I suppose if you go back to the days when men rose in the mornings and went out into the jungle or on to the plains to hunt for food, losing hair was a real problem. Just imagine the bright sun shining off the bald head. This beacon of light would frighten the game animals away faster than you could move downwind. It would be worse than dropping your spear or forgetting to bring your cudgel along, where the other members of the hunt could cover for you. But when your presence drives the potential food away. Now that’s a real problem. So they drive you out of the cave – no freeloaders allowed. You do your best to join the women in the gathering part of the survival exercise. Berries and roots are not disturbed by your lack of hair. In the end, you probably starve to death and this serves as a terrible warning to the other members of the tribe. Some of the men experiment with animal skins, hoping to invent baseball caps. Others try rubbing earth or other substances on to their scalps. At the very least, it all cuts down the glare factor.

It’s no different today. Were it not for the development of other skills which can be sold in exchange for food, all balding men would starve. This just leaves the other reaction. Women often see balding men as undesirable for breeding purposes. Who wants to have children with someone who may pass on the balding gene? It’s much kinder to let natural selection end these poor creatures and leave the human race stronger and more hairy as a result.

So men who see the first signs of premature male pattern balding slowly emerge must take action to preserve their credibility for breeding purposes. Other problems can be cured. Dental work can correct less than perfect teeth. Cosmetic surgery can remove excess fat and smooth away early wrinkles that might betray age. Style gurus can advise on clothes to wear. This just leaves the hair. Fortunately, the researchers had one of those lucky accidents. There’s this wonderful myth that scientists set out with a hypothesis, devise experiments and prove themselves brilliant. Ironically, there’s just as much discovered when experiments go hopelessly wrong. Bright-eyed and not defeated, they try to find the reason for their humiliation.

So it was with those scientists trying to find a way of treating prostate cancer. Imagine their surprise when the drug trials suddenly produced more hair on the heads of many participating men. After recovering from their Simpson “doh” moment, they realized they might have a money-spinner on their hands. Several trials later, the FDA was convinced and a license was issued. Propecia could be released on to world markets as the only drug to have been fully tested and approved by government regulators. It’s a great marketing strategy when you can tell the truth about your product. Too often in the past, marketers had to lie and cheat their customers, moving on to the next town quickly before the scam was discovered. This time, they really could say Propecia stops hair loss and hold their own heads up proudly.

In popular culture, it’s the women who are supposed to be the most obsessed by the way they look. Such is the pressure for social acceptance, many spend amazingly large sums of money on cosmetic surgery and other treatments to keep the relevant parts of the body trim and all wrinkles away from the face. Yet, on the quiet, men can have equal concerns albeit most do not spend the same amount of treatments. For some reason, men seem to forget they also go through a menopause where their hormone levels change. This causes that unfortunate swelling of the belly, loss of muscle tone and mass, a slowdown in the sex drive and, sometimes, depression. The skin loses some of its elasticity. Fine lines and wrinkles appear. Eyesight and hearing tend to decline.

Some men manage to go through the danger years between 40 and 70 with only the smallest changes. Others find their lives more seriously disrupted. For example, because the hormone level affects the prostate, some men need to urinate more often. Age also brings an increased risk of heart disease, a loss of up to 15% in bone density and changes to the autoimmune system. Unlike women who have been offered hormone replacement therapy for many years, doctors have had little interest in devising a similar treatment for men. Rather they have picked individual symptoms and devised specific remedies to deal with them, e.g. to treat heart disease, erectile dysfunction, and so on. Put into context, however, testosterone levels fall both because of aging and because of weight gain. So, men who are overweight are more likely to show age-related changes earlier. Nevertheless, doctors don’t consider it appropriate to boost the general level of testosterone, so certain clear risks emerge. As bones weaken, the risk of fractures from falls rises, the libido becomes less urgent and some men experience erectile dysfunction, artherosclerosis rises the blood pressure, and mood changes occur with many growing more depressed.

Outside the purely medical problems comes a greying of the hair, then hair loss on the way to inevitable thin cover or actual baldness. This can be very damaging to self-confidence. Hair dyes have been around from the time people started noticing how some plants could change the color of “things”, but it’s only recently that a real remedy for hair loss has emerged. Of course, there have been fake medicines for centuries. Now Propecia brings the promise of a stop to hair loss for male pattern baldness. But, as with everything, there’s a slight catch. To get the best results, you should start taking this drug as soon as the diagnosis is confirmed. If you delay and age continues to thin your hair, the chance of regrowth disappears and the hair loss may not completely stop. The medical evidence from clinical trials is clear. Propecia is most effective when taken by younger men as early in the hair-loss cycle as possible. The other problem, of course, is that, once you start, you should be prepared to continue for many years. Hair loss will resume when you stop.

Whatever you do, there are always benefits and costs. It’s exciting to drive a fast car but, the faster you drive on a busy highway, the more likely an accident. Tearing yourself away from the television or PC screen can reduce the risk of short-sightedness, but lead to boredom unless you find something like reading or knitting exciting. Making choices is a chance to see what you find interesting, what abilities you have and how you want to spend your free time. So this week’s burning question is what your decision would be if you are about thirty years old and you find yourself showing early signs of male pattern baldness. For many, hair loss is a frightening prospect. Although the majority of men are married or in a stable relationship by the age of thirty, there’s considerable embarrassment. Society has managed to persuade young men they must all have thick hair sprouting from all visible surfaces (and then some). Rather like the rites of passage involving large quantities of beer and throwing up in your best friend’s car, men have been brainwashed into thinking themselves less than manly if their hair thins and falls out. In fact, the younger they are, the worse the apparent “crime” against their gender nature. This means everyone would immediately start popping the pills to stop the loss – right?

Well, perhaps you might want to slow down the panic reaction. The research world works by looking at the evidence. Whichever side of the argument has the better facts in support wins the day. The “traditional” view is men who start losing their hair earlier have a higher risk of prostate cancer. The reason is the way testosterone works in the body. The evidence suggests men lose their hair early because they have too much testosterone. When this turns into dihydrotestosterone and builds up in the scalp, hair thins and, when it falls, it does not regrow. This same high level of testosterone is also associated with the development of growths in the prostate. Some are benign but the majority are malignant. But the precise cause and effect is uncertain and complicated by the fact that growths in the prostate seem to affect an increasing number of the male population as it ages. Perhaps all men are at risk of growths simply because they are getting older.

The other side of the argument comes courtesy of the University of Washington which has just published the results of a study of some 2,000 men aged between 40 and 47. It seems men who were balding by the age of thirty had the lowest risk of developing prostate cancer. Why does this matter? The most effective of the drugs used to treat male pattern baldness is called propecia. It works by preventing testosterone from acquiring the dihydro bit in front. If there is less dihydrotestosterone, the hair stays thicker and regrows when it falls out. Now here comes the kicker. What no one can tell you is which represents the trigger for prostate cancer. It could be the presence of more dihydrotestosterone is what slows the cancers down. Taking the propecia could therefore be increasing the risk you will get cancer. So which is more important? Do you want to keep your hair no matter what? Or do you want the lowest risk of cancer? Until there’s more research into the way testosterone works in a man’s body, this is all guesswork, but what you decide will tell us something important about you.