Alopecia is the abnormal loss of hair, commonly referred to as baldness. It can affect any area of the skin, causing, for example, the loss of facial or eyebrow hair, but it primarily affects the scalp.
There are different types of alopecia, but the most common, responsible for more than 90% of cases, is androgenic alopecia or male pattern baldness. This trait is strongly influenced by male sex hormones: androgens.
Male baldness affects a large portion of the population. Studies indicate that 50% of men at age 50 experience some degree of baldness, a percentage that increases to 80% by age 70.
Physically, it has no greater consequence than the loss of hair itself. However, for some individuals, it can be a significant social issue, particularly impacting the self-esteem of those who experience it.
It is therefore not surprising that in 2021, approximately 3.4 million hair transplants were performed worldwide, with a total value of 1.8 billion dollars.
Male baldness has always been surrounded by claims that have been debunked over time but still persist in popular culture. Let’s analyze some of them.
If I Have Gray Hair, I Won’t Go Bald
“Those who go gray won’t go bald,” says an old popular saying. This is one of the oldest and most widespread myths.
Gray hair is simply hair that has lost its pigmentation due to a decrease in melanin production. This can occur for various reasons, such as a vitamin B12 deficiency or the depletion of melanocyte stem cells, mainly associated with aging.
Fun fact: There is a genetic predisposition to gray hair.
However, this does not affect the hair growth cycle, and so far, studies have not found a relationship between baldness and gray hair.
On a personal note, as someone who has gone gray for many years, thinking that at least gray hair clings more firmly to the head has always been a comforting thought.
Baldness Is Inherited Directly from Our Mother
You have probably heard that if your maternal grandfather is bald, you will be too. This belief is widespread, but it is not entirely accurate.
Research has shown that baldness is strongly influenced by genetics, but it follows a very complex inheritance pattern.
It is true that the most important genes related to baldness are found on the X chromosome, which men inherit directly from their mothers. However, there are hundreds of other involved genes spread throughout the genome that we inherit from both parents.
Therefore, our mother’s inheritance, as well as our father’s, influences our predisposition to baldness. The genetic factor of baldness comes from both parents.
Can Hereditary Baldness Be Prevented?
Androgenic alopecia is not “curable”, but it is preventable.
Currently, there are two pharmaceutical treatments that have been proven effective in slowing or delaying hair loss: topical minoxidil and topical finasteride (topical applications have fewer side effects than oral ones).
Additionally, platelet-rich plasma injections have also demonstrated their effectiveness.
Once alopecia is already established, the solution is a hair transplant—a procedure in which hair is taken from unaffected areas and implanted into bald areas.
Understanding our genetic predisposition to male baldness can help us take preventive actions to minimize its impact as much as possible.
For this, genetic analyses, such as those from tellmeGen, which provide information about this risk, can be very useful.
Autoimmune Baldness: Alopecia Areata
Alopecia areata is one of the most common forms of hair loss, with an incidence ranging between 0.2% and 2% of the global population, depending on the region.
What makes it unique is that, while it is multifactorial like most types of alopecia, it is considered to have a strong immune component—it is an autoimmune hair loss condition.
It occurs when CD8+ T lymphocytes accumulate around the hair follicle, preventing hair growth and ultimately leading to its loss. It is difficult for cells to work on giving you a beautiful mane when the immune system decides to turn your surroundings into a battlefield.
Another interesting detail is that the genes involved in alopecia areata are shared with other autoimmune diseases such as type 1 diabetes or rheumatoid arthritis.
Alopecia areata can affect men, women, and even children. Family history increases the risk—between 4% and 28% of those affected have relatives who also suffer from the condition.
If you have a grandparent with alopecia areata, your chances are higher compared to someone whose grandparents have a full head of hair.
Most cases arise from the combination of genetic predisposition and environmental triggers. Stress is believed to be the most significant trigger for alopecia areata.
The first symptom is hair loss in patches, typically ranging from 1 to 4 centimeters. It is a localized form of hair loss. There are different types of alopecia areata, but two are particularly striking:
- Alopecia Areata Totalis: The result is not just patches, the entire scalp loses hair, leading to complete baldness. This typically occurs within six months of the first symptoms.
- Alopecia Areata Universalis: The disease affects the entire body, not just the head. Eyebrows, eyelashes, armpit hair, everything falls out.
The treatment for alopecia areata is very similar to other types of alopecia, and in some cases, the condition resolves on its own (40% of cases). Some people have completely recovered from alopecia areata.
However, patients may experience multiple episodes throughout their lives.
If spontaneous recovery does not occur, topical minoxidil and immunosuppressive treatments like corticosteroids can be used. If the patches are too large (or if calling them “patches” would be an understatement), dosage and administration methods of immunosuppressants are adjusted, and ultraviolet light therapy or laser treatments may be employed. These are therapies aimed at hair regrowth and controlling autoimmune damage.
Fortunately, the disease only causes baldness. There is no damage to other tissues or secondary complications. However, in some cases, alopecia areata may be a secondary symptom of a more serious underlying condition.
It is not uncommon for autoimmune responses to stem from other health issues.
In some cases, alopecia areata has been linked to celiac disease, and a gluten-free diet has led to hair regrowth.
But celiac disease has its own section on the blog!
