A cure for baldness is tricky - are these innovations the future?

From stress to genes and hormones and inflammatory conditions, the causes of baldness are many and interwoven. Photo / 123RF

Freezing follicles and hair farms may be on the horizon but, it's a costly and complex conundrum.

Why do we so care about hair? If we're not trying to wax it, pluck it, shave it, dye it, or otherwise forcibly remove it, we're desperately trying to put it back, popping pills, parting what's left, paying for surgery or brazenly painting it on. Anything rather than admit it's gone, lost, departed.

Baldness has an insidious power. "It has a massive psychological effect," says Mike Marsh*, not someone who generally crumples at the first challenge. He served for almost two decades in an elite branch of the British forces. Yet his thinning hair sent him running for cover. "Some of the guys [in my unit] were fine with it, would just shave their heads. But I felt very self-conscious. It has that emotional effect. People like me, we will do anything."

From now, that includes freezing follicles in hair banks, rather as some women might choose to preserve their eggs. The biotechnology firm HairClone, based in Manchester, has just been approved by the Human Tissue Authority to store follicular units (FU). The idea is that 50-100 such units will be taken from patients and used to clone dermal papilla cells (DPCs) found in abundance in the roots of healthy, thick hair.

It is an experimental treatment, which will ultimately involve (pending approval from the Medicines and Healthcare products Regulatory Agency) making the clones into a solution and injecting that into the scalp, repopulating the roots of thinning hair follicles with fresh new DPCs.

There is no guarantee it will work. Even if it does, Dr Bessam Farjo, HairClone's medical director concedes that it will require repeating every few years to top up DPCs. And yet, Mike Marsh is willing to take a bet. Like countless men and women with thinning hair, he will do anything to restore his mane.

"The procedure [to harvest his follicle sample] will cost around two thousand pounds," he says. "Then it is around £100 per year to preserve it. After that it will be about six thousand pounds every three to five years to culture and replace the cells.

"It is a gamble because it is experimental, but if the theory matches the experimental results it will be a complete game changer."

The global hair loss market is currently worth about $4bn, with sufferers like Mike willing to pay many thousands for the prospect of a renewed, lush mop. According to estimates from the International Society of Hair Restoration, there were more than 600,000 surgical hair restoration procedures performed worldwide in 2016 - almost triple the figure of a decade before.

The wonderfully acronymed British Association of Dermatologists (BAD) says that aged 50, about half of men have male pattern hair loss (MPHL, also known as androgenetic alopecia). And it's not just men going under the knife. Combined, female Pattern Hair Loss and associated conditions related to a group of hormones known as androgens leave 40pc of women with some some visible hair loss by the same age.

The problem, as BAD gloomily points out, is that "there is no cure". Rather it lists treatments including "licensed topical and oral treatments" - basically shampoos. But these can be expensive - and there are other costs. "Decreased libido and erectile problems are recognised side-effects of this treatment" it notes, which seems a high price to pay if a sense of manliness is what you are striving to regain.

Other options on its list include "wigs" and what it euphemistically calls "skin camouflage". There are downsides here too: "These preparations," it concedes, "may wash away if the hair gets wet i.e. rain".

Such lack of progress seems incredible. We live in an age of personalised medicine, in which the cost of sequencing an individual's entire genome has fallen from billions to hundreds of pounds. In which organs are routinely implanted, when a paralysed Polish man recovered movement after his severed spine was patched up with cells from his nose. From his nose! And we can't cure baldness? We can't conjur a few strands of dead-cells and stick them in where the old ones have fallen out? How hard can it be?

Very hard, it turns out. "Hair is far far more complicated than it appears," says Dr Farjo. "Every week, someone publishes another research paper that describes a compound or chemical that is supposed to play a role in hair growth and loss."

From stress to genes and hormones and inflammatory conditions, the causes are many and interwoven. "Hair is a whole system within the body," says Dr Farjo. "It's very complicated."

So while the money and the motivation has long been there, much of the hair replacement industry has remained more or less the same for 70 years, since surgical transplants were first offered in 1950s America.

Techniques then were unpalatable, and are testament to the desperation of poor patients. Surgeon used 4-5mm borers, like drill bits, to extract cylinders of FUs from the back and side of the head and reimplant them on top. To allow the skin to heal, the tiny discs of hair couldn't been placed too close together, so a colander effect was produced. Two or three repeat visits were required to fill in the grid. And even then, the blocks of transplanted hair hardly had the feathery feel of the original follicles. "Aesthetically it didn't look good," says Farjo.

More recently, surgeons started removing strips of scalp from the back and sides of the head to harvest FUs, each of which can contain between 1 and 4 hairs. Yet the average human has 100,000 such units, and the most such procedures could transplant without leaving livid scars was 4000 or so. Even with several ops, and skilful surgeons, the results were never perfect.

Now there is follicle freezing. Yet Dr Farjo admits that technologically sexy as it sounds, freezing can only hope to rejuvenate existing, if thinning, hair. "We're not close to growing hair from scratch," he laments. "We don't have the full answer about the interaction between hormones and enzymes and proteins to create hair, and even if we do, mechanically it can be hard to deposit in the tiny space and keep it there. We're years away. It's like nature has a protection to stop us curing baldness."

Not everyone is so downcast. In the US, the company Stemson Therapeutics is trying to clone not just dermal papilla but hair follicles themselves. The problem is that implanting such follicles is hard, so hair tends risks sprouting in all sorts of odd directions. Stemson hopes to overcome this by using a "scaffold" for cloned follicles. And in December last year another researcher, Angela Christiano, a professor of genetics and dermatology at Columbia University, described using 3-D printed follicle moulds. These were implanted in mice, which proceeded to sprout human hair.

*name changed