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Why
doesn't one single treatment work for everyone
There are probably different types of pattern baldness where one
contributing factor important in promoting hair loss in one person
is different from the factor promoting hair loss in another person.
For example, Dihydrotestosterone (DHT) may be a big promoter of
hair loss but for another person it may have a lesser role supplemented
by the effects of other androgens such as DHEA. Or perhaps the activity
of type I 5 alpha reductase is greater than type II activity in
one person but the reverse is true for another. Or one person has
more androgen receptors on the cells in their hair follicles such
that small amounts of androgen hormone has a bigger adverse impact.
The extent of hair loss may be the same in two individuals but
the importance of different androgens and androgen receptors in
the development of hair loss may differ from person to person. While
subtle differences in how baldness develops in different people
has yet to be proven, it is generally believed that DHEA may have
a much bigger role to play in female pattern baldness compared to
male pattern baldness.
All these subtle differences may mean that a treatment that works
well by acting to block dihydrotestoerone production through 5 alpha
reductase inhibition may work well for one person but will work
less well for another where hair follicles have high numbers of
androgen receptors that can be triggered by comparatively low levels
of dihydrotestosterone.
It is well known that drugs such as Propecia and minoxidil are
less effective for people who have had pattern baldness for many
years. This is probably due to hair follicle destruction. In the
early stage of pattern baldness hair follicles become miniaturised
but still produce small vellus hairs. These hair follicles could
still potentially be reactivated to produce full terminal hair again.
However, after several years of miniaturisation, hair follicles
become so weak that they stop growing altogether. These follicles
are entirely destroyed. Once destruction occurs it is impossible
to stimulate these follicles back into growth no matter how powerful
the drug.
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