When Baldy Wearies of the Raillery

Do you fret about your receding hairline each time you see yourself in the mirror? You could just give in and accept balding as part of growing old but, in your dark moments, you might secretly blame your ancestors, whether from your mother's or father's side for the gene that predisposed you to baldness. You might even take comfort in the old saying that bald men have bigger libidos.

Scalp hair usually grows from the hair follicle at an average rate of 1/2 inch per month. Each hair grows for 4-7 years, then rests, and finally falls out. A new hair then begins growing in its place. At any given time, about 85 percent of your hair is growing and 15 percent is resting.

Baldness occurs when there is a progressive miniaturization of hair follicles which results in shorter and finer hair. The final product is a miniature follicle with no hair. While the cause of the failure to grow a new hair is not well understood, it is associated with genetic predisposition and with the concentration of endocrine hormones, especially testosterone.

When testosterone enters the follicles of those genetically predisposed to baldness, the follicles increase their production of the enzyme testosterone 5-alpha reductase. This enzyme, in turn, converts testosterone to the hormone called dihydrotestosterone (DHT). Follicles exposed to DHT enter the resting phase and begin to atrophy and shrink. The follicle, however, remains alive, suggesting the possibility of new growth.

The most common form of baldness in men, alopecia or male-pattern baldness, is caused by a mixture of hormones and genetic predisposition. Typically alopecia begins at the hairline which gradually recedes to form a sharp widow's peak. The existing hair becomes finer and fails to grow as long as it did when one was younger. The hair at the crown also begins to thin, and eventually, the top points of the widow's peak meet the thinned crown, leaving a horseshoe pattern of hair around the sides of the head.

There are an estimated 3.5 million bald men over the age of 20 in Korea, roughly 23 percent of the total male population. As long as you are comfortable with your appearance, no treatment is required for this permanent condition, but recent research indicates that many men are bothered by their baldness.

The first-ever study by Kyung Hee Medical Center on male-pattern baldness examined how the 192 subjects' body image was affected by baldness. It showed that while 90.6 percent of the patients, with the average age of 27, were satisfied with their overall appearance, an overwhelming 92.2 percent were dissatisfied with the appearance of their hair. Some 60.5 percent said that they paid extra attention to covering up their baldness when they stepped out of the house.

Despite their concerns, however, only 17.2 percent of the subjects had previously sought treatment from a doctor, which indicates that most balding Korean men accept their lot. According to Cheil Jedang, only an estimated 7.4 percent of men suffering from male-pattern baldness are using medication to encourage hair-growth. The company manufactures Jikgong Mobalyeok, an over-the-counter lotion treatment that promises to encourage hair growth as well as to strengthen weak hair, with Glyceryl Pentadecanote as its main active ingredient.

Rogaine, a lotion of minoxidil, sold without a prescription in the United States to treat male-pattern baldness, may help hair to grow in 10 to 20 percent of the population, and may slow the loss of hair in 90 percent. "My hair actually started to grow back," said Kim Byung-ku, 60, who had previously tried other cures without success. His joy was short-lived because he began developing redness in the scalp some six months after he started using the lotion. This reaction led him to stop using the ointment. "I was afraid I would lose what new hair I had grown," he said.

If medicated lotions fail, you may want to take the next step and try Propecia, a prescription drug that works by inhibiting the enzyme that converts testosterone to DHT. "Propecia is effective in preventing further hair loss in 70 to 80 percent of my patients, although the rate of success depends on the different parts of the head," explained Lee In-jun, a dermatologist who heads Jun Hair Clinic in Dongseomun-dong, Seoul.

Despite the relatively high success rate, one of the biggest reasons men have for staying away from Propecia is its side-effects, which may influence the user's sexual life. "About 2 percent of all patients will develop sexual dysfunctions, such as reduced desire for sex, difficulty in achieving an erection and reduced sperm volume within the first year of use," said Dr. Lee.

It now appears, however, that those concerns can be laid to rest. The five-year Propecia study results announced last week at the American Academy of Dermatology meeting in Washington showed that after five years on the drug, only 0.6 percent of the patients studied had side effects which affected their sex lives.

If you do not want to mess with hormones, you can always turn to wearing a hair system or wig. Advances made in hair systems make today's wigs and hairpieces more natural and convenient than ever before. Hi-Mo, a local wig-maker has developed a special type of wig using polyester fiber that "remembers" its original style. It returns to its style even after showering or sleeping. "It combines the strength of synthetic hair and the naturalness of human hair," said Yoo Young-joon, manager at Hi-Mo. There is also a choice of detachable pieces that you clip on at home or fixed pieces that are tied to your natural hair or glued to the scalp at the shop. "Fixed pieces will look more natural because you come in once a month for a hair cut and to groom the hairpiece," said Mr.Yoo.

A 38-year-old neurosurgeon who chose to remain anonymous said that he was very satisfied with his clip-on hairpiece. "My friends thought I just had a new hairstyle. Patients now ask my age, concerned that I may be too young and inexperienced to operate on their brain tumors," he said.

The most drastic and invasive measure you can take is to have a hair transplant. This procedure entails removing tiny plugs of hair from the sides and back of the head, where hair grows densely, and implanting them on top and in front, the areas that are usually balding. Restoration is possible because the hair follicles on the sides and back of the scalp are insensitive to the hormones that cause alopecia in men and so will not fall out.

During hair-replacement surgery, a strip of hair-producing tissue is removed and dissected under a microscope into units of one to four hairs. Then a needle is used to make tiny incisions at the exact place and angle where the hair will grow and the tissue is placed there. "The procedure usually takes 4-5 hours and patients may require multiple sessions," said Dr. Lee.

Men with hair loss limited to the frontal area of the scalp are the best candidates for hair transplant surgery. As for its cost, expect to reach deep into your pocket. "It costs about 3,000 to 4,000 won per follicle. That translates into around 3 million to 4 million won per transplant which, on average, involves 1,000 follicles," said Dr. Lee.

by Kim Hoo-ran