Day after day, John Kreager looked in the mirror and saw his hair disappearing. A little bald spot at the crown. A little more across the front. Combing it sideways over the bare spots helped only so much.
"I got to the point where I couldn't hide it anymore," says Mr. Kreager, 41, a General Motors engineer and father of two.
After spending $6,000 for two hair transplant procedures and a scalp-reduction technique that patched over a couple of inches of shiny crown, Mr. Kreager has the look he wants.
It's not luxurious, Phil Donahue-looking hair. But it's enough to feel good about when he looks in the mirror to shave.
"I just didn't think I'd look good bald," says Mr. Kreager, of Highland, Mich. For many of the 55 million Americans losing their hair with age, baldness isn't fashionable. It's a painful reality.
But a bewildering array of costly, and even unsafe, options confront the men and women who want to replace what nature is taking away.
Much of the hair-replacement business is unregulated. Consumer expectations are unrealistic, or people fall prey to unproven treatments. Experts and consumers warn: Rogaine, the nation's only prescription drug for hair growth, costs $600 a year, must be used for a lifetime and doesn't work on everyone. It works best to grow hair at the top of the head and for younger people whose hair is starting to thin. Women may get better results than men. Still, there are lots of unhappy customers.
Non-prescription remedies sold in drugstores and on late-night television -- from sprays to vitamins to creams -- are largely unproven, despite a 1990 crackdown by the federal Food and Drug Administration. Some may cause allergic reactions; the sprays and creams could come off during exercise or sleep.
Results of transplants and other surgical techniques vary widely if done improperly, leaving unattractive hairlines or poor hair growth.
"In the last five years, we've had an influx of physicians getting into this," including plastic surgeons hoping to offset lost business from silicone-gel breast implant patients, says Mike Mahoney, executive director of the nonprofit American Hair Loss Council.
Doctors can attend quickie weekend courses and start a transplant business the next Monday, Mr. Mahoney and others say.
Young men often are the most disappointed, because they have unrealistic expectations.
White males aren't the only people who seek hair replacement.
The best female candidates have thin hair on top but thick hair in back, says Dr. Martin Tessler, a Southfield hair loss specialist. About 20 million American women have hair loss.
While new transplant techniques have made surgical restoration of hair more appealing to black Americans, they face different issues, Dr. Tessler says. Their side or donor hair may be curlier and may provide less transplantable hair to get a thick look.
Dr. Tessler sometimes transplants a small area as an experiment to show the man what kind of hair he will get.
Detroit dermatologist Dr. Lorna Thomas advises people to avoid any hair loss remedy without first discussing it with a dermatologist.