Andri, a 40-year-old university instructor whose name has been changed for this article, said that he recently started to sense that he was “aging rapidly” due to the significant widening of a bald patch on the crown of his head. The hair on the front side of his head has also started to recede, forming an “M” shape.

When he looked around, however, he noticed that not all men his age experienced such baldness. Although some had gray hair here and there, their hair had not started receding, at least not yet.

“Actually, my hair has been thin since I was a teenager,” he said.

He started developing a bald patch on the crown of his head in his early twenties.

“Many people joke that this is because I think and read too much,” he said, laughing. “But I think it runs in my family, since my father and older brother had also started to turn bald by the time they hit their forties.”

Accepting the biology that was his likely destiny, Andri decided to shave his head.

A similar story was told by Aryo, a 32-year-old man who works in the marketing division of a multinational company and whose name was changed for the purposes of this article.

Aryo still seeks treatments to help him grow and keep his hair before his bald patch eventually expands with age.

“I started applying a hair serum recently, just impulsively buying the ones that are offered in drugstores. However, I don’t know their efficacy. I’m just trying them randomly because they smell nice and they may help me grow my hair back. What are the odds?” he said phlegmatically.

Do the stories above sound familiar to you?

If you are seeking treatments for hair loss like Aryo, do not simply pick random treatments with dubious efficacy that may nonetheless cost quite a bit, according to Amaranila Lalita Drijono, a medical doctor and laser surgeon specializing in dermatology and venerology, who is also the chairwoman of the Indonesian Laser Dermatology Study Club.

“Many Indonesians already have the knowledge that baldness can be caused by genetics because they see the same pattern run in their families. Still, there are many Indonesians who start to worry that their baldness is actually a symptom of a different, underlying illness,” Amaranila told The Jakarta Post in a recent interview.

According to Amaranila, hair loss is a complex condition which can be caused by multiple factors.

“The hair follicle cells are very fragile. Therefore, physical and emotional stress, some medications, chemotherapy or hormonal disruptions caused by childbirth can cause hair loss. Individuals who are not aware of this can understandably worry if they see their hair suddenly falling at a rapid rate,” she explained.

“There is, however, another condition called androgenic alopecia, or androgenetic baldness, whereby the baldness is caused by genetic factors,” she continued.

Effective treatment of baldness caused by either of these factors requires a formal medical diagnosis, otherwise you might just waste your money on non-efficacious treatments like applying serums or certain kinds of shampoos which claim to mitigate baldness, explained Amaranila.

“The gold standard diagnostic tool for hair loss is the trichoscopy,” Amaranila said. Trichoscopy is a method of hair and scalp evaluation used for diagnosing hair and scalp diseases using devices to magnify the scalp’s surface.

The latest innovation in the trichoscopy toolkit is the trichoscan, a software-based method for the analysis of human hair that uses digital images taken from the scalp with a specially developed camera-optics system, according to trichoscan.com, a website offering the device.

“Trichoscans can diagnose your hair and scalp condition in a highly detailed manner. For instance, they can measure the diameter of your hair shaft, determining stage your hair cycle is in, while also measuring the density ratio between terminal hair [the mature hair] and vellus hair [immature, fine hair],” explained.

Vellus hair refers to miniaturization of hair follicles which causes baldness to appear more evident by causing your hair line to become less dense visually. Informally, these Vellus hair are called baby hairs, according to Amaranila.

“From the trichoscan, we can eventually find the exact cause of the baldness. For instance, it can be caused by a fungal infection or trauma due to psychological problems or just the prolongation of the hair loss stage due to hormonal disruption — medically termed as Telogen effluvium,” she said.

Doctors also interview their patients to discover health history that may correspond to baldness. “Baldness can also be caused by syphilis, a sexually transmitted disease. It can also be caused by an autoimmune disease called alopecia areata where the antibody can no longer distinguish one’s own cells from antigens, and it attacks and destroys these cells,” she explained.

Only after diagnosing the root cause of the hair loss can doctors prescribe effective treatments for patients — whether it is fungicide, antibiotics or steroid injections to help overcome fungal infection, syphilis or autoimmune disease, respectively. At the same time, the doctors can also prescribe certain topical products that contain minoxidil or hair cell growth factor to help regrow patients’ hair during recovery, according to Amaranila. For androgenic baldness in male patients, the oral medication Finasteride is still used worldwide but with special attention paid to the potential side effect of prostate cancer.

“Patients who have non-androgenic alopecia cases mentioned above can also consider a platelet-rich plasma injection —whereby doctors extract the plasma of the patient’s own blood to inject it into their scalps — to accelerate hair regrowth,” she advised.

“Patients who have burn scars on their scalps, however, will have no hair follicles left on their scar, thus making hair implants impossible. If they want to conduct hair implants on the scar area, they have to undergo a skin transplant first,” Amaranila said.

“By assessing the ratio between the terminal hair and vellus hair, we can at a certain point also decide that the patient has androgenic alopecia.”

Patients who have androgenic alopecia can explore several hair treatment options, the most efficacious one so far is a hair implant — where doctors take donor hair follicles from the patient’s own scalp in order to plant them in areas which have already been affected by baldness.

“The procedure, however, is expensive and a little bit uncomfortable as the surgeon has to plant the harvested of hair follicles one by one on the patient’s scalp, which is time consuming, depending on how many hair follicles the patient wants planted,” she explained.

When the patient no longer has donor hair cells on his own scalp, however, hair implants are much harder to perform, according to Amaranila.

“If that’s the case, you can use synthetic hair. However, since synthetic hair is a foreign object, sometimes your body will reject it, causing rashes and an itchy feeling on your scalp,” she said.

Laser treatments, called low-level light therapy (LLLT), have yet to produce a satisfying outcome among some alopecia patients.

“When genetically bald patients undergo these kinds of laser treatments, usually the treatments can stimulate only the vellus hair, instead of the terminal hairs, the thick ones. But, nowadays there is another breakthrough in hair regrowth by laser treatment with what doctors called the Erbium YAG combined with the NdYAG technology with quite promising results, and it is already available in Indonesia,” she said.

Fortunately, according to Amaranila, shaved heads have become trendy again among young men. “So I advised one male patient, just go ahead and shave your head, but make sure you have a healthy scalp first. It was not like long ago where you saw some men wearing wigs everywhere because they were embarrassed by their bald heads.”

Andri eventually shaved his head to save a lot of hassle. Aryo has not yet visited a dermatologist to determine whether his self-prescribed hair tonic treatments are efficacious or whether there are underlying factors causing his hair loss.

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