Pattern hair loss: Difference between revisions
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Revision as of 02:53, 13 October 2008
| Pattern hair loss | |
|---|---|
| Specialty | Dermatology  |
Androgenic alopecia (also known as androgenetic alopecia or alopecia androgenetica) is a common form of hair loss in both male and female humans, chimpanzees, and orangutans.[1] In male humans in particular, this condition is also commonly known as male-pattern baldness. Hair is lost in a well-defined pattern, beginning above both temples. Over time, the hairline recedes to form a characteristic "M" shape. Hair also thins at the crown of the head, often progressing to partial or complete baldness.
The pattern of hair loss in women differs from male-pattern baldness. In women, the hair becomes thinner all over the head, and the hairline does not recede. Androgenetic alopecia in women rarely leads to total baldness.
A variety of genetic and environmental factors are likely play a role in causing androgenetic alopecia. Although researchers are studying risk factors that may contribute to this condition, most of these factors remain unknown. Researchers have determined that this form of hair loss is related to hormones called androgens, particularly an androgen called dihydrotestosterone (DHT). Androgens are important for normal male sexual development before birth and during puberty. Androgens also have other important functions in both males and females, such as regulating hair growth and sex drive.
Hair loss and genetics
Much research went into the genetic component of male pattern baldness. Research indicates that susceptibility to premature male pattern baldness is largely X-linked. Other genes, that aren’t sex linked, are also involved.
Large studies in 2005 and 2007 stress the importance of the maternal line in the inheritance of male pattern baldness. German researchers name the androgen receptor gene as the cardinal perquisite for balding.[2] They conclude that a certain variant of the androgen receptor is needed for AGA to develop. In the same year the results of this study were confirmed by other researchers.[3] This gene is recessive and a female would need 2 X chromosomes with the defect to show typical male pattern alopecia. Seeing that androgens and their interaction with the androgen receptor are the cause of AGA it seems logical that the androgen receptor gene plays an important part in it's development.
Other research in 2007 suggests another gene on the X chromosome, that lies close to the androgen receptor gene, is an important gene in male pattern baldness. They found the region Xq11-q12 on the X-chromosome to be strongly associated with AGA in males. They point at the EDA2R gene as the gene that is mostly associated with AGA.
Other genes involved with hair loss have been found. One of them being a gene on chromosome 3. The gene is located at 3q26[4]. This gene is also involved in a type of baldness associated with mental retardation. This gene is recessive .
Another gene that might be involved in hair loss is the P2RY5. This gene is linked to hair structure. Certain variants can lead to baldness at birth while another variant cause “wooly hair”.
Men with androgenic alopecia typically have lower levels of total testosterone, higher levels of unbound/free testosterone, and higher levels of total free androgens including DHT.[5][6]
5-alpha-reductase is responsible for converting free testosterone into DHT. The genes for 5alpha-reductase are known[7]. The enzymes are present predominantly in the scalp and prostate. Levels of 5alpha-reductase are one factor in determining levels of DHT in the scalp and drugs which interfere with 5alpha-reductase (such as finasteride, which inhibits the predominant type 2 isoform ) have been approved by the FDA as treatments for hair loss.
Sex hormone binding globulin (SHBG), which is responsible for binding testosterone and preventing its bioavailability and conversion to DHT, is typically lower in individuals with high DHT. SHBG is downregulated by insulin.
Increased levels of Insulin Growth Factor-1 (IGF-1) have been correlated to vertex balding [8]
High insulin levels seem the likely link between metabolic syndrome and baldness. Low levels of SHBG in men and non-pregnant women are also correlated with glucose intolerance and diabetes risk, though this correlation disappears during pregnancy. [9]
Hair loss and lifestyle
While genetic factors seem to play the principal role in the development and progression of androgenetic alopecia, lifestyle also plays a minor role as demonstrated by the vast increase in male and female pattern baldness in Japan after World War II, when the country moved to a higher calorie, higher fat diet and a more sedentary lifestyle. Also, pattern baldness (androgenic alopecia) was either rare or non-existent among hunter-gatherer and other, less westernized societies eating in their traditional manner. [10]
Daily, vigorous aerobic exercise (as opposed to short workout periods designed to raise androgen levels and build muscle or more sporadic exercise) has been shown to reduce baseline insulin levels as well as baseline total and free testosterone, significantly lowering baseline DHT.[11] It has been suggested that weight training may have a detrimental effect on hair by increasing testosterone levels; however, there is at least one study that indicates a decline in free testosterone as result of weight training.[12]
Treatments
While most people with male pattern baldness choose to accept the condition as they accepted their hair color or shape, there are baldness treatments which can reduce or halt hair loss, and in early stages or in rare cases, reverse it entirely. Treatments include:
- Dutasteride
- Finasteride
- Hair transplantation (does not treat pattern baldness, since the affected hair is most likely to continue to thin).
- Ketoconazole
- Lignans from flaxseed, sesamseed, or Norwegian spruce
- Minoxidil
- Topical Caffeine [13]
See also
- Hamilton-Norwood scale: The scale that rates the severity of androgenic alopecia in males.
- Ludwig scale: The scale that rates the severity of androgenic alopecia in females.
References
- ^ "The latest on baldness cures - includes related information", Duke Health News, December 1994, via findarticles.com
- ^ Hillmer AM, Hanneken S, Genetic variation in the human androgen receptor gene is the major determinant of common early-onset Androgenetic Alopecia (AGA). Department of Genomics, Life and Brain Center, University of Bonn, Bonn, Germany.
- ^ Levy-Nissenbaum E, Bar-Natan M, Confirmation of the association between male pattern baldness and the androgen receptor genr Danek Gartner Institute of Human Genetics, Sheba Medical Center, Tel Hashomer, Israel
- ^ Hillmer AM, Flaquer A, Genome-wide scan and fine-mapping linkage study of AGA reveals a locus on chromosome 3q26. Department of Genomics, Life and Brain Center, University of Bonn, D-53127 Bonn, Germany.
- ^ Stárka L, Cermáková I, Dusková M, Hill M, Dolezal M, Polácek V (2004). "Hormonal profile of men with premature balding". Exp. Clin. Endocrinol. Diabetes. 112 (1): 24–8. doi:10.1055/s-2004-815723. PMID 14758568.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ Demark-Wahnefried W, Lesko SM, Conaway MR; et al. (1997). "Serum androgens: associations with prostate cancer risk and hair patterning". J. Androl. 18 (5): 495–500. PMID 9349747.
{{cite journal}}: Explicit use of et al. in:|author=(help)CS1 maint: multiple names: authors list (link) - ^ Ellis JA, Panagiotopoulos S, Akdeniz A, Jerums G, Harrap SB (2005). "Androgenic correlates of genetic variation in the gene encoding 5alpha-reductase type 1". J. Hum. Genet. 50 (10): 534–7. doi:10.1007/s10038-005-0289-x. PMID 16155734.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ Signorello LB, Wuu J, Hsieh C, Tzonou A, Trichopoulos D, Mantzoros CS (1999). "Hormones and hair patterning in men: a role for insulin-like growth factor 1?". J. Am. Acad. Dermatol. 40 (2 Pt 1): 200–3. PMID 10025745.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ McElduff A, Hitchman R, McElduff P (2006). "Is sex hormone-binding globulin associated with glucose tolerance?". Diabet. Med. 23 (3): 306–12. doi:10.1111/j.1464-5491.2005.01780.x. PMID 16492215.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ Cordain L, Eades MR, Eades MD (2003). "Hyperinsulinemic diseases of civilization: more than just Syndrome X". Comp. Biochem. Physiol., Part A Mol. Integr. Physiol. 136 (1): 95–112. PMID 14527633.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ Daly W, Seegers CA, Rubin DA, Dobridge JD, Hackney AC (2005). "Relationship between stress hormones and testosterone with prolonged endurance exercise". Eur. J. Appl. Physiol. 93 (4): 375–80. doi:10.1007/s00421-004-1223-1. PMID 15618989.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ Ara, I.; Perez-Gomez, J.; Vicente-Rodriguez, G.; Chavarren, J.; Dorado, C.; Calbet, J. A. L. (2006). "Serum free testosterone, leptin and soluble leptin receptor changes in a 6-week strength-training programme". British Journal of Nutrition. 96 (6): 1053–9. doi:10.1017/BJN20061956.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ Fischer TW, Hipler UC, Elsner P (2007). "Effect of caffeine and testosterone on the proliferation of human hair follicles in vitro". Int. J. Dermatol. 46 (1): 27–35. doi:10.1111/j.1365-4632.2007.03119.x. PMID 17214716.
{{cite journal}}: CS1 maint: multiple names: authors list (link)
Bibliography
External links
- International Society of Hair Restoration Surgery Resources for finding doctors, and more information about hair loss. This is one of the leading organizations in the world on hair loss.
- Scow DT, Nolte RS, Shaughnessy AF (1999). "Medical treatments for balding in men". Am Fam Physician. 59 (8): 2189–94, 2196. PMID 10221304.
{{cite journal}}: Unknown parameter|month=ignored (help)CS1 maint: multiple names: authors list (link) - Commercial treatment reviews Examines hair loss products, and the claims made by their manufacturers.
- How Hair Replacement Works Covers oral medications, hair transplant surgery, and topical treatments.
- Alopecia UK
- Help 4 Alopecia
- [1] USA Today article examining the impact of baldness on career success.