The sudden development of bald patches can be devastating for boys, says a leading dermatologist.
They are far more likely to become desperately unhappy than girls.
It can lead to a reluctance to go to school and social isolation, says Professor Rodney Sinclair, who has studied the psychological impact of alopecia areata, an auto-immune disease that causes baldness.
In severe cases it has led to suicide, with four Australian boys taking their own life in 2011.
"Adults just don't get how devastating it can be."
Disfiguring circular patches can develop almost overnight, says Prof Sinclair, director of dermatology at Epworth Hospital in Melbourne.
He had assumed girls would struggle more than boys.
"But, girls with 40 to 50 per cent hair loss can conceal it completely.
"Even with total hair loss, a wig on a girl is less obvious than for a boy."
A small patch is noticeable on most boys, however.
"They have to front up to school the next day.
"Even if there is no teasing and nobody says anything, the child is likely to feel embarrassed and worry about what people might be thinking."
Doctors and parents should be aware that young men and boys with rapid-onset alopecia areata are at particular risk, says Prof Sinclair, who has published a letter about his concerns in the Medical Journal of Australia.
Common issues include poor self image, grief and loss and sleeping disorders.
Two of the four boys who committed suicide were aged 14, one was 16 and one was 17.
They were among 196 Australians who registered with the condition from 2010 to 2012.
One of the great frustrations is that it is unpredictable, says Prof Sinclair.
The hair can fall out and grow back and fall out again.
It usually peaks around six-to-eight years old and again around the age of 16.
In rare cases all the hair on a person's body falls out permanently.
"Children and parents need advice on treatment and on how to camouflage their bald patches. They might also need psychological support."
We believe early intervention with cortisone could cause regrowth and prevent future loss.
"A parent should see a doctor immediately if their child develops an unexplained bald patch," he says.
"Being different is difficult for boys. It is the reason for the high rate of mental health issues among gay boys," says beyondblue CEO Kate Carnell.
"What's important is that parents talk about it and that people have access to the support they need."
* Readers seeking support and information about suicide prevention can contact Lifeline on 13 11 14 or the Kids Helpline 1800 55 1800 (for young people aged 5 to 25)
