Hair today, gone tomorrow

Most people expect their hair to thin when they approach middle age. However, for a man to start balding in his 20s, or even earlier, this would likely be devastating upon his self-image and confidence.

For example, former tennis player Andre Agassi said losing his hair in his late teens was a "big deal" to him. In a television interview after his retirement, he recalled how tormented his brother was when he started losing hair at a young age, and that the incident in turn had affected him as well.

Agassi, who was also afflicted with the same condition, started losing hair in his late teens, and had to wear a wig by the time he was 19 to hide his condition.

At that time, he thought hair loss could be "probably the worst thing to happen to a person". He was so self-conscious of wearing a wig, as he feared it would slip off in the heat of a tennis match.

(He did wear one in his first French Open final in 1990, where he lost to Andres Gomez, and he partly attributed his loss to his anxiety over the wig.)

There is little or no study to back claims that premature hair loss, also called male pattern baldness, is caused by stress or dietary factors. In fact, most cases do have a genetic basis, and in 95% of cases, a condition called androgenetic alopecia (AGA) is responsible.

The main culprit behind AGA appears to be a combination of genes that make a person susceptible, and a male hormone or androgen called dihydrotestosterone (DHT). DHT is created when an enzyme called 5-alpha-reductase interacts with testosterone, another male hormone.

DHT shrinks hair follicles - but does not reduce their number - until they no longer produce visible hair. The levels of this hormone are higher in men who are genetically predisposed to male pattern hair loss (see Typical progression of AGA).

DHT binds with the androgen receptors on hair follicle cells to create what is called the androgen-receptor/androgen complex (ARAC), which then gets transported into the cells.

As the dermal papilla of males have a larger number of androgen receptors compared to females, it is no surprise that AGA is mainly a male problem. The pattern of hair loss in females is also different from males.

Once inside the hair follicle cell, ARAC can bind with specific regions of the cell's DNA called androgen-responsive elements. When an ARAC binds with an androgen-responsive element (ARE), it causes a change in the behaviour of the cell. It is thought that specific ARE's are responsible for initiating the process of miniaturisation of the follicle that eventually leads to hair loss.

"AGA afflicts 30% of men by the time they hit 30 years of age, and goes up to 50% by the time they hit 50. And it hits 90% of men when they reach 70," said Dr Steven Chow, president of Malaysian Society for Hair Science (MSHS).

In classic male pattern baldness, hair is lost in a well-defined pattern, beginning above both temples. Hair also thins at the crown of the head. Often, only a rim of hair around the sides and rear of the head is left.

AGA can hit males even before they hit their 20's, but the problem with AGA is that it happens so slowly and insidiously that it takes a while before one fine day, it becomes painfully obvious to the loved ones of the person having AGA.

"Most people try to live with it until at some point where the situation is no longer bearable, or until the hairdresser points it out," said Dr Chow.

Most men would do anything just to have their crowning glory back, and are easy prey for those selling unproven products in the market.

The bad news is that there are no shampoos or massages or tonics or balms that have been clinically proven to halt or reverse AGA.

The good news is there are two clinically-proven drugs that can slow down, or reverse the condition.

"There are a lot of myths surrounding hair loss, but there are scientific reasons behind hair loss," said Dr Chow.

He added that MSHS was set up in 2003 to enhance the development of the science of hair and skin.

"It was the first time a society of such nature was formed in Malaysia, consisting of specialists in skin, hair, nails and so on, including general practitioners and scientists who are interested.

"With about 200 members, MSHS organises an annual forum on hair science. Our message to the public is that hair loss is a medical problem, and can be treated."

Hair loss in women

Some causes of hair loss in women

·Hereditary female-pattern baldness

·Scalp disease

·Anaemia

·Crash dieting

·Thyroid disease

·Autoimmune disorders such as alopecia areata

·Trauma or severe psychological stress

·Hormonal changes such as childbirth

·Medications such as birth control pills

·Cornrows, braids, tight hairstyles

Possible treatments:

·Minoxidil (2-5%)

·Cortisone therapy

·Hair transplantation surgery

·Laser therapy

·Anthralin cream

The future:

·Hair follicle cloning. Within five years, doctors hope they will be able to harvest hair stem cells from an adult’s head, put them in areas of hair loss, and generate new hair cells.