor results. Yet for the vast majority of people a properly executed hair transplant can yield very pleasing results. Some people even feel as if the benefits are life-changing, and for that reason the number of people availing of worldwide hair transplants has skyrocketed into the millions in recent years ( https://markets.businessinsider.com/news/stocks/every-13th-man-has-a-hair-transplant-according-to-bookimed-study-1028724168#:~:text=Hair%20transplant%3A%20facts%20and%20figures%20As%20the%20Hair,transplant%20as%20the%20most%20effective%20treatment%20option%20annually ).
On 10th December, 2020, at age 30, I finally underwent a successful FUE transplant procedure at the hands of Dr Marwan Saifi in Wrocław, Poland. My decision to go with this surgeon was carefully considered. Although I had started using finasteride and minoxidil (with no serious side effects) before this appointment, I was prepared to accept a rejection from the doctor, prepared to swallow it like a bitter pill. I was going at it with the mentality that if I (for some reason) can’t be treated I will find a way to accept my hair loss and get on with life. Gladly on this occasion I did not need to leave Poland with unsatisfactory news.
Dr Saifi and his team transplanted 2,040 grafts to the hairline and mid-scalp area. They also sharpened the temporal peaks at the sides of my head. I was given pills and several injections. The whole procedure was painless albeit stiff because I had to sit still for the whole day. It took about 10 hours and I felt as if I was in safe hands the whole time. Saifi’s team are experienced, careful and diligent. His nurses help implant the hairs while he extracts them and makes the incisions himself. Like most decent surgeons Saifi angles the grafts in an artful manner to help produce very natural results. I was given a meal halfway through the day and when it was all finished I was sent home with some advice on how to care for my raw scalp and transplanted grafts.
I was no different to most patients in that shaving the head was necessary for my procedure. My head looked a bit raw and swollen in the days after surgery, which is to be expected when 2,040 piercings are made at the front and back of the head. Yet the recovery time was very fast. In just a few days the back of my head had healed very well. The top went scabby and scruffy looking over the space of about two weeks, and then the newly transplanted grafts fell out. This is all normal with FUE transplants. My head was numb for several weeks after surgery, and my skin a little pink, but eventually everything went back to normal. 3 – 4 months later as promised the new hairs started sprouting abundantly. At 5 – 6 months a fantastic impactful result could be seen. At 8 months it was better yet. I would say it thickened up until the 10 month mark and after that nothing else really happened.
15 months later I am very happy and pleased with my hair transplant. Minoxidil and finasteride have dramatically slowed my hair loss, and I believe they have made my hair darker too. I don’t know why my hair seems darker than it did a few years ago, but it does. I know that I will likely need more transplants to sustain my full barnet but I am hoping those appointments will not be necessary for many years to come.
For young men, shaving or buzzing the head often serves as a marker for embracing MPB. Testament to how upsetting hair loss can be is the fact that many men avoid shaving their head (for years) until few alternatives remain.
Letting go and embracing life as a bald man is not an easy option for many men, it wasn’t easy for me. I found it startling when I saw some guys in their early 20’s rapidly ageing through MPB; guys that lost it all very fast looking 32 by the time they were 22. While I can’t deny that some men look great with a bald head, the truth is that many men simply look better with a full head of hair, and some men really look a lot worse off when affected by hair loss. This may sound cruel, but it’s true, and it scared me because I felt as if hair loss was not doing me any favours regarding my appearance.
I was and still am an individual that thoroughly enjoys the flexibility of changing my hairstyles. I like the creative opportunity that it permits; the self-expression that it can speak of and the compensation it pays to my presentation, and I know that many men feel the same way about their hair. All you have to see to be sure of this is the growing prominence of expensive barber shops and designer haircuts. There’s no doubt about it – modern man loves his hair and he makes no bones about it. Men are catching up on women when it comes to the amount of time and effort they spend on grooming, and according to a survey conducted by HIS Hair Clinic; 94% of men fear hair loss as their biggest concern in relation to ageing ( https://www.medicaldaily.com/going-bald-named-greatest-aging-fear-94-men-257516 ). MPB really is an uncomfortable fact of life that is welcomed by very few.
To reiterate I would say that research research research is the most important thing anyone can do when making decisions about hair loss. I would say speak to medical professionals although so many of them are capable of telling lies. Prepare to be shocked by the amount of crap in the market – some of it pushed by reputable doctors. Products like hair loss peanuts, hair loss vitamins and hair loss protein are useless. I would be skeptical of the magic laser treatment too. Check out decent forums and websites. Learn to keep your eyes peeled for marketing clinics and dodgy activity. Maybe even check out The Bald Truth (a hair loss podcast on YouTube) and read Hair Transplant Real, it’s a book about the scary side of the hair transplant industry. The hair transplant industry is a crazy insane scary thing, but it’s also totally amazing too.