Why Are Israeli Men Going Bald So Early?

Some 70 percent of men in the world are at risk of balding before they enter their sixth decade.

It begins at the temples - or on the top of the head. Many men are familiar with the deficit incurred when the sum total of hair growing in is less than that which is falling out. At a more advanced stage, there's a merger between hairless patches, and the result is a bare pate - a fate that is not usually accepted with acquiescence, to say the least. "It's uncomfortable," the men say. "It hurts your self-esteem." "It makes you look older." "I'm afraid of looking like my grandfather." Or, as one summed it up: "It's impossible to explain why being bald matters. A bald head matters because it's a bald head!"

"We lose hair all of our lives, it's a sign of aging," explains Dr. Alex Ginzburg, a dermatologist and hair-transplant specialist. Male pattern balding may be a natural and universal phenomenon, but he claims it is particularly severe among Jews. "Just as Jews tend to have bigger noses, we have a strong tendency toward baldness. Generally speaking, Jews - especially of Ashkenazi descent - tend to go bald more than Christians and Muslims."

Some 70 percent of men in the world are at risk of balding before they enter their sixth decade. It can begin when they're in their 30s, when about 30 percent of them suffer some kind of hair loss. By age 40, half are losing hair; and at age 50, 70 percent are going bald to some extent.

Genetic and hormonal factors cause baldness: Children of a bald father are more likely to go bald themselves, and the trait can also be passed down through the mother. The hormone that causes male pattern balding is dihydrotestosterone (DHT). According to Ginzburg, all men possess the hormone, but it is their genetic makeup that causes it to affect their hair. The hormone shortens the hair's growth phase and causes a degeneration of the follicle that nourishes the growth process. The result? The hair becomes shorter, thinner and paler; eventually it falls out and is not replaced. The primary areas affected are the temples and crown, whereas the back of the head and the areas under and behind the ears are more resistant to hair loss.

As if the Jewish predisposition were not enough, Ginzburg cites another discouraging fact for local men: The process is now beginning much earlier than in the past.

"We're not imagining it, it's really happening. We are going bald earlier than we did 20 or 30 years ago. When I was 20," he notes, "none of my friends were going bald. Now two out of three guys in their early 20s are beginning to lose their hair. A high percentage of young men experience this by their army service."

Zvika (not his real name), 31, is half bald already. His own story lends credence to Ginzburg's claims: "My father and I went bald at the same time: He was 65, I was 25. When he was my age, he had plenty of hair. I never imagined I would start in my 20s."

Researchers around the world are struggling to find an explanation for why hairlines are beginning to recede so early. Says Ginzburg: "Some believe that the reason is stress, but I don't buy that. Weren't people stressed 20 or 30 years ago? Stressful situations can be a factor, but they've always existed, and still we are going bald earlier now than we used to."

One other seemingly obvious explanation - a lack of certain vitamins - also seems implausible to him: "For men, this is certainly not the case. Vitamin deficiency might cause hair loss in women, but even then only among a small percentage. Generally, in Israel, we don't have people suffering from a serious deficiency."

So what does cause baldness? Ginzburg claims that in recent decades various factors have been suggested, but they haven't been proved by scientific research. His view is that exposure to increased levels of radiation and changes in nutrition have affected our genetic makeup and trigger the balding process earlier. Thus a man who, according to his natural "biological clock," would in the past have gone bald at 40 is now seeing his hairline recede in his early 20s.

"The food we put into our mouths is preserved or frozen. In practice, we eat nothing but hormones. Another thing that has changed is radiation. While in 20 years the effects of radiation will be better understood, it is quite clear that balding is one. Some effects are discovered only later. For instance, 30 years ago, people used to sit in the sun to get their vitamin D. They didn't know that such exposure causes skin cancer."

'Simple solution'

Male balding has apparently spurred a new trend in hairstyles in Israel, one that began appearing more than a decade ago. Singer Rami Kleinstein was among the first to sport a gleaming "designer pate" and today quite a few of these are seen glistening in the streets.

"I don't believe there is any way of stopping the hair loss, so I went for the simple solution," says Zvika, who says he shaves his head regularly.

Clean-shaven heads may be popular locally, but they are less common elsewhere in the world, says Dr. Ofer Nordheimer Nur, a cultural historian and Internet scholar from Tel Aviv University.

"Unlike in other countries, the 'designer' bald head has become popular here, and it communicates a number of messages," he explains. "In Europe, a person who walks around with a shaved head is considered a 'skinhead' - that is, a violent, psychologically disturbed person with ties to the radical right and neo-Nazism. In Israel bald heads do not have the same connotations."

Shaving one's head may reflect an acceptance of the balding process. So why bother to shave off remaining hair instead of proudly wearing it?

Nordheimer Nur: "The trendy shaven head makes the natural balding a kind of secret, as though people don't know that part of the baldness is natural. That's what people want to hide - the loss of their youth.

"During some eras, going bald did not bother people as much. In the 19th century, for example, you had to look older in order to find a good job. The 20th century has brought about a revolution: Young people are the ones who count."

Nordheimer Nur adds that the bald head is popular locally because Israelis are sensitive about their appearance, and shaving is a cheap, simple, even flattering solution. "We care very much about how we look, for historical and cultural reasons - for example, the perception during the Holocaust that Jews are ugly."

Men determined to fight thinning hair constitute the target audience for an entire industry of supplements, hair products and medications. Their manufacturers claim they can halt the process and sometimes even make new hair grow. Disappointment is palpable among several who had high hopes.

"I tried many things, and spent quite a bit of money on them," says a 27-year-old Tel Aviv resident. "But it simply did not work. Combs that invigorate the blood flow, sprays, creams, vitamins - it's all nonsense. It was a waste of money. I found only one thing that works: an electric razor. Now I shave my head."

"It's a huge industry, worth millions of dollars - and a lot of bullshit," Ginzburg says. "Vitamins, creams, what-have-you. If a bald guy walks into a health store and asks what they have for hair loss, they'll sell him his own grandmother. For many such men, the situation is extremely upsetting - like losing a finger. They'll do anything to stop hair from falling out. So they spend NIS 200 here, NIS 200 there, thinking the last product they tried didn't work, but maybe this one will."

"The solutions offered at pharmacies create total confusion," says a representative for the anti-balding drug Propecia. "Any manufacturer can release his formula or anything else he wants. We get balding men who have tried eggs or frogs' legs and have given up; they can't find a solution with proven effects. I've come to accept my own bald head - but for some it's a serious issue, so they'll try anything. Balding is not a cosmetic problem, it's a medical problem. You have to consult a doctor, not try all kind of quacks' cures sold at pharmacies. The public refuses to understand this."

Those who have come to terms with their thinning mane and only want to disguise the process can use the cosmetic solutions widely used in show business. One is a powder known as Toppik, made of the same organic keratin protein as human hair. The powder, which comes in various colors, disguises areas with thinning hair. A package costs NIS 150-200. Another option is a toupee, which has become less popular in recent years; indeed, securing a hairpiece in place apparently damages remaining hair.

There is also Minoxidil, a spray applied to the scalp, which causes the dilation of blood vessels and augments the blood flow, which then carries more minerals into the follicles to prevent them from dying, and keeps hair from falling out.

"Minoxidil has revolutionized the field," Ginzburg explains, adding that it is estimated that the spray is effective in 40 percent of cases, and that among one-quarter of users, it even leads to new hair growth. The second "revolution," he notes, came about a decade ago with Propecia, the only prescription anti-hair-loss drug approved by the U.S. Food and Drug Administration. The active ingredient in it, finasteride, delays transformation of the male hormone testosterone into dihydrotestosterone. Studies have shown that Propecia, taken daily, succeeded in stopping hair loss in 90 percent of users; among about 60 percent new hair actually began to sprout.

The two main disadvantages of Minoxidil and Propecia are the fact that users become dependent on them, and they are not cheap. Discontinuing the medication will cause resumption of hair loss within weeks or months. A month's supply of Propecia through the country's HMOs costs NIS 200 (the full price is NIS 300); annually, Propecia's local sales amount to around NIS 100 million. One can of Minoxidil (80 ml.), which lasts 30-40 days when applied twice daily, is about NIS 145. According to estimates, 50,000 Israelis rely on anti-balding medication (prescription or otherwise).

Another, more expensive, option is hair transplants, in which hair from non-balding areas (such as the back of the head and neck) is relocated to the bald patches. About 95 percent of follicles can be successfully transplanted this way and will continue to grow hair without being affected by the gene that causes baldness.

Ginzburg: "Such hair does not fall out. I have a Korean colleague who wanted to make sure the technique worked. He transplanted nape hair to the palm of the hand and elsewhere, and it worked. We've done transplants of armpit hair. I once treated an ultra-Orthodox man who wanted hair added to a certain part of his beard, so we needed wiry hair. Where do you get that? The pubic area."

Hair transplants are a $1.5 billion business worldwide; about NIS 10 million is spent each year in Israel alone. The average cost of a transplant is NIS 14,000 to NIS 17,000. Professional ethics prevent Ginzburg from revealing whom he has treated, but says his clients include singers, politicians and especially lawyers. About the latter group he says: "Having hair gives them power."