How to keep your hair on

Men can now take out insurance to pay for treatment should they start going bald. But is the quest for follicle rejuvenation pure folly? Maxine Frith reports, while Simon Carr describes his brush with hair replacement

Men have been trying to turn back the tide of receding hairlines for more than 5,000 years, with varying degrees of success.

Men have been trying to turn back the tide of receding hairlines for more than 5,000 years, with varying degrees of success.

The Egyptians advocated a potion of iron, alabaster, onions and honey that had to be swallowed after reciting an invocation to the sun god, while Julius Caesar favoured applying a paste of ground horses' teeth and deer marrow to the head.

If only they'd listened to Hippocrates. The father of modern medicine hit the nail on the head 2,500 years ago when he observed that eunuchs do not go bald. Yet it took scientists until the first half of the 20th century to pinpoint why.

The most common form of hair loss - male pattern baldness - is caused by an enzyme that converts the male sex hormone testosterone into dihydrotestosterone (DHT). DHT damages the hair follicles, causing them to stop growing and leaving men with a receding hairline.

Even Hippocrates realised that castration may be too high a price to pay for a full head of hair, and instead recommended a putrid mixture of cumin, pigeon droppings, horseradish and beetroot as a cure for baldness.

However, the concoction proved disastrous. Hippocrates became ever more bald, so much so that, even now, extreme cases of hair loss are referred to as "Hippocratic baldness".

One in two men in Britain suffers hair loss before the age of 50, with only Germany having a higher rate of baldness among European countries. But whereas six out of 10 German men opt for treatment, 90 per cent of Britons suffer in silence.

One of Italy's oldest insurance companies, Cattolica Assicurazioni, has announced the first ever policy to protect against going bald. For £220 a year, men can now guarantee that they'll have access to hair replacement treatment worth £5,325 should they need it in the future.

Experts say that, even in Britain, more men are prepared to pay thousands of pounds for a better head of hair. The Belgravia Centre in London is Europe's largest hair-loss clinic and sees more than 1,000 people a week. Its owner, Michael Harris, says: "I think there is huge demand out there for help in treating hair loss, and attitudes are beginning to change.

"It can be devastating for a young man to lose his hair. The problem is that there are so many small clinics and shops offering all kinds of lotions and potions that they claim can cure baldness, when in fact there are really only two treatments that are clinically proven." These are minoxidil, marketed by Pfizer under the brand name Regaine, and finasteride, sold as Propecia.

Regaine is a solution that needs to be rubbed into the head twice a day for at least four months. It works by increasing the supply of blood and nutrients to the follicles, producing thicker, more visible hair. Two-thirds of the men who use it see some improvement in their hair growth after four months, and the benefits peak after about a year.

Regrowth can be as much as 25 per cent of existing hair, and a new, stronger version called Regaine Extra can produce even better results. A three-month supply can be bought over the counter for about £60, or from US websites for just £10.

Despite the success, it does have a downside. Once started, treatment with Regaine has to continue for the effects to remain. Regrown hair will start to disappear a few months after the treatment stops and the balding process begins all over again.

Propecia is a pill, available on private prescription in the UK, but not on the NHS. Made by Merck, it works by blocking the action of an enzyme in the body called type II 5-alpha reductase, the enzyme responsible for converting testosterone into DHT.

Propecia stops hair loss in 80 per cent of the men who take it once a day, and leads to new growth in 30 per cent of cases. But the drug can have unpleasant side effects, including loss of sex drive and temporary impotence. As with Regaine, it has to be taken continuously for the benefits to remain, and costs about £30 a month.

The Belgravia Centre recommends that men try a combination of both Propecia and Regaine to get the best results, with a 12-month course costing between £700 and £1,500. Most other drugs and lotions, says Harris, have no proven clinical effect and may be a waste of money.

Another option is a hair transplant. Pioneered by a Japanese dermatologist in 1939, the early attempts at transplanting hair resulted in a rather artificial "rug" effect, but the latest techniques mean it can be impossible to tell who has had surgery.

Dr Bessam Farjo, who runs two clinics in London and Manchester, charges between £2,000 and £6,000 per transplant. He says: "When people first think about hair transplants, they tend to think of bad examples that look artificial, such as Elton John's. But the way we do them now is very different. More men are coming in to have treatment - I think they see a friend or family member have the transplant and realise it can look good."

Male pattern hair loss is usually inherited, and a man's genetic make-up means that hairs on certain areas of the head will contain receptors for DHT, while others will not. Those hairs with DHT receptors are the ones that will be damaged by the hormone, causing baldness. Generally, the "receptor" hairs are on the front, top and crown of the head, which is why most men go bald there but retain growth elsewhere.

Dr Farjo's technique involves taking a block of hair from an area of the head where there is growth, such as the side, and dissecting it under a microscope into tiny patches containing just two individual hairs each. Needles are then used to prick the bald area like a pin-cushion, and the "healthy" hair is inserted into the holes under local anaesthetic. Depending on the size of the area being transplanted, the operation can take up to nine hours.

Because the transplanted hairs do not have the DHT receptors, they will grow healthily and will not be damaged. The hair tends to grow back at about a third of its original density, and some people opt for further surgery to increase thickness.

As demand grows, companies are spending millions of pounds researching new cures for hair loss. One of the latest discoveries involves a form of oestrogen called equol, which is made when bacteria in the gut break down chemicals known as isoflavones. Equol appears to stop DHT from attaching to receptors on the hair follicles.

Isoflavones are found naturally in soya beans, which may explain why Japanese men, who eat 10 times more soya than their British counterparts, have much lower rates of hair loss.

Another cutting-edge theory is that men could have stem cells harvested from their skin, which could then be used to grow new hair follicles.

But men are warned to temper their desire for a lustrous head of hair with caution when it comes to private clinics that may be little more than cowboy outfits. Elizabeth Steel runs the support group Hairline International, which gives advice to men and women suffering hair loss. "We advise our members to stay away from private clinics to avoid losing their cash as well as their hair," she says. "It is just money down the drain."

One man killed himself after a hair transplant went wrong, she says, and some clinics charge thousands of pounds for an initial consultation.

But she admits that some men will grasp at even the faintest hope of a new barnet. "Some men have told me that they knew the exotic and expensive remedies they were given were not going to work but that they just wanted to enjoy the temporary light at the end of the tunnel."

The Belgravia Centre (020-7730 6666; www.belgraviacentre.com); The Farjo Medical Centre (0870 755 5495; www.farjo.com); Hairline International ( www.hairlineinternational.com)

The bald truth about remedies

REGAINE

A clinically proven lotion available over the counter or on the web. Needs to be rubbed into the scalp twice a day, and effective in two thirds of men. Costs around £60 for three months, but hair loss will return if the treatment is stopped.

Does it work: Yes; it has been subjected to rigorous academic trials in respected scientific journals.

PROPECIA

A tablet that has been shown in trials to prevent hair loss in 80 per cent of men and stimulate new growth in 30 per cent. Available on private prescription for £30 per month. Has to be taken continuously and can have side effects, such as impotence.

Does it work: Yes. It has been through academic research and is the only treatment approved by the US Food and Drugs Administration.

HAIR TRANSPLANTS

Surgery performed under local anaesthetic that redistributes "healthy" hairs. Costs vary. Once done, the hairs continue to grow and no further treatment is necessary. Support groups warn that some clinics may be little more than cowboy set-ups and the results can be disastrous.

Do they work: Sometimes. It is vital to pick a reputable clinic, rather than a business operating as "Harley Street experts" - they are likely to be anything but.

PALMETTO BERRIES:

Sold in health food shops for around £5 for a pack of thirty capsules. A study has shown that the berries can inhibit production of DHT, the hormone that causes hair loss. They can also help with prostate problems.

Do they work: Possibly. The efficacy of herbs and vitamins are notoriously difficult to test, and many lotions and supplements are useless, but an initial trial has shown they may help.

STEM CELL GRAFTS:

Scientists have managed to grow hair on bald mice by using stem cells - the body's master cells. Stem cells were harvested from the skin and coaxed into follicle cells which then "seeded" into the bald mice, causing hair growth. Could be a success but still a long way off.

Do they work: Impossible to say. The work has so far only been done in mice.

Simon Carr: From Wiltshire to Harley Street - in search of a healthy covering of thatch

Some with bigger features can get away with hairlessness. But my eyes are too small for me to carry baldness off attractively. So away we went to Harley Street for a consultation in hair replacement therapy.

I'd started in Wiltshire, in fact. The Oxford phone-book had led me to an executive town-house an estate on the struggling side of Swindon. He was a referral agent for a clinic run by Indian technicians near Gatwick airport. It's a far-flung business, this.

The initial pitch is persuasive. For a couple of thousand pounds, they slice off strips of skin at the nape of your neck, above your hairline. Then that gets sewn up, offering a buttock lift at no extra charge. They cut the strips into little squares with two or three hairs in each segment, and then implant the tabs into your gleaming skull.

The reasoning, which is surely good, is that for many men this back-of-the-neck hair will grow naturally for the rest of your life. You're a bit of a bloody mess for a while, so you wear a hat or perhaps go on holiday. It's quite important that your co-workers don't find out at this stage as the mockery is cruel, even in these enlightened times. After the caked blood has fallen off, the sprouts grow almost imperceptibly until you've got your thatch back. They say this happens so gradually that people don't notice, particularly, and for all I know, it's true.

Two or three things worried me. The businesslike nature of the business didn't give me any confidence that I was going to be looked after. If my contract was with the agent rather than the principal, for instance, I wouldn't enjoy the battle for reparations when things went wrong. The fact that the agent was as bald as a billiard ball wasn't a great endorsement.

In Harley Street things were worse, not better. My interview was with a Vietnamese surgeon (as I say, it's a cosmopolitan business). I asked him what caused baldness. He didn't know. I asked him for some "before and after" photographs. He said they were on his website which was on another computer. Er...yes, okay. "Will you implant the hairs so they form a whorl from the crown?" I asked. "Otherwise it'll look like it's woven, won't it?"

That didn't seem important to him, so I really wanted to see those photographs in the hope that he understood hair replacement better than he understood the internet.

The thing that finally pushed me out of the door wasn't the cost. I get squeamish in these Harley Street clip joints. It had happened once before that I'd been in one for a consultation on another condition. A Lebanese doctor had seen me and made his pitch (the treatment I'd been having was "potentially fatal" he said). Then I'd been taken to another room where a saleswoman made the financial pitch. This was real sales too, not daffy, English "how-embarrassing-to-talk-of-money" sales. If you get out with your wallet in one piece you've done so by the skin of your teeth. I did get out by the skin of my teeth. But don't get me started on Harley Street dentists.