Losing your hair can be a big concern for men and women alike. As bodybuilders, we are interested in sculpting our bodies to maintain or improve our self image and confidence. Male Pattern Baldness (MPB) can go directly against what we are working so hard to achieve (unless you are one of the lucky few who happen to suit a bald head).
There are several types of hair loss, such as androgenetic alopecia, alopecia greata, telogen effluvium, hair loss due to systemic medical problems, e.g, thyroid disease, adverse drug effects and nutritional. Of the different types, androgenetic alopecia is the most common cause of hair loss, affecting about 30% of individuals who have a strong family history of hair loss.
There is some controversy and confusion as to the hereditary responsibility for MPB. Some people will say it comes from your Mother's Father, others from your Father. I'm here to tell you that the current research we have available still doesn't make it clear as to who is responsible.
That being said, often a good indicator of MPB predisposition is your mother's brothers, and potentially your Mother herself. Under the X chromosome theory, in order for a female to exhibit issues with hair loss, they would need two X chromosomes affected, so if there is any female balding that pre-dates you in the family, this could be a semi-realistic tell-tale sign.
The mechanism behind hair loss isn't straight forward either, although the hormones dihydrotestosterone (DHT), estrone and estrodiol (estrogen) seem to be the primary offenders.
It is proposed that MPB is caused by a genetic sensitivity of hair follicles to DHT, which causes them to shrink or "miniaturize" when exposed to it. This shortens their lifespan and prevents them from producing hair normally. This can be demonstrated by those individuals with McGinley syndrome which results in limited DHT production. Men with this syndrome do not suffer from enlarged prostate and do not become bald. (4)
That considered, some authors and experts will ONLY consider the use of DHT inhibitors as a remedy for slowing or reversing hair loss (outside of a transplant), although those of us with an inquisitive mind have to question this.
DHT is a hormone which is converted from testosterone; MPB is a hereditary condition has been show to worsen with age. In fact, MPB is noticeable in about 20% of men aged 20, and increases steadily with age, so that a male in his 90s has a 90% chance of having some degree of MPB.(2) Now, if you know anything about the male endocrine system (read: the system which regulates most hormones), you'll know that testosterone levels decrease at a rate of 10% per decade from the time you turn 25-30 years of age (dependent upon the author you get this value from).
So, decreased testosterone would mean decreased by-product through the amplification (5-AR) pathway and subsequently less DHT (read: old = less test = less DHT).
So why is it then, that as men age their hair loss accelerates? We know their DHT levels aren't increasing….as we know their testosterone levels have been higher in the past (DHT:T ratios remain constant over a mans life). (5)
Some Doctors and researchers believe the problem lies with estrogen, more precisely the interaction between Sex Hormone Binding Globulin (SHBG), estrogen and insulin like growth factor – 1 (IGF-1). The proposed mechanism under this model is estrogen sticking to SHBG attached to the membrane surface (scalp). IGF-1 then interacts with the estrogen up regulating the number of DHT (androgen) receptors.
As men age their Testosterone to Estrogen ratio progressively gets worse (read: estrogen rises and testosterone decreases). So it is proposed that the mechanism for MPB follows suit with that of prostate hypotrophy…. It's the increased interaction between SHGB, estradiol and IGF-1, which creates more androgen receptors allowing for DHT to do its damage. (6)
To recap, as men age, we have MORE estrogen, and LESS testosterone and therefore LESS DHT. But it's the increase DHT receptors that allow the smaller quantity of DHT to exert its effect at the hair follicle. If we can successfully reduce one of these elements (estrogen) we see reduced DHT receptor sites -- and hopefully a reduction, reversal or cessation of hair loss (a reduction in SHGB may be of benefit here also).
Now you might be thinking "without DHT, the number of receptor sites is irrelevant." And that's a fair comment. But you have to understand that the reduction of systemic DHT is a delicate balancing act, and something you don't necessarily want as a male, and in particular as a bodybuilder.
First of all, DHT competes with estrogen at the estrogen receptor, helping us reduce excess estrogen complications (fat gain, gyno, etc). (7) Second, DHT is a much stronger androgen than testosterone – it binds about 3-5 times more strongly to the androgen receptor.
Read more from this MESO-Rx article here.
So if we start crushing our DHT levels, our bodybuilding progress will suffer. Thirdly, DHT is very much a male hormone, helping our libido and maintenance of erections. For the bodybuilding individual, Serious Supplements recommends an integrated estrogen and DHT management plan (without compromising gains in the gym and the bedroom) for the reduction and reversal of hair loss.
We have prescription and OTC supplement options for helping us to manage both estrogen and DHT – we’ll focus on the more prevalent and effective of the available options.
The following are systemic reducers of DHT. These products will reduce serum DHT. Remember that the beneficial effects of these products should be weighted against the possible side-effects such as impotency, reduced strength and muscle mass, decreased libido, reduced sperm count, and gynecomastia.Taken from Androgens and hair loss, Alsantali, Adel; Shapiro, Jerry, Current Opinion in Endocrinology, Diabetes and Obesity: June 2009 -Volume 16 - Issue 3 - p 246-253:
Finasteride is a selective inhibitor of type 2 isoform of 5a-reductase, an enzyme that converts testoserone to DHT.
Oral finasteride 1 mg per day has shown mild-to-moderate hair regrowth in 61% of patients with vertex baldness and in 37% of patients with frontal baldness. Also, finasteride prevents further hair loss in 80% of patients with vertex baldness and in 70% of patients with frontal baldness. Finasteride significantly increased scalp hair weight in men with AGA. The improvement was evident as early as 12 weeks. At 192 weeks, treatment with finasteride produced a net increase in hair weight by 46% comparedwith the placebo group. Furthermore, treatment with finasteride resulted in a net improvement inthe anagen-to-telogen ratio of 47%
Simular to the above, except it inhibits both type 1 and 2 5a-reductase. Should be more effective than propecia/fenesteride because type 1 is more prevalent in the scalp.
Dutasteride, a dual 5[alpha]-reductase inhibitor, is currently approved for treatment of benign prostatic hypertrophy. The serum half-life of dutasteride is about 4 weeks. In a randomized placebo-controlled study, 2.5 mg dutasteride improved hair growth in balding men more rapidly and to a greater degree than 5 mg finasteride did.