About half of the world's people begin to lose the hair on their heads when they reach 50, if not before. Experts say hair loss can affect any mature adult, regardless of gender or ethnic background, and is usually more dramatic in men than in women. But nowadays there are many more solutions than buying a hairpiece. Bald or balding people can choose from a variety of treatments.
Male pattern baldness begins at the forehead and on the crown, and gradually progresses until the scalp is completely exposed.
A balding 50-year-old American expresses the feelings of many others who, like him, are experiencing hair loss - a genetic trait that develops under the influence of the male sex hormone testosterone.
"It's pretty devastating, to be honest with you. Up until about five or six years ago I think, I had pretty decent head of hair, and it is a masculine thing to have hair and it is devastating to lose it, to look in the mirror and see a bald man looking back," he says.
North Carolina dermatologist Amy McMichael says there are medications that can block testosterone and help prevent male pattern baldness.
"We do that with Propecia, which is a pill that you take daily," she explains. " It's a prescription that has to be written by a physician and that can block one of the hormones that cause hair loss."
According to Dr. McMichael, this medication cannot reverse hair loss, but it can help stop the shedding process. It can also strengthen limp or thinning hair.
"It looks like re-growth, " says Dr. McMichael, " because you allow those hairs that are progressively getting smaller to lengthen and thicken, or you just keep what you've got, which is to us dermatologists a success in the treatment of hair loss right now."
Amy McMichael says that although Propecia does not treat women's hair loss, there is a different medication that women can use to treat their condition.
"They can use Monoxidyl. That's a topical solution that prolongs hair growth. [The brand] Rogaine is the same as Monoxidyl. Rogaine can be very effective in women. It just has to be applied twice daily to the affected areas of thinning and the scalp. But you have to read closely to make sure that you understand the side effects and possible complications," she says.
One of those possible complications is low blood pressure. Rogaine was originally given to patients who suffer from hypertension, or high blood pressure. Some who were bald or balding started growing hair. Taking advantage of this discovery, medical experts created a diluted form of the original medication as a treatment for hair loss. Dr. McMichael says that even scientists are not exactly sure how it works.
"Rogaine doesn't work on hormones. Rogaine works from the outside, and it doesn't care where you put it," explains Dr. McMichael. " You can put it on your nose and grow hair there if you want to. It just elongates the hair, allows the hair to stay in that area where you are placing the Rogaine longer."
But many people choose a different approach to dealing with hair loss. One of them is a transplant. Dr. Robert Bernstein, associate professor of dermatology at Colombia University in New York, says that this surgical procedure has been perfected to the degree that people cannot tell the difference between transplanted hair and natural hair.
"On hair transplant, the tissue is your own hair, taken from another part of your scalp. The new procedure, called 'follicular transplantation', where hair is transplanted in little tiny groups of one to four hair the way it grows, looks totally natural," he says. " Unfortunately, when hair transplantation was developed 30 years ago, the hair was moved in these little punch graphs and those were what people identified with the plugs."
Plugs are grafts of 20-30 hairs implanted into the bald or balding spots of a patient's scalp. According to dermatologist Robert Bernstein, early plugs looked artificial, like dolls' hair.
But hair transplantation has been improved. The surgical procedure lasts about seven hours. It costs about $7000 and involves relocating 7,000 or so hairs. In other words, about a dollar a hair. But even this treatment has its downside. Occasionally, the patient's natural hair around the transplant will fall out, leaving a new bald spot to be filled. Also, according to our balding 50-year-old, transplants may, like wigs, look artificial.
"As far as I know, they are all detectable. And I think they look wrong. I've known people who have done that, and their hair looks different. It looks like a transplant. There is really - as far as I can tell - no way to cover it up. You just have to learn to live with it," he says.
For some men, hair loss is traumatic. Some may take solace from fashion trends that are kind to bald men. More and more movie actors, singers and sports personalities shave their heads. And many women, like this 30-year-old writer, report finding the shaved look attractive.
"I've known a lot of sexy bald men in my life. Not just in Hollywood, either. Though I would admit: Ben Kingsley, sexy. Sean Connery, sexy. Harrison Ford, almost bald, getting there, is very thin-haired, is very sexy," she says.
Other women such as this 35-year-old broadcasting producer, stress that personality, not a hairy head, is what makes people attractive.
"I mean, it's got nothing to do with the hair. It's whether I like the guy. When I meet him he's either got hair or he doesn't. Right? I don't care. If he is a nice guy, if he is a good-looking guy, I mean the hair goes with him - or not. Right?" she says.
To people with thinning hair, these comments may be encouraging. But the fact remains that hair loss can be a source of unhappiness or embarrassment for many men and women, who try to treat their condition by turning to medicine or cosmetic surgery.