What is Genetic Hair Loss?
Cells are the basic structural and functional unit of the human body. These cells carry ‘genes’ in the cell nucleus. These genes (DNA) have information from the mother, father, and their previous ancestors also. Many factors contributed to the health of the person, but family history plays a significant role. Some of the diseases are directly inherited from the parents (Hemophilia, cystic fibrosis, etc.), and some can be affected by genetic history. Hypertension, diabetes mellitus, and androgenetic hair loss are examples of such diseases that are precipitated by a defective lifestyle. Still, genetics plays an essential role in their pathogenesis.
Hair loss or baldness is also known as alopecia. The main causes behind hair loss are genetic and hormonal. Hormones secreted by gonads and adrenal glands, i.e., androgen(testosterone) when converted to Dihydrotestosterone (DHT) are responsible for miniaturization of hair in genetically prone individuals, so this type of hair loss is known as “androgenetic hair loss”. Such type of hair loss is much more common in men as compared to women.
Hair loss is widespread now in the younger population also. It may be due to other factors like nutritional deficiencies and stress, but genetic predisposition plays an essential role in hair loss due to any of the causes. According to one study, hair loss due to androgenetic reasons starts as early as 14.
The incidence of hair loss is around 11% in patients below the age of 20 years. It increases as age advances; in the age group of 26-45 years, it is 40% which rises to 57% at 60 years of age. A person looks older than his age if he suffers from baldness; in such cases, it causes psychological disturbances and depression, and he may not be able to concentrate on his/her work. In the older age group, it can be accepted as a part of natural aging.
Reasons Behind Genetic Hair Loss
Clinically androgenetic hair loss starts with thinning of hair and a recession of anterior hairline in males and thinning hair in the central part of the scalp with increased parting width and preservation of hairline in most females.
As the grade of baldness increases, there will be hair loss in the mid-scalp and crown in males, but the back of the scalp (occipital area) remains unaffected. It is due to a lack of receptors for androgen (DHT- dihydrotestosterone) in the occipital region.
There are three types of enzymes in the dermal papilla cell of the hair follicle. These are 5 alpha-reductase I, 5 alpha-reductase II, and aromatase.
5 alpha reductases I and II are responsible for converting androgen(testosterone) into DHT (dihydrotestosterone). In genetically prone individuals, even the average level of DHT can cause significant hair loss. Factors increasing level of DHT will further increase hair loss, use of anabolic steroids for muscle building or too much of gym is an example for increasing DHT level. Some of the herbal medicines like Saw palmetto reduces DHT level and thus helps in controlling hair loss.
Can Genetic Hair Loss Be Cured?
Unfortunately, there is no permanent cure for genetic diseases, so it is valid for hair loss also.
A most important point to understand here, hair loss is a multifactorial disease. If any factor responsible for hair loss is there in a genetically prone person, it may result in early hair loss. We can control or delay the process of hair loss by treating these factors.
A sedentary lifestyle is responsible for various health issues in humans, obesity, hypertension, diabetes mellitus is all interrelated, but they can be very well controlled by taking preventive measures like a healthy lifestyle. A healthy lifestyle means eating healthy food, exercising daily, and managing stress by yoga, pranayama, and dhyana properly. It will help in reducing oxidative stress at the tissue level and keep a person healthy. Hair is the mirror of one’s health. If you are happy and healthy, your hair will also improve accordingly.
Protein, vitamins, and essential minerals like iron and zinc play a crucial role in maintaining hair health. Healthy hair can reduce the negative impact of environmental factors and genes by keeping hair healthy.
Also, USFDA approved medicines help to control hair loss and reverses miniaturization in androgenetic hair loss.
Finasteride – it is a 5 alpha-reductase II inhibitor, so it decreases DHT formation from testosterone and thus helps in hair growth.
It is used in androgenetic alopecia in men at 1mg per day, and in post-menopausal females, the dose of the drug is 5 mg per day. Its effect starts appearing after 6 months of its use, and maximum results are seen after 12 months.
Side effects are decreased sexual desire in 1% of the cases. Enlargement of breast or gynecomastia is a rare side effect.
Finasteride has a plasma half-life is only 6-8 hours it means after taking a tablet of finasteride, it will be there in the patient’s blood for only 8 hours. If a patient feels any of the side effects, he can stop its use, and these effects will be reversed.
Precaution – it should not be used by pregnant females.
Minoxidil – Minoxidil is used for topical application in both men and women. It is the only USFDA approved medicine for female pattern hair loss. Minoxidil is available as 2% and 5% solution, gel, and foam.
Dose for men – 5% application on the affected areas of the scalp twice daily.
For women – 2% application twice daily or 5% once a day.
Minoxidil increases the duration of the anagen phase and thus increases hair growth and improves density.
Precaution – it should not be used by pregnant females.
Other Treatments To Control Hair Loss
PRP- Plate-rich plasma – It promotes hair growth by releasing various growth factors, which stimulates stem cells present in the dermal papilla.
Exosomes-EVs – More studies are required to understand its effect on hair growth.
LLLT- Photo biomodulation – low light laser therapy- stimulates photoreceptors and thus increases hair growth.
Dutasteride is both a 5 alpha-reductase I and II inhibitor; it reduces DHT level to more than 90 % but has more side effects.
Oral minoxidil – useful for those who are allergic to topical applications.
Anti-androgens – Cyproterone acetate and spironolactone.
In a nutshell, we can say that Androgenetic hair loss is usually precipitated by some other factor like some illness, mental stress, nutritional deficiency, or environmental factor. We cannot wholly cure genetic hair loss, but by treating underlying precipitating factors, we can control and delay the process of androgenetic hair loss.