Running For Cover by Bill Lewis Inseparable from the start, we went everywhere together. Never one without the other, we were as tight as tight could be: salt and pepper, love and honor, Sears and Roebuck. Somehow, as youth gave way to adulthood, our relationship changed. We drifted slowly apart, each going our own separate ways. As the gap widened, I wondered what had gone wrong, longing for the days when we were one. My hair began falling out when I was 22, raising doubts about my genetics and choice of shampoos. Though Grandpa was bald, and Dad was affectionately called Hairline North, the ignorance of youth provided a security blanket. I overlooked hairballs in the shower by never looking down, blaming the glare of bathroom mirrors on high-wattage bulbs. Outdoor activity and topical burn were byproducts of ozone depletion and unleashed UV rays. With my forehead growing, it became impossible to ignore the first crisis of my life. Is bald beautiful? Did God create a few perfect heads and cover the rest with hair? At 25, I made my first investigation into hair loss replacement. The Internet was unheard of, and trips to the library were inconvenient, but it became apparent that hair transplantation offered the best hope for recapturing my youth. Having become a father, and finding the cost of transplants equivalent to trading off my first-born male, I resumed the ignore-it-and-it-will-go-away policy. Several years elapsed in a whirl of parenthood and little-league baseball. Turning 37, with more head than hair, I made one final stand: Find that miracle cure, or let Mother Nature take her course. Armed with Internet access and the title of Hairline North, Jr., I began my quest for redemption. Columbus wanted to prove the world was round, Captain Kirk wanted to go where none had gone before. Since it lacked a more noble cause, some people said my journey smacked of low self-esteem. These comments generally came from individuals with a full head of hair, just back from the cosmetologist for their latest suck and tuck. Though "vanity" rhymes with "sanity," and too much of one results in too little of the other, I considered my expedition a trek toward possible self-improvement. Accessing search engines, using phrases like "balding," "hair loss," and "hair replacement," I surfed the 'net. Sites ran the gamut, from the federal government and medical groups to Hair Club for Men and Apollo. I found well-researched pages by individuals, recoup-your-hair-by-tomorrow destinations, and even an association of baldheaded men, fittingly located in Morehead City, North Carolina. Bolstered by mountains of information and a treasure chest of treatments, I could almost feel my remaining hair grow in anticipation of new neighbors. Unfortunately, further research dimmed the prospects for losing my newest nickname, Cul-de-Sac. The April 1997 issue of FDA Consumer magazine estimates forty million men and twenty million women experience hair loss, and Americans spend an estimated $1 billion annually combating the problem. While men suffer the brunt of the joke, a woman's hair loss is generally of a thinning nature. Though diet, stress, and disease are factors, 95% of all hair loss is hereditary. Called androgenetic alopecia, or male pattern baldness (MPB), the trait is genetic and can be passed by either parent. "The culprit is called dihydrotestosterone, or DHT, which is derived from androgen, a male hormone," explains the FDA. "Circulating through the bloodstream, androgen is converted to DHT by the enzyme 5-alpha reductase. Those with greater enzyme activity have more DHT binding to hair-follicle receptors. If flooded by DHT, the follicles sprout thinner and thinner hairs until nothing regrows, and the follicles eventually wither away." Much of the explanation was Greek to me, but I had a firm grasp on the "nothing regrows" and "wither away" parts. Simply put, certain hair follicles are preprogrammed to fall. Wearing hats won't cause it. Standing on one's head to increase blood flow isn't the answer. Being kind to others won't change a thing. My voyage had but three ports of salvation: pour it on, glue it on, or sew it on. Elixirs promising regrowth are eternal, but only the last decade has yielded products of any significance. In 1988, pharmaceutical giant Upjohn introduced Rogaine, a topical application containing a 2% solution of minoxidil. Available over the counter in 1996, Rogaine appeared to be my knight in shining armor. Only after surfing well researched, individually posted 'net sites (one in particular) did Rogaine look more like "no gain" to me. Tony Perricone created The Bald Man's Home Page, an award-winning site dedicated to hair loss and treatment. A service manager from Agura Hills, California, Tony transformed personal experience and research into a peerless source of information. While hair replacement sites offered light at the end of the tunnel, Tony's showed that the light just might be the glare from atop my head. Rogaine works on the crown area of the scalp, but only 26% of users see tangible results, with an even smaller number reporting dense regrowth. Applied twice daily, Rogaine requires a lifetime commitment. Discontinued use results in a penalty, eliminating any gain. Possible side effects include scalp irritation, lowered blood pressure, and impotence, albeit for a small number of users. "I tried Rogaine...in its first trials," stated one participant. "It lowered my blood pressure to the point that it was difficult or impossible to achieve an erection. This is not an advancement!" Amen, brother. Rogaine's web site claims that no in-depth studies have been performed on my nemesis, frontal baldness. Common sense suggests that a product showing any promise would be tested over the entire head. Did Edison discover electricity and wire half his house? Skeptical, I obtained the literature that accompanies the boxed product: "Rogaine is for men with hair loss or thinning that begins at the top of the scalp...frontal hair growth has not been demonstrated in clinical trials." In December 1997, Merck & Co.'s Propecia&trade; became the second FDA-approved product to gain marketing clearance for the purpose of regrowing hair. Available by prescription only, the tablet form of Propecia contains 1 milligram of finasteride, a drug commonly used to treat male prostate enlargement. However, by Merck's own admission, "...there is not sufficient evidence that Propecia works in the treatment of receding hairline in the temporal area on both sides of the head." Removing the hook from my mouth, I sailed to the next port. Known as toupees, hairpieces, rugs, and wigs, the great coverup dates back to Julius Caesar, who used a wreath of leaves to conceal his scalp. Our colonial forefathers wore wigs to suppress the glare by dawn's early light. Called "units" by today's manufacturers, hairpieces consist of synthetic fiber, human hair, or a combination of both. When attached to existing follicles, additions are known as bonding, cabling, microlinks, fusion, or weaving. Frontal hair lacking, units are affixed directly to the scalp with a variety of adhesives, tapes, clips, or water-resistant liquids. I also found adventurous souls who anchored bolts in their skulls, creating snap-on jobs so realistic only an airport metal detector would know for sure. Ranging in price from $500 to $2,000 and beyond, hairpieces require cleaning and maintenance at regular intervals. When affixed to existing follicles, units are constantly adjusted to accommodate the growth of remaining hair. Eventually, a rug's components deteriorate, and replacement becomes necessary every two to five years. Despite improvements, with high maintenance and airport security aside, the wig's biggest drawback lies in the obvious coverup. Why sport a hair helmet that doesn't fool anyone? Feeling like Casey at the bat, I swung into my final destination. Transplant procedures, which can include hair, punch and plug grafting, all employ the same concept: move hair-bearing pieces of skin from the sides and back of the head to the balding area. The use of each option is dictated by several factors, including the severity of hair loss, availability of sufficient donor areas, expectations of the patient, and most importantly, the ability to pay for the multiple sessions necessary to achieve desired results. A newer technique, micrografting, involves shooting one or two hairs into the head with a needle, recreating a very fine frontal hairline. Large micrografts move five to eight hairs at a time, while line grafts, which relocate strips of scalp, can transfer nine to 12. The American Hair Loss Council web site estimates that a square of paper 3.3 inches long adequately represents an area requiring five to six hundred standard grafts. Conservatively, at $10 per graft, I could spend nearly $6,000 to cover an area not much bigger than the Queen of Spades. An adversary of needles, knives, and bleeding, I searched for ways to move more hair with less pain. A technique called "flaps" rotates larger areas of hair-bearing scalp from the sides and back of the head. Still attached at one end to maintain blood supply, flaps allow continuous growth of hair, an advantage over grafts, which fall out before regrowing. Flaps bring not only more hair, but a higher complication rate as well. Since they require specific skills, inexperience on a doctor's part can produce excessive bleeding, scarring and infection. Citing adverse reactions, the FDA banned the use of synthetic fibers for transplantation: nothing new is added; hair is merely relocated. I wondered, with these procedures borrowing from Peter to pay Paul, who's going to reimburse Pete? And what happens when the balding area becomes larger than the hair-bearing acreage around it? The answer is scalp reduction, a technique that literally removes portions of bald scalp, bringing hair-bearing areas closer together, the idea being "the less head I've got, the more hair I'll have." It reminds me of a friend who bought a small car to make his house look bigger. Some recipients of this procedure complain about their heads feeling tight after surgery. Go figure. Transplantation is the most expensive option, with price tags ranging from $4,000 for minor hair loss to $25,000 and beyond for extensive procedures. MPB is a progressive disease, turning some men into transplant patients for life. Satisfactory results achieved today may be negated by further recession of the hairline tomorrow. Unless I found the "oasis" look appealing, I could plan on spending more money down the road. Having seen enough road already, I docked at The Bald Man's Home Page, looking for advice from other hair loss warriors. I found three personal experience articles, one written by webmaster Perricone himself. Each gave an honest, in-depth account of the writer's expectations, procedures and results. When finished, I no longer straddled the fence of indecision. Turning the search engines off, I disembarked with but one question in mind: What price vanity? Buying most people I know a six-pack and a birthday card ensures a friend for life. I won't sport a rug in the future or visit hair clinics. I will bid my youthful companion farewell, toss my comb in the trash, and sleep ten minutes later. Besides, if my son chooses Harvard, I won't be wearing his tuition on my head. Bill Lewis is a freelance writer from Kansas City, MO. I enjoy sports, the Internet, and crazy little women. His biggest achievement, and most prized possession, is his 13-year son, Billy, who laughs at his hair loss but has no clue what "genetics" means. Mum's the word. Feel free to e-mail comments or suggestions to <mrbill@toto.net>. Front page illustration courtesy of Max Lawler's Home Page.