Take action before it's gone
TRYING to prevent hair loss is not a new male obsession. For all we know, cavemen spent time staring into pools arranging their residual tresses into primitive comb-overs.

What is new, however, is that today's remedies actually work -- at least to some extent.

If you're already losing your hair and that bugs you, the sooner you start treatment the better. "It's easier to stop losing hair, than to replace hair that's gone," says Dr. Richard Strick, a dermatologist and UCLA clinical professor of dermatology.

Before a hair follicle shuts down, it first gets smaller and produces finer hair. So when you first notice that the hair on the top of your head or at your temples is finer than the neighboring hair, see a doctor. "Once the follicle has shut down it's difficult, sometimes impossible, to re-stimulate," Strick says.

Male-pattern baldness is by far the most common cause of hair loss: By age 30, one-third of men will show some signs of this hereditary condition, which is caused by a shut-down of hair follicles in response to DHT, a byproduct of testosterone.

But there are other, treatable conditions. One is telogen effluvium, a condition in which a person starts losing hair two to four months after a trauma, such as a major operation, high fever or job loss. This condition will reverse, and hair regrow, on its own. Another is alopecia, an autoimmune disorder that triggers hair loss and affects 2% of the population at some point in life. It often responds to cortisone injections.

If your doctor determines your case is male-pattern baldness, there is, of course, the option of a transplant -- and these days they offer men a very natural-looking alternative to baldness, says Dr. Craig Ziering, a Beverly Hills dermatologist who specializes in hair loss and restoration. For those who don't want to go the surgical route, two proven products -- Rogaine (minoxidil) and Propecia (finasteride) -- can stop or slow balding.

Rogaine, a well-studied topical solution available over the counter that is applied twice a day, is the most popular hair-loss treatment on the market. Research shows that 80% of patients who use it can expect to prevent further loss, and 80% can also expect bulked up hair, Strick says. It won't, however, restore what's gone, and results won't show up for several months.

Those sensitive to Rogaine in its traditional, solution form may find a newer product -- Rogaine foam -- more tolerable, says Dr. Claire Haycox, a dermatologist and associate professor of dermatology at the University of Washington in Seattle.

An increasingly popular treatment is Propecia, a pill available by prescription that can sometimes kick sleeping hair follicles back into production. It works by suppressing DHT. Studies show that 90% of men who take Propecia stop losing hair and grow more hair. Results usually show up in three to 12 months. Younger men do best: In a study of 253 18- to 41-year-olds, about half had significant restoration of hair follicles.

A rare but notable side effect: One in 200 men who use Propecia experiences a loss of sex drive that ranges from disinterest to impotence. Sex drive returns to normal when they stop the medication.

For both drugs, there's a caveat. Once you stop using them, you will lose all the hair you would have lost if you'd never used the product at all. "It's as if your body kept a clock and knew how much you were supposed to have lost by now," says Strick, who himself started using Rogaine when he was 46, then switched to Propecia when it became available.

As for other rays of hope, some are banking on laser devices -- hand-held combs or brushes that emit low-level light. Makers of the combs claim the devices promote hair growth. Most dermatologists say this is nonsense, but Ziering thinks there may be something to it. He offers an eight-month laser treatment package in which patients sit under a hood, akin to a hairdryer, several times weekly and use a hand-held device at home in-between. "It seems to give the clinical appearance of more hair," Ziering says.

A few other over-the-counter products may help. Volumizing shampoos and conditioners can fluff up what's there. Shampoos containing zinc, such as Head & Shoulders, were found in one study to promote minimal hair growth, Haycox says. Then there's Toppik, a hair fattening product available online. Guys can spray this protein powder -- which comes in eight different colors -- on their hair to make it look fuller. Like mascara sticking to eyelashes, the powder binds to existing hair, holding fast until your next shampoo.

As for other so-called remedies -- herbal concoctions, salves or special diets -- avoid them. "Don't forgo two legitimate treatments to try something unproven, useless and possibly even damaging," Strick says. "You waste your money. But worse, you never regain the time, or the hair, you lost trying."

There's always another option: accepting your baldness. If you go that route, avoid long, compensatory ponytails or bushy beards. They don't make you look more virile. And don't drape long strands over your bald spot: There's no woman on Earth it will fool. "Be nice to us, have a good sense of humor, buy us a piece of jewelry now and then, and we'll embrace your baldness," says dermatologist Dr. Mary Lupo, medical director for the Lupo Center for Aesthetic & General Dermatology in New Orleans. "But whatever you do, don't comb over."