Androgenetic alopecia is a genetic predisposition to hair loss that occurs after puberty. Essentially, your hair is damaged by your body’s reaction to androgen over-sensitivity. The body’s reactions are inappropriate and lead to various malfunctions and, ultimately, the death of your beloved hair. While most people with male pattern baldness are familiar with the abbreviation DHT, very few are aware of how it actually impacts your hair and what options can help slow or even reverse hair loss. DHT stands for dihydrotestosterone, which is an androgen and metabolite of the male sex hormone testosterone. This may be confusing if you consider that over 30% of women experience hair loss secondary to androgenetic alopecia. Now, let’s take a closer look at WTF DHT is doing to your hair and some common myths about hair loss.
What is DHT?
Dihydrotestosterone (DHT) is the most potent hormone of androgens. It’s considered a pure androgen due to its inability to aromatize. That means that, unlike testosterone and other androgens, it does not convert into estrogen. DHT is an important sex hormone that plays an essential role in the sexual development of male genitalia. Even into adulthood, DHT plays a major role in prostate function, body hair, facial hair, and, unfortunately…male pattern baldness. If you are a woman reading this, even though DHT can impact your hair too, it doesn’t play a significant role in your overall body function and development. In addition to DHT being unable to aromatize, it also has a long half-life, it is slow to dissolve, and aggressively adheres to androgen receptor sites. Unfortunately for those with the genetic pattern of hair loss, this means it will progressively damage your hair faster than your body can disassociate with the hormone.
So WTF is DHT Doing to Your Follicles?
As unfortunate as pattern loss is, the process by which DHT destroys your crowning glory is very interesting. It’s also extremely intricate and most health care providers do not properly educate patients as to what is occurring inside of their scalp, opting instead to take one-track approaches to treatment. Of course, a complex problem usually requires a complex solution, and one medication or compound is not a one-size-fits-all solution.
DHT is most abundantly found in peripheral locations, such as the scalp, where it adheres to androgen receptor sites on the hair follicle and begins altering the functionality of the organs’ key components. Most importantly, it begins breaking down the dermal papilla, which is essentially the brain of your hair follicle. The dermal papilla induces hair growth and regulates hair cycles. It’s responsible for the regeneration of the follicle and proper hair pigmentation, and it’s a significant reservoir of multipotent MSCs. Now, it’s important to understand that this is a progressive issue, and the simplest explanation for why it’s progressive is due to the slow disposal of DHT once it adheres to an androgen receptor. When your hair follicle’s receptor sites are saturated, it doesn’t simply “cap” out. Instead, every time it goes through the growth cycle and begins to develop again, it tries to adapt to the androgenic needs of its environment, creating more receptor sites for use of the DHT. Most believe that DHT simply adheres to the hair and begins to destroy it, but the truth is that DHT does all of its damage indirectly, affecting the environment and various functional mechanics of the hair organ.
Due to the genetic sensitivity to DHT, your body reads the DHT as something that doesn’t belong in the hair follicle, and it responds by triggering inflammation in an effort to dispose of it. Ultimately, this leads to chronic inflammation. Inflammation serves as a response with one of two functions. Function 1 focuses on migrating healing growth factors and cells to damaged tissue. Function 2 is an immunological response to foreign bodies that don’t belong, in which it will try to devour and remove anything it sees that is out of place. In the case of the scalp, the entire environment is attacked by this inflammation, and it slowly causes hair loss.
Next, the inflammation and DHT both have a negative impact on the dermal papilla’s ability to properly signal growth cycles and regenerative body mechanics. This means that the growth cycle of the hair begins to shorten, and the resting phase begins to elongate. Quicker overall shifts through the cycles mean that more DHT is adhering to receptor sites in a shorter period of time. Eventually, the hair will stop growing altogether and the organ will begin to atrophy and die.
Now, you’re probably thinking that it couldn’t possibly get any more intricately destructive than that, right? Well, it does. The broken signaling leads to imbalanced calcification regulators and when you throw in the chronic inflammation, it begins to cause an increase in fibrosis. Fibrosis is the formation of connective tissue in light of an injury that normally aids in healing (think of scarring). In this case, it does quite the opposite. The fibrosis and over calcification begin to harden the tissue of the scalp and crowd the environment, restricting blood flow to the scalp. If you have ever seen an older man’s bald scalp, you might have wondered why it’s leathery and ultra-thick. Now you have your answer.
Think of it this way, in the iron ages of castle sieges, one of the most widely adopted strategies for success was to cut off the trade routes to prevent the defending soldiers from getting food and water. This is essentially what’s happening in your scalp, except it’s worse because your blood also carries oxygen to your tissue. In other words, decreased blood flow means fewer nutrients and less oxygen, which means more cellular death and a quicker decline in scalp health.
Well, WTF Do You Do To Treat It?
First, we start with the cause: DHT! This is ironically the most simple part of the complex process of treatment. In men, you can use alpha5-reductase-inhibitors such as finasteride to block roughly 70% of DHT metabolization by inhibiting the enzyme that causes testosterone to DHT conversion. This is typically prescribed for hair loss as 1mg per day. In some men, if caught early enough, this can be sufficient to stop hair loss. In others, it can even reverse the miniaturization of follicles and cause the hair to grow back healthily. Since you are here reading this article, it’s probably safe to assume that you have read the horror stories of finasteride. While there is validity to these stories, it is a rare occurrence in men, but we still don’t recommend taking that risk. After all, what’s the point in hair if you lose sexual function?
Joking aside, MAXIM formulated a topical solution with finasteride, 10% minoxidil, caffeine, biotin, and hair & skin growth peptides to combat hair loss. When you take a pill, the dosage is usually higher than spot treatments because it passes through your liver and bloodstream twice, systemically blocking DHT conversion. This is why rare sexual side effects can occur in some men. However, with the topical solution, instead of 1mg pills, the compound contains just 1% finasteride, which translates to 0.01miligrams/ml. Yes, it’s only a fractional 100th of the drug that the oral contains. You would use it twice a day, totaling 0.02mg, which equates to a 50th of the oral prescription of 1mg. Because of this, and the directional focus of the topical using liposomal technology to deliver the medication to the hair follicle, there is a dramatically lower risk of seeing a systemic decrease in serum DHT.
Fun side note: this topical also shows to be 2% more effective at blocking the DHT conversion. Hopefully, you aren’t like me, being too bogged down learning about patient care and medicine to notice that you lost most of your hair (which I have since restored, for the record). If you are, you will have to live with the realization that a transplant may be necessary to restore the lost hair, and finasteride alone cannot regrow what has died and left the building. If you are somewhat early, but still have some cascading damage caused by putting off your hair loss for too long, you will need to treat the chronic remnants of DHT, such as inflammation, which can also worsen due to the fibrosis and calcification. I know…it comes full circle and keeps getting better, right? The good news is that it’s okay. Many people are still in a good stage to restore their hair without any transplant whatsoever. Others may need a small FUE and non-surgical treatments.
So let’s recap, we have identified 5 core components to DHT induced hair loss:
- Chronic inflammation
- Decreased blood flow
- Over calcification
- Over fibrosis
- Broken cell signaling
Let’s address the treatments accordingly:
- Chronic inflammation: If you have gone to a dermatologist, they are likely to try or mention the possibility of using steroidal creams or injections to treat your hair loss. Unfortunately, this is mostly due to a very basic understanding of what’s occurring beneath the surface. The reality is that most people are likely to see a noticeable result in a relatively short period of time. However, there is a caveat with detrimental consequences.
This is a classic case of treating the symptom, not the cause. By using steroids, you are only temporarily suspending symptoms and damage that are secondary (inflammation caused by DHT) and tertiary (damage caused by inflammation) instead of the root cause. Now you might wonder if you can just continue using steroids to prevent the inflammatory response, and the answer is both yes and no. You can, but it will slowly degrade your scalp, and eventually, this will induce hair death as well.
The answer to how to handle the inflammation is simple: stay well hydrated, make sure you eat in a way that aids in the prevention of negative inflammation, and most importantly – TREAT THE CAUSE!
Decreased blood flow, over calcification, over fibrosis, and broken cell signaling: Please note that treatments for #2 also treat symptoms #3, #4, & #5, which are caused by #1 and #5. It’s important to understand that these “symptoms” are a permanent issue if not treated as if they were an independent issue. Tissue perfusion is the essence of life within our bodies. Blood carries nutrients, oxygen, water, and just about every important healing factor through your body. There are several ways to improve blood flow to the scalp. The simplest method is to use a topical such as minoxidil, which effectively induces vasodilation. However, this has limitations because you still have inflammation, calcification, and fibrosis constricting blood flow. To really treat the decreased blood flow, I repeat, we have to treat the cause.
This cannot be done through medications, but it can be done through collagen induction therapies where we cause calculated microtrauma to the scalp, extracting natural growth factors and healing molecules from the body for reinjection, placing dissolvable foreign bodies into the scalp, and/or extracting healing mechanics through micrografting of hair follicles. These therapies are akin to biohacking, tricking your body into producing and migrating growth factors and healing molecules to acutely heal the newly damaged areas. This also aids in better tissue perfusion because, you guessed it, it uses the blood vessels to transport the healing mechanisms.
More importantly, all of these measures induce angiogenesis and activate fibroblasts, which produce collagen and initiate positive tissue degradation, which breaks down fibrotic tissue. Angiogenesis is the formation of new blood vessels from old vessels. Now, this doesn’t mean that it simply rebuilds the old road with some patchwork and replacement concrete. It also forms brand new bifurcations, like a multi-directional fork in the road, allowing for various paths of less resistance and improved tissue perfusion.
I know that I said there is no one-size-fits-all solution, and as you might have gathered by reading subsection #2, several treatments are mentioned. The reason for this is many of the delivery methods and treatment options require one of the other treatments to function properly. Subsequently, all of these areas of contention are treated during the process. With that said, micrografting is the only treatment mentioned above that directly impacts the cell signaling functions. This procedure works by extracting hair follicles from your donor area, which is not responsive to DHT and typically remains in good health. After extraction, the dermal papillae from the follicles are mechanically dissected, forcing them to extract hair follicle-specific growth factors while emptying its healing reservoirs into saline solution, which is reintroduced to the damaged hair in your area of hair loss. This can aid in the dermal papilla’s ability to restore signaling.
If you’re tired of wondering WTF your hair has gone, or WTF has happened to your hair, MAXIM is here to help. At MAXIM, we offer complimentary consultations with a focus on education first. We will sit with you to discuss your goals, analyze and explain the stage of progression you are at, and provide the most appropriate clinical pathway to reach your desired goals. Please call us or chat with us online to schedule your consultation with our team of hair restoration experts.
Authored by Joseph Hart, RN