Asim Shahmalak
He is a frequent media spokesman, and has written about the importance placed in hair over the centuries and the fact that baldness until recently was not recognised as a social or medical issue, despite the sometimes catastrophic impact it can have on confidence and mental well-being. He wrote: "Male pattern baldness (MPB), the main cause of hair loss, affects an estimated quarter of men by the age of 30 and two thirds by the age of 60. Until recently, the impact baldness might have on confidence and well-being was little understood or recognised by the medical profession at large."
Pattern hair loss
The fact that hair loss is cumulative with age while androgen levels fall as well as the fact that finasteride does not reverse advanced stages of androgenetic alopecia remains a mystery but some possible explanations have been put forward: Higher conversion of testosterone to DHT locally with age as higher levels of 5-alpha reductase are noted in balding scalp, and higher levels of DNA damage in the dermal papilla as well as senescence of the dermal papilla due to androgen receptor activation and environmental stress. The mechanism by which the androgen receptor triggers dermal papilla permanent senescence is not known but may involve IL6, TGFB-1 and oxidative stress. Senescence of the dermal papilla is measured by lack of mobility, different size and shape, lower replication and altered output of molecules and different expression of markers. The dermal papilla is the primary location of androgen action and its migration towards the hair bulge and subsequent signaling and size increase are required to maintain the hair follicle so senescence via the androgen receptor explains much of the physiology.