Options to Restore Fuller Hair

Androgenetic Alopecia (AGA), also known as common pattern hair loss is thought to affect forty million American men.  Less well-known is that it probably affects more than twenty million American women.    Characterized as a complex trait disorder, AGA manifests as a result of three key factors, genetics, age, and circulating hormones.  In women, the confluence of these factors generally arrives sometime in the fourth or early fifth decade of life.  

In contrast to affected men, when women lose hair they usually don't develop a distinct bald spot coupled with bilateral anterior temporal recession.  Instead, a general loss of density heralds the transition from healthy vibrant growth to much thinner coverage.  Over time, it can become difficult to cover the thinning areas and clinical pattern hair loss becomes increasingly evident. 

Historically, wigs (hair replacement systems) were the first go-to for women, and also men.  The advantage of a hair system is the immediacy and dramatic increase in density which may be accessed.  The disadvantages are myriad.  Wigs are uncomfortable, hot, itchy and destructive to the underlying scalp.  If a woman wasn't nearly bald before regularly wearing a wig, often she was after.  

Surgical hair transplantation is another treatment option available to either gender.  The technique of moving hair bearing skin tissue grafts from one part of the scalp to another dates back at least 50 years.   However, because hair loss in a woman can extend across the lower and rear portion of the scalp, this choice may not be as useful as it is for a man.   Moreover, since there is a fixed supply of permanent donor hair which may not be sufficient to fill the area of demand, the potential for "running out of donor hair" is a valid caveat.  In men, the opportunity to restore the balding scalp may be confounded by the progressive nature of the disorder.  Here, balding areas in the front of the scalp may be restored only to reveal progressive balding behind the area where hair grafts were placed.  This is known colloquially as ‘chasing a receding hairline’.   When donor hair bearing tissue is exhausted it can leave the patient looking somewhat more unnatural than if he’d simply allowed the hair loss process to proceed unhindered.  Even worse, the potential for a terribly dysaesthetic outcome is dramatically amplified when those with poor artistic skill are employed as transplant surgeons.  

Aside from surgical restoration and/or hair replacement wig systems, the two most common ways to treat pattern hair loss, also known as androgenetic alopecia (AGA) are medical drug-based therapy and non-drug botanical therapy.

Two general approaches have been taken with the drug-based approach. The first is the blockade of the androgen precursor enzyme 5 alpha reductase (5AR). Two isoforms of 5AR have been identified, each distinct from the other by pH and tissue localization. 

Type 2 5AR has long been more strongly linked to pattern hair loss while type 1 5AR was thought to be less important. Recent studies indicate that the molecular biochemistry may be more complex. Although the functional significance of the differential subcellular localization of type 1 and 2 isoenzymes in the hair follicle is currently unknown, the present data suggest that both may contribute to phenotype in an additive or synergistic manner.

The oral 5AR blocking drugs presently approved by the FDA for treating AGA are finasteride, a selective type 2 5AR inhibitor and dutasteride, a dual 5AR inhibitor. Due to the potential for feminizing birth defects, neither finasteride nor dutasteride is indicated for use by women. Minoxidil, a vasodilator long used orally to treat refractory hypertension, is available for topical use on the scalp and, unlike the 5AR blockade drugs, is thought to operate in compromised hair follicles via modulation of the cellular energy intensive ATP-potassium ion channel.  Here, the most commonly reported negative side effects have included atopic dermatitis and pruritus.  Less commonly, more serious side effects have been reported from the use of minoxidil.  

Clinically, the best outcome for any hair loss treatment occurs early in the disease process. Advanced hair loss (where the follicle is essentially denuded) does not generally respond well to treatment.

Now we turn to botanically-based hair loss treatment therapy. The reader may already be aware that numerous drugs originated first either as natural extracts or molecules synthesized all or in part from naturally-based extracts. One of the most well-known examples is aspirin, derived from willow tree bark. The same principle applies here. Naturally-derived 5AR inhibitors have been described for many decades.  However, until a seminal published study undertaken in 2002 (http://tinyurl.com/ylh2cg3) this approach had never been tested in the setting of pattern hair loss. Subsequent to this work, a number of naturally-based hair loss treatments became available. Typically, such treatments have tended to rely on anecdotal or inferred evidence rather than direct critical analysis of each given formulation. One consequence of such a “marketing driven” approach is that the anecdotal and indirect evidence very often fails to live up to marketing claims.

Importantly, pattern hair loss is described in the medical literature as a complex trait disorder. This means that numerous genes, biochemical and environmental factors contribute to phenotype. Thus, and as has been shown through years of documented clinical evidence, 5AR blockade represents, at best, only a partial solution to AGA.  In our lab, over the course of the past several years, a great deal of work has been underway to investigate additional factors that play significant roles in hair cycling as well as the onset and progression of AGA. Quite recently we showed that certain forms of micro-inflammation were of key importance in disrupting hair follicle homeostasis. With this hypothesis driving us forward, a series of basic science experiments were undertaken with collaborators at the University of Albany. Key genes linked to pathogenic hair follicle inflammation were identified and various compositions interrogated for their ability to reduce the expression of these markers.

After much effort, a test formula was found to be highly effective in blocking pathogenic inflammation in a hair follicle analog. The outcome of this work was described in a 2011 published study which appeared in the well-respected medical Journal eCAM: http://ecam.oxfordjournals.org/cgi/content/full/nep102

A USPTO patent application was filed and the composition used as a foundation for the development of hair growth stimulating formulations. While a place certainly still exists for drug-based hair loss monotherapy, e.g. finasteride and/or minoxidil, new multi-modal botanically-based therapies such as described herein may offer a number of compelling advantages over the pharmaceutical alternatives.

In 2016, in coordination with investigators at the University of Chicago, we built upon this work, testing a novel set of naturally-based compounds against the benchmark hair loss drug finasteride.   Remarkably, our proprietary formulation outperformed finasteride in down regulating key genes shown to be operative in the onset and progression of pattern hair loss.  The work was subjected to peer-review and subsequently published in the medical literature: Phytother R. 2016 Jun;30(6):1016-20. doi: 10.1002/ptr.5611. Epub 2016 Mar 17.