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Origin of Hair Loss
Hair loss is a multifactorial problem affected by genetics, hormones and environmental issues, as well as diet and daily activity. Many people believe that hair loss is passed down to men through their mother’s side or to women from their father’s side.
In 1916, a female physician named Dorothy Osborne started the myth that the baldness gene behaves in an autosomal dominant manner in men and an autosomal recessive manner in women.6 In fact, we now understand that hair loss is a complex trait and there is a contribution from both parents. Having said this, we also know that the majority of male pattern baldness is androgen related.7 The extent of expression of testosterone, dihydrotestosterone (DHT) and DHT receptors are hereditary in men and women. One- third of the sex hormone-binding globulin changes of age depend on genetic factors, as does the variability in testosterone concentrations.
Diets low in proteins and vitamins also will lead to unwanted hair loss. Essential vitamins for good follicular health include thiamin (B1), riboflavin (B2), niacin (B3), biotin and zinc. Additional supplements include boron, methylsulfonyl-methane (sulfur), L-cysteine, and L-methionine and lutein. A healthy active lifestyle that includes a balanced diet with nutritional and mineral supplements for hair health will maintain strong hair follicles, leading to thick hair shafts.
Male pattern baldness (MPB) also referred to androgenetic alopecia (AGA) is prevalent in Americans, affecting 30 million men starting as early as their teens and all the way into adulthood.8 Patients typically present with a focal distribution of hair loss in various stages well documented by the Hamilton-Norwood classification. This is a clinical grading scale for staging male androgenetic alopecia and describes the progression of male pattern baldness in a range from stages I to VIII. A gradual onset of hair loss occurs bi-temporally from the frontal areas with progression to a wider area of thinning hair that may or may not have bare patches. Men will experience minimal shedding, and pulling on hair will not yield a lot of hair.
More than 20 million women suffer from androgenetic alopecia as well. Female patients present with similar complaints of hair loss as their male counterparts. But female hair loss is further complicated by telogen effluvium, a more generalized distribution of hair loss more commonly seen in women than men. This condition is characterized by thinning hair, without bare patches, and prominent shedding and frequent telogen hairs when brushing or pulling on the hair.
In both sexes, the hair loss pattern described by androgenetic alopecia or telogen effluvium are primarily associated with genetic and hormonal factors. Multiallelic genetic factors exist from either parent that predetermine a person’s sensitivity to androgens. The hormonal factors affect androgen receptors, thereby reducing normal blood supply to hair follicles. Over time, this leads to atrophy of the miniaturized hair follicles and thinning hair. This process continues unchecked until the hair follicles have completely atrophied.
We can achieve complete reversal of follicular atrophy and hair loss when treatment is initiated within two years of its onset. Unfortunately, many patients wait 10 or more years after hair loss before pursuing any treatment. Most forms of hair loss that are diagnosed and treated at an early age respond to treatment. However, most treatments started late in the progression of hair loss are less effective and will only reduce or stop the progression.
Along with LHT, AGA has three commonly accepted forms of treatment: Minoxidil, antiandrogen therapy and hair transplantation.
Minoxidil is FDA-approved and available for men and women as first-line therapy for AGA and telogen effluvium. It’s available over-the-counter in 2 percent to 5 percent concentrations or up to 10 percent solutions by prescription. In use for 18 years, it shows minimal to moderate hair regrowth potential. The benefits of minoxidil will be lost, however, within six months if patients stop using it. Side effects may include itching, headaches, dizzy spells and possible heartbeat irregularities; most will resolve with regular use.
Antiandrogen therapy in the form of Propecia (finasteride) is available for men. Finasteride inhibits the 5-alpha reductase enzyme that transforms testosterone into the dihydrotestosterone (DHT) that’s primarily responsible for AGA. Blocking the action of DHT seems to stimulate minimal to moderate hair regrowth. Side effects may include impotence, loss of libido and reduced sperm count. Patients who cannot tolerate side effects are instructed to stop using the medication.
For patients with advanced hair loss or complete baldness who do not respond to medical treatment, surgery is the most substantial permanent solution. Surgical hair restoration is the only truly permanent solution to baldness. The process involves a series of grafting treatments that extract plugs of hair or individual hair follicles from the back of the head, where hair grows densely, and implanting them in the balding areas. Most patients require two to three treatment sessions. The cost varies on the surgeon’s expertise and whether he extracts/implants plugs or individual follicles. The latter is more time consuming and, therefore, more expensive.
If your patients haven’t tried a medical treatment, or don’t have advanced hair loss, then consider starting traditional medical treatments in combination with the Revage 670.
The treatment options are many and each can be customized. Fortunately, people no longer need to endure hair loss. The most important consideration for complete hair restoration is to start treatment at an early age and to save hair while patients have it.
With the Revage 670 we have the enhanced benefits of low-light level lasers that stimulate biophysical repair and neovascularization. This is a remarkable adjunct to the combination of other therapies we now have. It warrants further consideration and integration into practices serious about treating hair loss.
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