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First, I want to say this: I’m glad you’re here. Hair loss is something that most guys will experience in their lives, and if more of us talked about it instead of joking about it, maybe we’d all have better information. According to the American Hair Loss Association, two-thirds of American men will experience some degree of appreciable hair loss, with 85 percent of men “significantly thinning” by the age of 50. About 25 percent of men who experience hair loss begin the process before they reach the age of 21. In other words, this is a nearly universal experience—which makes the stigma surrounding hair loss all the more confusing.
Odds are, if you’re reading this, you are quite literally already balding or thinning—even if you don’t think you can see it. But don’t panic! First, it’s possible to look great bald. But secondly, there’s a lot you can do.
“There are so many triggers that can create balding, so it’s important to have a clear understanding of what actually impacts the process,” says Palm Beach trichologist Bridgette Hill. (A trichologist is a hair and scalp specialist who is not a doctor.) “There is no reason that balding has to be a reality in the 21st century.”
But before we get ahead of ourselves, let’s start at the root of hair loss.
What causes balding?
Balding is primarily genetic. But contrary to all those fun factoids you’ve heard about it being your mother’s father (or was it your father’s mother?) who caused your current situation, there's no strict rule to determine who is going to lose it.
What science can confirm is that the exact trigger for male-pattern hair loss is a hormone called dihydrotestosterone, otherwise known as DHT. “This comes from testosterone that’s naturally in your body, but if you have male-pattern hair loss, what you’ve inherited is a sensitivity to DHT in your hair follicles,” says Dr. Alan Bauman, a full-time, board-certified hair restoration physician. Basically, he explains, this sensitivity to DHT causes a “miniaturization of the hair follicle,” which leads to the overall weakening of hair growth. This manifests itself as that all-too-common receding hairline and thinning in the crown of your head (the “bald spot”).
But trichologists and doctors alike also assume that, beyond genetics, lifestyle factors also contribute to hair loss. “Something men don’t really talk about is emotional health and wellbeing, but that’s a trigger,” Hill says. “So is your diet—a lot of times, men have high-protein diets without lots of greens or folic acids, which are essential in making hair follicles and protein.” Dr. Bauman also adds that poor sleep, some medications, and smoking may worsen things, too.
Another interesting cause of balding may very well be in your protein shake. When Dr. Bauman assesses a patient’s risk factors, he looks for the typical things: inflammation of the scalp, sleep schedule, diet, and mental health. Now, he also asks about a patient’s intake of “excess testosterone,” which could come from supplements. “I’ve been doing this for 25 years and have treated about 30,000 patients,” he says. “We noticed a common thread of hair loss among guys in their 20s or younger who are in their workout regimen, taking bodybuilding supplements.” Some clinical research has shown that creatine supplementation, for example, increases the level of DHT in the bloodstream—which means it can exacerbate hair loss in anyone with a genetic sensitivity.
It all starts with the scalp.
There’s also the mechanical element of hair loss, which really lies in how we take care of our scalp. If you want to ensure that you hold onto the hair you have for as long as possible, you have to start getting just as serious with your head as you are about your face. Look at it this way: Your face shows signs of aging through wrinkles, dark spots, and sagging. Your scalp shows signs of aging through thinning and balding.
The first step is completely rethinking how you shampoo. “Men tend to shampoo every day, religiously without understanding the impact that over-cleansing has on the scalp or the skin,” says Hill. “But over-shampooing can destroy the equilibrium of the scalp—be gentle.”
Most short-haired guys can easily cut back on shampooing to once or twice per week, which I know can sound gross, especially for those of us who are using product in our hair every day. (But I don’t know a single woman who shampoos every single day, and most of them have a lot more hair than me!)
Instead of lathering up with the ‘poo, make your conditioning session more soothing. I love using the $10 Hairstory Brush in the shower—its silicone bristles are gentle enough to stimulate the scalp without going too heavy, but will still give you good stimulation and remove product, impurities, and dandruff. (It’s a lot gentler than using your fingernails.) As for conditioners, choose one based on what your hair’s needs are, or be safe with a standby like the Sachjuan Scalp Conditioner.
But care doesn’t just stop in the shower. In fact, you’d be wise to do a little extra work before and after for maximum results. Hill strongly recommends pre-shampoo oils, which coat your scalp to create a hydrating barrier on your skin. Post-shower, serums and treatments for your scalp can be applied before your styling products with no real impact on your final look. Sisley’s Revitalizing Fortifying Serum for the Scalp is packed with great ingredients and is super fast absorbing—just take three pipettes all around the head and rub in circles until it’s dried. If you’re looking for a more affordable option, try the Sachajuan Scalp Treatment, which feels just like a conditioner, or the Phyto Phytopolléine Botanical Scalp Treatment, which is a lightweight blend of essential oils. Otherwise, before styling, thinning guys would be wise to invest in a thickening spray, which instantly adds volume to the root of your hair—try Oribe Serene Scalp Thickening Treatment Spray.
You need more than just a hairstylist.
We’ve already given you the statistics on balding, which basically prove this: It behooves any and every man in their 20s who’s concerned about balding to schedule a consultation with a trichologist. A trichologist is a hairstylist who’s been educated about the diseases of the human hair and scalp. A consultation, which can range in price but will generally last from 30 minutes to an hour, will generally include an examination of your scalp under a microscope.
The person doing your scope will also be looking for anything from the miniaturization of the follicle (thinning) to a process called “follicular scarring,” which identifies areas of the scalp where the blood is no longer flowing. Hill may ask her clients to also submit a medical evaluation and blood work, which can be done with their doctors, so she can assess things like diet and nutrition. The goal of the consultation is for the trichologist to identify what your next steps are: Should you change your diet? Your grooming routine? Your sleep schedule?
“The consultation—no matter what phase of growth the client is in or what’s happening—needs to be honest and straightforward,” says Christyn Nawrot, Phyto’s director of education. She has told clients many times that, for example, their comb-over is no longer working, or that they need to make some serious lifestyle changes. But of course, sometimes there’s nothing a trichologist can do. That usually prompts a recommendation for you to visit a physician who specializes in hair restoration.
A trichologist may also point you in the direction of supplements. There are plenty of multivitamins for hair and nails, but a major player in the space for decades has been the Phyto Phytopanère. A trichologist may also recommend supplements that have been touted as alternatives to more serious medications (more on those later)—one popular choice is Viviscal Professional, another is Nourkrin for Men. Hill still suggests you confer with your physician before taking any supplements.
In general, though, building loyalty with a hairstylist as you begin to bald is crucial. “Subtle changes happen when people come in for haircuts,” says Nawrot. “At three to five weeks, we really can see different things happening on the body or the hair.” The right cut will help camouflage or hide areas where you’re balding, but switching it up on your stylist or barber might mean you’re going to someone who’s less familiar with your growth pattern. If you like what your current pro is doing, stick with them, and let them know when you may be taking measures to intervene with hair growth.
A lot of guys who are thinning also have the misguided propensity to grow their hair long, thinking that it will create the illusion of a fuller head of hair. “Work with your strengths,” says Trey Gillen, the artistic director of Sachajuan. “Where it’s thick, you can go really short, and where it’s slightly thinner, we can fade up into a slightly longer length without it looking obvious.” Overall, a shorter cut—even a buzz—will make balding or hair loss far less conspicuous.
If you’ve made it all the way down here, you’ve reached the point in the hair loss journey when all other options have either tired or failed—and now it’s time for the big guns.
Generally, any guy anywhere on the balding spectrum would do themselves a service by talking to their physician about balding. Popular medical therapies for balding include a pill called finasteride and a topical serum called minoxidil, most commonly known by the brand names “Propecia” and “Rogaine.” Finasteride blocks the creation of DHT in the body, but has garnered a bit of a bad reputation for its sexual side effects (decreased libido, erectile dysfunction, and decreased ejaculate volume). Dr. Bauman, however, insists they are “all classified as mild, and they happen in less than two percent of patients.”
Minoxidil, on the other hand, generally comes as a topical liquid which helps with hair growth. The drug can encourage slightly odd growth, according to Dr. Bauman: “The weaker, wispier hairs that are almost dead and gone start to kick in and grow again,” he says. “What sometimes happens is, those weaker hairs grow long at first, so you get a thin peach fuzz. But if you stick with the treatment, the quality and the quantity of that hair improves.”
There are loads of ways to access finasteride and minoxidil these days—including via the start-ups hims and Roman. But if you have the means and the access, a hair restoration physician like Dr. Bauman can prescribe a topical version of finasteride that contains Minoxidil. Since all of this is likely not covered by insurance, you’re looking at about $80 for a 30-day supply of compounded oral finasteride or $100 for a 30-day supply of the topical finasteride with Minoxidil. (Roman, on the other hand, costs about a third of that, at $35 per month.)
These medications are generally recommended across the board, even for patients who are also undergoing other types of intervention. But if you do reach the point where you need to go deeper, Dr. Bauman lays out a few other options.
The first is laser light therapy, which utilizes red light therapy on the scalp, a treatment that’s FDA-cleared for hair regrowth. Your doctor will prescribe a device that looks like an electronic cap to use for five minutes a day. This can be used in conjunction with other procedures (including transplants) or on its own. A top tier device will run you in the ballpark of $4,000 to $6,000.
A slightly more invasive next step would be to visit a doctor for a platelet-rich plasma treatment (PRP), which is referred to as a “lunchtime treatment” since you can be in and out relatively quickly and painlessly, thanks to the help of a local anesthetic. Essentially, the doctor takes a blood sample and spins it in a centrifuge, which concentrates the platelets. That plasma is then injected and applied back into the scalp. (If you remember the Kim Kardashian vampire facial, this is kind of like that…just for your head.) The PRP treatment gives a boost of hair growth for a period of time, and is recommended once a year. Expect a cost in the ballpark of $2,000 to $3,000.
In that same visit, you can also opt for an add-on service called PDOGro, which “is like a synthetic scaffold” for the scalp. There’s currently a trend in cosmetic surgery called “thread lifts,” where dissolvable, polydioxanone threads (commonly utilized as sutures) are used to lift the skin and apply volume. The threads are sewn under the skin—commonly in the lips, around the eyes, or jowls—and eventually melt away, creating collagen and new blood vessel formation. Dr. Bauman does the same thing on the head, since it theoretically will release growth factors and improve the skin tone of the scalp. Expect to drop around $5,000 to $6,000 for this.
Under the knife
The next, most major step is hair transplants. “If the follicles are dead and gone, then we need to do something to replace, redistribute, and relocate the follicles from the permanent zone—the back of the scalp—into the thinning or the balding area,” says Dr. Bauman.
You may be familiar with hair transplants as something called “hair plugs,” but today, traditional hair plugs are seen as an outdated surgery. Today, hair transplants use a much less invasive technique called “follicular unit extraction,” or “FUE,” which allows your doctor to take individual hair follicles from the back of your scalp and then redistribute them into a thinning or balding area. Since the doctors go one hair at a time, they are able to artfully control the angle, the position, and the orientation of the hairs. “That’s why it doesn’t look like you’ve had a hair transplant,” Dr. Bauman says. He recommends that, before booking an appointment, you ask to look through your doctor’s before-and-afters—specifically, for a patient with a similar hair texture and balding pattern as you.
Recovery can vary, but the key thing is: No heavy pain medication is necessary. “After a day, 99% of patients don’t take anything for pain,” Dr. Bauman says. They will need to keep the areas of the procedure clean and free of debris or “crust,” which can be done with gentle and regular shampooing for up to a week until you’re completely healed.
If all of this sounds too good to be true, that’s because we haven’t told you how much it costs. A typical transplant procedure could run you anywhere from $15,000 to $30,000, depending on your doctor, the type of FUE you’re in for, and the number of grafts required. The only way to get an accurate quote is to identify a (board-certified!) hair restoration physician near enough to where you live.
Fuck it, go bald.
At some point while I was doing the research for this piece, it occurred to me that preventing balding costs a whole lot of money. This is ironic, I thought, considering some of the sexiest guys on the planet are bald, from Jason Statham to The Rock. I decided to call up my friend Adair Curtis, one of the stars of Netflix’s Styling Hollywood, to talk about why bald is beautiful.
“I’ve always had such a huge forehead,” he says. “I never paid attention to my hairline, and it never really receded, but it always looked like it was receding.”
After voicing his frustrations to his barber in Los Angeles, she finally convinced Curtis to let her shave his head. “After she did it, there was no looking back!” Curtis now shaves his own head every other day, using some Kiehl’s Close-Shavers Squadron Ultimate Brushless Shave Cream and a classic three-blade razor from The Art of Shaving, followed up with a slap of Tend-Skin to prevent ingrown hairs. He also extends his skincare routine up there, too—cleansing daily, exfoliating weekly, and moisturizing regularly. “Lastly, I apply Coola Sunscreen Mineral Face SPF 30 in a matte finish.” (If you’ve never had a scalp sunburn, count your blessings…and stock up on SPF.)
Even if you don’t think bald is beautiful yet, consider that sex has a lot to do with power. And there’s nothing sexier than a guy who is confident in his look—confident enough to ditch his hair altogether. “It’s freeing to release the power grip that hair has over our lives,” Curtis says.
Curtis now rocks a mustache to complement his bald head, which the stylist Kristan Serafino conveniently points out is an excellent strategy to get guys more comfortable with the idea of losing their hair. “It’s not the end of the world, and certainly not the end of a varying grooming routine,” she tells me. “Just shift your attention to where hair still flourishes: your face!”
A good barber will help you with the right fade from your face to your sideburns to make sure things look sharp and not too jarring—but a beard and a bald head or a nice new mustache will give you something new to focus on, and create an exciting focal point for the rest of your face. (Especially if you’re worried about your baldness being distracting.)
Plus, Adair says, being bald comes with all sorts of benefits: “I save so much money on haircuts now that I’m able to shave it myself.”
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