There have been quite a few theories over the years regarding the cause of hair loss. The most widely accepted explanation for male and female pattern baldness involves a link between DHT and hair loss. In recent years however, research has shown that there’s a lot more going on, and DHT does not act alone.
Here’s an overview of what we’ve learned, starting with a brief rundown of DHT and hair loss:
What is DHT?
DHT is short for dihydrotestosterone. It is made from testosterone, which is converted to DHT by bonding with the enzyme 5-alpha reductase. Approximately 5% of free testosterone is converted into DHT. This conversion takes place in the prostate, testes, hair follicles, and adrenal glands.
DHT is very important to the early stages of our development of sexual characteristics, particularly during male puberty. It helps the body grow into maturity and regulate itself throughout the process. DHT is also responsible for characteristics of masculinity such as facial hair.
Later in life however, once this development is complete, the role of DHT seems to be very small. This has been debated quite often though, especially in the bodybuilding community. Some studies even suggest that DHT has an anti-estrogen effect and prevents estrogen-caused hormone imbalances. Currently, there is a lack of clarity on this topic.
There’s not a lot of information available on how important dihydrotestosterone is to women, although it is known to contribute to the body hair on girls after puberty. It may also play a role in determining when female puberty begins.
We still need to learn more about the exact role of DHT, but as far as the link between DHT and hair loss, now we know the truth. DHT is only one piece of the puzzle.
The History of DHT and Hair Loss
We’ve known about the link between DHT and hair loss for a long time, but where did it all start? To answer that question, we can go back to the 1940’s. A doctor by the name of James B. Hamilton experimented with androgen therapy using eunuchs as test subjects. A eunuch is a man who has been castrated (yes, they actually used to do this).
He noticed that these men did not become bald, and didn’t even show any signs of a receding hairline. His results showed that administering testosterone caused balding in some of the subjects. This was the foundation for the early theory that balding is a result of high testosterone.
Since then of course, we’ve uncovered quite a bit more information about this. We know that balding is linked to testosterone only through it’s by-product, DHT. We also know that it only occurs in men who have a genetic sensitivity to DHT, and that even men with low testosterone levels can experience hair loss.
How does DHT cause Hair loss?
DHT hair loss refers to a process where hair follicles produce a smaller and thinner hair over a period of time as a result of their genetic sensitivity to the effects of DHT. The follicle starts producing hair that resembles a sort of peach-fuzz, and eventually, no hair at all.
DHT is five times more potent than testosterone, so it will attach to the same places as testosterone much easier, and then stay there longer. If that place is our scalp, the amount of DHT is tiny compared with the levels in the prostate, but enough to restrict the follicles ability to grow hair. This effect is evident in those follicles that are genetically sensitive to this process.
The short version of how this happens is that DHT binds to receptors in the hair follicle and cuts off the supply of nutrients and proteins. This causes the follicle to basically “starve”, and become smaller over time.
DHT does not act alone
DHT is a very misunderstood hormone that has gotten a bad rap over the years, but it is still considered a bad guy when it comes to hair loss. It just isn’t the “only” bad guy. We’ve learned that there’s a lot more involved than just DHT.
Through studies, advancements in medical science and accidental discoveries, we’ve learned that there are others culprits to blame for genetic balding. Here are 3 worth mentioning:
PGD2 (prostaglandin D2 )
Many of you may remember the excitement generated in 2012 by dermatologists from the University of Pennsylvania. They announced that they had found that the enzyme prostaglandin D2 (PGD2) may be responsible for instructing hair follicles to stop growing hair.
The conclusion was that if the inhibition caused by PGD2 is removed, the result would be longer hair. Prostaglandin D2 levels are found to be elevated in balding scalps and It is thought that PGD2 prevents the cells from maturing. Based on this information, inhibiting PGD2 could prevent baldness from progressing.
The link between DHT and PGD2 is not clearly understood yet. Similar to DHT, PGD2 is thought to play a central role in male gonadal sex determination and is highly expressed in male genitalia. But here’s the interesting part. It’s believed that DHT plays a role in making and/or releasing PGD2. Also, DHT has previously been known to regulate PGD2 in other tissues.
So there it is, DHT is a major factor in the process of PGD2 related hair loss, and an important one at that! Still, I would prefer to see a treatment that inhibits PGD2 topically, than DHT internally. This way those rare side effects of DHT inhibiting medications would not be an issue. Everyone could enjoy the benefits of a working treatment for hair loss.
Various sources I have found online indicate that an agreement between scientists and drug companies looks positive. It may result in fast tracking the development of a PGD2 hair loss treatment for both men and women. It’s worth nothing that at this point however, there is no certainty that any treatment will be as effective at regrowing hair as it will be at preventing hair loss. So do what you can to keep what you have!
We’ll just have to patiently wait, and in the meantime, following a simple and consistent routine to fight hair loss would be a good idea.
There is a theory that hair loss is caused by thickening and hardening of the scalp tissue and excess sebum production. Also related to this theory, is the idea that this calcification is the result of chronic inflammation. This is brought up a lot when researching hair loss.
Many believe that inflammation may be one of the driving forces behind hair loss. It’s also the reason why ketoconazole works so well, as explain in my Nizoral article.
There’s even evidence that suggests that DHT may actually help in regulating inflammation, and that elevated DHT is a response to the inflammation. So DHT may be a symptom, and not a cause!
I’ve read information on various websites I have found that indicate that it is possible to reverse scalp fibrosis and release excess sebum trapped in the scalp skin using massage techniques. Apparently, the massage increases blood flow and allows the scalp to flush out any trapped DHT. Ah ha! There it is again ..DHT and hair loss, linked together. Not the main suspect in this case, but an accomplice!
I think it’s fabulous if anyone has had success with such a technique, but honestly, several 20 minute massages a day is simply too much of a commitment for me personally. That being said, who knows – if a few head massages and an increase in vitamin K can make a difference, I may add this to my daily routine one day. Never say never!
Another theory is that hair loss may be the result of an imbalance of testosterone and estrogen. Hormones regulate nearly every function in the body, and this certainly includes hair growth.
Many factors can cause an imbalance, such as obesity, abnormal thyroid, stress, menopause / andropause, poor diet, and medication just to name a few. The treatment for a hormonal imbalance would depend on the cause and should always be recommended by a professional. This is not something to play around with.
Quite often, you will find information that refers to DHT and hair loss as a “male hormone imbalance”. Personally, I find it difficult to label DHT in terms of genetic hair loss as a hormone imbalance.
Blocking DHT is still one of the best options to treat Hair Loss – for Now
We’ve come a long way in learning more about the link between DHT and hair loss. We now know it’s more complicated than simply blaming DHT and calling it a day. There are other culprits at work, and the next step will be developing hair loss treatments to address those causes.
One thing we know for sure is that DHT does play a major role in hair loss, and blocking it with a proven DHT blocker such as finasteride is one of the few available methods to treating hair loss at this time. Combine that with addressing the inflammation issue with a product such as Nizoral shampoo, and stimulating the delivery system with minoxidil such as Lipogaine or Kirkland brand. That pretty much sums up the proven treatments we have at our disposal today. Of course a healthy diet, exercise and proper sleep can certainly go a long way as well.
You can read more about treating hair loss this way in my article outlining my daily routine.
If we use what is available to us as mentioned above, we can hold on to the hair we have until new treatments are developed, tested and brought to market. It’s going to be at least another few years before we see this happen. If you’re hair loss is beyond the point of no return, you may want to consider transplant options, or simply rock the shaved head look.
Check back for any updates on this, and let’s hope we’ll see some new treatment options soon. Until then, DHT may not be the only bad guy, but it’s the only bad guy we can stop for now.