Definition of Hair Loss: It is defined as the loss of hair from a part of the body usually the head, its severity may vary from person to person and affects a large number of populations now a days. This condition of hair loss is popularly known by the name of baldness or alopecia. Most cases of hair loss are linked to the human genome (genetics) and the most common example of genetic hair loss is androgenetic alopecia.
Explanation of the Causes of Hair Loss: The cause of hair loss may vary from person to person, few causes are listed below-
Hormonal changes: Hormonal changes are one of the key causes of hair loss. women may experience hair loss after pregnancy or menopause due to hormonal changes. However, both men and women have seen to face hair fall when there is a change in thyroid hormone levels.
Trichotillomania: It is the type of mental disorder in which an urge to pull the hair happens which leads to hair fall in some cases.
Type of hairstyles: There is a certain type of hairstyle that has hair cell-damaging effects on the hair over a long period of duration, which will lead to hair fall.
Overview of Genetics and Its Impact on Hair Loss: Genetics is defined as the study of genes and genes are the segments of DNA, it determines the colour of the eye, the colour of the hair, the health of the hair etc. it also has a wide range of impacts on hair loss, it determines whether the particular person is undergoing hair fall or not.
Genetics and Hair Loss:
Human genome plays a key role in hair loss, commonly known as androgenetic alopecia. It is the most common type of hair disorder which is thought to be caused by a combination of two factors mainly genetic and hormonal factors.
Heredity and Hair Loss Patterns: In case the reason behind hair loss is genetics, it can be predicted as the baldness follows a pattern such as male pattern baldness (MPB) and female pattern baldness (FPB). Androgenetic alopecia is the scientific name for the MPB and FPB. In males, the male pattern baldness is started in “m” shaped pattern in the frontal region of the head while in the case of female pattern baldness, it occurs in the Ludwig pattern.
Genetics and the Onset of Hair Loss: As we know humans have 23 pairs of chromosomes, and it contains genetic Information. Among these 23 pairs of chromosomes, one pair is of X and Y chromosomes. Various studies suggest that baldness is associated with the AR genes found in the X chromosome. People who have this AR gene have to double the chances of getting baldness as compared to others who do not carry this AR gene.
Genetic Predisposition to Hair Loss: Generally, it is believed that androgenetic alopecia is polygenic which means it involves more than one gene, and it is also inheritable. So, if the patient’s parents are having a problem with hair fall, there is more chance that the patient also suffer from this hair fall problem in near future.
Examples of Genetic Hair Loss Conditions: There are several types of hair loss disorders are present such as androgenetic alopecia, alopecia areata, hypertrichosis, and telogen effluvium, among this androgenetic alopecia (AA) the most common type of hair loss disorder. It occurs in about 50% of men by the age of 50.
The Science Behind Genetics and Hair Loss:
Hair Loss Genes and their Function: A study was conducted in 2017 and it found that there are 63 genes, that have a direct influence on male pattern baldness or hair loss, only six out of 63 were found in the X chromosome. Among these 6 one gene named as AR gene has great potential to regulate hair loss. Changes in the AR genes can lead to male and female pattern baldness.
The Impact of Hormones on Hair Loss: Hormones have a significant impact on hair loss. A hormone called DHT (dihydrotestosterone) is made from testosterone by an enzyme called 5–alpha-reductase. The DHT hormone is found in the skin, hair follicles, and prostate. If the conversion of DHT hormone is increased then it will lead to hair loss.
The Interplay Between Genetics And The Environment: In the case of hair loss environment plays a significant role, sometimes environmental factors can trigger androgenetic alopecia and may also potentiate this condition. For example, if a person is taking anabolic steroids, then he is more susceptible to androgenetic alopecia.
Diagnosing Genetic Hair Loss:
Importance of a Medical Diagnosis: There is great importance of medical diagnosis of genetic hair loss, as genetic hair loss may be caused by hormonal imbalance, medications, and other lifestyle factors so by diagnosing physician can understand the actual cause of the hair loss, which is very helpful in treating hair loss, and give better results.
Tests To Determine Genetic Hair Loss: Genetic hair loss is diagnosed by a combination of medical history and some additional tests.
Medical History: The physician may ask about medical history such as the family history of hair loss, medical history and other factors that may potentiate the hair loss.
Physical Examination: A physical examination of the scalp may also indicate the severity of the hair loss, presence of a particular pattern of hair loss may also be helpful in diagnosing the hair loss.
Blood Test: A blood test is done to determine the other medical conditions that may or may not increase the hair fall, such as hormonal level, iron deficiency, vitamin deficiency etc.
Thyroid Level Test: This test is also performed to check the level of T3 and T4 hormones that are secreted by the thyroid gland and their amount may affect the hair loss condition.
Hair Pull Test: In this test, a small number of hairs are pulled by the doctor, if more than three hairs fall out while pulling the hairs, then it is believed that the patient is suffering from a hair fall problem.
Biopsy of the Scalp: In this test, a sample of the scalp may be taken out and examined under the microscope, it is proven to be beneficial in determining the cause of hair loss, and it also differentiates the androgenetic alopecia from other types of hair loss disorders.
Risks and Benefits of Genetic Testing: The benefits of genetic testing are that it allows early detection of hair fall problems, and the exact cause of the hair fall is also determined, which results in the selection of appropriate treatment options for a particular individual and offers good results.
Risks: Genetic testing does not have any physical effect on individuals as it does not consist of any serious side effects but a patient may feel some psychological issues after the test results, receiving the information that he is having the genetic hair fall can make him anxious, depressive and may also create self-doubt, sometime the test results may also reveal that for particular condition there is no treatment is available or only a limited treatment option are available that can make the patient even more depressed.
Treatment Options For Genetic Hair Loss:
Currently for androgenetic alopecia there are only two therapies which are FDA-approved oral finasteride and minoxidil.
Medications: There are only two medicine minoxidil and finasteride which are currently FDA-approved for the treatment of hair loss. minoxidil is the first-line medication for the treatment of mild to moderate AGA. It is most effective at the vertex and frontal regions of the scalp, where it can slow the rate of hair loss by prolonging the anagen phase and promote hair regrowth by increasing both hair diameter and density. Whereas, Finasteride, a medication that has been extensively studied and commonly used, has been approved for the treatment of male pattern baldness hair loss since 1997. This drug can be purchased over the counter which has made it much more cost‐effective for patients. It works by blocking the action of the enzyme Type II 5-alpha-reductase, which is responsible for converting testosterone to dihydrotestosterone [DHT].
Hair Transplant Surgery: Hair transplantation is a surgical procedure that removes hair follicles from one part of the body, called the ‘donor site’, and places them in a bald or balding part of the body called the ‘recipient site’. in this way, hair transplant surgery is used to treat mainly male pattern baldness.
Alternative Therapies: In alternative therapy laser therapy is one of the advanced technologies that is FDA approved for the treatment of hair loss. this low-level laser device is used for hereditary hair loss treatment for both men and women. A no. of studies shows that laser therapy may increase hair density in both male and female pattern baldness.
Lifestyle Modifications: Lifestyle modification is essential for the prevention of hair loss, as scalp massage in combination with suitable oil can be used to nourish the hairs which prevents hair thinning and hair loss, preventing the use of hard shampoo in hair can also be the safe practice for the prevention of hair loss.
Prevention and Management Of Genetic Hair Loss
Diet and Nutrition: The use of nutritional food which consists mainly of micronutrients such as vitamins B and C could prevent hair loss and increase growth, also intake of biotin capsules can strengthen the hair follicle and prevent their loss. In 2018 a study was conducted that concluded that vitamin D is associated with nonscarring alopecia, so taking an adequate amount of vitamin D can prevent this specific type of alopecia.
Scalp Care and Hair Maintenance: The scalp is the area where a high amount of hair follicles is present, and it is the area, which is mostly affected by microbes and dandruff, so for prevention of hair loss it is necessary to cleanse the scalp area by using shampoo or any other hair products to remove dirt, microbes, and dandruff from the scalp. Keep in mind that dermatologists suggest that after applying shampoo to the hair it is necessary to use conditioner to get healthier and thick hair.
Reducing Stress: A study was conducted by Dr Ya-Chieh Hsu of Harvard University that studied the mechanism behind the linkage of stress with hair fall. This study finds that stress hormones have a direct or indirect influence on hair fall. Reducing stress in human beings can result in a decrease in hair fall and better hair health.
Medications to Slow Hair Loss Progression: Medications have a great impact on hair’s regrowth and hair fall. Many medications such as finasteride are found very impactful in reducing the onset of hair fall by inhibiting the conversion of an enzyme. Some individuals have shown the growth of new hairs in the affected area by the oral use of finasteride. So, we can conclude that the finasteride oral medication can slow the onset of hair loss disorders such as androgenetic alopecia.
The Genetics of humans plays a major role in hair loss, the onset of hair loss, susceptibility to hair loss, and response to the treatment all these things are regulated by the genetics of the human. The most common type of genetic hair loss is androgenetic alopecia affects a large no of individuals both male and female. However, there are various treatment approaches available to treat hair loss such as hair transplant, laser therapy, and medication such as minoxidil and finasteride. Among them, medications are the most suitable and mostly opted by patients.
The early detection of hair loss using genetic tests can allow the physician to find out the best possible treatment available and select according to the needs of the patient and the severity of the condition, early detection of hair loss and starting treatment earlier can show promising results and show hair regrowth in individual.