Страници

вторник, 25 октомври 2011 г.

Hair loss part 2

2. Skull Expansion Causes AGA
This part explains how skull expansion causes AGA, and by doing so, provides answers to
all questions from part 1
2.1 Bone resorption and remodelling
2.2 Scalp capillary network
2.3 Remnant hair and development of the male pattern profile
2.4 Hormones and hair loss
2.5 Genetic link to AGA
2.6 Rate and location of hair loss
2.7 Re-evaluation of the current theory
2.8 What skull shapes lead to skull expansion?
2.1 Bone resorption and remodelling
When you’re growing up, your skeleton obviously gets bigger and bigger. This, of course,
includes your skull, which not only grows in size, but also changes shape.
Once you reach adulthood, bone resorption and remodelling will continue to maintain skeletal
integrity.
Together, these two essential processes constantly renew the entire skeleton throughout life.
For some, this simply means maintaining the bones – keeping them strong and healthy. But, for
those who suffer AGA, certain bones of the skull will continue to grow.
This is skull expansion, and is the direct cause of AGA within the MPB region of the scalp for
both men and women. It can also be considered as an exaggeration of the bone resorption and
remodelling processes.
2.2 Scalp capillary network
For all those with the genetic predisposition towards skull expansion/AGA, this process will
progressively stretch and pull tight the scalp tissue that overlies the skull. This constricts the
blood vessels which then reduces the blood supply.
Figure 3 shows how the main arterial network of the scalp will provide a strong blood supply to
the back and sides. But, within the MPB region, the follicles are only served by a much weaker
capillary network (not shown in the diagram). This illustrates how the MPB region is the most
likely area of the scalp to suffer a reduction in blood supply.
Skull expansion will, within the MPB region, reduce the flow of blood and so decrease the
supply of nutrients required by follicles to grow hair. In time, hair follicle miniaturisation and hair
loss will result.


2.3 Remnant hair and development of the male pattern profile
If you compare Figure 2 from part 1 with Figure 4 below, you can see that the
bones of the skull that underlie the MPB region are the frontal and parietal bones.
Figure 5 details these two bones. The frontal and parietal eminences represent the areas where
ossification commenced (in other words, where bone initially began growing as a foetus within
the womb).
From these areas, bone grows outwards, pushing against the surrounding bone tissue and so
causing the frontal and parietal bones to grow larger in surface area. It’s through this linear
growth that the full adult skull size is eventually reached.
There are two parietal bones (left and right) so each one obviously has its own parietal
eminence. But, you can also see that there are two frontal eminences as well. That’s because
the frontal bone actually starts out as two bones within the womb.
As these develop, they gradually fuse together and can leave a remnant suture line* (as shown
in Figure 5). This will usually disappear as a baby grows into a child, but the two frontal
eminences remain.
* Suture lines mark the connection between the bones of the skull.
Skull expansion of these two frontal eminences (left and right) will cause hair loss at the front
hairline. This explains why, in most cases, hair recedes at the left and right temples and not
across the entire front hairline.
It also explains why some remnant hair often continues to grow at the front - you can see this in
Figure 2 and Figure 6 below. (Basically, remnant hair will continue to grow wherever there is no,
or little, skull expansion).
This provides the answer to question 1 in part 1.
In Figure 6 you can see how the frontal and parietal bones of the skull relate to the pattern of
hair loss for someone with severe AGA.
Now, can you see how the temporal ridge seems to coincide with hair loss along the sides of
the head?
Well, this is no coincidence!
Within each parietal bone, the parietal eminence (that causes skull expansion) only lies above
the temporal ridge. So, it logically follows that hair loss can also only occur above this line. And,
as a result, the temporal ridge marks an approximate boundary between hair loss and hair
growth on the sides of the head.
Hair will always continue to grow at the lower back of the head because here, the occipital bone
largely remains unaffected by parietal bone expansion. You can clearly see the occipital bone in
Figure 4.
By analysing of the structure of the skull (specifically the frontal eminences, temporal ridge and
occipital bone), the familiar male pattern profile of hair loss can be explained.
This provides the answer to question 2 in part 1.
2.4 Hormones and hair loss
Androgens, like DHT, can be linked to both hair loss and hair growth. DHT causes facial, body
and pubic hair to grow in men during puberty, but it also has a direct connection with AGA.
How can this be?
DHT is a steroid hormone which means that, whilst it stimulates new hair growth, it also has an
anabolic effect on bone formation 7. In other words, it makes bone grow! And it’s through this
continued bone growth (skull expansion) that overwhelms the hair growth promoting effects of
DHT.
This provides the answer to question 3 in part 1.
For men at puberty, steroid hormones are responsible for the rapid increase in bone growth
(and muscle development) they experience. This also explains the connection that exists
between bodybuilding and AGA - bodybuilders often suffer hair loss because intense weight
training will increase testosterone and DHT levels (as do anabolic steroids).
2.4.1 Sebum
Sebum is a waxy, oily substance secreted by the sebaceous glands within hair follicles. Its
production is governed by androgens (including DHT) so it’s easy to see the connection
between DHT and sebum. As well as stimulating the skull expansion process, DHT can also
contribute to hair loss locally (i.e., within hair follicles) through excessive sebum production.
However, this is very much secondary to the skull expansion process.
2.4.2 Female hormones
Women generally experience AGA to a much lesser extent than men due to their much higher
oestrogen and lower testosterone levels.
Whereas steroid hormones like testosterone and its derivatives have an anabolic effect on bone
growth, oestrogen decreases the bone resorption process 8. Since the oestrogen levels in a
healthy pre-menopausal woman's body greatly exceed those of testosterone, there will be a
reduced tendency towards skull expansion.
However, low (post-menopausal) oestrogen levels can often lead to AGA. That’s because
testosterone levels will be higher (relative to the lower oestrogen levels) and so the bone
resorption, remodelling and skull expansion processes will all increase for those women with the
genetic predisposition towards AGA.
So, for all those men and women with this genetic predisposition, DHT will cause the frontal and
parietal eminences to grow during adulthood. This is the true underlying mechanism behind
AGA.
But, why do some have the genetic predisposition towards skull expansion/AGA whilst others
do not?
2.5 Genetic link to AGA
It’s long been known that a genetic link to AGA exists.
Most research currently places focus on the 5-alpha reductase and androgen receptor genes.
However, it’s the genes that determine skull shape and size that are responsible for AGA.
2.5.1 Sexual dimorphism
Sexual dimorphism 9 means that the form (shape, size, etc) can vary between the two sexes.
For example, women usually have wider hips, whilst men are generally taller and heavier (due
to bigger bones and greater muscle development).
Skull expansion is a largely sexually dimorphic characteristic, affecting men much more so than
women. Men will, quite simply, grow a bigger skull than most women. (This reflects the higher
androgen levels men have, as well as differences in genetic inheritance). More specifically to
AGA, this means that, for most women, the frontal and parietal bones will be proportionately
smaller than in the majority of men.
2.5.2 Growth potential
Associated with skull shape and size is its growth potential. This simply means that some skull
shapes are more likely to grow than others.
For example, someone whose skull shape has a high growth potential will be especially prone
to skull expansion, and so invariably develop severe AGA. And it follows that, anyone else with
a very similar skull shape and growth potential will most likely develop AGA to the same
extent.
Of course, very similar skull shapes often run in families, and you may already be aware that, if
your mother or father lost their hair, you too have a very high chance of losing yours as well.
(This explains the strong genetic connection that AGA can have within a family, especially
between fathers and their sons).
You now know that the genetically determined characteristics of skull shape and size form the
genetic link to AGA.
This provides the answer to question 4 in part1.
2.6 Rate and location of hair loss
Skull shape and its growth potential can account for the different rates of hair loss, and the
location (within the MPB region) in which it occurs.
2.6.1 Rate
The rate at which you lose hair is directly related to the extent of your skull expansion. This,
quite obviously means that, the more your skull expands, the more hair you're likely to lose.
For the 20% of men whose skull shape has a high growth potential, this explains why AGA will
rapidly start developing from puberty and can lead to extensive hair loss by the age of thirty.
However, in most cases, AGA won’t start until later on in life and will be a much more gradual
process - these skull shapes have a low growth potential.
Growth potential can, therefore, account for the variations that exist in the rate of hair loss.
This answers question 5 in part 1.
2.6.2 Location
Within the MPB region, the location in which AGA develops can vary.
For some, hair loss develops at the front (temple recession) or back of the scalp (a bald patch).
For others, AGA will affect both these areas simultaneously and will cause either diffuse
thinning throughout the MPB region, or more concentrated hair loss (a bald patch at the back
together with receding temples at the front).
Skull expansion of the frontal bone will form a receding hairline from the temples. Skull
expansion of the parietal bones will cause hair loss at the back of the scalp. And skull
expansion of the frontal and parietal bones simultaneously will create hair loss in the front and
back of the scalp at the same time.
This answers question 6 from part 1.
Convinced?
You should be!
Skull expansion is the true underlying mechanism behind AGA. It has explained how, for those
with the genetically determined characteristics of skull shape and size, DHT will cause the
frontal and parietal eminences to grow during adulthood. It has also explained how DHT can be
associated with both hair loss and hair growth, and provided answers to all six questions from
part 1 (something the current theory cannot do).
And, if you're in any doubt about skull expansion, why not simply contact a hair loss
specialist and ask those six questions – I guarantee they will not know the answers!
2.7 Re-evaluation of the current theory
Although the current theory for AGA could not answer those questions, it did nevertheless, raise
some issues that now need to be addressed.
Referring back to part 1, these involve the following –
1. Androgen receptor sites, 5-alpha reductase and DHT all appear to be more abundant in
the MPB region of the scalp than in non-MPB regions for those with the genetic predisposition
towards AGA.
2. A gene (or possibly several) may make follicles genetically programmed towards hair
loss (but only in the MPB region).
Ok, we’ve already looked at this before, but let’s examine these two fundamental parts to this
theory in more detail –
1. First of all, let me make this perfectly clear: 5-alpha reductase, androgen receptor sites and
DHT all exist in hair follicles for hair growth, not hair loss – your body does not want to lose
something that insulates and protects your scalp from the sun, rain, cold, bugs, etc.
The current theory does not explain how and why any such proliferation of androgen receptor
sites, 5-alpha reductase and DHT should occur within just the MPB region and nowhere else. In
my view, any proliferation of androgen receptor sites is due to upregulation, also known as
reflex hyperandrogenicity 10.
What this basically means is that the body tries (unsuccessfully) to grow more hair (i.e., to offset
skull expansion) by producing more DHT. It creates an increased expression of the androgen
receptor gene within the area of weak hair growth which then causes receptor site proliferation
to occur. (Once again, remember, that's what androgens like DHT do - they stimulate bone,
muscle and hair growth, not hair loss).
Furthermore, 5-alpha reductase, androgen receptor sites and DHT also occur in bone tissue 7.
Coincidence?
No way!
To me, it seems crystal clear that DHT accumulation within the frontal and parietal bones cause
these bones of the skull to continue growing – i.e., skull expansion.
2. The current theory has identified a number of genes that may be involved in AGA. These
include: the androgen receptor or AR gene (STU1), 5a-reductase genes (SRD5A1 and
SRD5A2), CYP17, etc. But, once again, no reason has been given why follicles in just one
(MPB) region of the scalp should suffer hair loss, but not in any other. This theory simply states
that each follicle must be genetically programmed for hair loss and that they appear to have a
greater number of androgen receptor sites 11.
As you now know, it’s the genes responsible for skull growth (i.e., shape and size) that cause
AGA. And, it’s this genetic connection that explains how AGA occurs within just the MPB region.
Through the upregulation of DHT (hyperandrogenicity, as described above) the increased
expression of the androgen receptor gene within the MPB region can be accounted for.
Now you know that skull expansion is the true cause of AGA, there is a new question that needs
to be asked...
Copyright © 2008 by Paul Taylor 16
Skull Expansion – True Cause of Genetic Hair Loss www.top-hair-loss-remedy.com
2.8 What skull shapes lead to skull expansion?
Figure 7 (below) shows two different skull shapes: one with no hair loss at all (i.e., a skull shape
that did not experience any skull expansion), and one with severe hair loss (i.e., the eventual
skull shape reached after, perhaps, many years of skull expansion).
You can see that, for those who suffer no hair loss at all, they’ll generally have a slightly more
square shape to the skull. But, for those who suffer severe AGA, the skull expansion process
will often create a somewhat rounded skull shape. (This rounded shape can also appear in both
front and side profiles).
This is only a very simple explanation, but it does nevertheless reveal the skull shapes that
generally correlate to the two extreme examples shown in Figure 7.
Other skull shape variations exist, and these determine where within the MPB region skull
expansion/AGA develops (front, back or both), and the rate at which this will happen. There are
also several skull shape characteristics that can be recognized and used to accurately predict
whether someone is likely to experience future hair loss and to what extent.
To learn about these skull shape characteristics and find out what skull shapes cause hair loss
at the front, back or both regions of the scalp, you'll need to read the next part.

Hair loss part 1

Why do we lose hair?

Androgenetic Alopecia

As its name suggests, androgenetic alopecia is a genetic form of hair loss that involves
androgens (male sex hormones). However, it’s also known as androgenic alopecia, AGA, male
pattern baldness (MPB) and female pattern baldness. In this blog, AGA is used. I also use the
term "MPB region" -this refers to both male and female pattern baldness because each
involves the same region of the scalp.

Whatever you call it (I used to call it “the bane of my life”) AGA is a condition, not a disease even
though it might feel like one!

This chapter examines the current theory for AGA and explains why it’s wrong!

1.1 DHT, androgen receptor sites and 5-alpha reductase
1.2 Female pattern baldness
1.3 Problems, problems, problems
1.1 DHT, androgen receptor sites and 5-alpha reductase
There’s been much debate about the true cause of AGA. Several factors have been linked to it
(genetics, hormones, nutrition, etc) and many theories exist that try to explain exactly what
mechanism is taking place.

There’s no doubt that androgens are the main blame -it’s long been known that a derivative of
testosterone called dihydrotestosterone (DHT) is directly related to this condition. But, exactly
how DHT causes AGA is still unclear to the hair loss industry.

Most hair loss professionals believe that DHT chokes the blood supply to the follicles. (A follicle
is basically a pouch through which the hair shaft grows).

Testosterone first gets converted into DHT by 5-alpha reductase (an enzyme produced within
the scalp). DHT then attaches to androgen receptor sites in the follicles (a receptor site is an
arrangement of molecules that binds to other molecules with a complimentary shape).

If DHT is produced in excess, and attaches to a large number of androgen receptor sites, it may
accumulate within a follicle and block its blood supply. This forces it to prematurely enter the
resting stage of the hair growth cycle.*

* The hair growth cycle -Anagen (the growth stage) normally lasts 3 to 5 years. Catagen (a 2
week shedding stage) is followed by telogen (the resting stage) lasting 3 to 4 months. Anagen
then restarts.
If a follicle enters the resting stage earlier than usual, the time spent in its growth stage will
obviously be reduced. This results in hair that becomes both shorter and thinner with each
successive growth cycle, and also causes hair follicle miniaturisation. Eventually the follicle
shuts down - it becomes dormant and hair growth stops.


If you ask almost any hair loss professional (trichologist, dermatologist, etc) for the mechanism
behind AGA, that's what they’ll tell you.
Convinced?


You shouldn't be - this theory has its problems!
I’ll reveal all these problems shortly, but first of all, you might be wondering how hair loss
involving male sex hormones can also affect women.


1.2 Female pattern baldness
Up to 50% of women will experience AGA to some extent during their lives.

The reason for this is simply because women produce a small amount of testosterone (mostly
from their adrenal glands) 1. Both men and women produce a small quantity of each others’
hormones in this way.

For most women, their oestrogen levels are usually high enough to completely overwhelm the
quantity of testosterone they produce. And the opposite is true for men.

It’s when oestrogen levels become low (e.g., due to the menopause) or
there’s an increase in androgen production (e.g., by stress, weight
training, etc) that AGA can start to show itself on the female body.

In women, AGA usually appears as diffuse thinning (this is evenly
distributed hair loss) on the crown of the head (see Figure 1).

Now, let’s get back to the current theory for AGA.

1.3 Problems, problems, problems!
To explain all the problems this current theory has, take a good look at
Figure 2.

This photo shows a typical example of a man with severe AGA, and you
can clearly see that the familiar MPB region of hair loss has almost fully
developed.

This MPB region needs closer examination:

Ok, first of all, notice how his hairline has receded from the left and right
temples, but not entirely from the center front region. In some cases,
this area keep growing reasonably strong, healthy hair throughout life
despite extensive hair loss all around it. I call this, "remnant hair".



You can see more remnant hair trying very hard to grow within the center crown area. And
behind it, another significant area of hair loss has developed into a bald patch at the back of the
head.

His baldness seems to have developed from the front (both left and right temples) and back of
his head independently (i.e., two separate areas of hair loss). And, where these two areas of
loss meet in the middle, some remnant hair continues to grow.

Notice how hair continues to grow normally on the sides and lower back of this head. This, of
course, gives him that familiar “male pattern” profile, or horseshoe shape, synonymous with this
type of hair loss.

Have you ever wondered why this pattern of hair loss always seems to emerge in nearly every
severe case of AGA?

It’s been observed that both the androgen receptor gene 2 and 5-alpha reductase 3 appear to be
more active within the MPB region in those who suffer AGA. According to the current theory,
this observation indicates that hair follicles within just the MPB region must be genetically
programmed 4 for this to occur.

But this still doesn’t explain why only hair follicles in this region should carry the AGA gene(s). In
other words, it still doesn’t give a reason why hair loss should be confined to the MPB region.

It’s been acknowledged by the hair loss profession that the actual mechanism causing hair
follicle miniaturisation within just the MPB region is still unclear. Furthermore, they accept that
several genes may be involved and that some other mechanism must also be taking place 5.

Another problem with this theory is that androgens are hair growth stimulators 6.

That’s right, androgens cause hair to grow!

The most obvious example of this is when pubic, facial and body hair starts growing during
puberty, all of which is caused by androgens (especially DHT).

This fact has been pestering trichologists and dermatologists for years – DHT should help hair
to grow, not hinder it. So there must be something else going on that's causing the follicles to
shrivel.

No explanation has been given by the hair loss industry as to how DHT can cause both hair loss
and hair growth.

Finally, DHT will not cause AGA in someone without the genetic tendency towards it (even in
high concentrations).

All of this now raises several questions concerning AGA. Questions that must be answered
before any theory can be recognized as the true underlying mechanism for this type of hair loss.
The current theory cannot answer these very important questions concerning the hair loss
process:


Q1. Why does remnant hair sometimes continue to grow within the MPB region despite
extensive hair loss all around it?

Q2. What causes the same male pattern profile (horseshoe shape) to develop in almost all
severe cases of AGA?

Q3. How can DHT be linked to both hair loss and hair growth?

Q4. What is the genetic connection to AGA?

Q5. Why does the rate of hair loss vary from person to person? (Up to 20% of men can suffer
rapid hair loss starting as early as puberty. But most don't experience AGA until later on in life,
and for them, this can be a much more gradual process).

Q6. Why does the location of hair loss vary within the MPB region? (Some people only lose hair
from the front (temple recession) or back of the scalp (a bald patch), whilst others lose hair from
both these regions simultaneously).

The next time, I’ll explain how skull expansion causes AGA, and provides answers to all these
questions.