Origins of Hair Loss

In 1916, a female physician named Dorothy Osborne started the myth that the baldness gene behaves in an autosomal dominant manner in men and an autosomal recessive manner in women. However, we now understand that hair loss is a complex trait, and a contribution exists from both parents. Having said this, we also know that the majority of male pattern baldness is androgen related. The extent of expression of testosterone, dihydrotestosterone (DHT) and DHT receptors is hereditary in men and women. One third of the sex hormone-binding globulin changes of age depend on genetic factors, as does the variability in testosterone concentrations.

Male pattern baldness, also referred to as androgenetic-alopecia, is prevalent in Americans, affecting 30 million men starting as early as their teens and all the way into adulthood. Patients typically present with a focal distribution of hair loss in various stages well documented by the Hamilton-Norwood classification. This is a clinical grading scale for staging male androgenetic alopecia and describes the progression of male pattern baldness in a range from stages I to VIII. A gradual onset of hair loss occurs bi-temporally from the frontal areas, with progression to a wider area of thinning hair that may or may not have bare patches. Men will experience minimal shedding, and pulling on hair will not yield a lot of hair.

More than 20 million women suffer from androgenetic alopecia as well. Female patients present with similar complaints of hair loss as their male counterparts. But female hair loss is further complicated by telogen effluvium, a more generalized distribution of hair loss more commonly seen in women than men. This condition is characterized by thinning hair, without bare patches, and prominent shedding and frequent telogen hairs when brushing or pulling on the hair.

In both sexes, the hair loss pattern described by androgenetic alopecia or telogen effluvium is primarily associated with genetic and hormonal factors. Multiallelic genetic factors exist from either parent that predetermines a person's sensitivity to androgens. The hormonal factors affect androgen receptors, thereby reducing normal blood supply to hair follicles. Over time, this leads to atrophy of the miniaturized hair follicles and thinning hair. This process continues unchecked until the hair follicles have completely atrophied.

We can achieve complete reversal of follicular atrophy and hair loss when treatment is initiated within two years of its onset. Unfortunately, many patients wait 10 or more years after hair loss before pursuing any treatment. Most forms of hair loss that are diagnosed and treated at an early age respond to treatment. However, most treatments started late in the progression of hair loss are less effective and will only reduce or stop the progression.

Compliments of Hair Journal International Summer 2008


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