Androgenetic alopecia

The male or female pattern baldness is divided into androgenetic not. Regardless of the type, we have seen that this involves a discomfort that leads to the loss of psychological well-being.

To support the afflicted (a large slice of the population), numerous studies have arisen that have led to a pharmacological response with curative effects, up to an aesthetic path with the autotransplant surgery .

The real treatment is the pharmacological one that slows down the miniaturization of the hair follicle, other solutions concern more cosmetic surgery.

The new frontiers are very promising and decisive but the feeling is that they have a time horizon of at least ten years, so we could see a significant and progressive replacement of the old techniques, starting from the second half of the twenties.

Although the cause of androgenetic baldness is outlined, even if not entirely, urban legends persist (the famous hoaxes) that lead a large part of the population to take substances or to behave completely irrelevant to its course.

One of these hoaxes associates some substances with the possibility of regeneration of the hair follicles . Their number is determined at birth in the fetal development stage and cannot be increased. Not even the transplant can change their number since in practice they are moved from one lush area to another that is lacking or lacking.

Similarly, the hypothesis that baldness has anything to do with brushing the hair is completely unfounded . Although the use of the comb is preferable to the brush, but for reasons that have to do with split ends, the force it would take to stress the hair bulb should be on the verge of damage to the scalp.

In general it can be said that hair care has to do with the state of shine and the sensation of softness and body, while as regards both male and female androgenetic baldness, the causes (so far associated) are of a genetic and hormonal, it is necessary to refer to the state of the art in terms of drugs which, as we have seen, to date are substantially two. In none of these cases there is a thickening of the scalp but only defense of those who already possess that are kept in good shape.

Every day we normally lose from 40 to 120 hairs which do not represent much compared to the total 110 thousand, in the case of androgenetic alopecia generally this fall is not increased, but the problem is that the fallen hair is replaced by increasingly weaker hair … to the point where the follicle will no longer produce anything.

As a mass phenomenon, it also generates a lot of attention from a business point of view, so you need to be careful and always check the sources of many statements that are a little too simplistic and decisive.

The same promises of low-cost surgical interventions, carried out in makeshift clinics outside the national territory, represent an alarming and completely out of control phenomenon.

To conclude, it is good to know the nature of this physical condition to be as supportive as possible to those who suffer from it to a high degree. The psychological element affects young people and women the most, it is they who need a path that is not only curative but also consoling and reassuring.

By androgenetic alopecia we mean the most common form of baldness . Generally there is, with the passage of time, a progressive thinning of the hair . It affects both men and women, albeit to a lesser extent. It can begin as early as adolescence and continue inexorably until the baldness we all know. Men over the age of 50 are more affected, while in women this phenomenon intensifies after the least break.

A country like the United States has around 50 million men and 30 million women affected by hair loss. In Italy, the phenomenon of thinning of the scalp affects 7 out of 10 men and 4 out of 10 women.

From these numbers we understand why it is not considered a real disease but, rather, an absolutely physiological condition. This does not mean that those affected by it live, especially women, a psychological condition of rejection and discomfort.

Hair thinning in men follows a common pattern. It all starts from the temple area , the hairline moves back generating the classic M-shape . At the same time, the hair also thins at the top of the head moving towards the front, generating total loss in the upper part of the head (partial baldness). Only in very rare cases does the loss also arrive in the lateral and posterior peripheral areas (total baldness).

While in men this process, in most cases, continues up to a significant percentage of hair loss, in women its evolution is different. It does not concern specific areas and the thinning is generalized , but total baldness rarely occurs. The prevailing area of ​​interest is that of the top of the scalp which, however, almost never gets to be totally hairless, but at most strongly thinned out.

It is not a disease as it does not cause symptoms or physical pain, but it is still a pathological condition that has recently been associated with other medical conditions. There is talk, in men, of a certain correlation with a series of pathologies, such as coronary heart disease , enlarged prostate , or type 2 diabetes , obesity and arterial hypertension.

In women, on the other hand, this correlation is found in conjunction with polycystic ovary syndrome which is characterized by a hormonal imbalance which in turn causes imbalance in the cycle, hirsutism (excess hair in some parts of the body), and obesity.

We tackle this issue by analyzing each of its components so that we can orient ourselves within the material without losing elements that could be precious for the individual.

The level of detail is very high but we will try to keep the description in an area that is easy for everyone to understand. Before starting it is imperative to say that sources are available by linking interested parties.

In the first part I considered it correct to immediately talk about the probable cause of androgenetic baldness (term equivalent to androgenetic alopecia), but the structure of the contents can also be tackled separately so feel free to read the paragraphs that are more the object of your direct interest use the index available below.

The causes of androgenetic alopecia

It is an established fact that androgenetic alopecia affects men more than women. Several risk factors contribute to the onset of this condition. Although a good part of them are still unknown, scholars have focused their attention on genetic causes , noting a certain degree of parental correlation.

The close link that is found is that with androgens , with particular emphasis on one of them which is called dihydrotestosterone, perhaps better known by its abbreviated name DHT .Androgens are essential both in the prenatal phase and in puberty.

Various functions are connected to them such as sexual desire and the regulation of hair growth and body hair.

Let’s see in summary, and with simple language, what has been hypothesized to be the cause of androgenetic alopecia, knowing the way of interacting of the hormones most responsible for this imbalance.Hair begins to grow already under the skin through the hair follicles . The process of growing groups (strands) of hair lasts for a period that can vary from two to seven years. At the end of this period, the growth stasis phase takes over and subsequently (we are talking about a few months), the hair falls out naturally. All these phases are analyzed in a specific paragraph.

This cycle always starts again from the hair follicle which is stimulated by androgens. When there is an increase in these hormonal levels, the hair follicles sensitive to them carry out their activity in an altered way, the cycle becomes shorter and the locks are shorter and less resistant. A condition of delayed replacement of lost hair begins to arise .

We can now try to go a little deeper and look for a genetic cause, given that this is only one of the many factors attributed to androgenetic alopecia.

So far we have dealt with describing a process, so to speak, mechanical , through which this alteration is produced, let’s see at the genetic level how it works, and therefore what is the real cause of this condition of discomfort.

Research points to several genes as a cause or contributor to androgenetic alopecia. It is on one of them, however, that the spotlight has turned on, the AR gene (the linked resource is in English, by activating the automatic translation from the settings of your browser, you will have no problem reading it in your language). Its role, among others, is to send instructions for the generation of the protein that functions as an androgen receptor . In practice, an alteration in the number of AR genes affects the activity of androgen receptors in the hair follicles. To date, however, it is still not possible to fully understand why the follicles, more stimulated, lose part of their normal activity and undergo this miniaturization.

Studies are focusing on correlations with other diseases (mentioned above), in order to understand the reason for the increase in androgens.

The AR gene, let’s delve into a genetic cause

To understand the causes of androgenetic alopecia it is not necessary to go so in depth, this does not mean that it is nevertheless interesting to address a topic that is hardly posed in the diagnostic phase.

However, the AR gene  1) remains the one most investigated as a genetic cause , so it is worth clarifying what its normal function is for completeness of information.As mentioned, the gene has the task of creating the protein called androgen receptor, the latter are the hormones, which also includes testosterone, which regulate the development of the male sex in some fundamental phases of growth.

The body then finds an adequate response through the receptors. In the human body, receptors are found in many tissues and they bind to androgens. DNA regulates the activity of genes, so their activation, and consequent deactivation, serves to direct the process of determining male characteristics. In addition to this, as already mentioned, androgens and receptors regulate the proliferation of hair and sexual desire, and this happens in both men and women.

In the AR gene, the DNA is composed of different segments, the one known by the name of CAG occurs in a repeated number in a range ranging from 10 (even less) to 36. It is this repetition that is investigated, assuming that from a its variation depends on the imbalance that leads the hair follicle to respond in an abnormal way, in practice the input that generates its functioning is not correct.

This gene is present in the X chromosome , it is assumed that in hereditary line it derives from the mother to the male child. The number of relatives in direct line or even second degree, determines an increase in the probability of incurring this disorder.

This is only probabilistic conjecture, also because it is known that hereditary baldness  involves multiple genes , which is why it is referred to as a polygenetic disease .

What are the consequences?

What happens in the scalp in practice is a slow reduction in the size of the hair follicles with the consequence of a production, at each subsequent cycle, of thinner hair , with less pigmentation and with a shortened growth phase, so their fall is anticipated.

The growth phase is called Anagen , in this stage the hair growth takes on an average size of 0.3-0.4 mm every day. As already mentioned, the duration of this phase lasts from 2 to 7 years and depends on hereditary factors but also on sex. In fact, it lasts longer in women than in men.

The involution phase is called Catagen , the hair follicle does not make the hair grow, which remains stationary at the same length. This is 2 to 3 weeks after the Anagen cycle.

The resting phase is called Telogen , there is no longer any activity of the hair follicle. The bonds become gradually weaker and eventually the hair falls out. This period lasts about three months after which the Anagen phase restarts.

If you are interested in learning more about the growth phases, read the article on the life cycle of the hair

Excessive hair loss follows a fairly precise pattern in men, while in women this pattern does not exist, in the next paragraph we will deepen this topic and try to outline the symptoms  that lead to the development of the condition of baldness.

How to recognize the symptoms of androgenetic alopecia?

Androgenetic alopecia manifests itself in two different ways depending on the sex. In humans we speak of receding hairline since it is precisely from the lobes of the fronto-temporal area that the thinning starts.

Even if in a less visible way, due to the fact of position more than anything else, the fall also affects the upper area of the scalp.

Although we often talk about hair loss, we have been able to see that in reality the hair becomes thinner and shorter to a size that is no longer visible, in this sense we should speak of thinning caused by the miniaturization of the hair follicle.

In women, the temples are not affected as is the case at the top up to the vertex. In the advanced stage, the bulb atrophies and the recovery procedure is much more complicated.

In the diagnostic phase, certain scales of measurement of the stage in which one is found are used, which are different depending on female  or male alopecia , and this is what we will see in the following two paragraphs.

The stages of male pattern baldness – Norwood-Hamilton scale

In the 1950s, James B. Hamilton was concerned with establishing a real code capable of describing the state in which androgenetic alopecia is found in a given male individual. The rarefaction of the hair affects the fronto-parietal lobes and the upper part of the head. The so-called Hamilton scale consisted of 5 different stages, in progression.

About twenty years later, another researcher, named Norwood, has inserted intermediate stages reaching a total of 7. The reference scale for men’s baldness , today is precisely the latter and takes, precisely, the Norwood scale name .

It is interesting to note that in the first stage there is no real baldness but only a hint identifiable with the classic receding hairline, hair loss is practically not found yet.

At the second stage, the frontal hairline begins to recede, from this moment on, androgenetic alopecia begins its progression that can last for several years.

Between the second and the third stage there is an intermediate one (Stage II A), in which the phenomenon is more marked.

Baldness is considered overt from the third stage. This is an important level usually evident in the elderly, or in young people with an early evolution. This stage precedes another intermediate stage from the fourth stage. Hair loss is extensive and the receding hairline appears symmetrical.

In the fourth stage, hair loss is also significant at the top.

In the fifth, the area of ​​the temples is devoid of hair and joins the upper part of the vertex of the scalp.

In the sixth stage, the affected areas are now hairless and we quickly reach the last stage corresponding to the absence of hair in the two typical areas of male baldness, we can see a semi-crown of hair in the back from ear to ear.

The stages of baldness in women – Ludwig scale

As already mentioned, androgenetic baldness in women occurs in the upper part, the scalp. The degree of intensity of hair loss was measured by Ludwig . In an arbitrary way, its scale is made up of three progressive levels in which in the first step a slight thinning of the crown area is highlighted, while in the third the stage is much more advanced or intense.

The Ludwig scale was born in 1977 and updated from time to time by revisions which, however, all refer to the same methodology. The Savin scale expands to Ludwig creating subcategories. In 2006, the researcher Sinclair finally wanted to simplify the Ludwig scale by proposing 5 phases of hair thinning, always in the upper area.

The diagnosis

It is necessary to avoid having a do-it-yourself approach as much as possible. The centers specialized in baldness are scattered throughout the national territory so it is good to carry out in-depth examinations to determine the causes and not to incur evaluation errors.

The dermatological examination is the first step which aims to ascertain the clinical history of the affected subject in correspondence with that of the family.It is good to act with caution and also investigate other diseases to avoid that the cause may come from other sources of hormonal disorder.

We will therefore try to exclude thyroid , diabetes , lupus , psoriasis . In fact, these are all diseases related to hair loss. For this purpose, a simple blood test will suffice.

The trichological analyzes are those that give way to form a true specific diagnosis, in which the probable causes are more clearly highlighted. The examination is done by taking hair samples in order to obtain a microscope image of the hair bulb.

A question that is often asked to specialists concerns the prevention of androgenetic alopecia. It can be said that at present there is no preventive path , genetic and hormonal causes occur independently of different lifestyles. At the most, it is possible to assume a series of virtuous behaviors that do not encourage the progressive path of androgenetic alopecia which are:

  • Avoid traumatizing the hair with aggressive chemicals (dyes);
  • Avoid too frequent washing;
  • Avoid treatments and straightening (including too intense hairstyles).

Although these indications are generic , they can offer comfort in delaying the effects of androgenetic baldness, but they are by no means the triggering cause which, as we have seen, has genetic origins.

What are the main types of alopecia?

It is good to clarify as much as possible the topic relating to baldness by identifying all types of alopecia and differentiating them from the androgenetic one which is only a variant. It must be said that the generic term of alopecia generally indicates the loss, or lack, of hair (and hair in general), in a widespread or limited way.

Non- androgenetic alopecia can therefore be of different kinds:

Alopecia areata

Hair follicles are not recognized by the immune system which attacks them. It is an autoimmune disorder that results in patchy hair loss. The name aerated derives precisely from the fact that hair is lost in limited areas as large as the diameter of a coin. There is no age or gender distinction and it can appear anywhere on the body. Compared to androgenetics, you can see hair regrowth, in a first phase with a light color, and then take on the natural one, the same thing can be said for the volume of the hair.

Alopecia totalis

It is a more advanced form of alopecia areata that takes up the whole head, so not only the scalp but also the facial hair.

Alopecia universalis

In the most acute form the aerated is known as alopecia universalis in which the loss of hair is generalized to the whole body. The cause is to be found in a progressive chromosomal mutation. There are currently no curative treatments, although cases have been observed in which hair and hair have grown back spontaneously.

Stress alopecia

When we talk about stress alopecia , also known as psychogenic alopecia, we are faced with a variant that is difficult to identify as it is very linked to the psychophysical state of the subject. It also tends to manifest itself with symptoms that can be confused at times with areata and at others with androgenetics.

Cicatricial alopecia

A rare disease in which hair loss occurs as a result of an inflammatory process that leads to the atrophy and destruction of the hair bulb which is replaced by scar tissue. It affects men and women, while in children it generally does not occur. By its nature it is irreversible since the follicle is really missing.

Alopecia barbae

It affects men in the face and neck area. It manifests itself in the form of hairless patches visible in the beard.

Traction alopecia

It has nothing to do with hormonal changes or genetic abnormalities. Much more simply, it is the consequence of too invasive hair styles. In practice, the excessive traction of the hair caused by certain hairstyles initially causes inflammation of the follicle.

If the traction continues over time, it can lead to real hair loss and formation of alopecic areas.

How to defend against common baldness

The androgenetic alopecia can be addressed in a specific manner by means of a process that attempts to ascertain the underlying causes. Too often popular beliefs indicate the stress factor as the cause par excellence of this condition, a specialist instead has more tests available to go in depth, and a little while ago we saw the extent of it.

It is good right now not to rely on hearsay or miraculous cures passed off as such by self-styled doctors or pseudo-specialists who appear on the net or in various social networks. In addition to the indicated path, an in-depth analysis, and perhaps the one that offers greater relevance, is the DNA test that highlights a generic future predisposition to develop baldness.

At the pharmacological level , we must refer to the only two active ingredients that have passed the control of the FDA  and have been approved for hair care. The first is  minoxidil which has been known since the 1980s for the treatment of hypertension.

Hair growth is one of its side effects. Its use, for this purpose, is for topical use localized in the part of the vertex of the scalp, where a certain effectiveness has been recorded.

The second is  finasteride which under the name of Propecia has been administered orally to combat androgenetic alopecia since 1997.

In particular, this drug was created to combat benign prostatic hypertrophy by acting as an inhibitor of the enzyme 5 alpha reductase which has the purpose of converting testosterone into dihydrotestosterone.Taking this drug slows down hair loss, while thinner hair begins to increase in diameter . These effects are noticed after at least 3 or 4 months of intake but are not extended to all patients. Unfortunately, it is necessary to continue taking the drug for years and as a side effect the most common side effect is a drop in libido, fortunately in a low percentage of cases.

In women who are in the years of fertility, there is an express prohibition to enter even accidental contact with the drug, to prevent possible malformations of the male fetus. However, the side effects are reversible from the moment you stop taking the drug. From what has been said, it is clear how important the direct control of the specialist and periodic analyzes is.

As already mentioned, DHT is mainly responsible for the miniaturization of the hair follicle with consequent atrophy, obviously in genetically predisposed people.

It is therefore necessary to refer to these two drugs for the treatment of common baldness , but several others are suggested online, which apparently seem to have miraculous effects. It is always advisable to contact a dermatologist possibly specialized in trichology in order not to run into medicines which, in the best of cases, have no effect … while at worst they could cause unwanted effects.

Hair transplant with FUT and FUE technique

For many the onset of baldness is a social psychological problem that precludes serenity, later we will also deal with this particular topic. In addition to the pharmacological treatments that have just been discussed, there are other procedures that have become commonplace .

We must immediately clarify that these are not real treatments but rather interventions that belong to cosmetic surgery .

To recover your hair mass, depending on the stage of thinning you are in, you can turn to other medical techniques that refer to the practice of transplantation .

The hair transplantation technique called FUT (Follicular Unit Transplantation), consists in taking a strip of scalp from a safe and non-sensitive area to DHT (where the hair follicles are still active and perfectly healthy) to another where the androgenetic alopecia is now in its most acute phase.The donor area is sutured, the scar of which, thanks to the modern techniques used, is practically invisible. In cases where some signs are seen (perhaps with shaved hair) it is possible to resort to the tricopigmentation technique to cover everything quite easily.

In the technique called FUT, the follicular sampling is meticulous and an attempt is made to make it as fast as possible and then carry out the graft. Speed ​​is directly related to the success rates of the repopulation technique.

The intervention lasts an average of 5 hours and, in theory, does not involve a pharmacological phase either before or after its execution. However, it must be said that drugs for the treatment of androgenetic alopecia can also preserve transplanted hair but above all they are extremely useful in protecting one’s indigenous hair which would otherwise continue the miniaturization phase until it disappears. This would compromise the aesthetic result given by the transplant, therefore many clinics recommend following treatments even after having performed the hair transplant. 

The FUE (Follicular Unit Extraction) technique was born more recently and initially had a lower degree of success than the aforementioned technique. Today, however, thanks to the evolution of extraction tools, called punch,  the gap with the successes of the FUT has been greatly reduced. To explain it in very simple words, it is a question of directly taking the hair follicles a bit like you would take the hair from a doll… one follicular unit at a time. The sessions are longer with a duration of 8 or 9 hours for the most severe cases. The punches used can be manual or motorized. The advantage of FUE is that there is no scar on the back of the head and the postoperative course is much faster.

The two alternatives are both applied, it depends on the subject to choose one or the other according to the state in which the progress of alopecia is and the type of hair left. FUT can be considered safer than FUE.

When we talk about autotransplantation, we often refer to the phenomenon of shock loss . In practice, after two or three weeks from the operation (regardless of the type of autotransplant whether FUT or FUE), the traumatic impact can cause a general state of suffering for those indigenous (non-transplanted) follicles that are already in a state of weakness. The fall is accelerated and can sometimes be irreversible . To strengthen native hair and avoid (or greatly reduce) shock loss, many surgeons recommend the use of finasteride for at least 6 months before surgery.

The course of transplantation techniques is good in the early days, however it should be noted that, with the passage of time, the process of androgenetic alopecia continues to act. For this reason, as mentioned, pharmacological treatment will still be necessary.

Psychological effects deriving from androgenetic alopecia

The psychological implications of hair loss leading to baldness are never sufficiently addressed . The main problem in those afflicted with it is the loss of self-esteem which can be a prelude to states of anxiety or real depressive states .

It does not only concern women as they are more exposed to aesthetic judgment, but also men, especially if this condition announces its effects already in adolescence .

Both consciously and unconsciously, we attribute a meaning to the hair that has to do with social status. In particular, the image of hair interacts in interpersonal and sentimental relationships since from it one can deduce the general state of well-being and health, as well as beauty, and for man in particular of physical prowess.

The closure in oneself is a usual consequence that manifests itself even before the most important phase, fear generates anxiety and this causes psychic discomfort.

In middle-aged men, insecurity is added to natural hair loss causing a depressive state, the only way to avoid being excessively involved in this condition is to control one’s emotional state trying to reach the awareness that we are faced with a completely natural phenomenon.

The successful image of balding celebrities, including show business, is helping to change the general sentiment , so the very short haircut is a good way to accept the transition. For now this is especially true for the male, while the experience of female androgenetic alopecia , from a psychological point of view, is in fact more complicated.

The future of research to definitively combat androgenetic alopecia

Recent developments both in stem cell research and in relation to new analysis tools connected to it, suggest that the path that is taking shape can give a strong shake to the prevention or definitive cure of this condition.

Up to now, studies have been carried out to encourage hair regrowth using stem cells from adipose tissue. However, the research intends to move to stem cells of the bulb that have a different embryonic origin.This approach has significant repercussions both in terms of success rate and its duration over time.

Since we are dealing with stem cells, there is no problem of rejection , furthermore the treatment has an evolution that can go from 3 to 6 months so it should still be repeated over time.Studies and experimentation also concern our country, and not only stem cells are the basis of the tests. It is believed that the new approaches may soon constitute a real response and / or alternative to the corrective actions currently adopted.

In this section, it is also necessary to report the news that has had a considerable following in the newspapers, according to which the egg yolk has anti- hair loss properties in itself . It all started with a publication  3) in the “Journal of Medicinal Food” about an experiment by a team of scholars from the University of Osaka in Japan.

We started with the simple observation of the early development of plumage in chickens which starts after only 14 or 15 days of life. The result obtained from the tests on mice bodes well for another line of study useful in combating baldness.

Before making shampoos with eggs it is good to wait for other clinical results and suitably tested products that highlight the effectiveness of the active ingredient

It should also be borne in mind that in the past many substances, mostly exotic, have been associated, without any scientific evidence, with thickening the scalp.

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The male or female pattern baldness is divided into androgenetic not. Regardless of the type, we have seen that this involves a discomfort that leads to the loss of psychological well-being. To support the afflicted…

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