Causes of baldness in men: a trichologist explains

Natalya Chemodurova, postgraduate student of the Department of Hygiene and Preventive Toxicology, Faculty of Physical Education, LNMU named after. D. Galitsky, founder of the “Club of Literate Trichologists”, head of the organization of trichological offices Gestil International (Ukraine)

The statistics speak for themselves: with age, up to 85% of men face the problem of hair thinning, and in 95% of cases the culprits of this process are androgens. At the same time, the levels of main androgens (testosterone, DHEA-S) and steroid binding globulin (SHBG) most often do not have pathological abnormalities in either women, much less men (increased testosterone levels in women with AGA are observed in no more than 5% cases).

The most common type of baldness is androgenetic alopecia.

J.B. Hamilton has studied this type of baldness since 1942 and created a table classifying the stages of baldness, and also identified the factors that cause androgenetic alopecia:

- excess of the male sex hormone dihydrotestosterone in the blood;

- normal amount of DHT, but increased sensitivity of hair follicles to it;

- an increase in the activity of the enzyme 5-alpha reductase, which leads to the conversion of testosterone to dihydrotestosterone.

In which areas of the head does the disease manifest itself most often?

With androgenetic alopecia, the baldness zone in the frontal and parietal region in men, as a rule, does not affect the occipital region; in women, thinning is observed throughout the fronto-parietal area of the scalp.

How can you tell if a person has this type of baldness?

With androgenetic alopecia, changes are observed that can clearly diagnose this type of baldness:

1. Hair thins and falls out.

2. Microscopic examination shows the presence of reduced follicles.

3. Baldness does not affect the lower occipital region.

4. There is an imbalance between hair follicles in the growth phase and the resting phase.

Reasons for the development of androgenetic alopecia

- the baldness gene is inherited;

- chemotherapy, use of antitumor drugs;

- staying in a room with high temperature conditions;

- aproteica diet (without proteins);

- heavy metal poisoning;

- diseases of the hormonal system, endocrine pathologies in women.

Treatment methods

In the vast majority of cases, it is advisable to treat androgenetic alopecia with external preparations, which should include agents with antiandrogenic properties that allow suppressing the connection of male hormones with the receptors of hair follicles, but not affecting the overall hormonal balance.

The most effective means used by modern trichology to stimulate hair growth and for various types of alopecia are lotions containing both herbal active ingredients and medicinal substances.

The following medicinal substances are used to treat various types of hair loss: minoxidil and its analogs, hormonal and non-hormonal antiandrogens, glucocorticoids, irritants, vitamin and mineral complexes.

There are specific treatment methods (antiandrogen therapy), which use drugs that reduce the destructive effect of dihydrotestosterone on hair follicles.

The mechanism of action of such drugs is: 1) by blocking the enzyme 5-alpha reductase, which converts testosterone into its active form - DHT, or 2) by reducing the sensitivity (blocking) of androgen receptors.

Nonspecific methods of stimulating hair growth, which are used for all types of baldness, consist of improving the nutrition of hair follicles and hair through external influences (massage and physiotherapeutic procedures) or taking appropriate complexes internally. Such complexes include vitamins, minerals, amino acids, oils, and herbs. They improve the structure, microcirculation, nutrition of hair follicles, and also stimulate hair growth and increase its strength.

External preparations with antiandrogenic activity occupy a worthy niche in modern trichology. For clinically significant baldness, combination preparations containing biogenic stimulants (placental, plant, vitamin-mineral, amino acids), antioxidants, vasodilators and anti-inflammatory components are recommended.

Antiandrogen lotions typically use 5-alpha reductase inhibitors. The ability to suppress this key enzyme responsible for hair loss has been proven in the dwarf palm Serenoa; the antiandrogenic effect has also been proven in a number of polyunsaturated fatty acids, vitamin B6, azelaic acid, zinc, caffeine, and procyanidins.

The products for stimulating hair growth are based on components whose effectiveness has been clinically proven and has a serious scientific basis. Thus, the stimulating activity of inositol, adenosine nucleoside, purine derivatives (methylxanthine), in particular caffeine, as well as pyrimidine derivatives (in the composition of nucleic acid hydrolysates) for hair growth is widely known. The presence of purine and pyrimidine bases in the derivatives makes it possible to obtain a stimulating effect. Nicotinic acid derivatives (nicotinamide, methyl nicotinate) significantly improve blood circulation in the hair follicles. Dwarf palm extract has a proven antiandrogenic effect - it blocks the activity of 5-alpha reductase type 2, as well as androgen receptors at the level of hair follicles.

Features of treatment

Before you begin treatment for androgenetic alopecia, you need to know everything about the features of this treatment and what results you can expect from the therapy.

1. The most important feature in the treatment of androgenetic alopecia is that real results can only be achieved with the use of specific antiandrogen therapy. The action of such drugs is based on reducing the effect of dihydrotestosterone (DHT) on the hair follicles. Antiandrogen therapy is the most effective treatment method.

2. For male pattern baldness, treatment can be 100% effective only in women. In men, it directly depends on the stage of the disease. Treatment can be effective only at the initial stage. The earlier it is started, the greater the chances of success.

3. Treatment of androgenetic alopecia is long-term. The first results appear after 3-6 months.

4. Androgen-dependent baldness cannot be cured once and for all - it is a chronic condition. Therefore, cessation of therapy is accompanied by relapses and the problem returns, as it lies at the genetic level.

5. A significant drawback of all drugs is the need for constant use, since a few months after their discontinuation, hair loss intensifies again.

6. After active treatment with strong synthetic drugs, when visible improvement is achieved, it is necessary to use drugs that do not have serious side effects, are convenient to use and have a low cost.

7. Antiandrogen therapy affects not only the hair, but also the skin, quickly clearing it of acne and reducing oiliness.

8. Antiandrogen therapy can stop hair loss, but restores its previous thickness only if the bulb has not yet been replaced by connective tissue.

According to statistics, from 10 to 15% of patients of trichologists have factors that aggravate hair health - diseases of the ovaries, adrenal glands, thyroid gland, iron deficiency, increased prolactin levels.

In such situations, comprehensive treatment of the problem is recommended using external agents that stimulate hair growth.

In 85% of patients, no abnormalities in the state of health that affect hair growth can be identified, since the process is associated only with the local effect of male hormones on the hair of the frontoparietal zone, without an increase in the level of male hormones in the blood. It is important for practitioners to make certain decisions in choosing a method and tactics of therapy, as well as to be able to evaluate and apply newly developed techniques.