Gone Today, Hair Tomorrow

By John Langone

"A field without grass is an eyesore," wrote the Roman poet Ovid, "so is a tree without leaves, so is a head without hair." For centuries, bald and balding men have winced at such unkind references to their predicament. Conditioned to regard hairlessness as a male curse second only to impotence, they have historically taken drastic measures to undo their baldness. Some have pretended to own hair, bewigging their shining pates with nylon or natural locks; others have recycled what little thatching they have left, combing a few camouflaging strands across their brows or having "plugs" transplanted from one part of the head to another. Still others have poured their hopes into the creams and tonics of quacksalvers, seeking the ever elusive miracle cure for the androgenic alopecia -- male-pattern baldness -- that plagued them.

Hope may, at last, be where the head is. Last week the Food and Drug Administration approved a prescription medicine that increases hair growth in some men whose hair is thinning on top but not completely gone. Marketed by the Upjohn Co. under the trade name Rogaine, it is the first product ever cleared by federal regulators for treating hair loss. Its key ingredient: minoxidil, a highly touted drug that, in tablet form, had already been approved to treat high blood pressure. Only by accident did researchers discover that minoxidil could also regrow hair. Anticipating a vast new market for the drug, Upjohn developed a liquid version and began testing it on bald heads. After twelve months, 39% of the men tested had moderate-to-dense hair growth on their crowns; 61% showed no growth at all.

Although the FDA action marks the first time the drug has been recognized as a baldness treatment, many doctors have already been prescribing it for their hair-impaired patients. Rogaine does not work equally for everyone, however. Best candidates: men under 40 who have been balding on the crown for ten years or less and who have a moderate amount of hair left. For some reason, the drug does not seem to work on receding hairlines. Says Dr. Robert Stern of Harvard Medical School, who chaired the FDA panel: "The most important thing is to have fuzzy hair left -- fine, light hairs."

Rogaine treatment requires perseverance: the lotion must be applied twice a day for four to six months just to see if it will work. Cost: up to $400. Says Stern: "The chances of substantial results are only one in five, a large investment for a reasonably low chance of real cosmetic benefit." Moreover, if the applications are discontinued, the new hair disappears within a few months and balding continues at its previous pace. Says New York Dermatologist Stephen Kurtin: "The biggest resistance to minoxidil is not that the results may be only fair, but that it is a lifetime commitment."

While minoxidil appears to be safe, the FDA advises patients to get a thorough physical before taking it and then see their doctors periodically. One reason: those who have cardiovascular disease and who also absorb the drug more easily than others may be at risk of developing an irregular heartbeat, among other side effects. None of the test subjects have suffered such serious problems, however, although some have developed such minor complaints as itching, scaling and blistering of the scalp.

And what about those poor bald souls for whom Rogaine is not recommended? Ovid's fellow Roman, the epigrammatist Martial, may have had the best advice: "Be content to seem what you really are, and let the barber shave off the rest of your hair."

With reporting by Georgia Harbison/New York