Are bald men more virile than their well thatched contemporaries?

The suggestion that bald men are more virile than their well-thatched contemporaries is probably an old wives’ tale, but it must be conceded that old wives are likely to be unusually authoritative in this matter.1

John Burton and colleagues were the first to examine the contentious view that an association exists between virility and baldness in 1979. Notably Burton himself was balding at this time. However, the hypothesis has never been directly tested. In Burton et al’s study of 48 men aged 35–64 years, surrogate markers of “masculinity” such as hair density on the trunk and limbs, serum testosterone levels, sebum secretion rate, sweat secretion rate, skin thickness, muscle thickness and bone thickness showed no relationship to baldness.1 Virility per se was not assessed. Factors suggestive of a possible association include the lack of balding among eunuchs2 and pseudohermaphrodites,3 indicating that testosterone and its biologically active metabolite dihydrotestosterone are prerequisites for common baldness.4 Furthermore, the principal side effect of treatment of male pattern baldness with finasteride (a compound that prevents the conversion of testosterone to dihydrotestosterone) is loss of libido and erectile dysfunction;5 and oral antiandrogen therapy is not used to treat androgenetic alopecia in men, as it has a profound inhibitory effect on the male libido, evidenced by its use to deliberately reduce sex drive in the treatment of deviant sexual behaviour in men.

In order to resolve this vexing question, we used data from a study originally designed to examine risk factors for prostate cancer.6 This study was conducted in Australia between 1994 and 1997 in men under 70 years of age. Men with prostate cancer were recruited from cancer registers, and unaffected controls were recruited from electoral registers. All subjects were interviewed in person and were categorised into four patterns of baldness (nil, receding only, vertex only and fully bald) by the interviewer (Box 1). At the end of the interview, in private, subjects completed a questionnaire that elicited not only their history of ejaculations obtained by any means between the ages of 20 and 49 years but also their number of sexual partners.

Ethics approval for the use of the data in this study was obtained from cancer registry human research ethics committees in Victoria, New South Wales and Western Australia.

There were 2836 men who took part in the original study. Information on sexual function and sexual partners was available for 2205 men. We performed a secondary analysis of risk factors for baldness using unconditional logistic regression with baldness as the outcome and adjusting for age. As there were no differences in associations between baldness and virility in men with and without prostate cancer, we combined the data (Box 2).

No significant association was found between baldness (either limited to vertex balding at the crown or being fully bald) and the frequency of ejaculations between age 20 and 49 years (Box 2), but bald men were significantly less likely to have had more than four female sexual partners in their lifetime.