The days of bad toupees and worse looking plug jobs are just about behind us. For more than 99% of human history, hair loss has pretty much been an unavoidable part of life. If you lived long enough, sooner or later, your hair, so dense and vibrant in youth, would thin, perhaps just a little, perhaps to the point of slick baldness. Until quite recently, no one could predict with certainty how extensive the loss would be. Even today, there is more art then science in gauging the rate, degree and extent of alopecia that any given person will experience.

For a certain percentage of people affected by the problem, the issue of baldness was never much of an issue. They recognized it as a normal part of aging, shrugged, sighed, and got on with the business of getting through their day. But for others, hair loss became the defining touchstone in their lives, driving many to desperation and some poor souls even to the point of suicide. Pattern hair loss also inspired a legion of creative individuals to imagine solutions, some quite ingenious, others just plain bad.

For thousands of years, concoctions were brewed, hair pieces fabricated, and incantations uttered, all in an effort to turn back the cruel tide. What always remained elusive was a genuine cure.

But as the saying goes, times they are a’changin. Particularly, within the past twenty years, medical science has begun to catch up with pent-up demand. Before we discuss things further, some perspective.

For the sake of brevity, let us touch on the three primary means to address pattern hair loss today. Cosmetic cover up, medical treatment, and surgical restoration. Cosmetic cover up consists of two main approaches. The first involves bulking up the hair or coloring the scalp so as to camouflage the problem. Alternatively, non-living hair may be applied to the scalp in some fashion, e.g. by the use of hair pieces or wigs.

Medical treatment is defined as the use of pharmaceuticals or, more recently, naturally-derived reagents. These drugs or natural compositions may be ingested orally or applied to the scalp, depending on their design.

Surgical restoration is a means to redistribute viable hair bearing skin tissue from the sides and back of the scalp to the front and top so that a cosmetically improved appearance is achieved. Kind of like using sections of lawn from your back yard to fill in empty spots in your front yard. Each of these treatment choices has their place and each has their limitations. At the present time, no single option works well for everyone.

But in coming years, the choices will undoubtedly get better. Much better, in fact. Today, in teaching universities, private labs and elsewhere, the search is on to develop a legitimate cure for pattern hair loss. With the space remaining, this article shall focus on the two most likely candidate approaches likely to bear fruit, gene therapy and hair cloning.

In the next decade, gene therapy will certainly become one of the game changers of 21st Century medicine. At the molecular heart of most debilitating and lethal disease, genetic mutations do their dirty work. Numerous forms of cancer, diseases of aging, and yes, even common pattern hair loss owe their pathogeneses to genetic mutation. Think of genes as the software running the cellular hardware in our bodies and you begin to grasp the concept of how genetic mutation occurs.

As the cells in our body age they are generally replaced, often multiple times. Copies of copies of copies are churned out, for the most part, each without defect or flaw. But as time passes, genetic errors accumulate. Some of these errors are relatively minor and we never notice their occurrence. Others are more serious. Eventually, the errors are serious enough that clinical disease ensues. Gene therapy is a methodology and a new medical discipline that, organ system by organ system, will, in effect, correct genetic errors and restore the cellular machinery to optimal performance.

In the hair follicle, key genes have already been identified, that when pathologically mutated, result in hair growth dysfunction. There are any number of hair loss diseases and most are mediated in some manner by genetic events. Common pattern hair loss happens to be a disorder where a number of genes effectively conspire to gang up on susceptible scalp hair follicles causing them to whither and die. Correcting these genetic errors, gene by gene, is high on the list of those molecular biologists focused on the problem at hand.

Hair cloning takes a different approach to the challenge in that rather than reprograming defective cellular machinery, brand new hair follicles are grown as complete organ structures from a carefully selected population of stem cells in vitro. These stem cells are extracted from whatever viable donor hair remains and amplified under culture conditions so that they become numerous. The cells are then subjected to growth factors and other stimuli whereby entire hair follicles are created in a three dimensional in vitro setting.

Ultimately, when viable, these newly grown hair follicles will be inserted into the denuded areas of the scalp where, presumably, they will happily and vigorously recapitulate a pattern of healthy hair growth. This amazing feat will require a synthesis of molecular biology, proteomics, 3D tissue scaffolding, and other marvels of 21st Century science. To achieve the goal we will need to develop an exquisitely detailed understanding of tissue organogenesis such that the newly synthesized hair follicle’s structural axis and polarity may be properly aligned. Let’s go through that concept again, but this time using an easy, albeit imperfect, analogy.

Imagine, for a moment that you are a future farmer trying to create a new onion from onion stem cells. At some point in the process you’ll probably want to make sure that the roots are pointing down and the stalk is pointing up, so that your onions don’t end up growing upside down or sideways. Same principles apply here. All the parts and pieces need to fit together correctly so that the machine works as it should. Using this crude analogy we can begin to appreciate some of the challenges of working in three dimensions that do not occur when, for example, growing a simple monolayer of cells in a petri dish.

Monumental challenges notwithstanding, the odds are reasonably good that in the coming decade, one or both of these approaches will constitute the new state-of-the-art in hair restoration methodology.