What causes male pattern baldness? - BaldTruthTalk.com
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  1. #1
    Senior Member gmonasco's Avatar
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    Question What causes male pattern baldness?

    I was reading the Wikipedia article on androgenic alopecia (i.e., male pattern baldness), and it contains the following passage about the causes of MPB:

    Male pattern baldness is caused by a genetic sensitivity of hair follicles to DHT, which causes them to shrink or "miniaturize" when exposed to it. This shortens their lifespan and prevents them from producing hair normally.

    Recently the existing theories have been challenged on the ground that while the androgens in question are responsible for hair growth on the face and all over the body of men, hair loss is only occurring at the top of the scalp. In a new theory it has been propounded that androgenic alopecia is a counterproductive outcome of the anabolic effect of androgens. It explains how hormonal changes in males lead to structural changes in skin and scalp which in turn cause hair loss.
    I'm not sure I understand what the second paragraph is trying to say. Can anyone explain it in simpler terms? It sounds like some are maintaining that DHT doesn't actually cause MPB because the only hair loss in MPB is at the top of the scalp rather than all over the body, and it's actually some other hormonal changes that are causing MPB.

  2. #2
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    I would ignore this 2nd paragraph. If you look at it you will notice it has a reference to an article. That is just the authors' theory on hair loss. Which doesn't make it right.


    Yesterday I also read a bunch of wikipedia articles about baldness and hormones because I had an appointment with an endocrinologist. This is what I could assemble from different articles:
    Androgenic alopecia is related to hormones called androgens, particularly an androgen called dihydrotestosterone (DHT).
    In women, the hair becomes thinner all over the head, and the hairline does not recede. This is dubbed "Female pattern baldness" and may occur in males.
    Male pattern baldness is caused by a genetic sensitivity of hair follicles to DHT, which causes them to shrink or "miniaturize" when exposed to it. This shortens their lifespan and prevents them from producing hair normally.

    Men with androgenic alopecia typically have higher levels of 5-alpha-reductase, lower levels of total testosterone, higher levels of unbound/free testosterone, and higher levels of total free androgens including DHT.
    5-alpha-reductase is responsible for converting free testosterone into DHT. The 5-alpha-reductase enzymes are present predominantly in the scalp and prostate.
    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 (ie, decreased the quantity) by insulin.
    Increased levels of Insulin Growth Factor-1 (IGF-1) have been correlated to vertex balding.
    Lower insulin levels and reduced stress both result in raised levels of sex hormone-binding globulin (SHBG). SHBG binds to testosterone.
    Only free testosterone improves muscle growth and insulin sensitivity, but free testosterone can also be converted to the ineffective (regarding insulin sensitivity) DHT. The levels of free androgens and not of total androgens are relevant to the levels of DHT in the scalp and the progression of male pattern baldness. In short, aerobic exercise is capable of significantly lowering DHT.
    Androgenic alopecia correlates with metabolic syndrome because typically bald men have low testosterone levels (hypogonadism) which can easily trigger also diabetes mellitus and erectile dysfunction. [...] behaviors which help to keep insulin levels low and reduce chronic inflammation might also help to preserve hair.

    Dihydrotestosterone (DHT) is an androgen, synthesized primarily in the prostate gland, testes, hair follicles, and adrenal glands by the enzyme 5α-reductase.
    DHT is the primary contributing factor in male pattern baldness. DHT plays a role in the development and exacerbation of benign prostatic hyperplasia, as well as prostate cancer, by enlarging the prostate gland. Prostate growth and differentiation are highly dependent on sex steroid hormones, particularly DHT.
    The drugs belonging to the 5α-reductase inhibitors group are commonly used for the treatment of those conditions. Dutasteride is approved for the treatment of BPH and is prescribed off-label for the treatment of MPB, whereas finasteride is approved for both conditions. Dutasteride is three times more potent than finasteride in inhibiting the Type II enzyme and 100 times more potent than finasteride in inhibiting the Type I form of the DHT-producing enzyme.
    Inhibition of 5-alpha reductase results in decreased production of DHT, increased levels of testosterone, and, perhaps, increased levels of estradiol. Gynecomastia is a possible side-effect of 5-alpha reductase inhibition.
    So it seems I have female pattern baldness, even though I'm male.

  3. #3
    IAHRS Recommended Hair Transplant Surgeon Dr. Lindsey's Avatar
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    With rare exceptions, male baldness is a combination of bad genes and bad luck. Not water, vitamin deficiency, diet, radio waves hitting the scalp, or cell phone use....all of which have been alledged to cause baldness by people seeing me since Jan 1 2011. Not counting the hypotheses that I heard last year or the year before or...

    You get your genetic potential for MPB from both parents. If everyone in both sides of your family is bald, I'd say you have bad genes (with regard to your potential for hair loss). If noone is bald, you have good genes. But as many bloggers know, there are gobs of examples of bald families with one kid having a full head of hair AND there are gobs of examples of hair filled families with a bald decendent. That is the luck component.

    Its probably genetic also, but scientists are not yet able to detect the nuances of the genetic code and all of the pre-destined variables one is "born with".

    So, as all patients to my office hear: If you have good genes, you may have good luck and not need much hair or any at all. But if you have bad genes, you ought to be conservative about how you spend your donor hair as you may need alot of it in the future. Which means, for younger patients with a significant history of major hairloss in their family, I'd push for a very conservative hairline, and avoiding the crown until it looks like the front is not "going".

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    Quote Originally Posted by gmonasco View Post
    I'm not sure I understand what the second paragraph is trying to say. Can anyone explain it in simpler terms? It sounds like some are maintaining that DHT doesn't actually cause MPB because the only hair loss in MPB is at the top of the scalp rather than all over the body, and it's actually some other hormonal changes that are causing MPB.
    The way I read that paragraph, the bit on counterproductive in particular is, the androgenic effects imputed by an increase in androgens within the body such as hair on the face and body produces a strangely counterproductive side effect of having less hair on the scalp.

    Is that right? Because if it is I sort of already knew that, we know from the research conducted by Follica at the start of this year that something goes wrong with the stem cells in the scalp, they are still present and are only producing microscopic hairs, so technically even bald NW7 men have thousands of microscopic hairs on their balding heads, we just need to find the correct intracellular pathway to reignite those faulty stem cells back into action, and by action producing the more mature protg cells which give life to new hair.

    I really believe the new treatments will come in the form of addressing the genes through forms of gene therapy such as Histogens HSC as opposed to addressing the hormones (Propecia etc), this seems to make more sense.

  5. #5
    Senior Member gmonasco's Avatar
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    Question

    I don't know if it ties in, but (as I think I've posted before) the differing efficacy of finasteride at holding off hair loss (i.e., it works best in the vertex, not nearly as well on the midscalp, and hardly at all in the hairline/temples) has led some to speculate that perhaps the forces behind hair loss also differ -- that perhaps it's something other than DHT (or other than DHT alone) which causes hair loss in the hairline/scalp as opposed to the vertex.

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