A few years ago, Dr. David Weinstein started to lose his hair. "I really was pissed off," he explained to me recently, in the tidy, tiny conference room of a co-working space in Manhattan. "I'm the only male in my family who managed to keep my hair! And I was in my mid-fifties, and all of a sudden it fell out. I thought, This is nuts. I don't like this. And then I thought, I know a little bit about regenerative medicine." Weinstein is a neuroscientist specializing in spinal-cord injuries and nerve regeneration. Working in his lab, in his spare time, he developed a drug compound he called RT1640.
Then Weinstein began experimenting on himself. "I didn't tell anybody I was doing this, including my wife. And, after a couple of weeks, I said, 'Look at my head.' And she said, 'Your hair is growing. Why?' "
Weinstein has big dark eyebrows and a kind face. Kind of an Elliott Gould vibe. I looked at his head. There was a spotty, thatchy outcropping of gray-black hair. Not exactly an overflowing abundance, but hair, to be sure. "I had nothing on top," Weinstein said. "You can see—I grew my hair back! And it grew back more or less the color I had when I was young."
Weinstein founded a company to develop RT1640 for the consumer market. That company, RiverTown Therapeutics, is to date tiny and unknown. But Weinstein is confident that he's discovered the cure for hair loss. Which would mean that he has found the solution to an ancient problem with an eternal stigma.
In II Kings 2:23-24, the prophet Elisha is mocked by a gang of surly kids. The kids "said unto him, 'Go up, you bald head! Go up, you bald head!' " Elisha "cursed them in the name of the Lord." Promptly "two she-bears came out of the wood and tore forty-two of them." Sometime later—in 2013—German researchers published a study indicating that men experienced hair loss as an "enormous emotional burden" that could lead to an "impaired quality of life" and "psychological disorders." Inversely, one study has shown that people perceive men with bountiful hair as likely having big penises.
People are also much, much more likely to vote for political candidates with hair. Only five elected American Presidents—John Adams, John Quincy Adams, Martin Van Buren, James Garfield, and Dwight Eisenhower—were bald or balding. Considering that eighty-five per cent of men older than fifty suffer hair loss, that's an astonishing record.
It is no surprise that Donald Trump is obsessed with hair loss. "Never let yourself go bald," he once told a Trump Organization executive. "The worst thing a man can do is go bald." During their brief dalliance, Stormy Daniels confronted him about his hair. "I was like, 'Dude, what's up with that?' " she said, to In Touch, in 2011. Trump laughed. Then he told her that he worried that "if he cut his hair or changed it, that he would lose his power and his wealth." Recently, Trump's physician admitted that the President takes the anti-baldness medicine Propecia.
Hair growth is a giant industry, with estimated annual sales of $3.6 billion. And every one of those dollars goes to products that do not provide actual hair regeneration. Rogaine and Propecia, the market leaders, can slow hair loss, but they don't grow new hair. They also come with the small risk of serious side effects. In 2011, Men's Health reported on a Propecia user who "lost all pleasurable sensations in his penis."
Quietly, however, progress churns. Joseph is the pseudonymous proprietor of the Web site Follicle Thought, a popular destination for hair-loss obsessives. Follicle Thought is dedicated to "what's next," Joseph told me. "What could be coming? Obviously we have other things to cure. But, like, what is the world doing about hair? Hundreds of millions of people really want it. It's a really deep, emotional, psychological issue for people." He paused. "I've put so much thought into that question."
Joseph and his readership, he said, are convinced that we are at a "peak moment" for the industry. He ticked off "platelet-rich plasma" and "injectable cell therapies" and other high-level technologies that are being developed by companies from New York to San Diego, Tokyo, and Stockholm. He won't make bets on who's going to win the arms race. But, he says, "if you were the first, that'd be fun for the trillion dollars that you'd make. Over the next few years? It's prime time."
In the nineteen-forties, a Brooklyn anatomist named James Hamilton studied prisoners in Oklahoma who, having been convicted of sexual assault, were castrated. Hamilton identified testosterone as the root of hair loss, and showed that men castrated before or during puberty did not go bald. He then injected groups of castrated adult men with testosterone and—duly, cruelly—watched their hair fall out.
In the following decades, researchers learned that testosterone does not work alone. An enzyme converts testosterone into a substance called dihydrotestosterone, or DHT, which causes hair follicles to shrink. DHT attacks the dermal papilla, the "brain" of the hair follicle, and is the main cause of male-pattern baldness, which affects more than fifty million men in the United States and also—largely unremarked upon, but true—more than thirty million women.
Rogaine and Propecia, the only commercial hair-loss products that have ever been proven to work, were both discovered accidentally. Rogaine, a topical product known as minoxidil in its generic form, was originally developed as a blood-pressure drug. Scientists do not fully understand its efficacy, but the working theory is that minoxidil protects the dermal papilla from DHT. Propecia, or finasteride, was originally developed as a treatment for enlarged prostates. It inhibits the creation of DHT. Both products have drawbacks. In order to be effective, minoxidil must be applied daily. Because of the hormonal imbalance that finasteride causes, women can take it only if they are postmenopausal. If you stop taking either drug, you will quickly lose the hair you would have lost in the duration of your usage. (Recently, on the actor Dax Shepard's podcast, Ashton Kutcher confided that he'd stopped taking finasteride. With awe, Shepard said, "I just think that's so risky of you.")
Gersh Kuntzman is a newspaper and magazine lifer and a semi-professional hair historian. In 2001, he published "Hair!: Mankind's Historic Quest to End Baldness," a slim, delightfully strange book that is one of the only comprehensive non-academic studies of the field. "There is nothing that can regrow hair once a follicle is destroyed," he wrote.
I met Kuntzman on a hail-heavy day, in the bottom lip of Manhattan, and we walked to a pizza-by-the-slice place. "I'll have the Gersh!" he shouted to the man behind the counter. The man was befuddled. The man's co-worker stepped in and gave Kuntzman a nod of recognition. A Gersh—a hot chicken-parm sandwich with spinach—soon appeared.
"People have been trying to sell a baldness cure since the beginning of civilization," Kuntzman explained. "And the methods by which they try to sell that cure have not changed dramatically. These new companies, they're trotting out the same promises that people trotted out in Roman times, when they said, 'Use this hippopotamus fat to grow hair on your head!' "
Kuntzman described the "snake oil" era of hair restoration, in the early twentieth century, when salesmen offered nonsense treatments, often with horrific results. One involved "cylinders of skin taken from the abdomen and sewn into your scalp to function as a sort of belt loop" for new hairs, Kuntzman said; another used paraffin injections that left some customers with lifelong horn-like head bumps. Most of the really ugly stuff ended in 1938, when the Food and Drug Administration began regulating the industry.
Today, disputed and odd solutions still exist, but they are largely harmless. A company called Capillus sells a specially engineered "laser cap for hair regrowth." It advertises prominently in in-flight magazines. But, as far as real cures, in the seventeen years since Kuntzman published "Hair!," he said, "not much has really changed."
For the first twenty years of my life, I took having hair for granted. One day, in college, I woke up and looked in the mirror, and was convinced that my hair was falling out. Not receding—dropping, that minute. Later that day, I told a roommate. He took a beat, and then asked, not without kindness, "Were you on PCP?" That semester, in a creative-writing workshop, I was moved enough to write a long, confused story about a teen-ager with male-pattern baldness who suffers a meltdown and robs the hot-dog counter where he works. By my late twenties, hair loss was something that I thought about all the time. I understood, largely, that my obsession was a specific expression of a more general anxiety. I've never been to therapy. There are many things that have led me to consider it. But one of the most distinct, definable, and pressing has been my obsession with hair loss.
I'm in my early thirties now, and a little less obsessed. In part, I assume, that's because I still have hair. It will one day go, I'm sure. For now, it's hanging on. But, when Joseph explained hair loss as a "deep, emotional, psychological" issue, I understood.
Last fall, the San Francisco startup Hims began a small publicity blitz. Its ads were all over in-boxes and social-media feeds and TV screens; they were even out in real life, on paper placards. Above a picture of a handsome young man with long, luscious dark hair, there was a bold claim: "Thanks to science, baldness is now optional." Hims, which also sells shampoos and erectile-dysfunction medication, has a minimalist aesthetic, designed by Partners & Spade. (The agency has done work for famed disruptors such as Warby Parker and Casper.) It also has an in-house journal called Savoir Faire. And, within all that attractive packaging and identity branding, the company was very casually offering the holy grail. My latent obsession led me to ask some questions of the ad campaign. It turns out that Hims's baldness pills are just finasteride, and their topical solution minoxidil. Thanks to expired patents on those products, Hims is able to sell them cheap. And yet ultimately they're providing the same old solution. Another false prophet.
Away from Silicon Valley, though, a clutch of companies are competing to provide the true cure. There are a few primary approaches. The San Diego company Histogen has been around since 2007, making it a veteran in this inchoate field. Histogen is working toward "an injectable for hair growth," its founder, Dr. Gail Naughton, told me. What Histogen wants to inject in you are extracts from "neonatal cells grown under simulated embryonic conditions." Histogen is convinced that these cells stimulate "growth factors" that signal hair formation. That's option No. 1: first, a cell solution is whipped into a hair-growing frenzy, in a lab; then it's punched into your head. "Some people would rather take a pill," Naughton acknowledged. "But we have some nice benchmarks, with something like Botox. You'll be able to have a physician come to a Tupperware party" and give the injections. The market, Naughton knows, will be huge. "It's not just hair," she said. "Anything in aesthetics has been booming worldwide. Anything to be more youthful-looking, anything to regenerate yourself. Anything to live longer."
In Vancouver, a Canadian company called RepliCel focusses on the hair follicle's "dermal-sheath cup cells," its C.E.O., Lee Buckler, explained. Buckler believes that DHT attacks these cup cells "like a parasite." Like Histogen, RepliCel's consumer product would be an injectable. The company would generate new versions of your cup cells, which would be implanted into your "affected area"—the places where your hair has fallen out. Boom: new hairs. (Theoretically.)
"We've learned how to isolate those cells and how to grow them," Buckler said. "We grew whisker hair on the ears and the paw pads of mice." Buckler quickly added that the majority of the new cup cells always migrate to the base of the hair follicle. "There's no danger they'd migrate to your eyeballs or somewhere weird," he said.
How about if you'd rather not get your head punctured? In Sweden, a company called Follicum is now doing Phase IIA clinical studies and planning to communicate results by the end of the year. The end product will be a cream or a lotion, one that could be applied as few as three times a week. In the first trial, Follicum claims, more than seventy-five per cent of patients experienced hair growth. This is the real dream, the one so artfully captured in the Hims ads: pop a pill, slap on some cream, and get Hair God locks.
Follicum's origins trace back to 2004, when two Lund University researchers targeting arteriosclerosis stumbled across a modified protein called osteopontin, which grew hair in mice. The researchers knew nothing about the hair-growth industry, but were quickly informed that there were big market demands, especially in Asia. "If you lose hair in Asia, you lose a lot of your credibility," Jan Alenfall, the C.E.O. of Follicum, said. "This was really a serendipity finding."
"How is it recruiting investors?" I asked.
"If the people you were talking to had little hair," Alenfall said, "they'd be very interested in giving money to the project."
RiverTown Therapeutics is in the Follicum camp: RT1640, the compound that David Weinstein developed, is applied topically. Compared to the aforementioned companies, though, RiverTown is way behind. Weinstein and his business partner, Michael Altman, are currently looking for investors to fund clinical trials. But only they have the flashy declaration that the founder has managed to grow back his own hair. Through coverage on sites like Follicle Thought, RiverTown is now a cult favorite in the hair-loss community.
"Everyone wants to try it," Altman told me. "We get inundated with e-mails saying, 'Tell me what the price is, I really don't care, I'll buy it.' " Weinstein looked at me. "You have your hair," he said. "I don't know why you're interested in this," Altman chimed in, with wildly unrealistic but much appreciated enthusiasm for my reporting. " 'Cause eighty million people don't! There'll be eighty million people reading this article!"
I asked Joseph what it might feel like to get his hands on an actual, proven hair-growth product. The question gave him pause. "It's hard to put into words," he said. "This would be the biggest, freeing, liberating thing for so many people. I mean, there would be smiles from coast to coast. That's the best way I can respond to that question. I think people would be smiling from coast to coast."
On a particularly obscure corner of the Internet, FarrellHair.com, there is a seventeen-minute-and-forty-eight-second video in which the actor Jason Alexander explains why he suddenly has hair. It's an unexpectedly entrancing bit of work. Alexander displays none of the cynicism of his iconically bald TV character George Costanza. Warmly and earnestly, he pours his heart out to Richard Farrell, the man who made his hair.
"Let's see, how did it work with Jason?" Farrell said, when I met him, in a sun-drenched suite on the thirty-fourth floor of the Marriott in downtown Manhattan. He was wearing all black: black boots, black-leather bomber jacket, perfectly snug black T-shirt. Tattoos poked out from his jacket sleeves, down to the tops of his hands—black roses and black birds and things. His dark, curly hair bounced past his chin. "I believe he just called up and made an appointment! I don't consider myself a hair guy to the stars at all. I work with regular people throughout the world."
Farrell makes what he calls "hair systems." They're not quite wigs or toupees—you can keep them on for weeks at a time. They cost more than a thousand dollars. Farrell was in New York for a week, holding meetings with clients in his hotel room. Now his rolling suitcases were packed. Malaysia, Singapore, South Africa, Russia: he's almost always on the road, satiating international demand for high-end hair pieces.
"This industry can be ruthless—full of liars," Farrell told me. "Just imagine how emotional people can be about their hair. If it didn't work, some bruiser could throw me right out the window!" He laughed. "I'd rather sell hamburgers than make people ugly. But they're always just so beautiful. I've done it almost forty-seven thousand times." (Forty-six thousand and seventy-four, he later clarified, in more than thirty years.) He was originally a hairdresser; he learned the ways of wigs from a stylist on the set of a Ronald McDonald shoot. Now he's an unabashed proselytizer. It's all in the details, he said. "Clockwise growth patterns. Counterclockwise retention. Gravity splits according to your growth patterns and gravitational force. Irregularly shaped hairlines. The density, the texture, the colors, the highlights, the grays, the curls, the curl clash. I mean, this is rocket science! We have proprietary techniques!"
In 1952, a New York dermatologist named Norman Orentreich invented hair plugs. He removed hair from the back of a patient's head, where it still grew, and grafted it onto the front. In the decades since, the transplantation process has become more refined. Following the lead of the pioneering dermatologist Robert Bernstein, most doctors perform follicular-unit extraction; instead of crudely ripping up large parts of the scalp, they pluck and move individual follicular units.
As I entered a small operating room at Bernstein's Midtown East medical practice, a front-desk secretary shouted out, "Hope you got a strong stomach!" Inside, a patient dozed in an operating chair, while nurses held a strip of back-of-the-head skin—something like a fat hairy caterpillar—with tweezers. They began dissecting the follicular units under a microscope.
The patient, a small, vaguely European man in his late forties, had rings on his fingers and a bloody, rectangular gash on the back of his head. It looked like a chunk of missing carpet. Bernstein pointed at the white opening of exposed scalp, and explained how easy it would be to stitch skin together over the gap. This was a traditional process for follicular-unit transplantation. Then Bernstein led me into a second room, where another patient was seated with his face in a massage-table-like padded hole. A portion of the back of his head was marked off. To his right was a boxy gray machine, roughly four feet by four feet, with a jutting mechanical arm. This was the ARTAS Robotic Hair Transplant.
The machine hummed, and the robotic arm extended out a thin steel needle, which it repeatedly and automatically punched into the marked-off area on the man's head. It's yanking out hair follicles, Bernstein explained: he had programmed the machine pre-procedure; now the robot knew exactly how deep to penetrate the skin and how far apart to make each incision. The patient rustled a bit and a nurse stopped him: "You can't move your head." Then, hoping to help him stabilize himself, she added, "You can hold on to the robot."
"The robot senses the movement of the scalp," Bernstein said. "It becomes one with the head."
After the robot was done, two nurses picked off the skin grafts and hairs and put them in petri dishes. While they prepared them for implantation, Bernstein explained the real future of the business: cloning. Bernstein has partnered with a Columbia University geneticist, Angela Christiano, who is working on duplicating hairs. The problem with hair transplantation is that you're moving hairs around, not creating new ones. Women affected by female-pattern hair loss, in particular, are left out: they don't have a thick back patch of "donor hair" to work with.
Cloning has seen many false starts and wrong turns, Christiano told me. Now her team is building "an artificial skin with a dermis and an epidermis, with molds made to mimic the dimensions of hair density," she explained. "When the artificial skin matures we pull out the pre-formed hairs and insert them into the skin." Bernstein is convinced that, in the next ten years, cloned hair will happen. "And then the supply and demand problem is solved," Bernstein said. "Without Bernanke!"
Christiano is more of a skeptic. Lab results are nice, she said, but "you can grow mouse or rat hair sixteen ways till Sunday. They grow beautifully!" She laughed. "Humans, not so much." She points out that there's so much we still don't understand. For one: Why does the hair on the back of men's heads stick around, even when all the rest drops? She also counsels caution when playing God with hair loss. Some companies are seeking hair-restoration cures by attempting to modify developmental-cell pathways. Those pathways, Christiano says, "are potent, and so it's tempting, but you have to make sure it's well enough controlled that you don't initiate a cancer signal."
And, for all of these collective efforts, Christiano reminded me, the only things that have really worked were discovered accidentally. Soon to join minoxidil and finasteride will be Xeljanz, or tofacitinib: originally developed for rheumatoid arthritis, it has remarkable effects on hair growth for patients with alopecia areata, an autoimmune disorder that causes patients to lose hair in big patches over their entire bodies.
I followed Bernstein back into the hallway, where the robot patient was walking to the bathroom. A blue scrub cap on his head was lightly splotched with blood. He smiled at me. "Think twice!" he said.
In the operating room, Bernstein prepped the robot patient for implantation, puncturing the man's scalp with a long needle. These are the "sites" where the hairs will go. Blood bubbled over his scalp, but the patient didn't seem to notice. The patient and doctor chatted loosely about summer houses and beers and boats. "Would I be a candidate for a surgery after this surgery?" he asked.
"This is your last ride," Bernstein told him. "You're done." The patient didn't have any more hairs to move around. Then Bernstein clarified. "With the existing technology, you're done. When there's cloning, we'll bring you back."
These days, when forced into windy outdoor situations, Trump is nearly always seen wearing a Make America Great Again cap. But, one wintry, blustery day this February, Trump walked up the steps of Air Force One capless. In the engrossing video footage, you can see the hair on the back of Trump's head part and rise, shooting up with power, almost in two separate flaps—one to the left, one to the right.
In just the past few years, we've made remarkable strides in understanding Trump's head. In March, 2016, with Trump the presumptive G.O.P. nominee, Gawker's Ashley Feinberg published a diligent and compelling investigation, "Is Donald Trump's Hair a $60,000 Weave?" It pointed to a high-end clinic called Ivari International that, for a while, at least, had the kind of complicated ties to Trump and Trump Tower that we'd later see in the dignitaries of various hostile foreign governments.
The contention could never be definitively proved. "Gawker was arguing it's some crosshatched weave that went beyond normal combing," Gersh Kuntzman said. "I studied weaves. If you look at it from any angle, it is something of an elaborate, multifaceted combover."
In Michael Wolff's "Fire and Fury," Kuntzman's theory is bolstered. Wolff writes that Ivanka Trump "often described the mechanics behind it to friends: an absolutely clean pate—a contained island after scalp-reduction surgery—surrounded by a furry circle of hair around the sides and front, from which all ends are drawn up to meet in the center and then swept back and secured by a stiffening spray."
I'd come to think that the simplest answer was the right one: this was regular male-pattern baldness, elaborately covered up. But the Air Force One incident only deepened the mystery. What kind of hair afflicted by male-pattern baldness rises in the back? I suddenly had no idea which parts of his head contained which hairs. Watching the flaps on the back of his head shoot up again and again, I became unmoored in my beliefs.
A few weeks after the Air Force One incident, while addressing a crowd at the annual meeting of the Conservative Political Action Conference, Trump caught himself on a giant monitor. Immediately, he checked his hair. What secrets were these camera angles exposing? Then—as far as I can tell, for the first time ever—he admitted to hair loss. "Oh, I try like hell to hide that bald spot, folks," he said. "I work hard at it. Hey, we are hanging in, we are hanging in, we are hanging in there. Right? Together, we are hanging in."
Where is the bald spot? What exactly are the dimensions of this bald spot? It's all so stupid, so tiringly stupid. In May, Trump's former personal physician, Harold Bornstein, revealed that Trump had sent people to seize all of his personal health records. Bornstein called it a "raid" that left him feeling "raped, frightened, and sad." He also claimed that it was revenge for having revealed to the media that Trump was on Propecia.
Why lie to us? Trump's head is the ugly extreme end of a national obsession. "Why are we still going down this road?" Gersh Kuntzman asked, during our conversation. "You're always looking for something . . . . The hair is always greener on the other guy's head. But if you actually go to a shrink and do work on yourself—"
It needs to be said: on Kuntzman's own head there was a full, nicely salt-and-peppered head of hair. And so, yes, perhaps that meant his self-affirmation spiel was flawed. But I couldn't help but be moved.
"I'm Gersh fucking Kuntzman!" he bellowed. "I say that every day!"