Thirty Years of Losing My Hair — and Why, at Fifty-Two, I Decided to Get It Back

Hair loss, when it happens slowly, is a strange kind of grief. Nobody dies, nothing dramatic occurs, and yet every few months the face in the mirror belongs a little less to the person you thought you were. I was twenty-one when it started, and I'm fifty-two now. I have spent, by conservative estimate, thirty years losing my hair one week at a time.

At twenty-one you don't lose your hair all at once. You lose it the way a beach loses sand — imperceptibly, then all the time, then in quantities that surprise you when you finally look at the ground. I first noticed it in the thinning at the sides of my forehead. Not a receding hairline, exactly; just a softness where a hardness used to be. I was eighteen when I had a full, stubborn head of hair. By twenty-one, something was measurably different, and I was the only person in the world who knew it.

That is, I think, the defining texture of slow hair loss. You notice it long before anyone else does, and nobody believes you when you describe it, and then one day everybody notices at the same time and you are quietly the last person to be told. The early years are a private negotiation with a mirror that has started to disagree with you.

The first round of advice I got was nutritional. Eat more yeast, someone said, for the B vitamins. I dutifully ate yeast. I ate kelp. I ate whatever the well-meaning told me to eat. Nothing works against androgenetic alopecia, though that is something you only learn afterwards. What yeast gave me was a sense of agency, and a sense of agency is the first thing you lose when your hair starts falling out.

Part IThe Sticky Years

At twenty-four I started on minoxidil. The five percent liquid. You drip it onto your scalp twice a day and you wait. The promise was that it worked in roughly one in three cases, which is the kind of statistic that sounds encouraging until you are the two other men. I stayed in the hoping camp anyway.

The problem with minoxidil, for anyone who has not used it, is that it leaves your hair in a permanent state of mild adhesion. Sticky is the honest word. You can feel it. Other people probably can too, though no one ever said. And because your hair, sticky with medication, no longer hung quite right, you compensated with product — pomades, gels, whatever pulled the thinning strands back into something that resembled a hairstyle. For several years in my twenties I was a man with sticky hair held in place by a second layer of stickiness, and this somehow counted as grooming.

The front held. The sides held, mostly. I was convinced, on my better days, that I had reached an equilibrium. The mirror and I had come to an arrangement.

Part IIThe Pharmaceutical Bargain

A few years after the minoxidil, finasteride arrived. Finasteride — sold as Propecia — blocks the enzyme 5-alpha reductase, which is the enzyme responsible for converting testosterone into the form of it that shrinks your hair follicles. I took it for a few months. Then my girlfriend, who would later become my wife, and I had an honest conversation about the arithmetic of taking a pharmaceutical drug for the rest of your life, and I stopped.

In the years that followed, my hair kept doing what hair does when untreated: it kept going. Not dramatically. A little more every year. The equilibrium the mirror and I had reached slowly renegotiated itself against my interests.

And then one ordinary afternoon I was in an elevator with two mirrored walls, which is a design choice I have never forgiven the architect for, and I caught the back of my own head for the first time in a long time. The crown was thinning. Really thinning. It had been thinning, presumably, for a while, but I had not seen it because you don't see the back of your own head without deliberate effort. That is the thing the elevator revealed: not the thinning itself, but the fact that I had been avoiding knowing about it.

I went home and went back on finasteride. I stayed on it for close to a decade. I was one of the lucky ones — I did not experience the better-known side effects the drug can produce, and there are many of them, and they are not trivial. What I got in exchange was a kind of suspended animation. My hair did not grow back, but it did not leave either. I was paying rent, and the rent was a daily tablet, and the apartment was a slightly thinner version of the hair I had at twenty-four.

Part IIIStopping

Around the time I turned forty, my wife and I started reorganising almost everything about how we lived. We cut out sugar. We went gluten-free — not because of a diagnosis, but because eating that way happened to remove a quiet volume of carbohydrates from our diet and we felt better for it. We began paying attention to things we had spent our twenties and thirties ignoring. And inside that larger project of becoming more honest about what we were putting into our bodies, the daily tablet began to feel like a loose thread.

I stopped taking finasteride. Both of us discussed it; both of us agreed. I knew what was coming, in the abstract. What I did not know was how fast it would come.

Finasteride does not let you down gently. The hair you would have lost during all the years you were on the drug does not drift away over a new period of similar length. It catches up in weeks. I went from a stable but thinning equilibrium to a visibly different head of hair in roughly a month. I looked in the mirror and the arrangement had been torn up entirely.

So I did what men do. I took clippers to it. I cut it very short, and I wore it short, and for a while I thought that was the end of the story — the graceful acceptance, the shaved head, the entry into a second phase of life in which I stopped fighting a battle I had already lost. I told myself this was dignity.

Part IVOn Male Vanity

There is a great deal of public conversation, and rightly so, about what women do to keep appearing a certain way — the cost, the time, the quiet labour of it, the cultural pressures that make some of that labour feel less like choice than like tax. There is considerably less conversation about the fact that men, at least some of us, care about these things just as much and are given a much smaller vocabulary to talk about it.

I am not going to pretend I was above any of this. I was not. Watching my face change in the mirror, year by year, was not trivial for me. What made it stranger was a second, quieter concern — the awareness that my wife was watching the same face change. We are together for thirty years by any reasonable accounting, and in that time I went from being a young man with a full head of hair to a middle-aged man who had lost most of it. She never said a word. She never once gave me reason to feel anything less than wanted. But I knew, in the way you know these things, that she was watching a gradual substitution of one person for another, and that there was nothing I could do about the substitution except keep being the person inside it.

Men are as vain as anyone. Some of us. Not all of us, but more of us than we admit. The difference is that the vanity is supposed to be secret, which makes it lonelier rather than less powerful.

Part VThe Decision

For years I told myself the shaved head was the settlement. And then a friend mentioned, in the casual way these things come up, that his brother had done a hair transplant somewhere in the north of Italy and it looked decent. That word — decent — mattered more than it probably should have. He didn't say miraculous. He didn't say transformative. He said decent, which is the word you use when something has been done well enough to stop drawing attention to itself, and that is exactly what I have been wanting my own hair to do for three decades.

I looked into the clinic. The procedure they use is a newer variant of FUE, in which the donor follicles can be harvested and split in a way that leaves the donor area largely intact — a concern for anyone like me who wears their hair short, because a patchy back of the head would simply be a different kind of problem than the one I already had. The instruments are much smaller than earlier generations of FUE required. Recovery should be faster. The next morning there is a check-up to confirm the grafts have taken.

I booked it. I paid the deposit. The procedure is scheduled for next Friday in Padua.

What I kept asking myself in the weeks leading up to the booking was whether I was doing something contrary to the acceptance I had been practising — whether booking a transplant was a failure of the graceful-shaved-head narrative I had spent years building. I have decided that it isn't. Acceptance and action are not opposites. You can accept what is happening and still decide to do something about the part of it that is within your reach. The failure would be pretending the two were the same conversation.

I have also, in the spirit of not making this harder than it needs to be, told everyone. Friends, colleagues, family. I am not sure whether men are supposed to be discreet about this sort of thing, but if there is shame in it, I have not located mine. If anything, the public declaration has made the whole project feel lighter — an accounting I am keeping in the open rather than behind the mirror.

Coming nextEpisode 02 — Padua

The next instalment covers the procedure itself — the morning drive, the clinic, the twelve or so hours in the chair, the first time I saw my own scalp mapped out in ink, and the strange quiet of the drive home afterwards. If this essay has been the thirty years of prologue, Episode 02 is the single day I spent doing something about it.

Stay tuned. I am documenting this honestly — the good, the awkward, the bits that are harder to write about than they should be — because I went looking for this kind of account when I was deciding and found very little. If something here is useful to someone who is in the decision I was in six months ago, that alone will have made the series worth writing.