It is a moment men dread: the barber asks if they want a haircut to help disguise their bald spot. For many men the fact they are thinning on top at all will come as a shock. They may have been aware of a gently growing expanse of forehead as their hairline recedes, but it is rather difficult to see on top of ones head. And even if they had an honest spouse to forewarn them, few choose to believe it until confronted by their naked crown in a barbers mirror.
It was like that for me. It was not until the age of 26, when I was asked by my barber if I used many styling products, that I realised how visible my scalp was from above. The rate at which my hair vanished after that was alarming, and I now consider myself firmly among the follicularly challenged members of society. I should have guessed it was going to happen my grandfather was bald by his mid-twenties, and baldness has a strong hereditary element.
Yet medical science is now offering men ways of keeping their hair for longer and perhaps even avoid going bald at all.
Jason Gardiner, the 39-year-old Dancing On Ice judge, recently revealed a new head of hair with some aplomb on the show after undergoing an expensive eight-hour hair transplant. Doctors grafted more than 3,000 follicles from the back of his head to his crown and fringe area.
The actor James Nesbitt, 46, also recently showed off how effective the procedure can be after two transplants. I would go as far as to say it has changed my life, said Nesbitt who, after the surgery, has landed several high-profile roles, including a part in a film of Tolkiens The Hobbit. Several years ago, I began losing my hair and, like a lot of men, it was a major concern to me. In fact, it was practically an obsession. But also Im an actor and in the public eye a lot and I really felt that my hair loss could affect my career prospects.
Others admitting to transplants include Duncan Bannatyne from Dragons Den, former England cricketer Graham Gooch and former England rugby scrum half Kyran Bracken. Mel Gibson and Nicolas Cage have also been the subject of speculation, but have never commented.
The results are a far cry from the early attempts by Elton John to replace his hair with transplants, and the Italian Prime Minister, Silvio Berlusconi.
Hair transplants are very good now, said Barry Stevens, general secretary of The Trichological Society, the professional body of hair scientists. When it started we were taking tufts of hair and it produced an effect a bit like a brush or a dolls head. We can now do transplants where single or double hairs are individually transplanted. There isnt anything out there that is as good.
The most common form of baldness is androgenic alopecia, or male-pattern baldness, which is thought to have a strong genetic component. This type of hair loss typically begins above the temples and causes hair to thin on the crown. The human head has on average 1,000 hairs per square inch. People lose around 100 hairs per day due to normal hair cycling, but with alopecia this can be far higher.
Research has shown that a hormone, dihydrotestosterone, is involved in androgenic alopecia, but the exact mechanism is unclear. It is thought that a genetic sensitivity to this hormone causes follicles to shrink, reducing their ability to produce hair normally. Still, the picture is complex as the hormone is also responsible for hair growth in other parts of the body.
A quarter of men begin balding in their twenties and two thirds have started going bald by 60. So with the majority of men suffering baldness before retirement age, why is it such a big issue?
Hair symbolises youth and health, explains Lucy Beresford, a psychotherapist who specialises in cosmetic appearance. If you have a good, healthy head of hair it is a shorthand way of your body saying that you have good genes. So going bald can really impact on peoples sense of self, as it makes them realise they are not the young person they think they are. It reminds them of their own mortality.