'I Wanted To Fight It'

While hair loss undoubtedly wreaks havoc with some men's self-esteem, the majority sees it for what it is: a sign of aging.

Chadd, of Minneapolis, noticed his hair was thinning in his mid- to late-20s, but he said it wasn't all that traumatic or depressing.

"I felt like I was getting older. I wanted to fight it and stay younger-looking," he said. "If I could find something that would prevent it, why not?"

He went to his doctor and got a prescription for Procepia, which he used for two and a half years. For one of those years, he also used Rogaine. Neither treatment worked.

"I thought, 'This is stupid to keep spending this money,' so I just quit," he said.

For now, at 35, Chadd is content to stick with a thickening hair gel that he's used for about 10 years.

"I do notice a difference with that, and that's about $15 for a couple of months," he said. Comparatively, he was paying nearly $100 a month to take Procepia and Rogaine.

Mike, a sales representative in Houston, was also more matter-of-fact when his hair started thinning at age 22.

"I'd have to compare it to those extra five pounds," he said. "If it was only my problem, it would have affected me a little bit more, but if you look around, it's pretty much a natural thing."

Still, Mike, now 26, has also tried a list of products -- some legitimate and some "snake oil" -- without much success.

"I might be a little big picky with (my hair)," he admitted. "I'm not really sure what stage I would be at if I hadn't tried anything. So even though I'm not gaining a lot, I haven't lost a lot, either. And that's what you hope for with any hair-loss treatment, is to keep what you have."

Mike's current regimen includes Propecia and an experimental drug that's going through FDA trials now. He's also trying an experimental concoction called "Oz Brew" that's 5 percent minoxidil with some dimethyl sulfoxide, or DMSO, which is known for penetrating skin into the bloodstream very quickly -- bringing with it the drugs with which it's mixed.

"I have tried to cut down to just the bare essentials because I was using so much stuff that I wasn't able to ever do anything," Mike said. "What's the point of growing hair if you have to sit inside all night because you need to put crap on your head all the time?"

Culture, Doctors Affect Treatment Decisions

Why do some men spend thousands of dollars on hair-loss products, as well as hours every day online discussing new treatments, while so many men are content to let nature take its toll?

Dr. Larry Millikan said culture has a lot to do with it.

Millikan, a professor and chairman of the Department of Dermatology at Tulane University in New Orleans, said some family structures focus on looking good, while others regard such attention to cosmetic appearance as vanity.

Geography plays a role, too: Millikan said the California image is in general vastly different than the North Dakota image -- but cosmetic attention is becoming more widely accepted everywhere.

Millikan agrees with Rubin, the NYU psychiatrist, that it's younger men who get the most nervous about their hair loss: "These 22-, 23-year-olds who all of a sudden start seeing a lot of hair in the sink. And they wonder, 'Oh my god.'"

But not all young guys are going to be particularly bothered by hair loss -- and sometimes you can just tell by looking whether they're cut out for medical treatment, Millikan said.

"Some of these people with these scraggly looking beards who look like they have last month's meals on their chin, they're probably not going to be good candidates for anything because they're not going to be that concerned," he said.

Well-groomed men tend to be more conscientious.

"The kind of person who devotes a lot of time for maintenance of the image is a better candidate," he said.

Millikan said he usually treats these men with Procepia, supplemented with Rogaine. Whether the patient gets hair transplants depends on his financial situation and his commitment, he said. Such surgery generally costs between $5,000 and $20,000, and its success can vary from location to location.

While the surgery can be very successful and look natural, several hairlosshelp.com forum participants said they wouldn't consider it because they have heard too many horror stories of "butcher" jobs.

Several also referred to experiences where dermatologists belittled their feelings about hair loss.

Rubin agreed that doctors probably aren't as sympathetic as they should be. And she said dermatologists aren't especially diligent about sorting out the men who should be referred to therapy for help in dealing with the emotional repercussions.

"It would be great if dermatologists became more sensitive to the emotional impact of losing your hair as a man in this culture," Rubin said.

Millikan admitted that managing balding patients is a "giant pain" for some dermatologists. He said hair-loss patients consume a lot of a doctor's time with their questions and recurring visits. He said they tend to become dependent.

But dermatologists who devote their practices to hair loss, and build up a staff to deal with specific patient issues, can justify giving patients the time and attention they're seeking. Millikan advised patients to call ahead to their dermatologist to find out if the clinic deals with treating alopecia.

"The front office will set you straight pretty fast," he said.

men with male pattern baldness don't necessarily have to visit a dermatologist, Millikan said. He advised men research options online and then gauge their own comfort levels with hair loss before seeking medical or surgical approaches.

But instead of jumping toward one of the two FDA-approved drugs or the plethora of unapproved ones, some men might find the most benefit in airing their insecurities with others who are going through the same thing.

"I think that's one of the good things about the Internet," Rubin said. "(The men) can talk with one another about something they might not want to talk about with a wife or girlfriend."

Perhaps in finding a way to come to terms with the emotional side effects of balding, these men can keep their cash and continue their lives -- with or without hair.

Related Article: A Hair-Raising Experience