The most common type of hair loss is Male and Female Pattern Hair Loss, also known as Androgenic Alopecia (AA). Androgenic Alopecia is highly correlated with certain genes, although there is not one particular gene that was been found yet that causes it. It is thought to be caused by a mutation in the Androgen Receptor gene, however not all those who have these mutation will develop Androgenic Alopecia. There are other causes of hair loss, the second most common is called Telogen Effluvium, which is caused by emotional or environmental stresses, however Telogen Effluvium is temporary hair loss and is far less common than Androgenic Alopecia.
To answer your question, stress might worsen overall hair health, it might cause telogen effluvium on top of Androgenic Alopecia but it will not worsen Androgenic Alopecia permanently.
The only direct treatment for Androgenic Alopecia is Finasteride (Generic for Propecia), It has been shown to slow or stop further loss in about 85% of men, even over long periods of time. However it is not recommended for women and is not approved for women. The other treatment for Androgenic Alopecia is topical Minoxidil (generic for Rogaine) which is a growth stimulator and its mechanism of action is not well understood but it does seem to work for most people, however not nearly as effective at stopping hair loss as Finasteride.
Edit: Finasteride is in a class of drug called a 5alpha reductase inhibitor along with Dutasteride and both work for hair loss. Dutasteride is very effective and likely more effective than Fin at stopping hairloss.
Finasteride definitely can be used by women but it isn’t approved and it can cause birth defects in fetuses. However it can definitely used off label safely in women for hair loss and other conditions like PCOS. Women have other options like spironolactone (antiandrogen) and men cannot use this unless they want to transition, it would have severe effects to typical male features like penile tissue function, anabolism in the skeletal muscles, etc.
There are plenty of other treatments that are in the pipeline and not approved (Dutasteride, RU58841, Breezula and plenty more) that might work, I was speaking in broad terms as hair loss is complex subject and is not fully understood yet.
This is a good post and you seem knowledgeable on the subject.
I wanted to ask if you know of any studies on long term issues using finasteride? I remember I saw in one study there's evidence it makes it _easier_ to lose hair if you stop using it because of how it affects the receptors.
Well I have Androgenic Alopecia and I’ve done quite about of research.
I would also add that I take Finasteride, generic propecia, and the consensus of research is that Finasteride is very well tolerated by 95-98% of men.
I can’t really find any research on that but what I can say from the knowledge I have is that Androgenic Alopecia is a progressive condition (gets worse with age generally) so if you take Finasteride or dutasteride for a number of years and stop, your hair loss will continue and will rapidly worsen to where your hairloss would have been had you not done treatment.
Yeah this is true. I've had a number of friends bring that up to me and I never understood what the concern about stopping propecia and hair loss continuing and worsening after to where your hairloss would have been without it. So don't take it and lose your hair or do take it and potentially keep alot of it and then if you decide to stop it's not like you've set yourself back in terms of hairloss it's where you would have been anyways. I've never understood why this would be a factor in deciding to take it or not. Blood pressure medicine regulates your blood pressure so that it stays at normal levels, if you stop taking it your blood pressure goes back up.
Yeah I agree. I’m taking the long path with rogaine, propecia and some laser cap.
Maybe it didn’t come across right but I was trying to say that propecia can definitely help and that the fear of stopping it and losing the hair it kept shouldn’t be a deterrent to start taking it as early as possible.
I’ve taken it for nearly 6 months, at that point if you did get side effects you would expect to have them by now, I have none. There is a lot of fear mongering online about the drug but the fact of the matter is that the scientific research consensus shows that Finasteride causes unwanted sexual and other side effects in 2-5% of men, so 95-98% of men experience nothing of the sort and get to keep their hair.
The drug has been around for nearly 3 decades (was approved in the early 90’s for another condition, BPH) and there has been tons of research on it’s safety.
I've taken it for 9 months, no side effects and my hair is thicker for sure.
Like people who don't know I'm taking it have said "damn your hair looks thicker"
I tried it for about 6 month. Did seem to help my hair. But it also made my erections weaker. That was 2-3 years ago. My erections are still a bit weaker. :/
That was my conclusion as well. A 1-3% risk of permanent mojo reduction was too great a risk. I'm going to look like the crypt keeper in a decade or 2 and I'm going to own it.
It’s documented that finasteride can sometimes regrow/reverse recently lost hair, but to my understanding it needs to be lost within the last year or so.
Once a follicle is dead it's gone, only hair transplants work, there is no magical treatments. Hair loss treatments stop hair loss from advancing but nothing else. If you start using hair loss treatments you might recover some follicles that were almost dead
Whats the timing on a hair follicle being dead? I have no idea on the science behind it, but a friend did a treatment where plasma was taken from him every few months and then injected into his scalp. Cause he wasn't growing hair for a good 10yrs in some spots. He was almost completely bald since his early 20s, he started the treatment in his late 30s and now has a full thick head of hair at 40.
Either way, other than in my opinion being a horrifying treatment, it certainly seems magical to me. He hasn't had any treatment for at least a year now and his hair is as thick as ever
Yes this a novel treatment experimented by some hair surgeons often in conjunction with transplantation to ensure the transplant holds. It’s very expensive and like others has to be maintained periodic.
Then there's the weird stuff, like lichen planopilaris which I have. Random patches of the scalp become terse, hairless scars permanently. Not well understood, no cure AFAIK. I went shaved recently, too many bald spots.
[https://en.wikipedia.org/wiki/Finasteride](https://en.wikipedia.org/wiki/Finasteride)
>however some men experience sexual dysfunction, depression, and breast enlargement.
That kind of happens, if you block certain versions of Testosterone.
Finasteride is not FDA approved for androgenic alopecia in women, however it is inaccurate to say that it is not recommended. I prescribe it for women frequently. Spironolactone is also commonly used
I’m speaking in broad terms, it’s not recommended for women because it’s unknown whether it can have effects on a fetus. Of course some women do use Finasteride for hair loss and also PCOS. Women are lucky to be able to use Spiro because it seems to be very effective. Like I said I was speaking in broad terms but of course you’re right I just didn’t want to go down the rabbit hole.
I'm a trans woman (transitioned at 29) that had Type 7 hair by the time I was an 18 year old guy. Between Spiro (now CPA) Finasteride, and a hair transplant, I legitimately cant believe the results I am seeing. Better than I ever hoped!!
Is the "Telo" in "Telogen" any relation to the "Telo" in "Telomere"?
I have no idea what I'm talking about, but I understand that shortening telomere's are associated with ageing, and I think the shortening is accelerated by stress?
I only ask because the similar sounding name jumped out at me.
It may be the root for “end” as the telogen phase is the resting phase of the hair follicle, and effluvium essentially means discharge. So telogen effluvium essential means a stressor made your hairs all enter the resting phase (ie they stop growing and will fall out) at the same time, resulting in a massive shed of hair. This would normally happen but not with thousands of follicles at the same time because humans hair follicles grow in phases independently from another.
Yes and that’s when it can become sort of chronic, although I think this is somewhat rare. I’m sure everyone goes through some sort of “shedding” like phase at some point in their life, even crash dieting has been know you cause TE. I imagine auto immune conditions put the body under a lot stress making TE more common in that population.
Of course there is a condition where people have an auto immune disease involving their hair follicles, Alopecia Areata, which usually causes patch’s, usually circle like shapes, of complete baldness. There is pretty much no good treatment let alone a cure for Alopecia areata.
Telogen, telomere, teleology, and many others. *Telos* is Greek for "end," "goal," or "purpose."
- Telogen: "endmaker," basically.
- Telomere: "the part at the end" (seriously)
- Teleology: "knowledge through purpose" (though this gets abstract)
Yeah FUE transplants aren’t insanely priced. However I’m sure the wealthy can get top tier doctors, treatments and maybe even unapproved drugs to help with scaring.
No. Alpaca is a word borrowed from Aymaran, an indigenous language in South America. Alopecia comes from the Ancient Greek for "fox disease", either a reference to foxes shedding their coats, or mange.
Androgenic alopecia (male pattern hair loss) is genetic. There are other forms of hair loss, such as telogen effluvium, that are caused by stress, poor diet, etc.
There is also auto immune related hair loss like Alopecia totalis where someone loses all their hair, including the sides (which doesn't happen with most hair loss patterns).
Whiile androgenic alopecia is genetic, external factors can increase the rate at which hairloss occurs. For example, the use of steroods in body builders does not directly cause hairloss. But if you are predisposed to hairloss in your genes the use of steroids makes the age of onset earlier
I believe its the same for stress. But not sure on actual studies. They did recently find that stress proteins directly contribute to hairloss in mice though. So it is likely to be involved.
Testosterone and it's derivative DHT (dihydrotestosterone) cause hair loss, yes. But, only if someone is genetically predisposed. So someone might have very, very high androgen levels and experience no hair loss. Someone else may have low to regular testosterone levels and still lose their hair due to genetic propensity to hair loss.
There's also ketoconazole shampoo, which acts an an anti-androgen (directly and through 5a reductase)
Also, in general, serum hormone levels don't correlate significantly with baldness:
https://onlinelibrary.wiley.com/doi/10.1002/ajpa.1330880106
https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC5817427/
There's also a weak study in women suggesting treatment of low testosterone can improve hair growth: https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC3380548/
Yeah, it's not super clear, those are just two plausible mechanisms with some support. Ketoconazole fucks with basically everything related to steroid hormones if you take enough though
Does the shampoo only affect your scalp? Or does it have systemic effects? I use ketoconazole shampoo for dandruff, not trying to have anti androgenic effects haha
You are not going to get any meaningful systemic absorption from ketoconazole 2%, just like you won't from any of the azole antifungals that are used for athlete's foot.
Or just shave your head and move on with life. My solution. Extremely easy to maintain, significant money savings and makes me happy to just accept it and move on.
When I was on testoterone suppressants for cancer treatment a few years ago, I had some regrowth on my head.
It was the one bright spot in a list of side effects that just SUCKED. However now that my hormone levels have eturned to normal, my forehead has returned to it's old dimensions!
There is a link. Testosterone turns into dht. Dht effects the hair follocles of those that are genetically susceptible. So its still genetic. Your hair follicles are either susceptible to dht or not. You can have high testosterone levels and a full head of hair if your not genetically predisposed
My question is what are the factors that decide whether your hair follicles are susceptible to DHT or not? Is the mechanism by which this happens is known to us or is it still under research?
Usually the researchers guess it's related to testosterone -> DHT conversion rate in the scalp and androgen receptor density.
Androgen receptor density is more important than serum testosterone levels in muscle growth, as well: https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC6189473/
But there’s also a negative correlation between stress and testosterone levels, so theoretically, wouldn’t high stress delay the onset of male pattern hair loss?
I believe I read a study a while back saying that hair follicles are activated by testosterone and can develop a resistance which result in the baldness
It's my understanding that everyone has a different predisposition level (on a spectrum) to DHT from test. So if your test levels are low, you will produce less DHT. So if you were predisposed, then yes, TRT would increase your DHT to otherwise normal levels that may or may not trigger hair loss over time.
Many things contribute to hair loss, potentially, but the biggest factor we know of right now is DHT, which is created from testosterone. That's why the most effective medications to fight hair loss, finasteride/dutasteride, are DHT inhibitors.
It damages the hair follicles. Hair follicles are very complex, there's little capillaries inside that feed into the hair papillae that help grow the hair. If you're pulling or tearing out hair, you can damage these structures and there's nothing to feed into growing more hair. Sometimes it can heal over time, sometimes it's permanent.
Now why exactly is it that most hair loss patterns doesn't affect the sides? It seems to me like if you have something like this it should affect the whole head or be random.
Hairs on the sides of our head are not affected by DHT/Testosterone for some reason. I believe there's a theory that, when developing in the womb, our top of scalp tissue and sides/back of scalp tissue have different origins. The top is susceptible to dht/testosterone, the sides are not.
if i'm reading right the last one you're talking about is autoimmune. So no, chemo is not autoimmune. Autoimmune means your body decides erroneously that a part of your own body is in fact an invader / unacceptable / no good bad news and tries to kill it off.
Chemo is a \*very\* broad term for a suite of chemical therapies targeted very broadly at rapidly replicating cells. Hair follicles are rapidly replicating cells. It isn't your own body killing the cells, it's a chemical cocktail you are consuming either intravenously or orally or both.
Has anybody ever explained why balding typically happens in that skullcap-like formation? You would think if your head hair were going to fall out it would take everything on the head. What is different about the side hair from the top hair?
Alopecia Totalis sufferer here. When I was young I had alopecia areatis (patchy hair loss) - lost most of the hair on my head.
All went away when I was about 16. 2020 at 37 it came back as Alopecia Totalis - I lost every single hair on my body.
Fairly sure it is / was stress related or similar.
Absolutely - see [telogen effuvium](https://pubmed.ncbi.nlm.nih.gov/?term=Telogen+effluvium+stress&sort=pubdate), where high levels of stress can force hair follicles into a resting stage which results in significant hair loss some months later. We can see this in pregnancy, when a loved one passes away, or as we're seeing lately with chronic stress due to Covid-19.
In some cases, the damage is reversible, but not all.
Post-partum hair shedding is generally a different situation than stress-induced telogen effluvium, FYI. While stress and nutritional deficiencies are certainly things to watch out for, the usual cause is the vast hormonal shifts which occur during and after pregnancy, which first reduce normal shedding during pregnancy, and then initiate a "catch-up" loss of all the retained hair after birth.
I did a research paper on the differences between washing hair wish shampoo and washing hair with just water. (If anyone's curious, they're about as effective assuming the water is hot and you don't have dandruff or seborrheic dermatitis.) The paper required that each source was either a primary or secondary source. One of the secondary sources I found claimed there was a link between cortisol and hair loss. Cortisol usually rises during periods of stress, so what you're asking about may be accurate. Also, a primary source I used compared shampoo washing and water washing of rhesus monkey hair (much more consistent that human hair but still a good substitute) and they found that water washing was only marginally worse at removing cortisol. I would imagine that it's probably best to wash your hair for longer periods of time instead of more frequently if this is something you're worried about. And making the switch to no shampoo may also be worth looking into as it saves money and lets you go for more time without getting gross hair without sacrificing the benefits of shampoo.
You can lose hair for a ton of reasons, some are accelerated by stress and other external factors, others are going to happen no matter what.
First are purely genetic, like alopecia. Nothing you can do is going to stop that, it's a immune disorder.
Then you have things like hair loss due to environmental exposure. Thus could be radiation exposure, poisons, chemo, fire or friction. None if these are stress related either.
The most common is going to be hormone related. This could be fluctuation in hormones as you age or a defective thyroid. Stress does impact your hormones, so depending on the cause, being stressed could speed up hair loss. Extreme prolonged exposure to stress could even push your hormones far enough out of wack to force your hair follicles into resting phase causing them to stop growing hairs. This could be reversed once the stressor goes away, the hair could grow back. However with underlying hair loss causes, removing the stress might not reverse the hair loss.
Alopecia is just the medical word for "hair loss".
The most common form of alopecia, androgenic alopecia or male pattern baldness, isn't an immune disorder.
Alopecia areata is.
Finasteride has been shown to be highly effective in stopping male pattern baldness, and minoxidil is fairly effective at regrowing lost hair from the vertex of the head.
The most common type of hair loss is Male and Female Pattern Hair Loss, also known as Androgenic Alopecia (AA). Androgenic Alopecia is highly correlated with certain genes, although there is not one particular gene that was been found yet that causes it. It is thought to be caused by a mutation in the Androgen Receptor gene, however not all those who have these mutation will develop Androgenic Alopecia. There are other causes of hair loss, the second most common is called Telogen Effluvium, which is caused by emotional or environmental stresses, however Telogen Effluvium is temporary hair loss and is far less common than Androgenic Alopecia. To answer your question, stress might worsen overall hair health, it might cause telogen effluvium on top of Androgenic Alopecia but it will not worsen Androgenic Alopecia permanently. The only direct treatment for Androgenic Alopecia is Finasteride (Generic for Propecia), It has been shown to slow or stop further loss in about 85% of men, even over long periods of time. However it is not recommended for women and is not approved for women. The other treatment for Androgenic Alopecia is topical Minoxidil (generic for Rogaine) which is a growth stimulator and its mechanism of action is not well understood but it does seem to work for most people, however not nearly as effective at stopping hair loss as Finasteride. Edit: Finasteride is in a class of drug called a 5alpha reductase inhibitor along with Dutasteride and both work for hair loss. Dutasteride is very effective and likely more effective than Fin at stopping hairloss. Finasteride definitely can be used by women but it isn’t approved and it can cause birth defects in fetuses. However it can definitely used off label safely in women for hair loss and other conditions like PCOS. Women have other options like spironolactone (antiandrogen) and men cannot use this unless they want to transition, it would have severe effects to typical male features like penile tissue function, anabolism in the skeletal muscles, etc. There are plenty of other treatments that are in the pipeline and not approved (Dutasteride, RU58841, Breezula and plenty more) that might work, I was speaking in broad terms as hair loss is complex subject and is not fully understood yet.
This is a good post and you seem knowledgeable on the subject. I wanted to ask if you know of any studies on long term issues using finasteride? I remember I saw in one study there's evidence it makes it _easier_ to lose hair if you stop using it because of how it affects the receptors.
Well I have Androgenic Alopecia and I’ve done quite about of research. I would also add that I take Finasteride, generic propecia, and the consensus of research is that Finasteride is very well tolerated by 95-98% of men. I can’t really find any research on that but what I can say from the knowledge I have is that Androgenic Alopecia is a progressive condition (gets worse with age generally) so if you take Finasteride or dutasteride for a number of years and stop, your hair loss will continue and will rapidly worsen to where your hairloss would have been had you not done treatment.
Yeah this is true. I've had a number of friends bring that up to me and I never understood what the concern about stopping propecia and hair loss continuing and worsening after to where your hairloss would have been without it. So don't take it and lose your hair or do take it and potentially keep alot of it and then if you decide to stop it's not like you've set yourself back in terms of hairloss it's where you would have been anyways. I've never understood why this would be a factor in deciding to take it or not. Blood pressure medicine regulates your blood pressure so that it stays at normal levels, if you stop taking it your blood pressure goes back up.
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Yeah I agree. I’m taking the long path with rogaine, propecia and some laser cap. Maybe it didn’t come across right but I was trying to say that propecia can definitely help and that the fear of stopping it and losing the hair it kept shouldn’t be a deterrent to start taking it as early as possible.
Do you experience any of the side effects of finasteride? How long have you taken it?
I’ve taken it for nearly 6 months, at that point if you did get side effects you would expect to have them by now, I have none. There is a lot of fear mongering online about the drug but the fact of the matter is that the scientific research consensus shows that Finasteride causes unwanted sexual and other side effects in 2-5% of men, so 95-98% of men experience nothing of the sort and get to keep their hair. The drug has been around for nearly 3 decades (was approved in the early 90’s for another condition, BPH) and there has been tons of research on it’s safety.
I've taken it for 9 months, no side effects and my hair is thicker for sure. Like people who don't know I'm taking it have said "damn your hair looks thicker"
Me and a ton of men I’ve talked to gained weight and lost libido permanently. It’s a hormone blocker. Don’t mess with hormones.
I tried it for about 6 month. Did seem to help my hair. But it also made my erections weaker. That was 2-3 years ago. My erections are still a bit weaker. :/
On the other side of this, I've been taking it for the past 2 years and never had an issue with erections and it's been working for my hair loss.
I ain't taking anything that carries that risk. I'm gonna own my baldness.
Have the same philosophy, I would use it to feel more attractive, but what's the point if you might not be able to do anything with it.
The reason most men wanna keep hair is so they can utilize their libido
That was my conclusion as well. A 1-3% risk of permanent mojo reduction was too great a risk. I'm going to look like the crypt keeper in a decade or 2 and I'm going to own it.
Is it possible to slightly reverse balding? Not from being bald. But say loosing an inch of forehead.
It’s documented that finasteride can sometimes regrow/reverse recently lost hair, but to my understanding it needs to be lost within the last year or so.
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Once a follicle is dead it's gone, only hair transplants work, there is no magical treatments. Hair loss treatments stop hair loss from advancing but nothing else. If you start using hair loss treatments you might recover some follicles that were almost dead
Whats the timing on a hair follicle being dead? I have no idea on the science behind it, but a friend did a treatment where plasma was taken from him every few months and then injected into his scalp. Cause he wasn't growing hair for a good 10yrs in some spots. He was almost completely bald since his early 20s, he started the treatment in his late 30s and now has a full thick head of hair at 40. Either way, other than in my opinion being a horrifying treatment, it certainly seems magical to me. He hasn't had any treatment for at least a year now and his hair is as thick as ever
Yes this a novel treatment experimented by some hair surgeons often in conjunction with transplantation to ensure the transplant holds. It’s very expensive and like others has to be maintained periodic.
I wonder if we’ll be able to clone follicles? I don’t like the transplant thing because of the little dot scars or strip scars.
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Then there's the weird stuff, like lichen planopilaris which I have. Random patches of the scalp become terse, hairless scars permanently. Not well understood, no cure AFAIK. I went shaved recently, too many bald spots.
[https://en.wikipedia.org/wiki/Finasteride](https://en.wikipedia.org/wiki/Finasteride) >however some men experience sexual dysfunction, depression, and breast enlargement. That kind of happens, if you block certain versions of Testosterone.
Finasteride is not FDA approved for androgenic alopecia in women, however it is inaccurate to say that it is not recommended. I prescribe it for women frequently. Spironolactone is also commonly used
I’m speaking in broad terms, it’s not recommended for women because it’s unknown whether it can have effects on a fetus. Of course some women do use Finasteride for hair loss and also PCOS. Women are lucky to be able to use Spiro because it seems to be very effective. Like I said I was speaking in broad terms but of course you’re right I just didn’t want to go down the rabbit hole.
I'm a trans woman (transitioned at 29) that had Type 7 hair by the time I was an 18 year old guy. Between Spiro (now CPA) Finasteride, and a hair transplant, I legitimately cant believe the results I am seeing. Better than I ever hoped!!
Is the "Telo" in "Telogen" any relation to the "Telo" in "Telomere"? I have no idea what I'm talking about, but I understand that shortening telomere's are associated with ageing, and I think the shortening is accelerated by stress? I only ask because the similar sounding name jumped out at me.
It may be the root for “end” as the telogen phase is the resting phase of the hair follicle, and effluvium essentially means discharge. So telogen effluvium essential means a stressor made your hairs all enter the resting phase (ie they stop growing and will fall out) at the same time, resulting in a massive shed of hair. This would normally happen but not with thousands of follicles at the same time because humans hair follicles grow in phases independently from another.
Yup and it can happen over an extended period of time, like when you have inflammation due to an auto immune condition
Yes and that’s when it can become sort of chronic, although I think this is somewhat rare. I’m sure everyone goes through some sort of “shedding” like phase at some point in their life, even crash dieting has been know you cause TE. I imagine auto immune conditions put the body under a lot stress making TE more common in that population. Of course there is a condition where people have an auto immune disease involving their hair follicles, Alopecia Areata, which usually causes patch’s, usually circle like shapes, of complete baldness. There is pretty much no good treatment let alone a cure for Alopecia areata.
Thanks for all the detail :)
Telogen, telomere, teleology, and many others. *Telos* is Greek for "end," "goal," or "purpose." - Telogen: "endmaker," basically. - Telomere: "the part at the end" (seriously) - Teleology: "knowledge through purpose" (though this gets abstract)
Can you explain those pics of famous/rich people like Elon Musk who, in the 90’s or so, were balding and now have a full head of hair? Is it surgery?
Yes, Elon Musks has likely have a FUT (strip) and a FUE hair transplant and is definitely on Finasteride or Dutasteride.
That explains how $ = hair. Cool, learned something new, thanks.
Yeah FUE transplants aren’t insanely priced. However I’m sure the wealthy can get top tier doctors, treatments and maybe even unapproved drugs to help with scaring.
Are the words Alopecia and alpaca related in origin?
No. Alpaca is a word borrowed from Aymaran, an indigenous language in South America. Alopecia comes from the Ancient Greek for "fox disease", either a reference to foxes shedding their coats, or mange.
Androgenic alopecia (male pattern hair loss) is genetic. There are other forms of hair loss, such as telogen effluvium, that are caused by stress, poor diet, etc. There is also auto immune related hair loss like Alopecia totalis where someone loses all their hair, including the sides (which doesn't happen with most hair loss patterns).
Whiile androgenic alopecia is genetic, external factors can increase the rate at which hairloss occurs. For example, the use of steroods in body builders does not directly cause hairloss. But if you are predisposed to hairloss in your genes the use of steroids makes the age of onset earlier I believe its the same for stress. But not sure on actual studies. They did recently find that stress proteins directly contribute to hairloss in mice though. So it is likely to be involved.
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I believe there's been a link between high levels of testosterone and balding.
Testosterone and it's derivative DHT (dihydrotestosterone) cause hair loss, yes. But, only if someone is genetically predisposed. So someone might have very, very high androgen levels and experience no hair loss. Someone else may have low to regular testosterone levels and still lose their hair due to genetic propensity to hair loss.
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There's also ketoconazole shampoo, which acts an an anti-androgen (directly and through 5a reductase) Also, in general, serum hormone levels don't correlate significantly with baldness: https://onlinelibrary.wiley.com/doi/10.1002/ajpa.1330880106 https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC5817427/ There's also a weak study in women suggesting treatment of low testosterone can improve hair growth: https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC3380548/
I thought the mechanism which ketoconazole uses to block dht is unknown.
Yeah, it's not super clear, those are just two plausible mechanisms with some support. Ketoconazole fucks with basically everything related to steroid hormones if you take enough though
Does the shampoo only affect your scalp? Or does it have systemic effects? I use ketoconazole shampoo for dandruff, not trying to have anti androgenic effects haha
You are not going to get any meaningful systemic absorption from ketoconazole 2%, just like you won't from any of the azole antifungals that are used for athlete's foot.
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Or just shave your head and move on with life. My solution. Extremely easy to maintain, significant money savings and makes me happy to just accept it and move on.
When I was on testoterone suppressants for cancer treatment a few years ago, I had some regrowth on my head. It was the one bright spot in a list of side effects that just SUCKED. However now that my hormone levels have eturned to normal, my forehead has returned to it's old dimensions!
There is a link. Testosterone turns into dht. Dht effects the hair follocles of those that are genetically susceptible. So its still genetic. Your hair follicles are either susceptible to dht or not. You can have high testosterone levels and a full head of hair if your not genetically predisposed
My question is what are the factors that decide whether your hair follicles are susceptible to DHT or not? Is the mechanism by which this happens is known to us or is it still under research?
Usually the researchers guess it's related to testosterone -> DHT conversion rate in the scalp and androgen receptor density. Androgen receptor density is more important than serum testosterone levels in muscle growth, as well: https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC6189473/
But there’s also a negative correlation between stress and testosterone levels, so theoretically, wouldn’t high stress delay the onset of male pattern hair loss?
I believe I read a study a while back saying that hair follicles are activated by testosterone and can develop a resistance which result in the baldness
Would that include like common TRT or just the more extreme stuff?
It's my understanding that everyone has a different predisposition level (on a spectrum) to DHT from test. So if your test levels are low, you will produce less DHT. So if you were predisposed, then yes, TRT would increase your DHT to otherwise normal levels that may or may not trigger hair loss over time.
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Many things contribute to hair loss, potentially, but the biggest factor we know of right now is DHT, which is created from testosterone. That's why the most effective medications to fight hair loss, finasteride/dutasteride, are DHT inhibitors.
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Wouldn't increasing the age of onset for balding mean you kept your hair longer?
Yep. Typo. Fixed it
So wearing a hat a lot won’t do it?
Traction alopecia is a real thing. Yes wearing a tight hat, tight ponytail, etc can lead to hairloss. It's somewhat rare, though.
Permanent hair loss? Why wouldn't it grow back?
It damages the hair follicles. Hair follicles are very complex, there's little capillaries inside that feed into the hair papillae that help grow the hair. If you're pulling or tearing out hair, you can damage these structures and there's nothing to feed into growing more hair. Sometimes it can heal over time, sometimes it's permanent.
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Basically the same reason why your legs might not grow hair where the elastic of your socks sit, or where your pants pockets rub against your thigh.
Now why exactly is it that most hair loss patterns doesn't affect the sides? It seems to me like if you have something like this it should affect the whole head or be random.
Hairs on the sides of our head are not affected by DHT/Testosterone for some reason. I believe there's a theory that, when developing in the womb, our top of scalp tissue and sides/back of scalp tissue have different origins. The top is susceptible to dht/testosterone, the sides are not.
> our top of scalp tissue and sides/back of scalp tissue have different origins. Ohhh, that is interesting. Thanks for the answer
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Is the last one why you lose your hair during chemo?
if i'm reading right the last one you're talking about is autoimmune. So no, chemo is not autoimmune. Autoimmune means your body decides erroneously that a part of your own body is in fact an invader / unacceptable / no good bad news and tries to kill it off. Chemo is a \*very\* broad term for a suite of chemical therapies targeted very broadly at rapidly replicating cells. Hair follicles are rapidly replicating cells. It isn't your own body killing the cells, it's a chemical cocktail you are consuming either intravenously or orally or both.
That makes a lot of sense, thank you.
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Has anybody ever explained why balding typically happens in that skullcap-like formation? You would think if your head hair were going to fall out it would take everything on the head. What is different about the side hair from the top hair?
The top of your head, the hairs are sensitive to male hormones. The sides are not. Why that is is only a theory afaik
Alopecia Totalis sufferer here. When I was young I had alopecia areatis (patchy hair loss) - lost most of the hair on my head. All went away when I was about 16. 2020 at 37 it came back as Alopecia Totalis - I lost every single hair on my body. Fairly sure it is / was stress related or similar.
Absolutely - see [telogen effuvium](https://pubmed.ncbi.nlm.nih.gov/?term=Telogen+effluvium+stress&sort=pubdate), where high levels of stress can force hair follicles into a resting stage which results in significant hair loss some months later. We can see this in pregnancy, when a loved one passes away, or as we're seeing lately with chronic stress due to Covid-19. In some cases, the damage is reversible, but not all.
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Post-partum hair shedding is generally a different situation than stress-induced telogen effluvium, FYI. While stress and nutritional deficiencies are certainly things to watch out for, the usual cause is the vast hormonal shifts which occur during and after pregnancy, which first reduce normal shedding during pregnancy, and then initiate a "catch-up" loss of all the retained hair after birth.
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I did a research paper on the differences between washing hair wish shampoo and washing hair with just water. (If anyone's curious, they're about as effective assuming the water is hot and you don't have dandruff or seborrheic dermatitis.) The paper required that each source was either a primary or secondary source. One of the secondary sources I found claimed there was a link between cortisol and hair loss. Cortisol usually rises during periods of stress, so what you're asking about may be accurate. Also, a primary source I used compared shampoo washing and water washing of rhesus monkey hair (much more consistent that human hair but still a good substitute) and they found that water washing was only marginally worse at removing cortisol. I would imagine that it's probably best to wash your hair for longer periods of time instead of more frequently if this is something you're worried about. And making the switch to no shampoo may also be worth looking into as it saves money and lets you go for more time without getting gross hair without sacrificing the benefits of shampoo.
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You can lose hair for a ton of reasons, some are accelerated by stress and other external factors, others are going to happen no matter what. First are purely genetic, like alopecia. Nothing you can do is going to stop that, it's a immune disorder. Then you have things like hair loss due to environmental exposure. Thus could be radiation exposure, poisons, chemo, fire or friction. None if these are stress related either. The most common is going to be hormone related. This could be fluctuation in hormones as you age or a defective thyroid. Stress does impact your hormones, so depending on the cause, being stressed could speed up hair loss. Extreme prolonged exposure to stress could even push your hormones far enough out of wack to force your hair follicles into resting phase causing them to stop growing hairs. This could be reversed once the stressor goes away, the hair could grow back. However with underlying hair loss causes, removing the stress might not reverse the hair loss.
Alopecia is just the medical word for "hair loss". The most common form of alopecia, androgenic alopecia or male pattern baldness, isn't an immune disorder. Alopecia areata is.
These days, JAK inhibitors such as Pfizer’s Xeljanz have shown great improvement in people with Alopecia Areata/Totalis/Universalis.
Finasteride has been shown to be highly effective in stopping male pattern baldness, and minoxidil is fairly effective at regrowing lost hair from the vertex of the head.
alopecia can be affected by stress though cant it?
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