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The
Cause and Treatments of Genetic Hair Loss
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The
Hair Growth
Cycle and the Stages of Hair Loss
In most mammals, hair does not grow continuously, but undergoes
a cycle of activity involving periods of growth, rest and shedding.
On the human scalp, from 100,000 to 350,000 hair shafts experience
three growth stages:
(I) Growth phase
during which the hair root bulb penetrates deep into the dermis
with the cells of the bulb dividing rapidly and differentiating
in the process of synthesizing keratin, the substance of the
hair shaft itself. In normal humans, this growth phase is thought
to last from one to five years;
(II) Transitional phase
is marked by the cessation of mitosis, or cell division within
the root bulb. This phase lasts from two to three weeks; and
(III) Resting phase
during which the hair is retained within the scalp for up to
12 weeks before the emerging new hair developing below it dislodges
the shaft from its follicle.
Hair loss can begin in men as early as their 20's and women
in their 30's and 40's. The first sign is hair becoming finer
and shorter. With time, the ratio of growing hairs to resting/shedding
hairs shifts from 9:1 to 2:1.
- The
Cause of Male Pattern Baldness (Androgenic Alopecia)
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Male
Pattern Baldness affects 50% of men and 30% of women in the
United States. It is generally accepted that genetic hair loss
in men and women arises from an inherited predisposition to
circulating androgenic hormones which produce DHT from testosterone,
a steroid hormone that circulates and is found in hair follicles.
DHT interferes with the normal growth of keratin protein within
the root bulb and causes the follicle itself to atrophy. The
enzyme 5 alpha reductase is required for DHT to be produced.
Compounds which selectively block both forms of this enzyme
have a high success rate at halting premature hair loss.
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Minoxidil
(Rogaine®) Therapy
In the late 1980's the Upjohn Company received FDA approval
to market Rogaine® (minoxidil) as an anti-baldness therapy.
Its active ingredient is a 2% to 5% solution of minoxidil (originally
prescribed as an antihypertension medication), applied as a
topical solution to the scalp. While retardation of hair loss
is widely reported (90% in the clinical trial), actual new hair
growth occurs among only 10% to 15% of users. Older men are
less likely to see results than younger ones, and hair regrowth
is reported only on the crown portion of the scalp, not at the
temples. Compounding the low regeneration rate is the risk of
subjects developing heart lesions, headaches, weight gain and
facial hair (among women) with continued use. Women are not
advised to use the 5% solution.
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Merck
& Company’s Propecia® (finasteride) is a 4-aza-steroid
analogue of testosterone which acts to bind 5aR type 2. It is
a prescription product taken in tablet form at a dose of 1 mg
per day. Eighty-one percent of those who used the active product
in clinical trials reported some hair growth after two years
based on counting hairs (versus the control group’s 46% showing
some hair growth) However, only a 10% gain in total hair shafts,
or 138 hairs of 880 base hairs, was reported by the Propecia®
users.
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Propecia®
is contraindicated for women as a teratogenic, having been shown
to cause birth defects in the male genitals of primate offspring
whose mothers received the drug during animal testing. Possible
side effects for men, though very rare, include decreased libido
and possible impotence. While the clinical trials reported these
conditions occurred in only 1% to 3% of users, many men are
not willing to take the risk. Women are advised not to make
contact with the pill.
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