Mechanism of Androgenic Alopecia: Addressing Speculations Through Empirical Evidence

October 2019 in “ Dermatologic Therapy ”

Deepak Upadhyay, Amit Sharma, Ganti Dattatreya Sarma, G. D. Gupta, Vineet Kumar Rai

androgenic alopecia DHT 5-alpha reductase testosterone Finasteride Minoxidil fibrosis calcification hair growth hair loss endocrine factors genetic predisposition AGA Dihydrotestosterone 5AR Propecia Rogaine

TLDR Hair loss in men is mainly caused by hormones and genes, and while current treatments can slow it down, they can't fully stop it.

The 2019 study "Mechanism of Androgenic Alopecia: addressing speculations through empirical evidences" explored the causes of Androgenic Alopecia (AGA), a condition affecting about 50% of males aged 40 to 75 years. The study confirmed that AGA's occurrence depends on endocrine factors and genetic predisposition, with Dihydrotestosterone (DHT) being the main androgen responsible for AGA. Inhibiting 5-alpha reductase (5AR), which converts testosterone to DHT, can improve hair growth and slow hair loss. However, existing treatments, such as Finasteride and Minoxidil, do not completely cure the condition. The study also highlighted the role of fibrosis and calcification in hair loss, with balding skin having only 60% of the total oxygen level in non-balding skin. The researchers concluded that understanding the molecular mechanisms and aetiology of AGA could lead to future targeted treatment strategies.

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Research cited in this study

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A Hypothetical Pathogenesis Model for Androgenic Alopecia: Clarifying the Dihydrotestosterone Paradox and Rate-Limiting Recovery Factors

research A Hypothetical Pathogenesis Model for Androgenic Alopecia: Clarifying the Dihydrotestosterone Paradox and Rate-Limiting Recovery Factors

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The model suggests that scalp tension could lead to hair loss, with factors like blood vessel hardening, enlarged oil glands, and poor microcirculation also playing a role. It also hints at a possible link between skull shape and baldness pattern.

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Topical drugs and near-infrared light therapy show potential for treating alopecia.

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Minoxidil and finasteride combo maintains hair density effectively.

research Cause of Androgenic Alopecia

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Male pattern baldness may be caused by scalp pressure on hair follicles, which increases with age and leads to a cycle of hair loss. This process is not directly determined by genes.

research Androgenetic Alopecia: Overview, Epidemiology, Pathophysiology, and Treatment

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Various treatments exist for hair loss, but more research is needed for better options.

research Genetic Basis of Alopecia Areata

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More research is needed to understand the genetic causes of Alopecia areata to develop better treatments.

research Molecular Basis of Androgenetic Alopecia: From Androgen to Paracrine Mediators Through Dermal Papilla

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Male pattern baldness involves hormones and cell signals affecting hair growth.

research Male Androgenetic Alopecia

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Current treatments for male pattern baldness include minoxidil and finasteride, with new options being developed.

research Management of Hair Loss

74 citations , April 2005 in “Dermatologic Clinics”

Minoxidil and finasteride are effective for male hair loss, minoxidil for female hair loss, and various treatments like corticosteroids work for alopecia areata; treatment should be tailored to the individual.

research Androgenetic Alopecia in Women

139 citations , June 2003 in “Journal of Investigative Dermatology Symposium Proceedings”

Androgenetic alopecia in women needs more research and better management strategies.

research Genetic Analysis of Male Pattern Baldness and the 5α-Reductase Genes

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Male pattern baldness is likely caused by multiple genes, not just 5α-reductase genes.

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FCE 28260 (PNU 156765), an under-explored 5α-reductase inhibitor, showcases promising results in research by Giudici et al., outperforming well-known treatments like Finasteride in reducing the conversion of testosterone to DHT. Its superior efficacy, demonstrated through lower IC50 values in both natural and human recombinant enzyme studies, suggests it could offer more effective management of DHT-related conditions. Additionally, its lower molecular weight hints at better potential for topical application, potentially offering advantages in treating conditions such as androgenic alopecia. Despite its potential, it has not advanced in development, possibly due to financial limitations, leaving its therapeutic prospects and side effect profile largely unexplored.

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A 15-year-old is concerned about hair loss, possibly at Norwood 2 or 3, and is using shampoos and conditioners recommended by a trichologist. Suggestions include considering topical minoxidil and consulting a doctor about topical anti-DHT treatments like finasteride or RU58841, but avoiding 5-alpha-reductase inhibitors at this age.

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