Androgenic Alopecia (AGA) or male pattern hair loss is a common issue experienced by many men and can occur as early as the early 20s. AGA is a gradual process in which the follicle or root of the hair progressively becomes unhealthier. Rather than falling off rapidly, the hair strands slowly become thinner as the follicle loses its ability to support hair growth. Once the hair has become too thin to remain rooted within the follicle holding it, the hair eventually falls off.
Unfortunately, once the hair falls off and the follicle dies, there is no way to reverse the process and the area of skin becomes what we know as a bald spot.
The main hormone that has been identified as causing this process is Dihydrotestosterone (DHT). DHT as the name suggests is a derivative of Testosterone and is found naturally in the system. For reasons still unknown, DHT increases the rate of hair shrinkage and follicle death especially in the hairline and crown but not the back of the head.
How do I know if my hair is thinning?
Most of the time, it is the partners or family members that notice a receding hairline or that your hair is thinning. However, simply running your fingers through your hair can give you some idea of the overall thickness of the hair in that area. Thicker hair means the follicles are still healthy while thinner hair may be a sign that you may start to bald soon. Also, if you are losing more than 100 strands of hair a day, this is a problem. In the clinic, the doctor can use a magnifying device to scan through your scalp and assess how healthy your hair and the follicles are.
Doctors also commonly use the above scale know as the Norwood Scale for Male Pattern Balding to stage the severity of hair loss.
What can be done?
The are 3 general approach to treating AGA
- Slow down the hair thinning and follicle death
- Reverse hair thinning
- Transplanting new hair into areas of follicle death
Slow down the hair thinning and follicle death
Oral medications that slow down the conversion of Testosterone to DHT are used to reduce the amount of DHT in the scalp. When the hair follicles are exposed to less DHT, they remain healthy and can support the growth of thick strands of hair. This group of oral medications are called 5-Alpha Reductase Inhibitors, the 2 commonly used ones are
- Finasteride
- Dutasteride
While these medications have been shown to reduce DHT levels and improve hair growth, there is also a risk of developing Erectile Dysfunction as a side effect of these medications. A review of the clinical trials done with these 2 medications show the risk of developing ED is about 1.5 – 4%. This does go away albeit with some time after stopping the medication. However, there have also been reports that this side effect can be permanent.
Reverse hair thinning
Topical Minoxidil
Topical treatment of Minoxidil has also been shown to not only slow down but reverse the process of hair thinning. Although the mechanism of how it does this is unknown, clinical trials have shown that topical application of 2% or 5% Minoxidil solution to the scalp was able to increase overall hair counts with 5% Minoxidil being more effective than the 2% formulation.
The main side effect to Minoxidil is scalp irritation, the improved foam preparation is free of propylene glycol and does prevent this issue.
Because it takes time for the medication to accumulate in the scalp and effect change, it is important that you keep using Minoxidil twice a day for at least 4 months before assessing its efficacy.
Regenera
Autologous Skin Micrografting is a new way of reversing the process of hair thinning. This method is done by taking micrografts (samples of skin from healthy areas of your scalp – usually the back of your head), processing them to extract stem cells which have the ability to rejuvenate the hair and follicles. The extracted stem cells are then injected into the areas of the scalp where the hair is thinning.
This is done in the clinic and only takes 30 – 45 minutes and only requires a single treatment.
I liken this treatment to adding fertiliser to the soil, the stem cell solution provides extra nutrients for the unhealthy areas of your scalp. Overtime, the stem cells help improve the condition of that area of the scalp and allow the hair to grow better.
I do find that this treatment works especially well when used in combination with Minoxidil.
Oral Proteoglycan Supplements
There has been a lot of science and research into the role proteoglycans play in the scalp to support hair growth and repair. Now Oral Proteoglycan Supplements are available that can stimulate hair regrowth. This supplement is usually taken at a high does for 4 to 6 months. Then reduced to a maintenance dose.
Transplanting new hair into areas of follicle death
Moving hair follicles from well growing areas to the areas where the follicles have already died is a surgical procedure done under local anesthesia. It tends to be less popular as the procedure takes 4 – 6 hours.
In the past, plastic surgeons used to take whole segments of skin and graft them on the bald areas. Now individual follicles or strips of follicles are removed and planted into the deficient areas.
The scarring from the newer methods of follicle implantation is much lesser than the surgeries done previously
In Summary
In summary, there are a range of options for treating AGA. However, the most important thing to do is to identify the problem early. AGA is a gradual process hence, picking it out early does increase the chances of being able to slow down or even reverse the process.
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