Normal Hair Growth and Hair Loss

For those concerned about hair loss, many myths abound but useful information can sometimes be difficult to obtain.   In healthy well-nourished individuals of both sexes the most common hair related problem is thought to be pattern hair loss. To begin with, three things need to occur in order for one to lose hair due to common pattern hair loss (by far the most prevalent kind).

To be susceptible to this disorder three factors must coincide.  First, one needs to have the genetic predisposition.  This means that a person needs to inherit genes that render one susceptible to the chronobiologic and biochemical triggers that result in pattern hair loss.

 Three factors involved in normal hair growth and pattern hair loss

Each of these three factors, genetics, chronobiology, and biochemistry are exquisitely complex. For example, it is widely believed that the genetics of pattern hair loss are associated with a fairly large number of genes interacting in intricate orchestration. This is one reason why there are so many degrees and variations of pattern hair loss within the general population.

In unaffected individuals, scalp hair typically grows for a period of two to five years at a rate of approximately one half inch per month. After a ninety day resting cycle new hair replaces the old one which has been shed.  In those suffering pattern hair loss, a change in the cycle of hair growth is thought to occur. Growing cycles become shorter and resting cycles more frequent.  A negative change in the caliber of the hair may also be indicative that one is coming under the effects of pattern hair loss.

 Female Pattern HairLoss

In both genders, typically, the onset of male or female pattern hair loss (Andro Genetic Alopecia - AGA) occurs in late puberty or early adulthood.  In men, advanced pattern hairloss may result in loss of hair such that the only remaining coverage is found exclusively in the temporal and occipital regions. Women are prone to exhibit a more diffuse type of hair loss with pronounced thinning in the parietal region.

Interestingly, recent studies suggest that women with some markers of insulin resistance are at significantly increased risk of female pattern hair loss.   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.

Pattern hair loss in women 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.

 How DHT affects hair follicles in the scalp

From a susceptibility standpoint, the inheritance pattern in both sexes effected by AGA is polygenic. Interestingly, the onset and incidence of the disorder in women closely parallels that observed in males. The disorder begins in susceptible hair follicles, where the hormone Di-Hydro-Testosterone (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 a miniaturized phenotype.

This process occurs within a genetically predetermined anatomical region of the scalp. The resultant clinical picture may thus be described as pattern hair loss because the area of loss is segregated within a fairly well defined zone of the scalp.

 5-Alpha-Reductase and Pattern Hairloss

Strikingly, both females and males diagnosed with pattern hair loss have higher levels of the enzyme 5-Alpha Reductase 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.

In either gender, the differential diagnosis of AGA is typically made based on the patient's history and clinical presentation. The common differentials include alopecia areata, trichotillomania, and loose anagen syndrome. Less typically, the cause of hair loss may be associated with disorders such as lupus erythematosis, scabies or 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.

 Successful use of botanical treatment for pattern hair loss

From a treatment perspective,  the monotherapeutic interventions against female pattern hair loss have included topical minoxidil, oral spironalactone, oral flutamide and other antiandrogenic compounds. In men, finasteride is indicated whereas the potent antiandrogen spronalactone is not. Finasteride, a type 2-selective 5alpha-reductase inhibitor, was approved in 1997 as the first oral pharmacologic therapy for the treatment of men with androgenetic alopecia.

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 placebo controlled, & double blinded research, HairGenesis, containing type 1 & 2 5alpha-reductase inhibitors has shown interesting activity against this disorder.

The results of this work has been outlined in a peer-reviewed, published IRB study.  In the published monograph, HairGenesis was described as having been successfully tested in 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 and efficacy in appropriately selected subjects. Follow up studies are being planned. Evolutionary improvements to the HairGenesis treatment line are ongoing.

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