If there is one nonlethal medical condition — other than impotence — that all men live in mortal fear of, it is baldness. Loss of hair and loss of reproductive function — or the opportunity to engage in it — are so firmly linked in the male psyche that doctors are advised to encourage patients to talk about this anxiety. All men need reminding that a receding hairline is not necessarily synonymous with a receding sexual horizon.
Everyone — men and women — loses some hair over the course of a lifetime. Some men lose more than others, and some start losing it immediately after the onset of puberty, since hair loss is associated with sexual development and the body’s production of androgen. This unfortunate, but natural, process has been blamed on everything from ancestry to diet. Today scientists know a great deal more about the process of going bald than they did just a few years ago, although its root cause remains something of a mystery.
My brothers and I grew up with the assurance that we would never go bald because our mother’s father had died with a full head of hair. That was psychologically reassuring — in fact, we have all retained our hair — but medically suspect. Although heredity definitely plays a role in the endurance of a man’s bushy topography — a male with all bald forebears is very likely to end up that way, too — there are exceptions to the rule. And fingering a particular relative as the determining factor in your own baldness is practically impossible.
Extraordinary hair loss can result from nothing more than stress, such as that caused by an illness or surgical procedure. But shedding can be brought on by less dramatic stressful circumstances — presumably including excessive worry about going bald — and in many such cases the hair will grow back once the anxieties are allayed or the issues resolved.
Hormonal changes can also trigger loss of hair, as can the use of certain medicines, including anticoagulants, antidepressants, too much vitamin A, medicines used in the treatment of gout, and chemotherapy. Infection of the scalp can cause hair to abandon it, and so can certain diseases like diabetes and lupus. As simple a reflex action as pulling at one’s locks can result in hair loss.
The most common forms of baldness in men are male-pattern baldness or androgenetic alopecia — marked by that bald spot on the top, or vertex, of the scalp — and the receding hairline. Both involve malfunction of cells that grow hair, known as follicles, which slow production and begin to shrink. Although the follicles remain living tissue, they don’t produce normal, visible hair, and this dormant stage can last indefinitely.
In some cases, baldness can be overcome by the wonders of prescriptive science, which vary from Draconian to benign, and from quite effective to practically useless. The National Institute of Arthritis and Musculoskeletal and Skin Diseases, which includes under its broad umbrella the phenomenon of hair loss, has found that the success of such treatments depends upon several factors. The most important of those factors are a man’s age, how much hair is missing and how complete a remedy he envisions.
In other words, a young man with moderate hair loss is more likely to regain it than a man who is almost completely bald and has been that way for a long time. The objective is spontaneous regrowth, but achieving that does not mean a man will necessarily recover his full head of hair. He may simply stop the hair from falling out, and that may prove to be a source of disappointment, even when the procedure is partially effective.
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