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The Tressless sub-Reddit is the internet’s largest gathering place for the bald and balding. It has more than 400,000 members, many of them young men stunned that their follicles have betrayed them so early. They share photos of their thinning scalps, vent about their diminished sex lives and self-esteem, track infinitesimal fluctuations in the size of celebrities’ foreheads, and ask questions like “Is Propecia an acceptable name for a daughter?” Mainly, they talk treatment: what works and, more often, what doesn’t. “I think I am done for,” reads a representative post by a 21-year-old who tried the popular medications but kept shedding anyway. “Should I shave it all and accept defeat?”

The Tressless community’s biggest frustration may be with the lack of progress. Technology has advanced in almost every other domain — we have self-driving cars, ChatGPT, and earbuds that translate foreign languages in real time — but the best hair-loss treatments are decades old and only marginally more effective than a good toupee. “WTF have we been doing for the last 30 years?” one redditor asked recently, prompting a 336-comment complaint session that at times showcased a surprising level of scientific fluency, with users citing journal articles, biochemical pathways, a broad spectrum of documented side effects, and the convoluted mechanics of FDA approval to explain the shortcomings of the current offerings.

There are the standbys, minoxidil (often known by its brand name Rogaine) and finasteride (Propecia), which have been on the market since the ’80s and ’90s and are still the only drugs approved by the FDA for hair loss. They can help preserve the hair you have, but both come with downsides. To get the full benefits of topical minoxidil, you have to rub it into your scalp twice a day, every day, forever. There’s a pill version, too, but it can cause dizziness and heart palpitations. Finasteride works better for some, but only for men, and only if they’re comfortable with the risk of erectile dysfunction, which in some cases can be permanent. Dutasteride, finasteride’s off-label nuclear-strength cousin, is more potent but equally deleterious to boners. Meanwhile, hair transplants can occasionally work wonders, but they’re expensive and frequently require international travel. Then there are laser helmets, platelet-rich plasma injections, microneedling, and a galaxy of supplements, which tend to work better at enhancing primary treatments than on their own. No currently available treatment seems to work for everyone, and, crucially, none can reliably do the one thing everyone wants, which is regrow thick, mature hair on parts of the scalp that have already gone bald. Nothing ever has. Until — maybe — now.

Last year, Tressless members started posting about a new potential treatment for hair loss that landed on their radar after the American Academy of Dermatology’s annual meeting was rocked by some early trial data. The drug, called PP405, was developed by Pelage Pharmaceuticals, and it works differently than the usual medications. In pattern baldness, or androgenetic alopecia, hair follicles don’t disappear. They gradually shrink and start producing thinner, shorter “vellus” hairs instead of thick, pigmented “terminal” hairs. Eventually, they go dormant and stop producing hair altogether. Minoxidil and finasteride try to rescue those struggling follicles before they reach that point, the former by increasing blood flow, the latter by blocking the conversion of testosterone. But PP405 is more ambitious, aiming to revive follicles that have already shut down by reprogramming the metabolism of their stem cells. In theory, it doesn’t just slow hair loss; it reactivates the parts of the scalp that have already surrendered — and seemingly without side effects.

Tressless has seen many so-called baldness cures come and go, so the initial response to PP405 was cautious. It’s “very interesting” and could represent “a new mechanism of treating hair loss, if it bears out in further clinical studies,” noted the first post to mention it in March 2024.

But the mood didn’t stay cautious for long. As Tressless members dug into the science and began circulating screenshots from Pelage’s website showing how quickly PP405 could work, the tone shifted to barely contained euphoria. By the time Pelage officially announced the impressive results of its Phase 2a trial this past June, the sub-Reddit had already declared PP405 the drug that would finally change everything. “Sprinkle that PP405 on my scalp like I sprinkle salt on my steak,” one member wrote. “BLESS PELAGE AND BLESS PP405 GIVE ME THAT SHIT RIGHT NOW,” posted another. Someone even wrote a poem:

r/Tressless, raise your balding heads,

For soon, we won’t need those meds.

For perfect hairlines we strive,

The dead follicles we’ll revive.

The reason I still cling to life?

Pee-pee-four-zero-five.

On some days, it seems like PP405 is the only thing Tressless wants to talk about. Threads dissecting its mechanism and trial design routinely draw hundreds of comments. In theory, the drug won’t go to market for a few more years, and that’s assuming it clears regulatory approval, which is far from guaranteed. But that hasn’t stopped it from becoming the sub-Reddit’s obsession, a vessel for all of its members’ longing and desperation. As Ozempic and Viagra........

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