Materia Medica Malaysiana

The bald truth

TURNING bald in your 20s may have an emotional effect on some men but not on Azman Hashim (not his real name). He started losing his hair when he was 23. Now at 29, he is almost bald.
Instead of running to the nearest doctor or hair specialist to remedy the situation, Azman shaved his head instead.

"My father also lost his hair at a young age so I guess it is genetic. I don't have any problems with being bald. My friends do not tease or make fun of me." He is not seeking any treatment because he does not see it as a major issue.

"Why should I spend money on a hair transplant, wig or any of those products that claim to help your hair grow back?" Azman is among two million Malaysian men who have male pattern baldness, scientifically known as Alopecia androgenetica. It is the most common cause of hair loss in men.

Dr Steven Chow, a consultant dermatologist and president of the Malaysian Society of Hair Sciences, says that as long as the baldness is not affecting the person's quality of life, seeking treatment is entirely a personal choice.

"Hair loss can be treated. But as long as you do not mind the baldness, it is perfectly okay if you do not want to seek treatment.

"Though hair itself is not a vital organ, it has a major impact on your emotions. There are important social and cultural factors determining what is normal and what is personally acceptable." Dr Chow says Alopecia androgenetica is responsible for about 90 per cent of hair loss in men over the age of 50.

"Some men can experience hair loss as early as in their late teens. In this group of people, they will lose their hair progressively with time if left untreated." Dr Chow says that the common male pattern hair loss affects men regardless of race. "There is no statistical proof that one race is more predisposed than the other." There is usually a family history of baldness in the parents or close relatives. Hence the tendency to be bald is genetically determined.

The common male pattern hair loss starts with a receding frontal hairline. Gradually the hair on top of the head (the crown area) also begins to thin. Eventually, the two balding areas meet to form a bald patch, leaving a typical U-shaped hair-bearing area around the back and sides of the head. The hair at the back of the head and the side usually is not affected.

Men who suffer from baldness can blame it on testosterone. In the hair root, this hormone is converted to dihydrotestosterone (DHT) by an enzyme called 5-alpha reductase. DHT is an even more potent form of the male hormone and this acts on the hair forming cells in the hair root.

The hair growth cycle occurs via three main phases. The first is known as the anagen phase, in which the hair undergoes a phase of continuous growth and can last up to six years. This is then followed by a short resting phase or catagen which lasts for between two and four weeks. The last is the telogen stage in which old hair is gradually shed from the scalp. This phase usually lasts from three to four months before the anagen phase resumes.

"DHT will act on the hair follicle cells during the anagen phase and accelerates it into the telogen phase, thus limiting the duration available for active growth. What happens is that with each cycle, the hair that is formed is gradually thinner than the previous one. Eventually only miniature hairs are produced, resulting in baldness." For male pattern hair loss, men have a choice of using oral medication, external lotions or a surgical hair transplant.

The drug Finasteride has been proven to treat male pattern hair loss. Taken once daily, it slows down the hair loss process and produces regrowth and thickening of miniaturised hair.

Another form of treatment is the 5% Minoxidil lotion which is applied on the affected areas of the scalp, says Dr Chow.

Originally used to treat high blood pressure, studies have shown that 5% Minoxidil may help grow hair significantly in up to 20 per cent of those who use it while slowing the rate of loss for up to 90 per cent of users.

Male pattern hair loss can also be treated with surgical procedures which involves removing hair follicles from unaffected areas of the scalp and transplanting them to the balding areas. The cost is about RM10,000 per session.

"You may need to transfer at least 3,000 to 5,000 hairs to cover the balding frontal area. It is important that men who choose this procedure have enough hair in the donor area before they undergo the operation.

"It is effective but costly because some people may need two or more sessions. Also the success depends entirely on the expertise and skill of the surgical team. In inexperienced hands, it can be disastrous."


It afflicts women too


IF you think only men can go bald, think again. Women too can suffer from common pattern hair loss.

"Female pattern baldness is just as common but the onset is usually at a later age compared to common male baldness," says Dr Steven Chow, a consultant dermatologist and president of Malaysian Society for Hair Sciences.

According to the society's website, 31 per cent or 2.36 million of the adult women in Malaysia are believed to suffer from varying degrees of female pattern hair loss.

Female pattern baldness begins around the age of 30, becomes more noticeable at 40, and can be even more evident after menopause. This type of hair loss is permanent.

Women can also suffer from hair loss due to severe physical and emotional stress, surgery, serious illness , thyroid irregularity, hormonal imbalance following childbirth and following the stopping of birth control pills.

Hair loss also occurs quite commonly in women who are on crash diets and lose a great deal of weight over a short period of time. Dr Chow says in some situations, pattern baldness in women is associated with an endocrine or glandular problem. This is particularly so in women with polycystic ovarian syndrome where baldness is also associated with infertility, obesity, diabetes mellitus, acne and excessive facial hair growth.

Women with this problem have relatively high levels of male hormone activity, he says. The excessive production of the male hormones, androgens can be from the adrenal glands, the ovaries or from metabolic conversion in fat cells. Among other things, this results in an androgenic form of hair loss.

The pattern in female hair loss is different from that in males. Women usually have hair loss limited to thinning at the front, sides or crown, but it rarely progresses to total or near baldness as it does in men.

Female pattern hair loss can be treated with 5% Minoxidil lotion. Hormonal modulation with an androgen-blocking agent can be prescribed for those with a hyper-androgenic syndrome. In selected patients, hair transplant is also a possibility.

However, many women may not seek treatment for hair loss "particularly so if it occurs at an age when they can also suffer from other illnesses. So seeking treatment for the common hair loss is not necessarily the first thing in their minds," says Dr Chow."

In most cases, except due to menopause, hair re-growth will resume after the patient returns to a normal diet or health.