The mockery never stops. It was once jokes about dodgy syrups or slapstick featuring windblown combovers. Then a virtual team of cricketers, from Graham Gooch to Shane Warne, were dispatched into back-page magazine adverts but failed to erase the embarrassment associated with hair-loss treatments. "All that money and he's still got hair like a dinner lady," spat Boy George of Elton John, who appeared to confront his receding hairline with various fancy treatments over the years. The scorn kept sprouting up, even this week when Gordon Ramsay has been ridiculed for looking "shockingly pale and bloated," as the Daily Mail put it, days after he had reportedly undergone a state-of-the- art hair transplant at the swanky Alvi Armani clinic in Beverly Hills.

But behind the social stigma of the balding that affects 25% of men in their 20s and 60% of men before they are 40 is a more shocking development: hair transplants are getting quite good, and men are starting to boast about their flash new rugs.

Hair loss has been an accursed symbol of a loss of virility and vitality for centuries. Baldness is one of God's favourite punishments in the Old Testament. Samson's strength vanished when Delilah discovered his pact with God and she ordered a servant to cut the Israelite's flowing locks. More recently, Danny the hirsute hippy in Withnail & I, advised against a haircut. "Hairs are your aerials. They pick up signals from the cosmos, and transmit them directly into the brain. This is the reason bald-headed men are uptight."

And uptight men have been: Winston Churchill was the last man to overcome this brutally visible sign of ageing and become prime minister; the political failure of Neil Kinnock, Iain Duncan Smith and William Hague has been ascribed to their lollipop heads. Lib Dem MP Mark Oaten blamed his use of rent boys on a midlife crisis that was precipitated by the sudden loss of his hair. Reading testimonials and talking to men who have paid up to £40,000 for hair-loss treatments, almost all ascribe a chronic lack of confidence at work and at play to their shining pates.

Now, however, hair-loss treatments have moved on to the high street. Boots is stocking Nanogen, a range of products designed to conceal hair loss that includes a spray-on fibre treatment which adds artificial hairs to your thinning rug for a weather-proof "perfect quick-fix treatment that lasts all day". While Italian PM Silvio Berlusconi leads the way in political transplant stakes, we may even have our first prime minister to proactively tackle the root causes of hair loss. The Guardian's elegantly bald Simon Hoggart gleefully noted David Cameron's "piscatorial patch" back in June but last month, from his perfect vantage point in the press gallery, wrote that "the goujon had vanished. Combover? Likely, but risky. A weave? Just possible." And unlike the hideous hairbrush- style plugs of yore, recent celebrity recipients of hair transplants, including John Cleese and James Nesbitt ("They've changed my life. It's horrible going bald. Anyone who says it isn't is lying"), don't look folically challenged at all.

Ramsay may look troubled but surgeons agree that his puffy face is likely to be a temporary, harmless side-effect of a possible operation: during hair transplant surgery, the skin of the scalp is often injected with a saline solution to widen and tighten the surface area to make it easier and safer for surgeons to work on. If anti-inflammatories are not taken and if Ramsay ignored instructions to avoid strenuous exercise and sleep with his head slightly elevated after his op ("and, in my experience, celebrities often ignore instructions", says one hair surgeon), the saline fluids can slip down the front of the face. This soon wears off.

Hair transplant surgery is a far cry from the old-style weaves, which involved glueing other people's hair to your scalp. In surgery, hair is removed from the back of a patient's head – where it continues to grow even on monkishly bald men – by one of two techniques. Follicular unit extraction (Fue) isolates the most basic grouping of hairs, the follicular unit, which can contain one, two or three hairs. These are removed one by one with a microdrill, a 1mm bore, after a local anaesthetic. The alternative "strip technique" involves the removal of a block of skin containing hairs, after which they are dissected under microscope into individual follicular units.

This is fairly intricate surgery and transplant surgeons view themselves as fine artists. Dr Antonio Armani, the director of the Alvi Armani clinic where Ramsay reportedly had his operation, writes on his website of how he is "inspired by the genius Leonardo da Vinci" and he remodels patient's hair according to "Vitruvian design . . . inspired by Roman/Italian art". The real skill in transplant surgery, according to Dr Bessam Farjo, a hair restoration surgeon based in Harley Street, London and Manchester, is how these extracted hairs are implanted into the balding zone. Before any hair loss, a head has 100,000 hairs. A man with a horseshoe of hair left has lost 60,000 hairs. From the remaining 40,000, the surgeon must take enough to cover his shining pate without leaving him hairless around the back and sides. Farjo typically transplants 6,000 to 8,000 hairs from back to top. Not quite Renaissance painting, it sounds more like papering over the cracks.

"That's where the surgeon's skill and artistry come in – to try to place the hairs in a particular way to make more of them. The biggest difference between one surgeon and another is the ability to design something that looks suitable and natural," says Farjo. "It's not about making you look the way you used to; it's about making you look good using the resources that you have, starting from the way you look now."

Surgery is getting better because the technology and techniques are improving, the industry is growing and surgeons are sharing more expertise and information at conferences, according to Farjo. An operation typically costs £3,500 to £10,500. But this hefty investment does not guarantee success. Spex, a 35-year-old businessman from the Midlands, had his first, disastrous hair transplant in 2000. Ten years, eight transplants and £40,000 later, he finally has a head of hair he is happy with, and has become a consumer champion, "a hair transplant veteran" as he puts it on spexhair.com, his thriving blog. He continues to be known only by his alias because he has always kept his hair treatments secret; colleagues in his daytime property management business have no idea he is fighting for the rights of the bald by night.

"I've been on this hair-loss journey myself and I know what an evil industry the hair-loss industry is," he says. His first five operations were "inappropriate", he says, until he found Dr Alan Feller, a surgeon in New York, who "repaired me with a major hair transplant operation into my hairline, which hid the previous outdated work". Two smaller operations finally filled in the "strip scars" on the back of his head.

Like Farjo, who regularly advises men to delay an operation and slow their loss with drug treatments first, Spex believes men must not rush into a hair transplant operation to be "butchered" like he was. In recent years drug treatments using minoxidil (Regaine) and finasteride (Propecia) have been hailed as near-miracle cures. Last month, the BBC reported doctors' concerns of sexual dysfunction linked to young users of Propecia. Its makers, Merck, say less than 2% of men suffer sexual side effects, which disappear when the treatment is stopped. Spex dismisses such scares. "Millions have been taking the drug and very few have side effects," he says, urging men to use drug treatments to get their hair loss under control. If they rush into a transplant, the subsequent loss of hair can leave them looking far more absurd than when they were just naturally bald.

Treating hair loss, Spex counsels, should be undertaken in the same way as A-levels. Men should embark on six months of study and meet patients who have undergone operations. "There are a lot more mavericks than there are good clinics," says Spex. "Hair loss creates a lot of anxiety and vulnerability and the hair-loss industry will always capitalise on that. But there are several reputable clinics around the world – it's a question of doing the research and they float to the top quite quickly."

With a waiting list of several months, Farjo has not needed to advertise for several years because of word-of-mouth referrals – crucially, a sign that men are now talking about their transplants. Fears of being viciously mocked for vanity are receding as cosmetic procedures from teeth-whitening to breast implants become unremarkable everyday investments. "There's a lot more awareness that we can slow down hair loss and a lot more awareness that transplants can look good," says Farjo. "That's partly because there are more celebrities talking about it, but the internet has been a major development – with forums and chatrooms prospective patients can read reviews of the doctors." With all the charlatans, does the industry need to be more closely regulated? Farjo thinks not; surgeons are already regulated by local health authorities, among others. "You can regulate the qualifications of the doctors but it's very difficult to regulate the quality of the work. You can have all the qualifications you want: it doesn't guarantee you results."

While Spex's continued anonymity may show that men are still not completely comfortable with discussing hair loss and its treatments, he is convinced the tonsorial tide is turning. "You wouldn't believe the number of people who have had hair transplants," he says. "With state-of-the-art hair transplant procedures you would look at me and you would never know, even if you started picking through my hair like a monkey."

The final sign that British men would be at ease with cures for baldness? If King William ascends to the throne with a fine thatch of strawberry blond hair harvested from the sides of his royal bonce.