I'm not saying it's not possible, But evidence hasn't been shown yet for increase of AR expression over time in the balding scalp. At least not that I know? Maybe FGF11 does.
Also remember I don't hypothesize that AR expression is the problem, FGF11 does. I'm more in the camp of cell cycle arrest or senescence that relies on indicative evidence shown in papers by various researchers. That would be my line of thinking. Pure hypothetical thinking of me though, I don't make claims or project it as the truth.
You make a interesting point about fibrosis. Before I didn't think it was such problem in AGA. Simply because fibrosis is literally scarring and too much scarring will simply destroy the hair follicle, just as we see in cicatrial alopecia. Cicatrial (scarring) alopecia consists basically of fibrosis that leads to complete destruction of the hair follicle that is seen as irreversible. Until, one day maybe we are able to induce morphogenesis of hair follicles that could potentially fix the problem in something like cicatrial alopecia.
Guess I was wrong and you make a very good point, I do think fibrosis plays a role in (advanced) AGA. When we look at a study of Domyati(1.) for example;
In the frontal bald area of AGA, perifollicular fibrosis consisting of loose concentric layers of collagen was generally absent in 16 cases (40%) or mild in 14 cases (35%) in young age with mild AGA (Figure 2c). It was more marked, even with destruction of follicular structures, in the old age group with advanced AGA. The arrector pili muscle may be retained (Figure 2d). Perifollicular fibrosis showed highly significant correlation with both age of the patients (r = 0.78, P < 0.001) and correlated significantly with the severity of baldness (r = 0.46, P = 0.003). It showed significant inverse correlation with perifollicular inflammation (r = )0.31, P = 0.048). In normal controls, neither inflammatory infiltrate, apart from sparse perivascular infiltrate in a few biopsies, nor perifollicular fibrosis was observed in all studied specimens.
In the frontal (bald) area of AGA, perifollicular inflammatory infiltrate was observed in the majority of cases (90%). Meanwhile, no fibrosis was observed in 40% and only 10% showed marked fibrosis and complete destruction of hair follicles in the old age group with advanced AGA. These results are close to those observed by El-Domyati who reported inflammatory reaction in female subjects with AGA with destruction of follicular structure and replacement by fibrous tracts in severe cases. Meanwhile, Abell26 reported an inflammatory reaction in 75% of balding patients, focal fibrosis in 25%, and destruction of follicular structures in 5%.
Kligman25 demonstrated that perifollicular fibrosis was due to deposition of concentric layers of perifollicular collagen. The perifollicular fibrosis was evidenced by degranulation of follicular adventitial mast cells as well as enhanced collagen production by neighboring fibroblasts which resulted in 2- to 2.5-fold enlargement of the follicular dermal sheath.27
So I do believe fibrosis can become a problem and in some advanced cases even in AGA can cause destruction of the hair follicle, which would make AGA irreversible in some (very advanced) cases. Only creation of new hair follicles would help in this case.
That being said out of all the studies I would personally place my bet that AGA is simply premature senescence. Everything that happens correlates with senescence imo, including the inflammatory aspect of AGA. I hope this evidence towards senescence is completely wrong though, cause that would be f*cked up.
One thing is for sure imo, if you can make sure you take preventative measures. You might regret it later if you don't.
1. http://www.ncbi.nlm.nih.gov/pubmed/19527330)
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