Those suffering from baldness seek effective hair loss treatments to prevent further thinning and stimulate regrowth of the affected hair. However, many walk away disappointed as the core issue has not been addressed accurately. This is where an integrative medical approach is necessary. Written by Dr Sly Nedic…
Androgenetic Alopecia (AGA), or male pattern baldness, is a disease characterised by early hair thinning and loss. This is the most common form of alopecia in all ethnic groups, affecting up to 80% of men and 20-40% of women.
While initial signs of androgenetic alopecia usually develop during the teenage years, hair loss generally occurs between the age of 20 and 30 by gradual thinning and loss in the hairline and crown area. Its frequency increases with age, with many times being a sign of other health issues.
It has been noted that early-onset AGA is a strong predictor of the premature onset of severe coronary heart disease and cardio-metabolic syndrome, as well as prostate cancer and high blood pressure. What’s more, people with high BMA (body mass index) may suffer from severe AGA and progressive thinning of hair, often causing psychological distress in patients presenting with AGA.
How does baldness develop?
The hormone dihydrotestosterone (DHT) is the primary hormone responsible for the chain of events that results in hair loss in men and women. DHT is produced by the conversion of testosterone which is induced by the enzyme 5-alfa reductase. Simple binding of DHT to the androgen receptor (AR) in the hair follicle is responsible for hair loss.
The hair on the back of the head does not contain these receptors, which is why it is always spared. After DHT-binding to the receptor occurs, the hair’s growth phase becomes shorter, while the telogen-resting phase becomes extended. This leads to gradual miniaturisation, or shrinking, of the hair follicle, and is then followed by the development of fibrous tracts.
Ultimately, the hair loss is caused by the miniaturised hair follicle falling out – a process that is progressive and irreversible, if left untreated.
What is the cause of baldness?
Male pattern baldness, or AGA, is a multifaceted disease with a strong genetic component. There is scientific evidence that a genetic variation in the AR gene on the X chromosome (rs6152) is associated with the premature onset of baldness (Hillmer et al. 2005), meaning that maternal inheritance is significant. It has also been found that genetic variations in a region on chromosome 20 play an additional role (Richards et al. 2008).
Hormone levels (in women,) stress, diet, and nutritional depletion also seem to influence AGA’s evolution. With 85% of this disease being genetic or inherited, it would seem as if nothing can be done to cure it.
However, this is exactly where the options and advancement of cutting-edge integrative medicine come to the fore.
Challenges in treating baldness
Hair loss in androgenetic alopecia is irreversible. Therefore, identifying genetic predispositions as early as possible, together with the introduction of the early personalised intervention, is the only way of effective prevention in stopping premature hair loss.
Since baldness is a naturally progressive disease, therapy should be orientated towards three required outcomes:
- Stopping hair loss;
- Induction of hair regrowth; and
- Hair restoration in bald areas.
Patients suffering from baldness seek effective hair loss treatments that undertakes to not only prevent further thinning but which will stimulate regrowth of affected hair as well. Unfortunately though, inadequate diagnosis, lack of genetic counselling, (or perceived limited efficacy of a therapeutic regime), and possible adverse events to conventional treatment, may all result in a premature stopping of treatment, disappointment, and lack of compliance.
The Integrative medical solution to baldness
For all patients suffering from baldness, it is crucial to be adequately educated about the disease. Counselling is required to address lowered self-esteem and lowered quality of life, particularly in women and younger male patients.
The progression of hair loss is divided into various stages depending on the severity, namely (1) the Ludwig scale for women; and (2) the Hamilton-Norwood scale for men. Explanations to patients on which stage on the scale they are currently, goes a long way in helping them be realistic about the successes of interventions and in making the decision to undergo hair transplants, that much easier.
A genetic screening test for AGA, which helps identify patients at high risk for this disease, offers the possibility to start a medical treatment before visible signs of hair loss actually appear.
Identifying a genetic predisposition provides great insight into how progressive baldness is in each individual and how far the baldness will advance. If we want to stop hair loss effectively, we need to know how fast we are heading towards that very outcome.
Stop DHT activity on receptors
Understanding the cause of any disease is essential for its cure, and in the case of AGA, this implies stopping DHT activity on a receptor.
Since this problem is genetic and we cannot change the sensitivity to DHT activity, we need to apply additional intervention to attenuate hair receptor sensitivity to DHT, aiming to stop hair loss.
Integrative medical practitioners will use purpose botanicals for this, as the latter has no side effects. Unfortunately, these botanicals need to be used indefinitely as genetic predisposition will persist.
In male-pattern baldness, hair micrografting with progenitor cells, and microinflammation in the follicular bulge will enhance the disruption of stem cells, resulting in irreparable damage.
This means the follicle will never grow new hair. Before the process of hair thinning develops further, we can induce hair regrowth with a micrografting process, where we use progenitor cells (stem cells related group), harvested from nearby tissue (fat tissue in the neck area) that has the potential to differentiate into hair cells.
This process will induce hair regrowth in the area where the hair is affected, but not yet lost, and can act as a stand-alone therapy or supplementary to a hair transplant.
Conventional medical treatment with minoxidil and finasteride
Minoxidil remains the mainstay of therapy by conventional doctors for AGA in men. This medication, which is used for the treatment of high blood pressure, is found to have a side effect of hair growth, amongst others. Integrative physicians, who always find the cause and treat the reason in the most non-harmful way, are reluctant to use pharmaceutical drugs that do not have any relationship with the cause of baldness.
Side effects and indefinite use for sustainable results contribute to the premature stopping of treatment and lack of compliance. Finasteride, a pharmaceutical drug that blocks 5-alfa reductase activity and DHT sensitivity of hair follicles, is a potent drug in stopping hair loss. However, its debilitating side effects are the reason for low compliance by patients and limited use by integrative physicians.
Nutritional supplements rich in amino acids, trace elements (Cu, Zn, Iron, etc.), and vitamins, including biotin, are considered beneficial as a supporting treatment for AGA.
Hair transplant and Robotics in hair restoration
The ultimate goal for every patient with baldness is to restore hair in the bald area permanently. Patient selection for hair transplantation is crucial for a successful outcome.
According to standard guidelines, hair transplantation can be done in any person with pattern hair loss, good donor area, good general health, and reasonable expectations.
However, one should exercise caution in young patients with early, evolving alopecia and patients with Norwood grade IV and higher.
More inspirational in South Africa is the presence of robotic hair transplants. This state-of-the-art hair transplant offers major upgrading on hair restoration with more natural results.
The robot uses sophisticated imaging technology that can determine the location, angle of the growth, and direction of each follicular unit and plan a random pattern to extract them. With this approach, it is virtually impossible to detect the harvesting site once the healing is over, and patients are delighted to know that their donor site will not have any scarring or look unnatural.
Furthermore, robotic technology precision allows harvesting a much higher amount of healthy hair (less transaction rate) in a much shorter period.
The advantage for patients is that they will get nearly all extracted hair in a healthy condition with excellent safety, once any human error is eliminated.
Platelet-rich plasma also has a place as a supporting procedure for AGA patients. The patient selection remains crucial in PRP, and the procedure should not be prescribed for all patients with AGA. In a hair transplant, PRP can be the correct holding solution for the grafts.
However, some research has concurred that it is unsustainable in the long term and can only be used for a maximum of 6 months.
Although causes of baldness might not be curable, modern integrative medicine provides ample and appropriate interventions for all desirable effects in managing baldness: from stopping the hair loss, or enhancement of hair regrowth to permanent hair restoration with robotics.
Resources www.8thsense.co.za. References available on request.
Written by Dr Sly Nedic – MBChB (Bel)
- Founder of 8th Sense Medi-Spa, Sandton www.8thsense.co.za
- Board-certified doctor of WOSAAM (World Organisation of Society of Anti-Ageing Medicine)
- Member of IHS (International Hormone Society)
- Member of A4M (American Academy of Anti-Ageing Medicine)
- Faculty member of Preventive Genetics- Laboratories Reunis, Luxembourg
A2 Disclaimer: This article is published for information purposes only, nor should it be regarded as a replacement for sound medical advice.
This article was written by Dr Sly Nedic and edited by the A2 team EXCLUSIVELY for the A2 Aesthetic & Anti-Ageing Magazine Autumn Edition (Mar-Jun 2021. Issue36).
A2 Magazine prints only four magazines each year – reporting seasonally on everything you need and want to know about aesthetics, anti-ageing, integrative medicine, quality and medical skincare, cosmetic dentistry and cosmetic surgery in South Africa – where to go, who to see, what to expect, something new and so much more! Never miss an edition – click here for more info about where you can buy the print and/or digital copy of A2 Magazine (including back copies).
To make use of our content for re-publishing, kindly contact us for approval firstname.lastname@example.org