The impact of male hormones or androgens on genetically sensitive follicles causes androgenic baldness.
Certain conditions must be met for this type of baldness.
Hair loss in androgenic alopecia only occurs with people that have a specific genetic code. This is transferred as an independent gene or within a group of genes, and can be inherited from the father or the mother. The gene is expressed dominantly. It can be expressed both in men and women, which means the androgenic baldness can transfer to both sons and daughters.
Everyone that carries the baldness gene will not also express it. The gene must first be expressed for androgenic baldness to occur. Whether the gene is expressed depends on different factors – hormones, age, stress and other. If somebody does not have androgenic baldness he either does not have the gene or the gene has not expressed.
The specific gene or group of genes, responsible for androgenic baldness, has not yet been identified. Scientists believe that the gene is a part of a synthesis of male hormones, enzymes (5-alpha reductase) and hormonal receptors in the follicles. These are the three main factors contributing to the male pattern baldness.
5-alpha reductase is an enzyme that converts the male hormone testosterone into its more potent form dihydrotestosterone (DHT). The latter connects to the androgen receptors in the follicles.
With the continuous development of genetic medicine it is likely that scientists will soon identify the gene responsible for male pattern baldness and consequently enable its genetic treatment or prevention.
Hormones that take part in the mechanism of androgenic hair loss are male hormones or androgens. They work through a number of biological mechanisms. Their functioning is based on the interaction with receptors on the membrane or within the cell. Different androgen hormones affect the same type of cells in different ways. Most body hair under the influence of androgens accelerates growth, while fine hair on the head falls out.
The occurrence of male pattern baldness is influenced by testosterone in dihydrotestosterone (DHT). Testosterone is a relatively inactive form and converts into DHT with the help of the 5-alpha reductase enzyme. This enzyme is therefore crucial to the development of androgenic baldness. We can find it around follicles. DHT has the capability of connecting with androgen receptors in hair follicles, while the potency of testosterone is significantly weaker.
The interaction of hormones with follicles causes changes that manifest themselves as shortening or the growth (anagen) phase. The lengths of catagen and telogen phase stay the same, but this means their share increases from 10 to 20 %. This means that more hair is at the resting phase at the same time. Besides this the size of the affected follicles also changes, which means that the new hair is thinner, shorter and more fragile.
Why some people develop androgenic baldness and others do not, despite having all the necessary androgen hormones and receptors, is not yet completely clear. There are a few possible explanations:
- The number of androgen receptors on individual follicles is bigger in people prone to baldness, which is why the effect of the same amount of androgen hormones is bigger.
- The sensitivity of receptors is bigger in people suffering from hair loss and therefore the same amount of receptors causes a bigger effect of androgens.
- The activity of the 5- alpha reductose enzyme in bald areas is bigger and causes a higher concentration of DHT in comparison to testosterone.
The presence of genes and hormones is not enough for androgenic baldness to develop. The process also takes a certain amount of exposure to hormonal influences. The necessary time of exposure to reach the consequence of hair loss differs among people and depends on the expression of the gene and the amount of androgen hormones in the blood.
Even in people who are not predisposed to androgenic hair loss, the length and thickness of the hair reduces with age, which also leads to reduction of number of hair.
There are several ways for the hair to fall out. Some of them are extensive and require medical assistance, other are limited and transitional. The most common is telogen effluvium, which is a consequence of stress. The hair stops growing, stays in the resting phase for a few months and then falls out. It then regenerates within 6-9 months and starts growing again.
Alopecia areata occurs due to the autoimmune attack of the white blood cells on the hair follicles, which causes hair loss. It usually affects a few centimetres of the skin surface, only in rare cases all hair falls out. This kind of condition requires medical intervention.
Stress is often the basic cause of hair loss, but only since recently have we been discovering its true influence on people. The modern way of life connected with everyday stress can be the basic cause of hair loss which is why it makes sense, that you examine your way of life in case of hair loss and search for ways to reduce stress.
The Norwood classification
The Ludwig classification
Treating hair loss with follicle transplants
This is a surgical, minimally invasive method, which in comparison to other classical methods reduces the recovery time and the possibility of complications. It is becoming a standard of hair loss treatment. However, due to its technical complexity, its introduction has been relatively slow.
What is follicle transplant?
Follicle transplant is a modern technique of baldness treatment. Unlike some of the old methods, individual follicles are transplanted, each of which contains between 1 and 4 individual hairs. Older methods transferred larger groups of hair, which caused an unnatural appearance. In this method, however, the result looks completely natural, because the sample of transplanted hair looks the same as a natural one.
The surgical procedure of follicle transplant consists of two steps. The first step, called FUE (Follicullar Unit Extraction), consists of the use of a special device to take out individual follicles from the donor area. The device contains a special spinning needle with a diameter of 0.8 – 1.0 mm, with which we cut out the follicle from the donor area. What remains at the donor site is a small hole (a round wound), which heals in a few days without leaving any visible scars. We perform the procedure under local anaesthesia so it is completely painless. This way we avoid a classic elongated scar in the back of the head. The method enables us to choose the strongest and healthiest follicles.
In step two we implant the transplants (grafts) into the recipient area. To do that we use special micro pencils that enable a precise implantation of the grafts. When choosing the pattern, density and the direction of implanted hair, we follow the natural appearance of the scalp. This way we achieve a natural look without any unnatural clumps of hair.
The purpose of a hair transplant is to improve your look and increase your self-confidence, which means that it is necessary to talk to our surgeon about your precise wishes and goals for the procedure.
In order for us to prepare hair implants the candidate must have hair on the side and the back of the head. This area is where the follicles are extracted and then moved to the areas where there is shortage of hair. What also affects the result is the texture of the hair, direction of growth and waviness (curliness) of the hair.
There are also limitations to the hair transplant and we advise persons with a very low amount of hair against the procedure.
Before the procedure we must assess the cause of hair loss, the process of it and the genetic impact.