It is a condition to which different men have reacted differently down the years – and not all of them with great grace.
Hair loss and balding has resulted in some of the stranger personal choices of the rich and famous through the ages. For Bobby Charlton, the English football legend, the solution was to grow his remaining locks and comb them over his naked scalp – a look that couldn’t fool a spectator sitting in row Z, let alone anyone else. Pop star Elton John went for a ginger toupee to cover his disappearing mane, while actor John Travolta has sought solace in a transplant that is even less convincing than his widely panned performance in Battlefield Earth.
The reaction of Roman emperor Julius Caesar, meanwhile, was even more drastic: he gave himself an ultra-short crew cut and is said to have considered ordering every man in Rome to do the same so he wouldn’t look out of place.
All these responses are inspired by one common emotion: utter despair at going bald. And now, research appears to prove what many men have long insisted on – that such despair is not just a vain overreaction, but a real and desperate psychological sensation to a condition, which, in many cases, is irreversible.
A study carried out by Charité - Universitätsmedizin Berlin, a teaching hospital, suggests that balding, and the perceived loss of virility and youth it is associated with, regularly leads to depression, stress and anxiety. Because it has been shown to reduce feelings of self-worth, it has been linked to obesity and insomnia.
A separate survey by Hairline International is said to have found morbidity rates increase by 14 per cent in men suffering hair loss. All of which is particularly bad news for us in the UAE.
Hair loss rates in the country are among the worst in the world, according to a YouGov research. Around 67 per cent of men have experienced it, compared to an estimated 40 per cent worldwide.
Factors including the harsh climate, big city stress, poor diets associated with expat living and heavy highway pollution all cause excessive hair shedding. Contrary to the popular urban myth, there is no evidence the water does.
‘I think it would be sensationalist to say this is a mental health time bomb,’ says Dr Michael Ryan, Dubai-based trichologist who works at the hair loss clinic Hair Spa Dubai. ‘But neither should we underplay its significance. The medical industry had tended not to give credence to the destructive psychological impact that losing hair has on men. That’s wrong. It may not be a life-threatening illness, but the fact is that there are large numbers of men in this country whose self-esteem, happiness and well-being are devastated because of this condition. That should be a major concern for us as a society.’
If that’s a worry, however, it leads to one difficult question: given that a cure for hair loss remains largely the stuff of wishful thinking, is there really anything that can actually be done?
Eight years ago, Omar* started losing his hair. At first, he noticed it coming out in the shower, then on his pillow. He didn’t give it much thought until one day, while shaving, he turned slightly in front of the mirror and saw that his hairline was notably thinning around his temples. He was 21.
‘I know this will sound ridiculous, but it was like being physically hit by a train,’ he says. ‘I was reeling. I sat on the loo with a mirror, staring at myself, holding it in different ways, trying to figure out if it was a trick of light, but it was just unmistakable. It was thinning.’
The initial shock didn’t wear off.
‘I spent two or three years paranoid that people could see my hairline was receding,’ he recalls. ‘I felt like a lesser man because of it. I felt inferior; like part of my future had been pulled away from me. You know, “forget my 20s, I’m an old man already”. And every time I thought, “OK, maybe this doesn’t look so bad”, it seemed to recede a little more.
‘When my friend first noticed it, I wanted to die. I sound melodramatic, but I stopped going out, my performance at work dipped, even my diet changed. I would just stay at home, comfort eating.’
Omar, an electronics distributor in Oud Metha, who is originally from Algeria, is today reconciled to his fate. He wears his remaining hair ultra-short and grew a trim beard to give himself a kind of Hollywood hard man look.
‘I looked into all sorts of cures,’ he says. ‘I couldn’t afford a transplant and I wasn’t convinced it would work, but you name an old myth and I went for it. I toured half the independent shops in Al Karama buying various lotions and potions, rubbed caffeine on my scalp, applied coconut oil and even tried some prescription medicines.
‘Someone told me I should hang upside down to get more blood to my head, and I did that a couple of times as well.’
If the future king of England has been unable to reverse a receding hairline, you’ve little choice but to accept it.
One day, he was flicking through a magazine when he saw a picture of Prince William, who was clearly facing his own follicle difficulties, and something clicked.
‘I remember thinking, “If the future king of England can’t stop hair loss, what chance do I have?’’’ recalls Omar. ‘That made me realise I’d only stop worrying when it was actually all gone. So I shaved it off. And that was it. I still wish every day I had hair, but what else can I do?’
Omar is far from alone in what he experienced. According to the YouGov research, some 35 per cent of men in the UAE who have lost hair say they experienced severe anxiety or depression as a result. For those with hair who were questioned, it is the number one physical condition they want to avoid.
‘In terms of evolution, we have hair on our heads to attract a mate,’ says Dr Ryan. ‘When we experience balding, even though our rational selves say that this does not change who we are, there’s a deep sense in our DNAs that this is our youth and vitality disappearing.
‘Of course, it’s nothing of the sort. But that is precisely what makes body dysmorphia issues so difficult to resolve: they’re not necessarily logical. The result is a deeply painful and disturbing psychological condition.’
So, what can be done to mitigate the effects of balding?
The answers are really down to the individual, and fall into two categories: prevention where possible, and acceptance where not.
The first thing to understand, however, is that not all balding is equal. There are two distinct kinds of hair loss. The first is hair shedding, caused by external conditions such as a bad diet, stress, too little sun (and the vitamin D it provides), not enough sleep and environmental changes like moving to a new place. This is not only stoppable, but reversible too.
With shedding, simply tweaking your lifestyle can work wonders, says Dr Ryan. ‘Adding more protein to your diet, getting more exercise, cutting out smoking and finding ways to reduce everyday stress can all help to improve your hair’s thickness.’
Male pattern balding, however, is more difficult to prevent. This is the second category of hair loss and it’s genetic, passed on through your mother’s side of the family. No amount of external changes can stop it.
‘These are the people who, if they find it appropriate, need medical intervention,’ says Dr Ryan.
This includes prescription drugs such as finasteride (sold under the brand name Propecia) and minoxidil (sold as Regaine), laser therapy and dietary supplements, which block the testosterone DHT from causing thinning. Yet none of these are fool-proof or perfect.
Most hair loss prevention drugs have potentially devastating side effects such as loss of libido, while laser therapy remains somewhat hit-and-miss. DHT blockers have been shown to work in only 70 per cent of cases, and even then, its success is limited.
More pertinently, none of these treatments actually cure the problem.
‘They just keep it at bay,’ Adam Penstein, one of New York’s most renowned dermatologists, says. ‘The moment you stop applying them, you start losing hair again, sometimes faster than before.’
Transplants are another option, especially as prices continue to be driven down.
Techniques and methods vary but, broadly, such operations will extract hair from the back of the head and then graft the strands, one by one, on to the bald patch. Cost depends on the skill of the surgeon and the extent of loss but, in Dubai, a good transplant will set you back between Dh15,000 and Dh50,000.
‘Operations are becoming increasingly sophisticated and a viable option,’ says Dr Ryan. ‘Of course, it’s up to the individual, but I’d say, get the information, think about how you feel and consider this as a possibility. You very rarely hear a guy say they are unhappy with the results.’
But remember that this is not a one-stop solution. Once the transplant is done, the patient needs to take hair loss prevention drugs for the rest of their life or the follicles will disappear once again.
For those of us without that kind of cash to spare, or the willingness to use daily drugs, there’s one solution. And it’s far easier said than done.
Finding a style that suits your hairline is one way of slowly coming to terms with the condition. Stylists and online advice can help. There are literally thousands of cuts – the buzz, power doughnut, the Caesar, et al – that give the impression of more hair without hinting that you’re trying to cover anything up. Plus, a good shampoo will thicken and volumise what locks you do have.
Bear in mind that most men who suffer male pattern balding take up to 15 years to lose their hair. It rarely happens much quicker.
If that’s not enough, find support. This is important, says Dr Asim Shahmalak, the celebrity British hair transplant surgeon and broadcaster.
‘Psychotrichological disorders are accompanied by feelings of disfigurement, and depressive and anxiety disorders including social avoidance. There is no shame in seeking help for these feelings.’
Family, friends, life counsellors and even doctors can all assist. It’s what they are there for. Most importantly, though, keep in mind that you are far from alone.
Balding can never take the shine off your achievements, as Sean Connery, Michael Jordan and Bruce Willis prove.
Look around you. In the world of sport, movies or music, for example, thousands of men are all experiencing the same thing. Being follically challenged never stopped Bruce Willis, Winston Churchill, Michael Jordan, Sean Connery and millions of others from achieving greatness and fame.
‘The key for me,’ says Omar, ‘was understanding that this is absolutely natural. No one in the world judges you on the amount of hair you have on your head.’
FIVE TIPS TO CURB HAIR LOSS
At the outset, it must be said that not all hair loss can be prevented. Even with medication, some baldness is sometimes inevitable. But following these tips have all been shown, in some cases, to reduce hair fall.
Eat right A good diet allows your body to maintain absolute peak conditions and that means retaining hair. Think protein, iron, zinc and omega fatty acids, which points to red meats, eggs, fish and lots of green leafy vegetables. Drink lots of water, too, to rid the body of toxins. And, in this case, the old adage that breakfast is the most important meal of the day is absolutely true. ‘This is when the hair is in need of protein the most, so an egg is ideal,’ says Dubai-based trichologist Dr Mike Ryan.
Reduce stress Stress is thought to cause hair loss because it raises the amount of the hormone cortisol in the body. Hair follicles react badly to this, and are weakened. By taking positive steps to cut stress from our lives, there should be a positive effect on thinning hair.
Stop smoking The toxins present in your average cigarettes damage pretty much every part of your body – and hair follicles are no different. That’s because nicotine and carbon monoxide restrict the flow of blood to the body’s extremities, including the hair. Without good circulation, the follicles begin to die.
Consider medication Drugs like minoxidil (which you massage into the scalp) and finasteride (generally taken orally) aren’t perfect by any means. They aren’t effective for everyone, have adverse side effects and once you stop using them, the hair loss will continue apace. Perhaps, of more concern, while finasteride functions by blocking testosterone that causes thinning, no one is really sure how minoxidil works. Yet, if you do feel desperate to stop further hair loss, it may be worth considering. Many men don’t, and many do advocate the decision.
Go nuclear A transplant is probably the last option, and only for those who can afford the Dh15,000-Dh50,000 starting price. But Dr Ryan says the technology has grown increasingly sophisticated, meaning the finished results are ever-improving. ‘With a good surgeon, these days,’ he says, ‘no one would ever know you’d had a transplant.’