Ever looked at your parents and thought how lucky you were that they had a full head of hair only to realise that one day your own hair was starting to thin? You might attribute your receding hairline to anything from stress, the horrible flu you had last month or even from wearing a cap every weekend but unfortunately it’s still probably related to something a lot less controllable – your genes.
Genetic hair loss is known as androgenetic alopecia but is often referred to as male pattern baldness or female pattern hair loss. The genetics of androgenetic alopecia is complex but if we’re talking basics, it involves an inherited sensitisation of genetically predisposed hair follicles to the hormone dihydrotestosterone (DHT). The affected hair follicles gradually shrink and the hair life-cycle shortens which results in thinning hair. In some cases the follicle eventually ceases to produce hair, shuts down and becomes dormant.
Up until recently, it was believed that the genetic tendency toward hair loss came from a gene on the X chromosome inherited from the mother’s side of the family. However androgenetic alopecia is a complex condition and more than likely due to the effects of several genes. Scientists recently confirmed the polygenetic theory with the discovery of another two genetic variants, completely unrelated to the gene on the X chromosome, which increase the risk of hair loss. These genes can be inherited from either or both sides of the family and whilst there are no official figures for women, research has shown that one in seven men are at risk of inheriting all three genetic variants which would increase their risk of hair loss sevenfold.
Androgenetic alopecia can start as early as puberty and up to half of the male population will be affected by the time their 50. This figure jumps to 80% by the time men reach 70. Almost half of all women will, at some point in their lives, experience some form of female hair loss but there is no official figure for female pattern hair loss specifically and the majority of women that are affected by androgenetic alopecia won’t notice any hair loss until menopause. It could be the drop in estrogen levels at menopause that leave women more susceptible to the effects of testosterone but some scientists have also noted up to 30 different hormones could play a part in female pattern hair loss (as opposed to just DHT).
“The difference in figures is partly because women’s hormones are not as high as men’s,” says Leonora Doclis, senior trichologist at the Belgravia Centre. “But there was also an understanding that a woman would need to inherit the tendency from both sides of the family.”
One study showed that in women with female pattern hair loss, the incidence of androgenetic alopecia in immediate male relatives more than 30 years-old was 54% and in female relatives older than 30 was 21%.
The difference in the appearance of hair loss due to androgenetic alopecia between men and women is evident but not easily explained. DHT is an androgen (male sex hormone) but is produced by both men and women. Perhaps the fact that men produce more testosterone could explain the earlier onset and more extreme symptoms.
“This could be partly true but the specifics are unknown so experts have agreed to term them differently because, although they are both hereditary forms of hair loss, the patterns are so different,” Leonora says.
Men will notice a receding hairline, the formation of a bald patch on the top of the scalp and gradual thinning on the crown that could eventually lead to baldness. Women instead notice a gradual thinning all over the scalp and a wider gap where the hair parts but very rarely experience baldness.
The good news is that hair loss is preventable and, contrary to popular belief, androgenetic alopecia is partially reversible. It has been extensively proven that finasteride, a 5-alpha-reducatase inhibitor, reduces DHT levels in the scalp by up to 70 percent. Propecia (containing finasteride), was approved by the FDA for the treatment of male pattern baldness in 1997 after years of controlled clinical studies proved it prevented the progression hair loss in most men and generated regrowth in about two-thirds of men. Unfortunately Propecia is not safe for women but there are other options.
Minoxidil is another FDA-approved medical treatment for hair loss for both men and women. It was originally licensed as an oral drug to treat hypertension but it soon became apparent that a high proportion of those taking minoxidil had increased hair growth on the scalp. Minoxidil was approved by the FDA for topical use in the treatment of androgenetic alopecia in 1986 but the mechanism of its action on hair growth is still unknown. Some evidence suggests it’s the stimulation of the hair follicle and opening up of potassium channels, however the rapid response of hair growth to minoxidil firmly suggests that it is a stimulator or promoter of hair growth.
The Belgravia Centre deals extensively with both male and female pattern hair loss and prescribe individual treatment course programs which are fully recognised by doctors and other medical specialists and based solidly on FDA-approved, clinically and scientifically proven hair loss treatments.
“These treatments work because the major contributing factor – DHT – is being dealt with,” Leonora says. “Propecia is one type of anti-androgen, meaning it blocks DHT, but there are other anti-androgens that can be combined with minoxidil and used by women.”
Like finasteride, medroxyprogesterone (MPG) and azelaic acid (AA) can also help to prevent DHT from interfering with the hair follicles function, effectively complementing minoxidil’s reaction with the follicles and adding to the response that is achieved. When MPG or AA is added to minoxidil it becomes a prescription-only treatment but in many cases minoxidil is sold without these ingredients.
The most effective treatment for male pattern baldness usually involves a combination of Propecia and minoxidil. The additive effect can be attributed to the different mechanisms of action of each treatment. The Belgravia Centre’s trichologists have found that the degree of success will often depend on the strength of minoxidil used and the complementing treatments that accompany the medication. Find out more about THE MOST EFFECTIVE COMBINATION OF TREATMENTS FOR HAIR LOSS.
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