Baldness in males is not a disease but an inherited predisposition. It is not confined to humans but also occurs in such other primates as chimpanzees and orangoutangs. After puberty all males undergo some change in the hair line and suffer some hair loss. The straight hair line on the forehead is replaced, after puberty, by a degree of recession on either side of the brow. Whether this will continue to extend, and will later be accompanied by thinning on the crown, depends on three factors. The two most important are whether or not there is a genetic background of baldness in the family, and whether normal male hormones are present. If, for example, a predisposed individual is castrated before puberty, he will not become bald. Should male hormones be later administered, he will become bald. Finally, there is the factor of age. By the age of 50, about 50 per cent of men have some degree of baldness. Women are usually protected from baldness of this kind by their female hormones. After menopause, however, their hormone levels drop off and gradually baldness may develop. Occasionally hormone disorders may occur, causing both baldness of the scalp and excessive hair growth in other areas.

The onset of baldness in males is accompanied by shrinkage in the size of hair follicles; this results in the loosening of terminal hairs, which then gradually fall out and are replaced

by immature vellus hairs. Ultimately these may also disappear, leaving scar tissue to replace the follicles. The rate of hair loss is vary variable. Progression may be rapid or slow. Frequently there is a rapid onset which then stabilizes, with no further

extension occurring for many years. Thinning and recession usually occurs in waves, interspersed with periods where there is no progression. If the individual is obtaining treatment during this stable period, he will ascribe the arrest of the hair loss to it: whereas actually the arrest is the normal pattern for that individual, a pattern which cannot be influenced.

There is no known treatment to either arrest the balding process or cause hair to regrow. Those cases where hair has been shown to appear on a previously bald scalp are cases of alopecia areata, where hair frequently returns anyhow. Philosophic acceptance is the best advice that can be offered. If however active treatment is sought, then either a well-made wig or a hair transplant is available. The latter consists of taking small five-millimetre cylindrical plugs of hair-bearing skin from the back and sides of the scalp, under local anaesthesia. Using the same instrument, holes are punched in the frontal area to receive the hair-bearing skin plugs. The technique is very similar to replanting seedlings; the art of the operator lies in knowing how and where to place the skin plugs. Some specialists can transplant 100 or more tufts in a single session, and within a few sessions achieve a reasonably satisfactory result.

There is no massage, cream, lotion or other concoction, either with or without vitamins and hormones, which has the slightest effect On either male or female baldness.

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