The epigenetic theory of hairloss.
A hair follicle exists in a continuously changing microcosm/environment called the epigenome.
The epigenome consists of the chemicals, nutrients, enzymes, hormones etc., that exist in the intercellular and extracellular environment.
The simplistic theory of testosterone induced DHT causing hairloss and baldness does not stand the test of logic nor our experience of efficacy of DHT blockers.
We find that DHT blockers don’t work for a large number of patients (or else there would be no bald hair doctors, at the very least).
If DHT alone were responsible for hairloss, then the peak concentration of testosterone (and DHT), around the age of 15 -18 years will have damaged most of the androgen susceptible hair follicles before the end of teenage.
Practical experience shows otherwise.
Hairloss progresses with human age. Something that is not factored prominently in the treatment of hairloss.
- Additionally, my own ongoing clinical research and tabulation of age coordinated hairloss shows that the current generation (those born in 1990’s) is experiencing hairloss almost 10 to 15 years prior to the age their predecessors did.
This is specifically true for the developing countries like India, where the shift from home prepared, ancestral diet to a “ready to cook/takeaway” food is a recent phenomenon (mostly occurring in last 10 -15 years).
You will need to examine the hairloss history for atleast 2 generations in the developed countries where the dietary shift occurred 30 to 40 years ago (that is where you find patients admitting that their grandparents experienced hair graying and hairloss at a much later age).
It’s not prudent to neglect these observations.
Recent research shows that our diet, exercise, stress levels, oxygen levels etc., has identifiable influence on our epigenome.
As the environment around the fast multiplying cells of hair follicles, deteriorates, many cells (follicular melanocytes and stem cells) deteriorate/age.
This is reflected by
- decreased multiplication of the follicular stem cells
- escape of stem cells from the hairfollicle to the surrounding dermis
- the melanocytes turn senile/zombie. These senile cells lead to decreased melanin production and vitiated intra and extracellular micro environment (due to harmful cytokine production among other things). The senile melanocytes don’t die and damage cells in their surroundings.
Assuming hair follicle to be a complete organ by itself, it has certain well defined boundaries (defined by the hair root sheaths). As the cells inside this organ start to weaken/age and turn senile, the environment doesn’t remain conducive to healthy multiplication of the stem cells. The stem cells, in this situation of an unhealthy intrafollicular environment/epigenome, are demonstrated to escape through a weakened/aged and porous root sheath.
This leads to progressive depletion of the stem cells, seen as hair miniaturization.
Lack of proper nutrients to support stem cell multiplication (as observed in the fast-food options increasingly chosen by patients), also lead to reduction of hair growth much like a child suffers from stunted growth following malnutrition.
Discussion/Conclusion : Relying on DHT blockers as mainstay of the treatment of baldness has not delivered consistent results.
Therefore, in light of recent research in epigenome modification, we need to examine all the factors that effect healthy hair growth and modify our treatment modalities accordingly.
A steady supply of nutrients required for hair growth like various vitamins, Omega fatty acids, antioxidants and NAD precursors are required to prevent premature hairloss/baldness.
At the same time role of transdermally delivered epigenome modifying supplements like Alpha Ketoglutarate, resveratrol, Nicotinamide Mono Nucleotide needs to be studied.
I have found positive effects (less daily hairfall, thicker hair shaft, faster speed of hair growth etc.), in individual patients and am conducting a more detailed research.
Use of senolytic drugs for removal of the senile cells, especially senile melanocytes, has potential to stop and reverse hair graying and hairfall.
Accordingly, there is urgent need to shift our focus from the older treatments using DHT blockers alone and to view the hair follicle holistically to address the epigenetic influences causing hairloss and hair graying.
Dr Capt Arvind Poswal