HAIR LOSS A COMPREHENSIVE GUIDE
Undisturbed, each terminal scalp hair grows for approximately approximately three to five decades. The hair transitions into a state where the observable portion over the skin is shed. No hair grows from the follicle for 90 days. Once this period has passed, a new hair lasts for another three to five years at a rate of about 1/2 inch per month and starts growing through the skin.
It’s believed that as many as 100 genes are involved in regulating the production, construction and cycling of scalp hair. Very few of these genes have been identified.
For those worried about hair loss, half-truths and many myths abound, but information can be difficult to obtain. Therefore, an objective summary of pattern hair loss is presented herein.
In healthy well-nourished people of both genders, the most common form of hair loss is androgenetic alopecia (AGA), also referred to as pattern hair loss. Approximately 40 million men are affected by the disease. Perhaps about 20 million American women are affected by the disorder. The difference between women and men is a woman suffering baldness usually retains her feminine hairline and encounters thinning behind this leading edge. In men, a distinct”routine” of loss manifests in which the frontal edge recedes at precisely the exact same time that a thinning zone expands in the posterior crown. In more pronounced cases, these zones meet and the person is said to be bald.
Importantly, three things will need to happen in order for one to be influenced by AGA. First, the genetic predisposition must be inherited by an individual. This means that the difficulty comes from one or both sides of your family. Second, one should attain a particular age. Old children do not experience pattern baldness. And third, one ought to have the circulating hormones that precipitate onset and progression of this disorder.
Typically, the first onset of AGA occurs in one’s early 20’s or late puberty. As a general rule, the earlier hair loss begins, the more pronounced it is likely to become.
From a perspective that is susceptibility, the principle hormonal trigger is 5-alpha dihydrotestosterone referred to as DHT. It has been demonstrated that in men pattern baldness does not occur. DHT is synthesized from the androgen hormone testosterone and is useful early in life and through puberty.
In adults, DHT is considered to cause considerable harm, but very little good. Diseases as pattern baldness and disparate as benign prostatic hyperplasia are both triggered by DHT. The synthesis of DHT occurs via two closely related forms of this enzyme 5-alpha reductase. Baldness treatment options that effectively interfere with the interaction between 5-alpha reductase and androgen hormones such as testosterone have been shown to provide clinical benefit in treating pattern baldness.
Because hair growth is regulated by multiple genes and attendant biochemical pathways, the underlying variables are extremely intricate. Another challenge to understanding hair loss has been the fact that humans, alone among mammals, suffer from androgenetic alopecia. Thus, no efficient animal model exists that would otherwise tend to shed light upon the key factors at work.
Hair Loss Variations Other Than AGA
The differential diagnosis is typically made based on clinical presentation and the patient’s history. The typical differentials for AGA include alopecia areata (AA), Trichotillomania, and telogen effluvium. The cause of hair loss may be associated with disorders such as scabies lupus erythematosis or skin manifesting disease processes. Scalp biopsy and laboratory assay may be helpful in ascertaining a definitive diagnosis, but, in these circumstances, should generally only follow an initial clinical examination by a qualified treating doctor.
Pattern Hair Loss Treatment Choices
This quip articulates three treatment options that are known as surgical hair restoration hair systems, and pharmacotherapy. A fourth option has evolved, which is also touched herein. This is therapy that is based.
Typical Hair Piece
Hair replacement systems have been in routine use at least. These products go by hair pieces, wigs, weaves, the expression hair integration systems, toupees and many other names. All have one thing in common–they are not growing out of one’s scalp. They must be attached with the skin or hair staying above the ears’ fringe and in the back of the scalp.
Attachment to the living scalp is never permanent, and for good reason. Aside from the fact that the unit itself wears out, basic hygiene dictates that the wearer regularly remove the unit to clean the underlying scalp and hair. There are almost always three fundamental elements to a hair replacement system. The first is the hair which could be natural, artificial, or a combination thereof. The second element is the unit’s foundation. Typically, the hair is woven into a fabric-like base that’s then attached into the scalp in some fashion. This brings up the next element; that is the means of attachment. Methods include gluing the foundation to the fringe hair, stitching the foundation to the fringe hair, or gluing the foundation to the scalp.
Potential benefits to hair systems incorporate the immediacy of achieving a complete hair”look” that can appear, to the casual observer, to approximate a complete head of hair. The pitfalls of hair systems are many and diverse.
In persons who are actively losing hair, vs. those that are essentially bald, the hair system itself may rapidly accelerate the process of going bald. Another disadvantage is the top edge that may give away the fact that there is a person wearing a hair system. By utilizing this problem has been addressed.
Hair systems have to be serviced and finally replaced themselves, because they are nonliving. The costs of servicing and maintaining a hair replacement system aren’t insubstantial–and these costs can dramatically exceed the initial price of acquisition.
Surgical Hair Restoration
Surgical hair restoration, commonly known as hair transplantation, exploits a phenomenon first described in the 1950’s. In appropriately selected patients, surgical hair restoration can constitute a positive solution
There are important caveats to hair transplantation. The concerns supply and demand. Without causing a damaging and florid foreign body response in the receiver an individual may not transplant hair from one person to another. Thus, both operator and patient are relegated to whatever hair bearing tissue is in place. It is important to and conserve place this resource.
The major caveat to hair transplantation concerns achieving endpoint results. There is that A hair line spotty or too sudden may seem worse than it did before it was restored. By the same token, hair behind the top edge that’s not revived in a fashion that yields meaningful density (e.g. 1 hair per mm/sq) frequently fails to approximate a full head of hair. Accordingly artistic excellence is at least equal in importance to fundamental surgical ability.
The caveat to hair transplantation identifies a problem called chasing a receding hair line. Since hair loss is relentless and progressive, it is possible that donor hair restored integrated into an area of scalp hair may end up as an island of hair because the hair behind it continues to erode. In this situation, in order to retain a complete appearance, patients are forced to fortify hair. This works well until the hair stops one or thinning eventually runs out of donor hair.
Ideally, for men undergoing transplant surgery, it would be helpful to incorporate a treatment alternative that safely and effectively arrested the progression of hair loss, allowing the surgeon to fill in the areas.
Drug-based Hair Loss Treatment Options
From a treatment perspective, the two most widely used therapeutic interventions against pattern hair loss have been topical minoxidil and oral finasteride.
Minoxidil, first sold under the trade-name Rogaine(TM) was initially developed as the oral contraceptive drug, Loniten(TM). In some patients who used minoxidil to treat blood pressure problems, it was discovered that strange hair growth occurred on scalp and the face. This was somewhat colloquially referred to as the werewolf influence. > From this monitoring compositions containing minoxidil were tested on balding scalps.
The benefits of Rogaine(TM) include the ability to arrest, and possibly reverse, pattern hair loss. According to Pfizer’s own marketing materials, Rogaine(TM) has primarily been shown to be effective in treating hair loss in the vertex and posterior scalp, but not the anterior hairline. Minoxidil is a drug with potential side effects which include skin and hypotension irritation.
It was hypothesized that finasteride could be useful in both pathologies, Since BPH is connected biochemically to the identical pathways that activate pattern hair loss. In placebo-controlled research on men with mild to moderate hair loss, Propecia(TM) was shown to produce clinically important benefit in arresting, and in some cases, reversing the development of the disease. Propecia(TM) is not indicated for use in women. Unwanted effects include reduced volume, in addition to decreased libido. Finasteride is considered a teratogen (can cause feminizing birth defects) and should not be handled by pregnant women or even those persons who may come into contact with pregnant women.
Like finasteride, dutasteride was initially developed to treat BPH. Unlike finasteride however, dutasteride inhibits both isoforms of 5-alpha reductase, while finasteride inhibits only type II 5-alpha reductase. Interestingly, a study undertaken by GlaxoSmithKline, the EPICS trial, didn’t find dutasteride to be more effective .
Clinical trials for dutasteride as a baldness drug were undertaken, but stopped in 2002. Side effects noted with the use of dutasteride include gynecomastia, changes to PSA levels effects and others that parallel the side effect profile described by the manufacturers of finasteride.
In December 2006, GlaxoSmithKline embarked on a new Phase III, six month research in Korea to test the safety, tolerability and effectiveness of a once-daily dose of dutasteride (0.5mg) for the treatment of AGA in the vertex area of the scalp (forms IIIv, IV and V on the Hamilton-Norwood scale). The effect that this study will have on the FDA’s approval or disapproval of Avodart for the treatment of male pattern hair loss in the United States is to be determined.
Especially, although on occasion in female patients drugs including flutamide & spironalactone have, sometimes been used off-label to deal with various types of hair loss. Each drug includes a host of potential side effects, and none has been approved by the FDA for the treatment of pattern baldness.
Non-drug established Hair Loss Treatment Options
Botanically derived substances have come as useful tools against AGA under investigation. This effort has been largely pioneered by the makers of HairGenesis(TM). Following the creation of HairGenesis(TM) a range of different products came on the market. Some integrated drugs like minoxidil. Others, used variants on the theme of formulations that are based. However, aside from HairGenesis(TM), none was supported with a third party, IRB tracked, placebo-controlled, double blind study–published in the peer reviewed medical literature. For those wanting to see how HairGenesis(TM) is considered to compare to other hair loss treatment options, a review of the HairGenesis(TM) Comparison Page is encouraged.
Inasmuch as the bulk of this website focuses on the advantages associated with HairGenesis(TM), the many points in favor of HairGenesis(TM) treatment will not be reiterated herein. Two factors are relevant to the discussion, however, and will be articulated.
First, the complex of naturally derived active compounds used in HairGenesis(TM) have been shown to function through pathways and mechanisms that are unique from one another, as well as separate and apart from those within which drug-based remedies work. Suffice to say that this monitoring has presented a unique opportunity to develop HairGenesis into a”cocktail” treatment wherein formulation synergy would most likely occur.
In plain English, this means that HairGenesis(TM) was designed to be higher than the sum of its parts.
The next crucial point is that research is actively underway by the manufacturers of HairGenesis(TM) to develop new, more innovative and more potent, versions.