Worried about what’s going on up top? We have the latest on how to best manage going bald
Balding is optional, the experts say, if you are prepared to seek treatment early enough. We have the latest on balding treatments, and what’s in the pipeline.
Mark was 26 when he first sought professional advice on his thinning hair. He’d noticed it even earlier, as had others, and it got to him.
“People started to tell me I had a receding hairline and I became really conscious of it. I was quite young, and for me going bald meant losing confidence, getting depressed,” Mark says. “It’s an awful experience to go through. Some people don’t care, but I did.”
Mark is now 42. It’s been a bumpy, and expensive, ride over the past 16 years but he is very happy with his new look, courtesy of a relatively recent hair transplant.
“I’m six months after the transplant now and I’m really delighted with how it looks,” Mark, who has chosen not to be identified in his photographs or use his real name, says. “The results are great. My surgeon (Dr Russell Knudsen) said I’m at about 70 per cent growth, so there’s a bit more to go. After a year the full results will be there.”
“I feel like a different person. I’ve started to exercise and I’ve lost 10 kilos. I really don’t think I would have done it without the transplant, because before that I was feeling like ‘I’m bald anyway, so who cares if I’m a bit fat’,” he says.
Balding? Who cares?
The emotional response some men have to going bald can run deep considering how commonplace it is. Balding men may feel hard done by, but the numbers show that it affects about one in five men in their 20s, one in three in their 30s and half by the time men reach their 40s. Indeed, some studies put the proportion of men who will experience at least some male pattern hair loss in their lifetime at 80 per cent.
For women the numbers are surprisingly high. Around half of women will be affected by hair loss in their lifetime, research shows. But the hair loss is generally “hair follicle miniaturisation”, the hair progressively transforming from thick strands to thin across the whole scalp.
There are plenty of influential figures who show baldness at younger ages doesn’t get in the way of success in their chosen endeavours. Political Peters Dutton and Garrett are examples, as are sportsmen such as swimmer Michael Klim, AFL star Gary Ablett Jr and Socceroo Aaron Mooy.
Internationally there are myriad examples of those out there loud and proud with a shiny pate, from billionaire Jeff Bezos to filmmaker Steven Soderbergh to basketball legend Michael Jordan.
But going bald early isn’t always easy to come to terms with, says Melbourne dermatologist Samantha Eisman.
“While we see many successful men with balding, and while certain societies may view this as a sign of masculinity, balding causes a lot of emotional distress, especially for those losing their hair in their teens and early 20s where it is a sign of ageing and, for some, unattractiveness,” Dr Eisman says.
“Balding can affect confidence, relationships and ultimately quality of life, with anxiety and depression in some. It’s not uncommon for individuals to become fixated with their hair loss, requiring psychological support.”
Queensland dermatologist Leona Yip says the Covid period turbocharged concern among young men about baldness, whether warranted or not, as they spent more time indoors obsessing about their looks.
“Over Covid I saw an increase in my practice in young men, some of whom weren’t yet balding, but have a perceived receding hairline, seeking preventive treatment,” Dr Yip says. “People are doing more meetings virtually so they are seeing their hairline and skin and saying ‘I don’t like this’.”
One of Australia’s pre-eminent hair transplant surgeons, Russell Knudsen, says the issue for men is not so much the fact of going bald but that it is happening prematurely.
“The young ones are devastated because it makes them feel older. They don’t feel like they’re going to attract the right partner in the right age group if they’re looking 10 years older than they should,” Dr Knudsen says.
“We’ve done population surveys on people who were losing their hair, asking how they felt about it. Seventy per cent said they didn’t really care, 25 per cent cared a little bit and 5 per cent cared a lot. Only maybe 1 per cent would have (a transplant) operation, though this might be up to 2 or 3 per cent as they now yield better results than previously.
“A lot say I wouldn’t mind this happening in 10 or 15 years from now. Can you get me to then?” he says.
Why do people go bald? And why isn’t there a cure by now?
It is literally the billion-dollar question, with a worldwide industry trading in prevention and treatment. It’s one thing to know why, another to know how to stop it.
There’s no doubt genetics is a big factor, in fact the predominant one. The genes that determine balding can come from either the mother or father’s side despite the notion that it is the mother’s side that predominates in this regard.
“But it’s not just about one gene,” Dr Yip says. “We’re talking about tiny genetic coding proteins, and there could be thousands or millions of them that make up a gene. It’s that variation in genetic coding that could predispose someone to baldness, or determine when they start going bald.
“Because of that it’s really hard for us to pinpoint the exact gene or genetic code that we want to target in our treatments,” she says.
Dr Eisman says while genetics is the primary factor, other influences are hormones and environmental or lifestyle factors including diet or smoking.
She says while there are “many exciting scientific possibilities (such as gene editing) it is unlikely we will have a cure this decade”.
Dr Yip warns men and women worried about thinning hair to beware of the pseudoscience that pervades the industry about new cures.
“There’s a lot of dramatisation about what can be achieved at the moment. The claims you see on social media and media in general are capitalising on the vulnerability of people looking for a cure,” she says. “But because it’s such a complex condition it’s unrealistic to expect a cure.”
“There are a lot of good treatments these days, and we’ve come a long way in the past 10 to 20 years in terms of delaying thinning and improving the chance of regrowth, but we can’t cure baldness until we can dissect that full genetic code and know exactly what’s causing it.”
Dr Knudsen says in the absence of a definitive cure, the internet is filled with other therapies, which he calls “cosmeceuticals” because they have to fall in the bucket of cosmetic, not regulated therapeutic remedies.
“It’s a space that’s rife with misrepresentation and expensive nonsense,” he says. “One therapy is vitamin B7, which is biotin. People buy this all the time, but one in 30,000 people are biotin deficient. My message is to seek a medical opinion.”
What are the latest treatments?
The usual first step is to slow down thinning, primarily with medication. Finasteride is the most common among this class of drugs, targeting an overactive enzyme in the hair follicle.
Dr Knudsen says it is quite effective in stopping hair loss, damping down the enzyme that is the root of the problem.
But what about the reported side effects, including sexual dysfunction?
He says male patients are reading on the internet about sexual side effects such as decreased libido or inability to maintain an erection, and are overreacting.
“The reality is that there is a 2 per cent risk, not a 100 per cent risk. And if you lower the dose you can lower the risk. It’s more the fear of the side effect rather than the reality of the side effect,” he says.
Dr Yip says there have been a number of different studies about the potential risk from side effects of these types of drugs.
“The original manufacture studies show an up to 5 per cent risk of sexual dysfunction, and that includes reduced sex drive or erectile dysfunction.
“Since then there have been studies that have reported potentially higher risk, but every study is quite different. For men who do experience those side effects, they would usually go away if we stop treatment … or we reduce the medication dose.
“Very controversially, mood problems have been described with these drugs, but again, it’s based on not very credible reports and studies,” she says, noting such conversations need to be had with every patient to outline the risks.
Beyond drugs to block hair growth, others have been developed to regenerate hair, including topical creams.
“The one most people know about would be PRP injections, which are platelet rich plasma,” Dr Yip says. “Patient selection is incredibly important for a procedure like that because it can be quite unpredictable.”
She also notes there are exosome injections, the latest trend in hair regeneration.
So how successful is it?
“The best figures we can come up with for using these kinds of medications is between a third and 50 per cent of people seeing improvement,” Dr Knudsen says. “But a lot of people come to us at a later stage, so if they came to us earlier we might see better results.”
There are other treatments in the development pipeline, including hair cloning, which involves harvesting and cryogenically storing hair follicles for a later date. When needed, the dermal papilla cells in the saved follicles are isolated and multiplied in a lab. Then these cells are injected into the balding areas of the scalp. It is yet to receive regulatory approval, but its proponents say clinical data shows promise.
Another is the advancement of stem cell therapies, where cells can be manipulated to stimulate hair growth and are then injected into the scalp.
Other research is focusing on whether a naturally occurring sugar, deoxy ribose, can be harnessed to boost the blood supply to hair follicles to encourage hair growth. Tests on mice have so far proven positive, and as a naturally occurring substance it is seen as being safer than manufactured drugs.
Dr Knudsen says finding a definitive cure is “incredibly complex” because the make-up of hair follicles is so intricate. While much money and effort is being expended, “the reality is that every time we have something promising in an animal study that has been tried with humans, it hasn’t worked”.
Mark tried medication for years, with only moderate success until his hair started to rapidly recede in his late 30s.
“When I first sought help I went to a few clinics. They were pushy and wanted to do a transplant straight away.
“Dr Knudsen told me I should try medications first and come back in a couple of years to reassess. It was such good advice and I’m glad I waited,” he said, but noted the medications didn’t have a transformative effect for him.
“I work outside and was able to keep hiding my thinning hair under a hat. But there came a moment when I knew that I didn’t want to be balder and I needed to consider a transplant.”
Hair transplants. Do they work and should I go overseas to get one?
Hair transplants are performed under local anaesthetic with minor sedation. The technique is to take naturally occurring groups of hairs, or grafts, from the back of the scalp and replant them in the areas where there is thinning or balding.
How many grafts a person needs will be determined by the degree of balding or thinning.
There are various techniques, and the cost can be steep. Dr Knudsen’s clinic offers a costing schedule on its website showing that for 1000 grafts the cost is between $7000 and $10,000 depending on the technique used. For 3000 grafts it is $16,500.
Dr Knudsen notes that the best results occur when people continue to use medications to slow balding in addition to the transplant.
“If you do the surgery without medication, you’re guaranteeing that you’re going to get a temporary result. The graft will last but the hairs around it will still fall out.
“I say to patients it is like topping up a leaking bucket without fixing the leak. If medication is used there can be a far greater time period between transplant surgeries.”
What about cheaper options overseas?
In previous years Thailand was the most popular destination for cheaper procedures, although Turkey has more recently become the go-to place.
Dr Knudsen warns you get what you pay for. He says the procedures there tend to be a “cookie cutter” production line, where often it isn’t a qualified surgeon who does the procedure.
“I had a young doctor come to see me. As he came in I looked at his hairline and thought to myself he’s been to Turkey. It was too low at the front, the direction of the hairs were all over the place.
“There are low-cost options in Australia too, following the same model. Unfortunately, the healthcare commission in Australia has deemed that as long as there is a doctor on the premises it doesn’t matter who does the operation, which I am astonished by,” he says.
Mark says he opted for a transplant because cutting his hair super short or shaving his head didn’t feel right.
“It’s not how I look. I have thick eyebrows, and I’ve just never had really short hair.”
He says the operation was worth the money.
“Yes, it’s expensive. It cost me about $14,000 to $15,000. For some people that’s an overseas holiday or a renovated kitchen. But I’ve never really done anything just for myself and so I thought ‘I’m just going to do it’.”
A final word
The practitioners say the key to a good result is to seek treatment early.
“Balding is optional,” Dr Eisman says, provided people take action.
One encouraging note is that younger generations of men seem prepared to do just that.
“I’d say that Gen X, Y and Z have a different take on it than baby boomers,” Dr Knudsen says. “They’re more willing to be doing something, even if people know about it. There’s less stigma.”
