Are there more bald men than women?

In addressing the hairy question of why there are more bald men than women, Professor Rod Sinclair proffers an answer as startling as a multi-coloured Mohawk. There aren’t. Women are just better at hiding it.

“Virtually no woman goes through life with a full head of hair, just as no man goes through life with a full head of hair,” says the University of Melbourne’s Professor of Dermatology. “Men have more severe and more extensive balding, but women also lose hair in very high numbers. They go diffusely thin.

“The pattern is different. They’re not completely bald like men are, they just go thin.”

The key to this follicular fallacy is camouflage, Professor Sinclair says, a trickery of the tresses that should go some way towards silencing the groans of men who can’t fathom why women spend hours and small fortunes on a grooming ritual that blokes see as a 10-minute process to be endured when they can no longer see their ears.

“When you talk to hairdressers and ask them what they do for a living, if they’re honest they’d say they spend half their working week cutting hair and half their working week with a clientele of women in their 60s and over who come in to get their hair set,” says Professor Sinclair, from the Faculty of Medicine, Dentistry and Health Sciences.

“The principle of that is that they’re essentially getting an elaborate comb over to disguise their hair loss.

“They’re getting it washed, blow-dried, volumised, set into position to camouflage their hair loss. They don’t touch it for the next seven days, then they come in and have the whole process repeated.

“We have 70,000 hairdressers in Australia. If they’re each spending half their working week doing that, we’ve got an army of 35,000 people in full-time employment doing combovers for women. It’s not that women aren’t going bald, there’s a conspiracy of silence.”

Baldness, Professor Sinclair says, is a polygenic disorder that resembles a poker hand. The more affected relatives you have, the greater the risk that your comb will be consigned to gathering dust on a bathroom shelf. “You might have a father with no hair loss – an ace and a king – a mother with no hair loss – an ace and a king – but you could still get two aces, two kings. If your father’s bald and he’s got three aces and your mother’s bald and she’s got three kings, your chances of getting two aces and two kings is really high.”

The parameters that are inherited genetically are the age of onset, the rate of progression and the pattern of baldness. Some people go bald only at the back of their heads, some just at the front. In women the back of the head is least affected, Professor Sinclair says, with diffuse thinning occurring across the top and front of the scalp and most noticeably down the centre.

The genetic roots, so to speak, of hair loss are underscored by the fact that identical twins lose their hair at exactly the same age, rate and in the same pattern regardless of environment, diet or lifestyle. Yet in non-identical siblings genetic control is inherited in different packets, which Professor Sinclair says explains, for example, why Prince Harry is losing his hair at a slower rate than Prince William.

“It might just mean that Prince Harry didn’t get those packets. It doesn’t mean that his paternity needs to be questioned. It’s that he inherited a different combination of genes, and when the cards have fallen that’s how it’s gone.”

Higher testosterone levels

The good news for royals and commoners alike is that Professor Sinclair’s work at the University of Melbourne has helped make Melbourne the world leader in the gene discovery and diagnosis and treatment of male and female pattern hair loss. The breakthrough came in the late 1990s when the University of Melbourne’s physiology department discovered the androgen receptor gene, which sits on the X chromosome, of which men have only one but women two.

While higher testosterone levels drive more obvious baldness in men, female hair loss happens when a woman who is genetically predisposed to the condition is exposed to androgens – predominantly male hormones that also exist in women.

“In every cell in a woman’s body, one of those X chromosomes is randomly inactivated so that they don’t overdose on the product of that gene. And that’s going to affect whether their father’s X is turned on or their mother’s, in every cell in the scalp. That changes the pattern.”

That male and female pattern hair loss are both genetically based suggest they contribute to evolutionary fitness, which Darwin was onto long before Shane Warne bowled into the hair treatment game.

“The fact that this is a gene that’s preserved suggests it contributes to evolutionary fitness – fitness to reproduce,” Professor Sinclair says. “While premature male pattern hair loss doesn’t affect virility, it makes some men less sexually attractive – I put the ‘some’ in there so as not to offend everybody.

“Female pattern hair loss normally occurs at or after menopause, and signals waning fertility to a prospective mate. In addition to the psychological problems associated, affected women appear to have an increased risk of metabolic syndrome, polycystic ovarian syndrome, hypertension, diabetes and high cholesterol.”

The potential health risks linked to baldness are why the 3500 women who visit Professor Sinclair’s clinic each year are tested for diabetes and high cholesterol. So, should the discovery that you’re getting a bit thin on top prompt grave fears for your health?

“Yes and no,” the Professor says. “You’ve got to die of something.”

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