Be Nice, Nursie,

I’ve enjoyed all your past tongue-lashings, but fear it’s my turn now. Lately, I’ve noticed more hair in my shower drain and less on my head. Is this the beginning of the end . . . balding? The last thing a “mature” HIVer like me wants to do is blind the boys on a sunny day with the glare off my head. Anything to encourage follicular fecundity?

-- Wigging Out in Wisconsin

Well Said, Wiggy!

While Nurse may have occasionally employed a tone a smidge too disciplinary, believe me, dear: It’s always administered with the greatest affection for her virally challenged brothers and sisters. Lord knows you have enough to handle without having an old nag like me adding to your -- pardon the expression -- headaches! Losing one’s hair is an irksome, and sometimes incurable, development. Besides the inexorable advance of the years, balding results from genetics, skin conditions, sudden weight gain or loss, fevers, certain diseases (including anemia and an overachieving thyroid gland) and meds, some of which the AIDSy take.

While balding is an equal-opportunity offender, men tend to molt more. One in four American men starts to lose hair by age 30; by 60, two out of three reach for a rug. If a teenager counts hair loss among the troubles of his turbulent years, chances are he’s working his way toward a weave in the not-too-distant future. Male pattern baldness usually starts at the temples and causes the progressive recession, thinning and decamping of the hair -- leaving victims with an unflattering horseshoe-shaped band on top. Also splendidly styled androgenic alopecia, this maddening malady is associated with high levels of testosterone. And hello, ladies: Female pattern baldness, which also begins around age 30 and worsens after meno-pause, causes the scalps of the second sex to thin evenly; only rarely do the gals lose it all. This kind of baldness, for him and her, is permanent, so here’s my severely starched shoulder to cry on before you read on.

In contrast, patchy hair loss resulting from conditions such as head fungus, skin and autoimmune disorders and stress-forced fallout is usually temporary. So is toxic baldness, which may resolve in months; it’s caused by a number of drugs, including cancer chemotherapy agents, cholesterol-fighters, anti-depressants and beta blockers. And HIVers anecdotally point to these meds as causes of lost locks: anabolic (muscle-building) steroids (such as testosterone), Megace, 3TC, hydroxyurea, alpha interferon, famciclovir and fluconazole.

Here, then, are Nursie’s hair-raising hints. Two drugs for male pattern baldness have hit the market: the over-the-counter (and good for the gals) topical minoxidil (Rogaine); and the prescription (guys-only) oral finasteride (Propecia). Both drugs are somewhat effective in maintaining -- and occasionally regrowing -- locks beaten by alopecia, especially at the scalp’s crown. (But don’t expect miracle growth at the front of that ebbing hairline.) These drugs tend to work best for men in their 20s and 30s balding for less than five years; they take up to a year to kick in -- and hair loss resumes when the meds are stopped. Side effects? For Rogaine, they include scalp irritation and itching; for Propecia, rash, itching, hives and swelling of the lips and face, breast tenderness and enlargement, and -- sorry, stud -- ejaculation difficulties, erectile dysfunction, testicular pain.

Hanging onto a head -- or mere wisps -- of hair means making nice to your scalp. Excessive oil clogs pores and causes hair-root malnutrition, triggering more shedding, so frequent shampooing can help. Some HIVers swear by Revitalize, an herb-and-nutrient-packed formula. The vitamin biotin can treat your tresses well, as do ginger (powdered or tea), fish or flaxseed oil and bioflavonoids (quercetin is one).

When the hairline starts closing in on the nape of the neck, it might be time to consider gluing on a hairpiece. Available in synthetic and natural hair, they cost $500 to $3,500. A more drastic step is a surgical transplant. Besides the discomfort and humiliation of sporting a plug, transplants are pricey ($1,500 to $10,000) and balding may progress in untreated areas. In the end, a few minutes in the shower with a disposable Bic razor and a dab of shaving cream may be the treatment -- glare or no -- to get you the kind of attention a wig won’t.