‘It can leave your self-image fractured’: how hair loss hits men – and what they can do about it | Hair loss

My dad is bald, and always has been. He’s had a shiny, hairless head with some growth protruding around the edges for the 27 or so years that I’ve been around. Throughout my childhood, his father always had the same carefully crafted combover – grey locks pulled forward neatly hid the tanned, hairless crown which sat underneath.

Mum’s dad – my Grandpa Oskar – just had a giant forehead for as long as anyone can remember: rear bushy follicles formed what could generously be described as a highly pronounced widow’s peak. Mum’s two brothers are the only other older male blood relations in my immediate family. They’ve both fared better. Receding? Yes. But still, hair is hair.

Which will be my future? I couldn’t tell you quite how much time I’ve spent agonising over this question. Through my teens it was something of a morbid fascination. In early adulthood, I’ve become a little fixated. I used to purposefully bring up the prospect of balding in conversation solely so an acquaintance would look up, shake their head, and tell me I was worried over nothing. Over time the response became a little more muted: “You can really barely notice,” some would offer. “There’s nothing you can do anyway,” was another standard reply. Mum has always thought I should stop being so vain. Who knows whether the change in tone came from a noticeable alteration in my appearance or a growing irritation with my self-obsession? Soon, I learned to keep my tedious concerns to myself.

Today, though, the smallest things can still send me into a spiral. Windswept pictures exposing the M-shaped hairline my gene pool has bestowed upon me need deleting, immediately please. I’ve followed my barber, Nik, across London boroughs. The idea of letting anyone else near me with clippers, in case they mistakenly snip off a section which never grows back, fills me with dread. Whole days have been ruined when, without my trusty hair gum, my mop has insisted on showing strangers the secretly bare bits of my scalp.

The most preposterous part of all this is that I’m barely even balding. For now, most of my head is covered with hair as thick, dark and unwieldy as it has ever been. Look at me face-on, that’s all you’ll see. Catch a glimpse of my side profile (it’s worse from the right) and it’s a slightly different story. Pull back my mane’s curtain and two distinct gaps – on either side of my face’s top corners – appear. Quite how quickly it’s happening I’m entirely uncertain. The extent to which it troubles me is hard to say. It’s not a constant preoccupation, more a peripheral pain. But I’m in no doubt – just as unwelcome hair is starting to appear in places I’d much rather it wouldn’t, my hairline is slowly but surely retreating.

In 2004, psychologists Sue McHale and Nigel Hunt asked local newspaper editors across the UK to publish a letter in their pages. It was a request for readers experiencing hair loss to share accounts of how it affected their daily life. “What we have since found,” explains McHale, a senior lecturer at Sheffield Hallam University, “is that whether it’s sudden hair loss or male pattern baldness, the consequences are the same.”

In the responses, she tells me over the phone, most people expressed similar sentiments: hair loss can cut to the core of our identity. “When someone looks in the mirror,” she says, “often the person they see is someone they no longer recognise. It can leave your self-image fractured, dramatically changed.” The result, she adds, is often varying degrees of anxiety and depression, with men struggling with the impact of hair loss – at whatever stage – regularly too ashamed to express how they felt. In both what it symbolises and what it means in practice, hair loss can feel devastating. It’s fairly obvious why. In a world infatuated with youth, it’s no surprise younger men are concerned about a process that signifies ageing, just when we are supposed to be in our prime.

Take the German study in which fictitious CVs listing the exact same experience were sent to HR bosses at 98 large companies: some featured a picture of an applicant with luscious locks, others had their hair digitally removed. Some 41% of hirsute men were invited to interview; just 27% of those without made the cut.

There has never been a bald James Bond nor a hairless contestant on Love Island. Growing up, bald men were never the superheroes and always the villains. Anti-bald-bloke prejudice may not be the world’s most pressing injustice. And in our culture obsessed with unrealistic and unattainable standards of the body beautiful, for some people – such as women and those from certain communities of colour – the loss of hair can be particularly profound. Sure, some men suit a sexy skinhead, but ours is a society that pays homage to hair. When it comes to male hair loss, there’s been little in the way of a body positivity movement which has – on other fronts – started to successfully push back.

Recently, I decided to start speaking about the underlying anxiety my hair continues to cause me. With the American Hair Loss Association estimating that by the age of 35, approximately two-thirds of men will experience some degree of appreciable disappearance, it seemed unlikely that I was the only person for whom the prospect was a cause for concern.

Rather than banging on about my barnet, I’d ask friends about theirs. The lucky, lusciously locked ones had no worries; a few others told me they’d tried products and potions. Some had cut their losses and shaved everything off. Far more, just like myself, saw recession and balding as a daunting spectre edging ever closer. And, like I had, they’d concluded semi-suffering in silence as the inevitable happened was their only choice. One, however, had recently taken a different tack.

Harry Engall was having a quiet drink with friends at a pub in south London at the start of 2020. He overheard a conversation between three lads standing next to him, while waiting to be served at the bar. “One of them said ‘God, I’d hate to have a receding hairline,’” Engall recalls, “and then all three of them just looked right at me.” Engall felt his face turn red, embarrassed and ashamed.

“I’m 26,” Engall tells me, “but I ran to the toilet and started crying. It wasn’t just that they’d clearly been rude to me. I’d always told myself maybe nobody else noticed my hair. But that confirmed it wasn’t just in my head.”

‘Luckily for me, what sounds like sci-fi might soon come to fruition.’ Photograph: Antonio Olmos/The Observer

Soon he was paranoid that strangers on the street might make a similar comment. For months, he refused to be seen without a cap. If, while getting ready for a date, he didn’t have one, there’d have to be a quick stop en route to buy one.

I find myself nodding, it’s totally relatable. The first few times a new partner stays over, I’ll have invariably snuck out of bed to style a do before they’ve stirred. It’s that or I’ll stay face down on the pillow until they’re out the door.

The summer before last I rekindled a relationship with an ex, both by accident and briefly. One evening we reminisced about how little had changed through the years in which we’d not spoken. “Well, except your hairline,” he joked.

Ten months after the incident in the pub, Engall stepped out of a clinic in Manchester. After an eight-hour procedure, his hair transplant was complete.

“It cost me five grand,” he says, “but the confidence it’ll give me, that way I’ll feel once it’s ready? I don’t think I could put a price on it at all.”

As he walked to the station, passersby were, in fact, staring. Not that he was bothered: the blood dripping from his forehead would soon, he hoped, be replaced by hair.

In a consultation room at Harley Street’s Private Clinic, a masked Michael Mouzakis is having a rummage around my scalp. The surgeon, who has been conducting hair transplants for close to a decade, is doing what’s known medically as the “pull test” – briefly yanking at my follicles to see what falls out.

“Yours is a typical pattern for male hair loss at an earlyish stage,” he says. Is that reassuring? He colours in the gaps on my forehead with a disconcertingly permanent-looking pen. Male pattern baldness, Mouzakis explains, is a gradual process: high testosterone levels mean areas will thin, follicles shrink and then sit in indecisive limbo. Without intervention, these hairs will become little pinprick vellus hairs, before eventually falling out.

Back behind his desk, Mouzakis talks me through my options. I could buy Minoxidil over the counter, a liquid or foam that is proven to help invigorate those indecisive follicles. Consistency is key: I’d need to rub the product into my hair twice daily until I hit my 50s, when the risky side-effect of altered blood pressure means I’d have to stop.

Then there are finasteride pills, which require a prescription. By reducing my levels of testosterone until it drops naturally in my 50s, my vellus hairs should start to grow back. The most common side-effect so far identified is reduced libido – some men will see their sex drive and erectile function drop.

“And then there are transplants,” the surgeon says, confirming I’m a suitable candidate. “We take follicles from a healthy area less prone to hair loss, generally the back of the head, and put it into the recipient area at the front.” In the last few years, this technology has come a long way.

Of course, there’s no guarantee my hairline wouldn’t then recede further. Based on my current trajectory, that’s likely to be the case. If I opted for a transplant, I’d also need to start taking medication, or else I’d be left with some strangely positioned gaps in my hair. Whichever I opted for, it could be a year until the results were visible: hair grows in cycles, there’s no quick fix.

“Hair loss is a medical condition you can fight, but you cannot win; it’s in our nature,” Mouzakis says, writing up the notes from our session. “Baldness you can delay and keep at bay, but for now there’s no turning back the clock.”

A few days later, I receive a quote via email. Getting in early for a transplant means there’d be less labour. For £3,750 I could have the procedure under local anaesthetic and be discharged the same day. It seems a reasonable price. Still, I can’t quite bring myself to book another appointment. I just sit, stroking my two strips of hair-scarce skin. A lifetime of permanent pill-popping, with potentially serious side-effects? I’m not sure I’m quite ready. Might science offer another solution, if I bide my time?

It was 2005 when Angela Christiano arrived fresh-faced at Columbia University. After completing her PhD researching skin conditions, she’d landed a job at the Ivy League institution. She was uncertain about what to study now she had her own lab. “Six months later, out the blue, I experienced alopecia areata,” she explains from her office. “All my hair suddenly just fell out.”

This marked the start of what she calls her odyssey, as she set about searching for answers through her research. Since then, there’s been little advancement in the types of drugs my surgeon had suggested. The field, she says, peaked 20 years ago.

“Conventional hair transplants are relocation: there’s no net gain in the number of follicles,” Christiano continues. But science has discovered those stronger back-of-the-head follicles retain their strength when moved elsewhere.

“The approaches that have evolved most fruitfully,” she says, “relate to stem-cell augmentation.” That’s artificially growing new hairs using existing ones, in layman’s terms. This is the challenge now facing Christiano: could one of these good hairs, plucked from a person, be replicated using technology and then restored? “Not just moving, but making more.” Christiano smiles: “That’s the holy grail.”

Researchers have tried all sorts of methods in their efforts to achieve this, from taking plasma from a patient’s blood and injecting it into precarious parts of the hair line to more advanced formulae made up of skin cells. As of yet, the results are unclear.

“I spend most of my time now trying instead to engineer a proto-hair,” Christiano says, “an actual structure that could be implanted into the scalp.” Frustratingly, high-quality hair loses its properties when placed into a Petri dish: standard stem-cell practices don’t yield results. Instead, she wants to find a way to engineer these hair tissues in a way that might restore their original strength.

This, she says, would be revolutionary for nearly all hair-loss patients, including radically changing things for younger people experiencing a slow recession.

“You’re young,” she says, generously. “If you got a transplant today, your hairline would keep moving back, so you’ll always be chasing it without also taking medication. You could keep topping up with further transplants, but at some point, you’ll have nothing left to move to the front.”

If Christiano can make a breakthrough, drugs and their dangers needn’t be a consideration. “We could start with just a handful of hairs taken from the back of the head and use them to grow a population of stem cells that could be kept frozen indefinitely and called up whenever you need more hair.”

Losing your hair could soon become much less cause for distress. Luckily for me, what sounds like sci-fi might soon come to fruition. Researchers who work on all sorts of bodily organs are searching for similar results.

Christiano often gets asked why she has dedicated her life to researching something that’s just cosmetic. “It’s the ‘just’ in that question,” she says, “that hurts the most. Sure, some people aren’t fussed about hair loss. But for many it’s socially and psychologically impactful, be in no doubt.”

Only last week she was on her way home from an appointment. Her alopecia means she still has an eyebrow that comes and goes. Sitting in the taxi, she couldn’t stop herself sobbing. Would a day ever come when what she’d lost would finally be restored?

It’s precisely this feeling that I’ve long been dreading, even if a little more of my hair will survive. It’s like I’ve been forced to take a seat on a train travelling in slow motion to Bald Town. Either I commit to trying to change course – which costs more than money – or sit back and ride it out. Now I know my options, what I’ll do, I’m still unsure.

Because my mum might be right – sometime soon my hair might feel a little less significant. Yes, I already know there are bigger things in life. Maybe one day I’ll think bald is beautiful. Right now, though, how I look – and my hair – remains an important part of who I am. It could well be vanity; it’s certainly superficial. But there’s no shame in saying how we feel matters, too.

“We’re doing our research not just so that we can give people their hair back, but also their lives,” says Christiano. “I should know, I could be one of them. And maybe one day, so might you.”

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