Androgenic alopecia

Androgenic alopecia is a genetic condition that affects men and women alike and causes the miniaturization of follicular units. The condition is very prevalent, that 50% of the male population is expected to be affected by the condition to a certain degree.

Throughout humanity, hair loss remained a phenomenon that inherently terrorized our self-esteem. While the condition doesn’t alter our physical health, it makes the individual appear older, subconsciously affecting the way they’re perceived as a potential partner.

Although androgenic alopecia has puzzled our species since the start of dawn, there still isn’t a cure, primarily due to lack of understanding of the characteristics of the condition. Below, we’ll thoroughly discuss androgenic alopecia at a molecular level along with its potential treatments.

Androgenic Alopecia Under A Molecular Lens.

Androgenic alopecia refers to the miniaturization of follicular units in reaction to androgens. The condition in a nutshell could be attributed to the varying sensitivities of follicular units to androgens. On the scalp, follicular units could either be androgen sensitive or androgen resistant. In other words, how follicular units react to androgens is not uniform, consequently, forming the notorious pattern of hair loss in androgenic alopecia. In general, follicular units near the crown and the hair line have a higher tendency of being androgen sensitive. Whether follicular units will respond by shrinking into complete dormancy upon binding to androgens or remain indifferent, is determined by genetic factors.

Since androgenic alopecia is inherited, the alleles that encode the condition are versatile which explains the varying degrees of hair loss in affected patients

Research suggests that follicular units prone to hair loss tend to have higher numbers of DHT receptors. DHT is an aggressive version of testosterone that binds to follicular units on the scalp to potentially trigger their dormancy.

How DHT is capable of producing contradicting cascade of events within the cells based on the location of follicular units in the body isn’t fully known. For although DHT is destructive towards follicular units on the scalp, it seems to have a polarizing role in follicular units on the body promoting their proliferation.

Treating Androgenic Alopecia.

The available treatment options for male pattern hair loss are split into two categories: non-advanced hair loss treatments and advanced hair loss treatments.

Once follicular units miniaturize, it is near impossible to revive the affected follicular units later on. Thereby, it is ideal to seek treatment as soon as symptoms of androgenic alopecia become noticeable.

Non-advanced Hair Loss Treatment.

If your hair loss has just begun and the effects of the condition did not result in noticeable balding, you may consider either Finasteride or Minoxidil.

Minoxidil.

Minoxidil is a solution that, through an unknown mechanism, provides follicular units with immunity against DHT. Minoxidil comes as either a serum or a shampoo that needs to be applied twice daily to maintain its effects. Side effects include increased body hair upon contact and possibly irritation on the scalp.

Finasteride.

Finasteride comes in the form of pills that can terminate the destructive effects of DHT. The mechanism by which the pills counteract hair loss is through the destabilization of the 5 alpha reductase enzyme that is responsible for converting testosterone to DHT.

Advanced Hair Loss Treatment.

Treating advanced hair loss is more complex and requires surgical intervention. Unfortunately, the dormancy of follicular units is permanent and cannot be undone. Therefore, neither Finasteride nor Minoxidil can reverse the effects of male pattern baldness once the condition has progressed past miniaturization.

Hair Transplant.

Hair transplantation is a surgical solution to hair loss that can either be minimally invasive or invasive based on the technique used.

The procedure offers permanent results. Since follicular units vary in sensitivity, in most cases patients would lose hair on the crow and the hairline excluding the sides and the back. The hair-loss resistant follicular units are often referred to as donor regions. As was mentioned above, androgen resistance is inherited, meaning the properties cannot be altered later on in life.

Consequently, follicular units are extracted from stable donor regions and relocated to balding scalp. Upon relocation, the grafts will adapt in their new placement and once past the one year mark, the hair will look, behave, and can be treated like natural hair.

Hair Transplantation Techniques.

The two primary methods of hair transplantation include follicular unit transplantation (FUT) and follicular unit extraction (FUE). Alternative techniques are variants of FUE, that enhance on the current technique for immaculate results.

1. Follicular unit transplantation: FUT is the conventional method and requires the excision of a strip of the scalp in order to extract follicular units. The method of graft extraction leaves a visible linear scar and inflicts nerve damage in the region that may or may not be permanent.

2. Follicular unit extraction: FUE is a recent technique that is less invasive than FUT. To obtain follicular units, FUE individually extracts donor hair. The technique of graft harvesting leaves microscopic scars and does not inflict nerve damage in the area.

While hair transplantation is the only permanent solution to advanced androgenic alopecia, patients have to meet other requirements. The most important of which is a sufficient supply of donor hair.

Follicular units are not replaced once extracted, therefore, a patient has to have a sufficient supply of donor regions that could cover balding scalp without jeopardizing the appearance of donor areas.

If you would like to have your scalp evaluated by a hair transplant specialist. The Vera Clinic Istanbul  is a hair transplant and cosmetic surgery center that offers free online consultation sessions for interested patients to address their concerns and evaluate their candidacy. Your assigned medical specialist will request photos of your scalp from various angles and assess, based on the images and degree of your hair loss, the potential of your donor regions to safely cover your balding scalp.