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Pride or Not, Most Men Don't Think Bald Is Beautiful

From the WebMD Archives

Jan. 5, 2001 -- Baldness didn't interfere with success for multitalented entertainers Isaac Hayes, the late Yul Brenner of The King and I fame, and others. But for the approximately 40 million American men that have to put sunscreen on their heads, the lack of locks may not be such a great thing.

Even in ancient Greek and Roman cultures, men tried various tactics to cover baldness. According to the FDA, even that famous wreath worn by Emperor Julius Caesar was an effort to cover a naked noggin.

In the 1940s, a scientific study showed that castrated men virtually never went bald. "But this is a rather drastic treatment," concedes David Whiting, MD, medical director of the Baylor University Medical Center Hair Treatment and Research Center in Dallas.

Whiting has been involved in studies using a component of the male hormone androgen that resulted in a drug called finasteride -- more commonly known as Propecia or Proscar -- which prevents hair loss and stimulates hair growth for some men. It's used for men who are genetically at risk for male-pattern baldness -- also called common baldness or androgenetic alopecia.

While finasteride was a major medical breakthrough in the treatment of hair loss, a recent study published in the International Journal of Dermatology says it's also a giant leap in improving men's views of themselves. Author Marcia Ramos-e-Silva, MD, PhD, writes that because one's physical appearance affects how people perceive him, many bald men have low self-esteem.

Ramos-e-Silva, of the Federal University of Rio de Janeiro's Sector of Dermatology in Brazil, writes that because finasteride can prevent hair loss, it's important for doctors to consider it as the first treatment for those facing baldness.

"It is vital, therefore, for the prescribing physician to bear in mind that the patient may suffer anxiety over the possible progression of hair loss in the future, while being able to tolerate his present condition," she writes. "For many patients, prevention of further hair loss alone will constitute acceptable management."

Whiting, who also is a University of Texas Southwestern Medical Center at Dallas dermatology and pediatric clinical instructor, tells WebMD that finasteride will prevent further hair loss in about 90% of men even five years after taking the drug and will foster regrowth in about two-thirds of men even two years later.

"Because it may be pretty effective in stopping the loss of hair, more so even than in regrowing hair ... then it makes sense to start taking it as early as possible," he says, noting that men can begin showing signs of common baldness as early as age 15.

Male pattern baldness is an inherited trait, which is caused when too much of the hormone dihydrotestosterone -- or DHT -- is in the blood. The DHT builds up in the scalp and damages the hair-producing follicles, which eventually die. DHT is produced when a chemical in the body converts androgen to DHT. Finasteride works by interrupting this chain of events, thereby reducing DHT production.

Interestingly, the same process is involved in both enlargement of prostates and in the development of acne.

In addition, some women also suffer from androgenetic alopecia, but finasteride is not approved for treating them. According to Whiting, testing has determined that the drug is not effective on postmenopausal women. Trials have not been done on women of childbearing age because it's already known that using an androgen-based drug on these women could result in birth defects in male babies.

Research goes on in search of better ways to save men's -- and women's -- pride: their hair. In fact, a number of companies are investigating drugs similar to finasteride, Whiting says.

"It's a very exciting field of research," he says. It's possible, he says, that if scientists can come up with different formulas to block DHT production, they could better treat and prevent baldness along with acne and enlarged prostates. However, he cautioned that successful therapy also could cause problems if used the wrong way.

The FDA approved finasteride for enlarged prostate treatment in 1992 and for treatment of baldness in late 1997.