Professor Rodney Sinclair routinely treats hair loss at his Melbourne clinic, Sinclair Dermatology. “100 per cent of men and women lose hair as they get older, and 50 per cent of men will have lost 50 per cent of their hair by age 50,” he said.

By age 30, a woman might see her ponytail has thinned, or that she’s shedding hair. “As they age further, women usually notice reduced hair density just over the midline part,” Sinclair said. “I don’t know an 80-year- old female with hair like an 18-year- old.”

The Sinclair Hair Shedding Scale measures the six stages of hair loss, with Stage 1 being normal, and Stages 5-6 being excessive. “In the final stage, many years after onset, a female will present with a visible scalp,” Sinclair commented. Sinclair has also developed a hair density scale to score hair loss in women.  In Australia, Stage 2 hair loss affects about three million women, and Stage 3 hair loss affects about 700,000 women.

Shedding off self-confidence

“Nobody welcomes young men losing their hair until about the age of 20, 21,” Sinclair said.

After 21, men might shave their heads to disguise a receding hairline. “People like Bruce Willis and George Calombaris, who have round heads tend to look good with a shaved head.

But a long-shaped head doesn’t work bald. If you can’t carry off that look, it reduces your attractiveness, and you have to work harder to find a partner.”

Sinclair said most hairdressers have a clientele of women in their 70s, 80s and 90s, who come in once a week to get their comb-overs set. “There are 70,000 hairdressers in Australia; ask them what a typical week is like and they’ll tell you that this is what they spend half their week doing.”

Is mum really to blame?

One of the balding genes (the androgen receptor gene, discovered in 1998) is passed on from mum. But hair loss is a polygenic condition, meaning the balding gene can come from the mother or father.

Treatment

There are two treatment goals. “One is to arrest hair loss because it’s a progressive condition. The other is to see if you can partially regrow the hair,” Sinclair said.

Australia has two hair loss treatments approved by the Therapeutic Goods Administration, the first being Finasteride for men. “Usually taken once daily, this is generally tolerated well,” Sinclair said. “But about two per cent of men will experience loss of libido or erectile dysfunction, which should reverse if treatment stops. Although there are chat groups online about the long-lasting side effects, so some men fear to take it.”

The second treatment available for men, and the only one for women, is Minoxidil, or Rogaine. This requires twice-daily application to the scalp, and regrowth will only become evident four months in – so compliance is key, as is starting treatment sooner than later.

“Once a hair follicle loses its attachment to the arrector pili muscle (the small muscle attached to the hair follicle), that hair will never grow again,” Sinclair said. Initially, Minoxidil was produced in tablet form, and tested as a blood-pressure- lowering treatment, “but what it actually did was make people hairy,” Sinclair exclaimed.

In clinical trials currently running at Sinclair Dermatology, low dose Minoxidil tablets are producing an increase in head hair, but not body hair, and with no impact on blood pressure.