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Hair Loss and Renewal

Principal Causes of Hair Loss

Other Causes of Hair Loss

Anti-androgens and DHT Blockers

Anti-inflammatory Agents

Hair Regrowth and Retention

SRCPs and Hair Regrowth Agents

Skin Remodeling and Hair Health

What are the Main Causes of Hair Loss?

• Androgenetic Alopecia (pattern baldness)
• Alopecia Areata (spot baldness)
• DHT Inhibition of follicle growth

Miniaturization of Hair Follicles and Diminution of Blood Supply

The combination of various hormones, diseases, or injuries, and immune effects progressively "miniaturizes" the involved hair follicle. The smaller follicle produces a smaller, thinner hair and has a progressively shorter growth cycle. The hair becomes shorter and finer with each hair cycle until it finally becomes "peach-fuzz". Thus, pattern loss is actually more a problem of replacement than of loss.

A major cause of this miniaturization appears to due to the development of striking changes in capillaries surrounding the hair follicles. Comprehensive surveys of the male scalp from birth to senescence find that very significant changes in the structure of the blood vessels of the scalp. The number of the blood capillary loops supplying the hair follicle is greatly diminished. The inadequate subepidermal circulation that can develop as males age does not provide a rich nutrition for the follicle. Strong hair growth requires a large flow of nutrients such as such as vitamins, minerals and amino acids so that the follicle can actively synthesize new hair.

Blood flow impairments to the follicle, and their reversal, may explain why the administration of copper peptides (such as Folligen and Tricomin) to the scalp increase hair growth and increase the size of hair shafts. It has long been known that certain copper-peptide complexes strongly stimulate angiogenesis or new blood vessel formation. In laboratory hair-growth models using mice, the copper-peptides in Folligen or tricomin increase hair follicle volume by 5 to 8-fold. It is likely that these copper-peptides also increase the volume of human hair follicles, although an increase is likely to be smaller than the change in mice. The increase in hair follicle size and the rate of hair growth caused by the administration of copper-peptides may be due to their causing blood flow changes that provide adequate nutrients to the follicle for strong hair growth.

Androgenetic Alopecia: Cause of 95% of All Hair Loss

Androgenetic alopecia or pattern baldness is the most common cause of hair loss is pattern loss, which eventually affects over 70% of men and 15% of women. In classic pattern, hair thins in a horseshoe pattern, although more diffuse loss can also occur. Painting - Self Portrait by Cezanne.

At least two sequential processes contribute to pattern loss, which begins as an abnormal sensitivity of the hair follicles to androgens of male sex hormones. In most people, this is followed by a local immune reaction to the affected hair follicle, which further damages it and is probably responsible for its eventual death. Both men and women experience androgenetic alopecia, or pattern hair loss, although men generally experience a much greater degree of loss. In men, the pattern of loss starts with the hairline or back of the head, advances to thin the top of the head, and often leaves just a fringe of hair extending from ear to ear across the back of the head and affects the thinner, shorter, and less pigmented hairs of the frontal and parietal portions of the scalp.

In women, pattern loss tends to be more diffuse, and occurs over a broader area. Women usually do not have bald spots, but rather have overall thinning hair. In diffuse hair loss in men or women, over 50% of the hair can be lost before the results are readily apparent.

Alopecia Areata “Spot Baldness”

Alopecia areata, the second major cause of hair loss, generally appears as patchy loss but may also occur as alopecia totalis, which involves the entire scalp, or as alopecia universalis, which involves the entire body. It occurs most frequently in young and middle-aged adults of both sexes. Although mild erythema may occur initially, affected areas of scalp or skin appear normal. This may be anywhere on the scalp or even the rest of the body.

Alopecia areata is also an autoimmune disease but without the normal hormonal component in pattern loss. In simple terms, white blood cells attack the hair roots resulting in loss of hair. About 30% of individuals with this problem are aware of a relative with this disorder; thus, there seems also to be a genetic component. At times, scarring (cicatricial) alopecia follows scar tissue formation resulting from inflammation and tissue destruction.

A variety of approaches are currently used for treatment; all are aimed at interrupting the "attack" of white blood cells upon the hair roots. The major therapies include topical and locally injected corticosteroids ; topical minoxidil along with anthralin; various topical irritants or sensitizers; special light treatments (called PUVA); and a number of experimental drugs which alter the immune system.

It cannot be accurately predicted when the condition may become occur. An episode might be precipitated during a illness or a physiologic stress. This type of hair loss may recur at any time. New patches of hair loss can develop while older patches are being effectively treated. Sometimes hair will regrow spontaneously over a period of months to years - this is less likely with more extensive hair loss. The areas of hair loss often have spontaneous hair regrowth. The new hair may initially be non-pigmented, with pigment production resuming at a later. Intralesional corticosteroid injections are beneficial for small patches and may produce regrowth in 4 to 6 weeks.

This condition is not transmitted by contact with a person who has it - it is not contagious.

DHT (dihydrotestosterone) Inhibition and Immune Cell Damage

The most current idea on androgenic scalp hair loss is that it is a two step process: (1) DHT acts on sensitive hair follicles to inhibit their growth and shrink their size. This is followed by (2) a decay in the health and vitality of the follicle and the surrounding skin. This causes immune system cells to damage the hair follicle and ultimately stop its hair growth. Blocking both of these steps is the best method to stop hair loss and regrow hair.

DHT is produced from the male sex hormone, testosterone, by an enzyme called 5-alpha reductase. Not all hair follicles are inhibited by DHT, for example, body hair in men may increase while scalp hair is lost.

Testosterone and DHT (dihydrotestosterone)

Testosterone and DHT, a metabolic product of testosterone, are required in males for normal development in the womb and for development in adolescence of libido or sex drive. They are important in the development of secondary sexual characteristics such as pubic and facial hair, and the maturation of male muscle mass and skeletal integrity.

Testosterone is the male sex hormone associated with sexual drive, fertility, muscle growth, and male psychosocial attitudes. DHT, is more essential for the fetal development of the male reproductive system and the male genitalia. If in males, the enzyme which converts testosterone into DHT is lacking during fetal development, then the female-appearing genitalia system will be formed although these men will be genetically males. These males appear physically as rather thin-hipped and small-breasted but highly attractive females. Normally, personality difficulties emerge since these men possess many male attitudes. At this point, genetic testing often reveals their basic male identity and hormonal therapy is often used to switch their body into a more male growth pattern.

However, later in life, a higher than normal blood DHT level appears to cause premature aging of the male reproductive system, male pattern baldness, and the prostate condition known as benign prostate hyperplasia which is a non-cancerous enlargement of the prostate gland. An enlargement of the prostate gland makes urination increasingly difficult in men as they age. The production of DHT in older men is not well controlled by biochemical feedback mechanisms and compounds such a saw palmetto oil or the Merck drug Proscar (finasteride) are used to reduce the body's level of DHT.

Menopause, Estrogen, and Hair Thinning

Estrogens, the feminizing hormones, can inhibit or counteract the follicle-shrinking effect of the androgens. Women have more estrogens circulating in their blood than men. As a result of this higher level of estrogens, even women having a genetic predisposition for pattern hair loss are protected from losing their hair because of the high level of estrogens in their blood. When these women reach menopause however, their estrogen level may decrease sufficiently, and the protective effect of the estrogen may be overridden by the DHT message. Then hair can begin to thin, sometimes rapidly. Some women are genetically pre-disposed to have pattern hair loss.

Estrogen supplementation can raise are estrogen levels, and help restore the emotional and physical condition of the patient to the pre-menopause states. It may also slow or stop hair loss triggered by menopause. However, hormone replacement therapy is a controversial treatment for menopause, with possible links to both increasing the risk of some cancers, and possibly reducing the risk of certain heart diseases.

Conflicting Studies on DHT and Hair Loss

Studies on DHT and hair loss are conflicting but the general conclusion is that DHT is a key player in hair loss but other factors influence the final outcome. It does appear that hair follicles in balding individuals are more sensitive to inhibition by DHT.

The first link of hair loss to testosterone metabolism was the very ancient observation that men who were castrated at a young age did not develop pattern baldness. Modern research has confirmed this but such men can develop baldness if they receive supplemental testosterone.

Individuals born with a deficiency of 5-alpha reductase suffer neither scalp hair loss nor prostate hyperplasia. The deficiency reduces levels of DHT and spares sensitive hair follicles. A study reported that adult males with congenital 5 alpha-reductase deficiency had decreased levels of dehydrotestosterone (DHT)1. These individuals had a small prostate gland throughout life and did not develop BPH. They also did not develop male pattern baldness or acne.

On the other hand, the genes controlling 5-alpha reductase activity and DHT production are not the only factor involved in balding. In a study of 828 healthy families comprising 3000 individuals, both young, bald individuals as well as older, non-bald individuals were compared for the genes controlling DHT production. It was found that the genes controlling DHT production in men are not the cause of male pattern baldness. This study shows that there is no overproduction of DHT, or if there is it is not caused by the genes that control DHT production (5-alpha reductase activity).

Another interesting finding of this study was that baldness did not follow a simple genetic inheritance pattern which suggests that multiple genes and or environmental factors control hair loss2.