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Hi everyone, and welcome back to Hair Loss Immersion. I’m Dr. Ghorbani, a plastic surgeon specializing in hair loss.
In this article, I’ll walk you through the causes and mechanisms of androgenetic alopecia (AGA). While many people have a basic understanding of how AGA works, a lot of important details are often overlooked. My goal is to fill in those gaps so you can better understand your condition. Let’s get started.
Family History and Genetic Predisposition
Androgenetic alopecia is genetic, meaning it’s passed down through your family.
But it’s not just your parents’ genes at play—your uncles, aunts, and grandparents on both sides of the family contribute as well.
The genetic component is so strong that identical twins often begin losing their hair at the same time and progress similarly in their hair loss journey.
What can you do?
- Look at your family’s hair history to get an idea of how dominant hair loss genes are in your family.
Cause of AGA – DHT and Androgen Receptors
A common term you’ve likely heard is DHT sensitivity.
Here’s what happens:
- DHT (Dihydrotestosterone) is a stronger form of testosterone.
- Some people are genetically predisposed to having more androgen receptors in certain areas, like the hairline, top, and crown of the scalp.
- These receptors bind with DHT, leading to its accumulation near the hair follicles.
Key takeaway:
- It’s not just the presence of DHT that causes hair loss; it’s the number of androgen receptors you have that determines your sensitivity. This number is dictated by your genes.
AGA Starts at Puberty
Here’s something surprising: Your genetic hair loss likely started when you were 13 or 14.
Before puberty:
- Children have thick scalp hair and very little body hair.
During puberty:
- Testosterone levels surge, increasing DHT production.
- This hormonal shift causes body hair growth and other changes like a deeper voice.
- If you have a genetically high number of androgen receptors, this increase in DHT can trigger scalp hair thinning.
However, it often takes years for this thinning to become visible.
The Miniaturization Process
The hallmark of androgenetic alopecia is miniaturization.
Here’s how it works:
- Hair doesn’t just fall out—it gets thinner over time.
- Eventually, your body stops producing hair altogether in affected areas.
What causes miniaturization?
DHT buildup interferes with the hair growth cycle:
- Normally, hair grows for up to 7 years.
- In AGA, the cycle shortens, and hair dies much sooner.
Additionally, hair follicles and their blood vessels become thinner, reducing the nutrients your hair receives.
The Role of Free Radicals and Inflammation:
- Cells under stress produce free radicals, which are toxic byproducts.
- When free radicals accumulate, the immune system triggers inflammation to eliminate the damaged cells.
- Chronic inflammation eventually leads to fibrosis—where hair follicles are replaced by simple tissue, permanently stopping hair growth.
Final stage: Total baldness in affected areas.
Telomeres: Accelerated Aging
There’s another mechanism involved: telomeres, which are like the batteries of each cell.
Each time a cell divides, its telomeres shorten, which limits the cell’s lifespan.
In AGA:
- The accelerated cell division due to DHT sensitivity shortens telomeres faster.
- This speeds up the aging process of hair follicles.
Apoptosis:
- The body has a built-in process to eliminate damaged or aging cells called apoptosis.
- In AGA, apoptosis signals the body to remove hair follicles prematurely, contributing to visible hair loss.
Secondary Factors
Beyond genetic mechanisms, other factors can worsen AGA or lead to additional hair loss types like telogen effluvium.
- Supplements like creatine: Increase DHT levels, amplifying the problem.
- Scalp infections: Can cause inflammation, accelerating hair loss.
- Diet and nutrition: While poor nutrition won’t worsen AGA, it can cause telogen effluvium.
Misconceptions:
- A poor diet doesn’t directly affect androgenetic alopecia. However, it can lead to other types of hair loss.
How to Address the Root Problem
To slow or stop AGA, focus on these key areas:
- Reduce DHT levels.
- Block androgen receptors.
- Prevent oxidative stress and free radical buildup.
- Extend the hair growth phase.
- Support hair health with proper nutrients.
For more detailed strategies, check out my other content on androgenetic alopecia.
Conclusion
Androgenetic alopecia is a complex condition driven by genetic and hormonal factors. By understanding its underlying mechanisms, you can take targeted steps to manage your hair loss effectively.
Explore more on Hair Loss Immersion for science-backed advice and personalized support. Together, we’ll help you take control of your hair loss journey.