Baldness Cure Still Proves Elusive

As medical problems go, hair loss is fairly insignificant. Nobody ever died from it, or even felt any physical pain--unless you count the discomfort of the occasional bald-spot sunburn.

But there are other kinds of pain. Just ask any young man who’s looked in the mirror and seen some old-looking guy staring back. “I look like my dad,” says one Orange County man in his late 20s. “And I’m just not ready for that yet.”

Some men try to hide the evidence with hairpieces or creative combing. A few decide to flaunt it in the Yul Brynner-Telly Savalas-Kareem Abdul-Jabbar tradition.

Others, like Sen. John Glenn, use spin control to try to turn it to their advantage. “The way I figure it, we’re only given a certain amount of male hormone,” he is reported to have said. “And if some men want to use theirs on hair, that’s OK with me.”

But enough men find the idea of a naked or thinly covered pate so distasteful that they’ve kept the baldness cure business going strong for decades.

Until 1988, however, no pill, ointment or snake oil derivative had been proven to help reverse the normal male pattern balding process, despite what you may have heard on late-night cable TV commercials.

Then the U.S. Food and Drug Administration approved minoxidil, trade name Rogaine, a drug that was first used to treat high blood pressure, as the nation’s first anti-baldness treatment. Upjohn, the drug’s manufacturer, had developed a minoxidil ointment after some high blood pressure patients who took it in pill form experienced hair growth on various areas of their bodies.

But Rogaine isn’t a cure for baldness--at best, it’s a treatment, say Orange County dermatologists who prescribe the drug. And it isn’t for everybody. The drug only seems to help younger men who are in the early stages of hair loss.

“If a person has lost a lot of hair, this is not going to help them,” says Dr. Gerald D. Weinstein, professor and chairman of dermatology at UCI Medical School.

Even then, there is no guarantee of success, Weinstein says. “The data are not good enough to say that it’s going to work in more than a very small percentage of people, around 10% to 20%. And there’s no way to predict whether an individual who has a modest amount of hair loss or is in the process of losing hair will be in that small population that improves.”

It takes several months, Weinstein says, before signs of improvement appear, even in the most successful cases.

And so far, Weinstein says he hasn’t really seen any success stories. “I don’t think I’ve treated enough people to get into that 10% to 20%,” he says.

Cheryl L. Effron, a dermatologist who practices in Anaheim Hills and Westminster, says she’s seen success in “more than half” the patients for whom she prescribes Rogaine.

“The improvement is variable,” she says. “I don’t quantify it. If they say they’re happy and retaining more hair, that’s what’s important.”

No one counts individual hairs, not even in the scientific studies that have been done, Weinstein says. He recommends that patients “take a few pictures before they start the drug, so that six months later they can take another look and get a better idea of whether it’s doing anything.”

Effron says: “A lot has to do with how a patient is instructed to use it. They need to put it on a really clean scalp, without a lot of oil or other products, like hair spray. And they have to do it regularly, twice a day.”

Now that the word is out about Rogaine--and Upjohn is making sure that it is, with advertisements including television commercials--Effron says more young men are coming in for help before the problem progresses.

“I’ve got some patients who are 16 and 17 years old, and their hairlines are already beginning to recede,” she says. “Most of my patients are very young men who value their appearance and don’t want to look older than their years.”

Effron says she also prescribes the drug for women who are experiencing female pattern baldness, which she describes as “more of a generalized thinning.”

Although there was some concern in the beginning that Rogaine might cause hair growth in unwanted areas, Effron says she hasn’t seen that or any other side effects. “I frankly don’t see any problems with this drug. I do tell people to wash their hands thoroughly after they apply it. But I haven’t seen any hairy palms. Nothing can make hair grow in a place where there are no follicles.”

Weinstein says he will prescribe Rogaine “at the request of patients who come in concerned about their loss of hair.” But first, he counsels them to “just accept it. That’s the primary approach. I try to get patients to accept the inevitable, or try something less invasive, like getting a hairpiece or taking the Yul Brynner approach. But if these people are so motivated as to want to try it for several months, this is the only preparation that has any possibility of helping.”

Other alternatives are hair transplants, in which small areas of skin with hair growth are moved to bald areas, and scalp reduction, in which the bald spot is cut out and the scalp is stretched and sewn together.

In those cases where Rogaine does work, the patient must continue using the drug to keep the new hair growing. “You have to use it for the rest of your life, or until something permanent comes along,” Effron says.

The drug costs $40 to $60 a bottle, and each bottle lasts four to eight weeks, Effron says. Checkups are needed every few months.