Hair Loss And Women's Health

AndroGenetic alopecia (AGA), commonly described in women as female pattern hair loss, is  thought to be caused by a combination of factors including age, genetic susceptibility and hormones. In both genders, the onset of AGA can occur in late puberty or early adulthood, though females effected by this disorder tend to present signs and symptoms somewhat later than males.

Interestingly, recent studies suggest that women with some markers of insulin resistance are at significantly increased risk of female AGA.  Moreover, a paternal history of androgenetic alopecia seemed to be a stronger predictor of female AGA compared to women with normal or minimal loss of hair. Female AGA has also been linked with hyperandrogenism and hirsutism and, most recently, also with polycystic ovarian syndrome (PCOS), even though epidemiological documentation of the latter association is not necessarily statistically compelling. Nevertheless, the association between polycystic ovarian syndrome and insulin resistance is well documented.

 Female Pattern Hair Loss

From a susceptibility standpoint, the inheritance pattern in female AGA is polygenic, and the onset and incidence of the disorder closely parallels that observed in males. The disorder begins in susceptible hair follicles, where dihydrotestosterone (DHT) has been shown to bind to the androgen receptor.
This hormone-receptor complex translocates to the cell nucleus, initiating a gene activation program thought to be responsible for the gradual transformation of large terminal follicles to miniaturized follicles.  This process occurs within a genetically predetermined anatomical region of the scalp. The resultant clinical phenotype may thusly be described as pattern hair loss because the area of loss is segregated within a fairly well defined zone of the scalp.

Strikingly, both females and males diagnosed with pattern hair loss have higher levels of the enzyme 5-alpha- reductase (5AR) and androgen receptor in frontal hair follicles compared to occipital follicles (hair follicles anatomically located outside the typical pattern of loss). Other predisposing factors such as differential cytochrome P450 levels in susceptible vs. non-susceptible hair follicles are less well elucidated but may have contributory relevance as well.

The diagnosis of AGA in women is supported
by a pattern of increased thinning over the frontal/parietal scalp with greater density over the occipital scalp, a retention of the frontal hairline, and the presence of miniaturized hairs in the effected zone of loss. Most women with AGA have normal menses and pregnancies. Extensive hormonal testing is usually not indicated unless signs & symptoms of androgen excess are present such as hirsutism, severe unresponsive cystic acne, virilization, or galactorrhea.

 Successful use of botanical treatment for Female Pattern Hair Loss

In most cases, the differential diagnosis of hair loss in women (female AGA) is made based on the patient's history and clinical presentation.   Typical differentials include alopecia areata, trichotillomania, and less commonly hair loss associated with disorders such as lupus erythematosis, scabies and other skin manifesting disease processes.  Scalp biopsy and lab assay may be useful in elucidating a non-pattern hair loss etiology but, in such cases, should generally only follow an initial clinical evaluation by a qualified treating physician.

From a treatment perspective,  the monotherapeutic interventions against female pattern hair loss have included topical minoxidil, oral spironalactone, oral flutamide and other antiandrogenic compounds.  Recently, botanically derived substances have also come under investigation as agents potentially useful against this disorder.

Because these botanical substrates have been shown to operate via different mechanisms of action from one another, a novel approach has been employed with an eye toward synergizing carefully chosen compounds into a "cocktail treatment".  One such compilation of botanical compounds is known as HairGenesis.  In uncontrolled, unblinded research, the use of HairGenesis against AGA in women has yielded remarkably positive results. HairGenesis has also demonstrated positive results in the setting of double-blind &placebo-controlled IRB research.  In this published study, HairGenesis was successfully tested in male treatment subjects over the course of a 22 week trial.

Anecdotal, historical, and basic science data for the compounds and complexes found in the HairGenesis formulation further support the hypothesis that HairGenesis offers safety & efficacy in appropriately selected female subjects.  Controlled & blinded IRB monitored clinical research examining this formulation in females is considered desirable and is currently in the early planning stages.

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