What Causes Hair Loss? A Deep Dive

by Andre
Published: Last Updated on

In this article, you would have learned that at least 50% of men experience some form of hair loss during their lifetime. You would have also learned that the best medical solutions available today target that nasty hormone floating inside of you called dihydrotestosterone, or DHT for short.

But why is DHT so bad? Is it even bad? Wait a minute, why am I losing hair on my head but not from my legs or beard? These are all good questions to be asking yourself.

Let’s explore and understand the mechanisms through which hair loss occurs and, more importantly, how this will help us to structure our natural-based solution for a hairier head.

It’s not you, it’s your hormones

We need to define a few terms before we go any further.

Androgens: The name given to the general group of male sex hormones. These are the hormones responsible for expressing male characteristics such as genitals, hair, muscle mass, and bone density

Testosterone: An androgen, and the primary hormone associated with developing the features that males’ possess. It is also an anabolic steroid (anabolic meaning ‘muscle growing’). It plays a role in the development of male genitalia and other ‘male’ features.

Dihydrotestosterone (aka DHT): Also an androgen, and an equally important hormone in the development of genitalia, hair growth, and other male-related characteristics.

5α-Reductase (aka 5AR): An enzyme which catalyzes the formation of DHT from testosterone. In layman’s terms, this enzyme reacts with testosterone to produce DHT. There are two types of 5AR (imaginatively called Type I and Type II). Type II plays a role when it comes to hair loss and therefore is of interest to us.

Hair Follicle: The organ found in the skin which is responsible as a whole for the production of hair. This is the gland from which each individual hair emerges

Dermal Papilla: A specific part at the base of a hair follicle that contains Androgen Receptors – the mechanism by which the follicle receives its ‘instructions’ from hormones about what to do next (grow, rest, or die ….no!).

New 3D hair follicle model to accelerate cure for baldness
Figure 1: A hair follicle is shown above. The base of the follicle is where the Dermal Papilla is located and where hormonal ‘instructions’ are received which then dictate how the follicle behaves over its lifetime

Androgens as a whole are the fuel in the engine of puberty and part of this is the development of terminal adult hairs all over the body. They are responsible for turning small and fine ‘vellus’ blondish-coloured pre-pubescent hairs into thicker, stronger, and darker adult hairs both on the head and body1.

Testosterone is the first protagonist in this unsettling tale of hair loss. In males, testosterone is produced in the testes and floats freely around our bodies. It plays a continual role in maintaining our male features including but not limited to: maintaining muscle mass, regulating sex drive, producing red blood and sperm cells, controlling our distribution and storage of fat, and of course the development of male=specific hair1.

Enter our second protagonist, 5AR. 5AR is an enzyme that is responsible for the formation of DHT from testosterone. 5AR comes in two main kinds:

  • Type I: Which exists primarily in the liver and skin
  • Type II: Which exists primarily in the prostate

The true importance of 5AR for hair loss, especially the Type II variety, wasn’t understood until the 1970s when a study on Dominican Republic hermaphrodites, named ‘Guevedoces’, was performed and found that these genetic males exhibited the following strange characteristics: ambiguous external genitalia, no beards, and no signs of pattern baldness.

What could be causing this? It was discovered that the Guevedoces were suffering from Type II 5AR enzyme deficiency!((https://science.sciencemag.org/content/186/4170/1213)) With little to no 5AR in their bodies to convert testosterone (which they did have) into DHT (which they didn’t), they suffered from undeveloped male characteristics, but at the same time, they didn’t experience any signs of pattern baldness.

With testosterone and 5AR a match (not) made in heaven, we come to their offspring: DHT. Clearly a lack of DHT means something for the male body. Its importance in the development of a fully formed male body is clear, but its absence seems a good thing for hair. What is it about DHT that appears to be driving hair loss?

The DHT Paradox: A Potent Androgen

At this point you may be wondering if DHT is the culprit, why isn’t all hair affected the same? Why do we not lose eyebrows or body hair over time in the same way? Why is DHT responsible for growing beards but at the same time balding on the top of the scalp? This is known as the Androgen Paradox.

To explain this further we first need to be more descriptive of the hair we are specifically referring to. There are primary 3 types we should consider:

  1. Androgen independent: Those that don’t depend on hormones to grow such as eyelashes
  2. Androgen dependent: Those that do depend on sex hormones to grow such as beard and body hair
  3. Androgen sensitive: Those that are sensitive to levels of hormones in the body, the ones we are interested in, the ones primarily on the top of the scalp

The fact is not all hairs are the same, and this, in turn, means they don’t all respond the same when exposed to certain hormones. The reason why this is the case is not fully understood but that doesn’t mean we cannot make educated guesses as to what is going on inside each follicle.

John Libbey Eurotext - European Journal of Dermatology - Do ...
Figure 3: The Dermal Papilla up close. Here we see how the interaction of hair follicle and hormones occurs

Firstly, hairs in common hair loss areas on the head appear to have more Androgen Receptors((https://pubmed.ncbi.nlm.nih.gov/9496234/)). This means that they are more sensitive to the levels of DHT flowing via the blood into the follicle. DHT, in turn, affects the growth stages of those hairs, shortening the Anagen Phase (growth) to the point where the hair spends more time dormant or renewing itself and miniaturises over time – hence disappearing. Combine this with the fact that DHT binds between 3-5x stronger than testosterone and it is easy to understand why hair follicles do not survive.

Secondly, different hairs appear to react differently to the same androgens. Beard hairs in the presence of androgens appear to increase their reproductive (healthy) capacity, but with the opposite being true for sensitive scalp hairs((https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1472916/)).

The interactions and resultant chemical expressions between follicle and hormone appear to differ by type of follicle being inspected. For example, beard and non-balding scalp follicles appeared to secret significantly more IGF-1 (growth factor) than did their balding scalp counterparts2.

There clearly is a lot going on in the interaction between follicle and hormone that we don’t yet fully understand, but we’d summarise our findings as follows:

Testosterone and 5AR play an inescapable role in the production of DHT in normal healthy males. DHT is an aggressive sex hormone (androgen) that plays a crucial role in the development of the male body, but its role regarding hair is paradoxical.

On the one hand, some areas of hair such as the beard appear to thrive in the presence of DHT whilst on the other hand, sensitive areas of the scalp (such as the crown), it appears to be an aggressive follicle killer.

The mechanism by which DHT kills off follicles is not entirely understood, but what appears certain is that DHT binds to the androgen receptors within the follicle, ultimately cutting off the blood and nutrient supply, resulting in hair follicle death.

Structuring our Natural Hair Loss Solution

Given the latest scientific evidence assessed above, there are two key culprits we need to target:

  1. Inhibit the activity of 5AR. This will help us reduce the amount of DHT being produced by our bodies
  2. Inhibit or ‘handcuff’ the damaging effects of DHT. Some DHT will be always be produced, but this will help us minimise its damaging effects to our hair

Luckily, Mother Nature has plenty of solutions on hand to help us. And not just mildly help us, but help us in a safe and effective way which doesn’t impact our underlying hormone levels because, after all, these are naturally occurring hormones and enzymes that we want in our bodies. We are just looking to minimise their negative effects.

Believe in the power of nature and you will be rewarded in ways modern medicine cannot provide. #StayHairyNaturally.

  1. https://academic.oup.com/geronj/article-abstract/4/3/200/591484?redirectedFrom=fulltext [] []
  2. https://onlinelibrary.wiley.com/doi/full/10.1111/exd.12339 []

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