Skip to main content

Quest for Hair Regrowth in Both Men and Women Suffering Androgenic Alopecia and Alopecia Areata, Part I: Causes

Leni, Pharm.D., is a graduate of U.C.S.F, a research chemist, university professor, retail pharmacist, and owner of Heaven Sent Hair Line.

Hair Regrowth After 6 Months Using Saw Palmetto Base Formula

Hair Regrowth After 6 Months Using Saw Palmetto Base Formula

The Natural Chemistry of Hair Growth and Loss

To most of us, losing your hair is like losing the icing on the top of a cake. It may still taste good, but it's not nearly as inviting. Let's review the chemistry of hair loss and the logic of earlier treatments.

Hair grows in several phases and is everywhere on our bodies except the palms of the hands, the soles of the feet, and the glabrous skin of the genitalia. Hair growth is influenced by genetics, thyroid hormones, corticosteroids, sex hormones (testosterone and estrogen in particular), and some drugs such as nifedipine, for blood pressure, and warfarin, for blood thinning. Other influences and causes of hair loss include:

• physical changes - childbirth, fever, menstrual dysfunction, infections, severe weight loss

• endocrine imbalances - hypothyroidism, hypo- and hyperpituitarism

• nutritional/metabolic conditions - protein, calorie, iron, zinc, and fatty acid deficiencies

• mechanical causes - tight braids, rubber bands, chemical and heat burns, nervous head rubbing habits

Today we'll talk about androgenetic alopecia, seen in both men and women because it is testosterone based but the balding patterns are different. Men tend to have receding hairlines and thinning on the crown. Women tend to experience a general thinning throughout the top of the head (see photos below). It often begins in the 20's but becomes more pronounced as we approach our mid years.

Curiously, hair growth over the scalp is inhibited by large levels of dihydrotestosterone (DHT). Large levels of DHT will also promote abnormal amounts of facial hair. Completely opposite its effect on the scalp. That is why so many bald men have long, thick beards. Increased facial hair also occurs in women who face estrogen depletion in menopause, polycystic ovarian disease (POC) and other endocrine abnormalities. The elevation of DHT is controlled by the conversion of testosterone (normally present) to dihydrotestosterone (DHT). This conversion is controlled in part by the action of the enzyme, 5-alpha-reductase. The more 5-alpha-reductase present, the more DHT that is made. If we can block the action of this enzyme, we can decrease the activity of DHT and allow for a halt of hair loss and a return to hair growth via healthy hair follicles. One of the first medications used to inhibit conversion to DHT was Propecia (aka finasteride).


Male and Female Patterns of Hair Loss

male, receding hairline, 30 years old

male, receding hairline, 30 years old

females, hair loss through out crown, 45 years old

females, hair loss through out crown, 45 years old

Scroll to Continue

Earlier Products for Hair Loss

Propecia

Propecia (finasteride) was initially used to treat prostate enlargement which is also a result of testosterone conversion to DHT. DHT is actively said to shrink the cells of the hair follicles, thus stopping hair growth. Propecia's success rate was poor, where only 30% of men experienced minor hair regrowth. The main side effect of the orally taken drug is decreased libido and erectile dysfunction. Initially it was chosen because it showed less feminizing effects than other DHT blockers then on the market. In my opinion a topical preparation might have avoided some of these side effects, however, Merck tabled the idea in order to expedite FDA approval of its use for hair regrowth based on its then current use as an oral medication for prostate enlargement treatment.

Minoxidil

Once the primary cause of hair loss was established around 1997, alternatives to Propecia where sought after. Most notably was the accidental discovery of minoxidil as a hair generating agent. Initially it was used as a high blood pressure medication. Patients, using it, experienced hair growth almost any part of the body. Thick patches of hair were popping up on the elbows, knees, back of neck due to minoxidil use. With such a side effect, it was obvious that its use would have to be topical, application to the scalp only. The mechanism of how it works is not proven but is believe to be stimulation of messenger DNA within the cell. More generally, minoxidil may act as an 'epidermal growth factor' on matrix cells delaying their aging, thus prolonging the duration of the anagen phase (growing phase) via the activation of the beta-catenin pathway. Some people experience full recovery of hair loss, most others get a small percentage of hair recovery. Nearly every product on the market, no matter how "New Discovery" it claims to be, has minoxidil as its main and probably only truly active hair regrowing ingredient. It remains to be seen what true value the many vitamins added contribute to real hair regrowth.

Now we have embarked on a whole new world of hair regrowth. Follow me for Part II, where I will review the many herbs and mechanical options of treatment for hair regrowth.

Alopecia Areata: Causes and New Hopes for Treatment (JAK Inhibitors)

Alopecia Areato

Alopecia Areato

Alopecia Areata (AA): An Auto-Immune Disease Which Attacks the Hair Follicles

AA involves multiple immune effector cells including CDS+ T cells and natural killer cells. This means the hair follicles (or some substance within) is being recognized by the body as some unwanted foreign product that must be destroyed and removed from the body. Imagine a swarm of bees sensing an ant roaming around in their hive. It would be all out war in their attempt to kill this ant and remove him from the hive, in protection of the Queen bee who must be preserved at all cost. These immune cells surround the hair bulb in formation (as would a swarm of bees) releasing inflammatory cytokines. Thus, they threaten cell death upon the hair follicles. Then there is the JAK/STAT pathway, the T-cell receptor signaling pathway and the Toll-like receptor pathway that emerge pathways of interest in alopecia areata. This means that the hair follicle is being attacked from several directions by different immune agents. Some cytokines (substances like interferon, interleukin, and growth factors, which are secreted by certain cells of the immune system and work to purify the body by removal of foreign substances from the body), are believed to drive the immune attack on hair follicles by signaling through the JAK/STAT pathway.

Those suffering with alopecia areata know that treatment for this condition is at best a hit or miss proposition. Despite the use of potent corticosteroids and herbs and even laser treatment, to date thirty percent of sufferers will experience regrowth in time with a continuous cycle of hair loss and regrowth. About 50% recover hair loss after a year but many will suffer several episodes of hair loss with less than complete recovery. Around 10% will develop alopecia totalis (complete loss of hair on the scalp) or alopecia universalis (complete hair loss on the scalp and the body). Toenails and fingernails can be affected and are often an early sign of disease progression. These signs include

• pinpoint dents in the nails

• white spots on nails

• nails with rough surface

• thin and split nails

In addition, hair strains develop an bulb like shape (thick on top, thin on the bottom), resulting in new hair growth breakage before piercing the scalp surface, and white hair growing into bald spots. Bald spots are often an obvious diagnosis for AA (coin sized bald areas anywhere about the scalp), but skin tests for immune response and blood tests for hyper immunity can easily identify AA.

Related Articles