In this post I'd like to sum up on what I have been reading here and expand on what I have studied along with it. Here is my theory on what might or might not going on in the process of Androgenetic Alopecia and during the treatments people/scientists have tried.
There are several factors in how hair can be negatively affected in Androgenetic Alopecia
1. Natural process of follicular aging, can be sped up by food, bad habits, environment, etc. You can see this in older men with pretty much no Androgenetic Alopecia (androgenic alopecia), their hair not being quite as when they were young. Diet especially [western, think insulin spikes and insulin restistance, caffeine overdosing etc.] have been anecdotally connected with Androgenetic Alopecia.
2. Androgenic hormones (T, DHT but also perhaps others like androstenedione) accelerate the aging process above in genetically susceptible individuals and may have direct additional miniaturizing influence on the follicles. Blocking them have definitely given good results but not full regrowth of lost hair. The good news is that androgens are not at it alone, i.e. they start a follicular destruction cascade. Without specifying it, this cascade affects not only follicles that are directly affected but also their neighboring follicles, possibly even triggering more of the androgen-related changes in them.
What could do we do with Androgenetic Alopecia now:
1. one pathway how to address the aging process would be to make a complete change of lifestyle to minimize insulin spikes, T spikes, oxidating processes in body etc.. This would mean no western lifestyle, no sports (T spikes), hardcore caloric restriction (I spikes), various herbal teas to increase antioxidating processes. Also no-fap and no pr0n (minimizing T levels), no sex and no hard physical work. Also rather not looking at human females [or any females of any kind] nor speaking to them, all of that would increase a healthy man's T. Yep, it's generally out of question for most of us living modern man's life but still, perhaps it's possible. Any volunteers?
2. another way shown to fix Androgenetic Alopecia at least temporarily would be using a nitric oxide (NO) donor such as nitrovasodilators (minoxidil). I'd call this "raping follicles from behind" because we're circumventing the androgens problem and treating the follicles from different angle. Vasodilation enhances follicular nutrition and spurs regrowth, i.e. minoxidil is believed to act by increasing vascular circulation to the hair follicle. It is certainly a radical nitric oxide (NO) donor which releases NO that activates the enzyme guanylate cyclase (sGC) which then causes the synthesis of the smooth muscle relaxant guanosine 3′,5′-monophosphate (cGMP), thereby promoting systemic vascular relaxation and dilation in order to increase vascular circulation and blood flow to hair follicles and hair bulbs. However, as soon as cGMP is produced another enzyme called phosphodiesterase 5 (PDE5) tends to degrade it and eliminate it. That is one of the reasons why topical Minoxidil is known to have certain shortcomings. It is effective in only about eight percent of adult male users. It produces “lanugo,†or baby-type, hair, which is relatively thin. Further, and perhaps most significantly, after approximately 30 months of continuous use, minoxidil shows a sharp drop in effectiveness probably due to local abundance of PDE5 which tends to fight the synthesis of cGMP which is needed as a vasodilator to enhance blood flow and vascular circulation to hair follicles and hair bulbs. This can be prevented by PDE5 inhibitor such as sildenafil (well know as male potency ehancer) which can be applied topically, as described in
this patent.
HOWEVER nitric oxide (NO) is also a free radical. Its oxidative degradation and products can most probably degrade the cells and speed up their aging. Human body produces its own antioxidant which is quite potent and has a powerful effect on NO: melatonin. But the effect of melatonin was abolished in the presence of the PDE5 inhibitors zaprinast and sildenafil (
described in this study). The direct toxicity of nitric oxide is modest but is greatly enhanced by reacting with superoxide to form peroxynitrite (ONOO-). Additionally, nitric oxide is the only biological molecule produced in high enough concentrations to out-compete superoxide dismutase for superoxide [which would otherwise
degrade superoxide to less damaging products].
Interestingly and probably most unfortunaly, this would give mixed results to a human guinea pig such as me regarding hair growth. I suspect the regrowth would be fast and notable but in time the faster degradation of follicular cells would result in apoptosis and enhanced hairloss (I am going to try anyway, this is just a theory after all).
3. Blocking androgens is yet another way to rape the follicles, this time directly from the front. This has been done to very good extent with eunuchs. A much more modern way would be to prevent T from reaching the follicles and/or prevent T from converting to DHT, possibly also block other androgens. I am surprised that after 10+ years of research there is no topical androgen blocker which would block these hormones from acting in the skin and follicles. The only one I can mention here is ketaconazole which should act as antiandrogen both preventing DHT synthesis even in skin (needs to be confirmed) and as a weak androgen receptor antagonist. What we really have are those 5-alpha-reductase (5AR) blockers which are not topical as far as I know and could have systemic effects throughout the body.
Additionally, one could try to apply alfatradiol (or estradiol hormone/steroid) topically to modify aromatase activity to convert T in skin to estrogens. From trans-gender treatments we know that estrogens are considered to be beneficial for ARA suffering people.
Next we could do something about blocking the androgen-induced cascade downstream. This can be probably accomplished at least partially with antihistamine cetirizine which partially blocks prostaglandin D2(PGD2) production [which was
shown to minimize follicles in at least one study]. Interestingly enough PGD2 also has vasodilatory effect.
4. Another way to go would be preservation: to use topical melatonin, a potent anti-oxidant hormone, to prevent oxidative damage to the follicles, as has been done
in at least one study before. From the little web research I've done it's obvious it can easily cross the skin and brain barrier and has
accumulatory effect in the stratum corneum (dead skin cells on top of living skin). HOWEVER this readily available therapeutic agent most probably cannot be used with minoxidil as it counteracts the NO releasing effects of minoxidil and other vasodilators based on NO release. Too bad, but perhaps minoxidil has also a de-scarring and skin-thinning effect (it reportedly depletes skin of keratin) which would warrant use of both agents together. Other cheap antioxidants like ascorbic acid (vit C) could be used systemically.
This preservative way could perhaps have nice results if combined with the anti-androgen way described above. One of the substances to avoid would be caffeine though, as it seems to increase androgen activity all over body (there are several studies confirming it). Interestingly enough there was one study which confirmed topical efficacy of caffeine in counteracting hairloss. That's how we got the Alpecin(R) product. However anecdotal evidence related to hair and stress points otherwise. Caffeine may actually raise the flee-or-fight body response: it stimulates a release of adrenalin which becomes a part of stress response in our organism. And body/hair doesn't react nicely to stress, regardless if it is just induced by a foreign substance several times a day. There might be a caffeine/stress threshold different for each individual because after I stopped with caffeinated coffees, I noticed my shedding has altogether stopped. While I still get a daily coke, it has most probably no negative effect on my hair.
5. Yet another way is hypoxia, as mentioned by one poster before, which perhaps disallows access of androgens and other substances to follicles. I have also read somewhere that there is a layer of stem cells which need a hypoxic environment to stimulate their division to begin new hair follicles or whatever they do. Not sure if this is related, this needs to be researched more.
In any case, from the above we can see how difficult this Androgenetic Alopecia problem is... if we block androgens, we get systemic problems and the effect is still not enough to get all of our hair back. If we introduce vasodilators to increase NO, the increased blood flow probably brings some more androgens along with melatonin every night which counters the NO and its activity. Even if we reduce scarring, we might get more androgens due to increased blood flow. If you go hypoxic on the little bastards, you risk their premature death. Just like you risk it when you go fully nitrous on them. And probably not one of these ways fcuks the follicles hard enough to make a complete overgrowth like we see at trans-gender people who go fully woman with their hormones.
These are exciting times though. I feel like we're finally cracking this thing. These are the times of real discoveries being made, really perhaps Flemming-like or Marshall-like (the guy who ingested the helicobacter to prove it creates peptic ulcers).