SUMMARY: In male pattern baldness, hair follicles stay “asleep,” in a dormant state, leading to permanent hair loss. Hair follicle death is another (far less common) way to lose hair. A cure for “sleeping” hair follicles would be to wake them up; a cure for damaged hair follicles would be to replace them. While simple in principle, we have no idea how to do these “simple” things. However, recent research into how our bodies use vitamin D has provided a critical key that could soon unlock the door to a cure for these two types of permanent hair loss.
By John Frank, M.D. | IAHRS, ABHRS, ISHRS, AHLA, XM Radio: ‘The Bald Truth’, NYC, June 25, 2013
Vitamin D May Cure Baldness But Not In The Way That You Think
According to the International Society of Hair Restoration Surgery1, over 50 million men and women in the U.S. alone suffer from progressive permanent hair loss. Over 750 million more suffer worldwide and current treatment costs run in to the billions.
With this much suffering and hair loss sufferers spending this much money on treatment, it is no surprise that researchers and pharmaceutical companies around the world are racing for a cure for baldness.
Two Ways to Permanently Lose Your Hair
Scientists understand the biology of permanent hair loss remarkably well. There are two ways to suffer permanent hair loss.
One way is by progressive and extended follicular dormancy. All hair follicles normally cycle into and out of a hair growth phase. At the end of a growth phase (typically lasting several years), the hair shaft falls out and the follicle takes a break, if you will, for a few months. However, certain conditions can cause a hair follicle to spend an abnormal time in its sleep or resting phase (called telogen). You get progressive hair loss when more and more follicles spend longer and longer amounts of time in their telogen phase. The result of this is gradually thinning hair, and as more and more follicles simply stay asleep, you go bald – permanently.
The most common cause of progressive and extended follicular dormancy is hereditary androgenetic alopecia or “male pattern baldness.” Androgenetic alopecia occurs when a genetic mutation causes large numbers of hair follicles to become sensitive to a natural hormone in the body called dihydrotestosterone (DHT). In individuals with androgenetic alopecia, the presence of DHT, over time, tells the hair follicle to shut down. In individuals with this hereditary disorder, not every follicle on the scalp is vulnerable to DHT. Only a certain number are, and they occur in a very predictable pattern2, which is why doctors refer to this type of hair loss, in men, as “male pattern baldness.” Women too suffer from androgenetic alopecia, but not as commonly as men do, and the pattern of loss is less predictable3.
A far less common cause of permanent hair loss is follicular death. Many things can cause hair follicles to die, such as chemotherapy, the autoimmune diseases scleroderma4 & discoid lupus and scarring alopecia5.
Current Treatments For Permanent Hair Loss
Hair transplant (or hair replacement) surgery is currently the only “cure” for permanent hair loss, but fortunately it is today a highly effective treatment, and it is so natural that it is practically undetectable.
Minoxidil and Propecia are hair loss drugs that are effective at stopping permanent hair loss — but they cannot re-grow lost hair.
Both surgical and non-surgical treatment options6, again while highly effective, have their drawbacks. Minoxidil and Propecia can have unpleasant side effects and surgical hair replacement, as effective and as natural looking as it is, can be a bit pricy for many people.
Vitamin D to the Rescue?
A spate of recent research has strongly implicated vitamin D as somehow being involved in triggering hair growth, but first a little background:
We need vitamin D to have healthy bones – specifically, we need vitamin D to absorb calcium. We get calcium through our diet but our skin makes vitamin D when exposed to sunlight.
Only as recently as 1999 did researchers discover a mechanism (a multi-protein complex called MED) that allowed vitamin D to bind to various vitamin D receptors (VDR) in different organs. By blocking MED, this prevented vitamin D from binding with its receptors in various internal organs and allowed researchers to study the negative effects of calcium deficiency on those organs.
In 2012, researchers7 then wondered if MED was also responsible for vitamin D binding in the skin. If so, then by blocking MED, they should see negative effects of calcium deficiency in the skin. Low and behold they found a range of disruptions in healthy skin maintenance including hair follicles shifting into a prolong telogen (sleep) phase resulting in hair loss.
Later research found that it was not vitamin D per se that is involved in normal hair growth function but a mediating vitamin D binding factor called LEF18.
That a vitamin D receptor is somehow involved in alopecia was strongly suggested in 2005 when the same researchers at Massachusetts General Hospital and Harvard Medical School suspected that a specific mutation in the vitamin D receptor (VDR) might play a role in alopecia, but the specific nature of the mutation was not clear at that time. Now it is – a mutation in LEF1 seems to be interfering with its normal function of waking sleeping hair follicles up.
With these discoveries, researcher now have critical information that could lead to the development of new gene and drug therapies that could shift hair follicles out of a permanent sleep phase caused by alopecia and into an anagen (awake) phase. This would be a true cure for androgenetic alopecia.
An interesting question is why would the VDR, of all things, be a trigger for hair growth? One possibility is that this could be a part of an evolved defensive mechanism for the body, i.e., sunlight causes vitamin D production and increase hair growth could be a way for the body to offset the potentially damaging affects of UVA and UVB radiation.
But what about the other cause of hair loss – permanently damaged hair follicles? It turns out that while vitamin D is not a direct trigger to wake up hair follicles taking an extended or permanent rest it may very well be a direct trigger for creating new hair follicles. Stay tuned for the next post: A Potential Vitamin D Baldness Cure – Part II!
References
1. ISHRS Statistics & Research.
2. Visual Symptoms of Male Pattern Baldness. The Mayo Clinic.
3. Treating female pattern hair loss. Harvard Health Publications.
4. Scleroderma. National Institute of Health Library of Medicine.
5. Scarring Alopecia. Medscape, Basil M Hantash, MD, PhD; Chief Editor.
6. Medical and Surgical Options to Restore and Maintain Scalp Hair. October 2005, International Society of Hair Restoration Surgery.
7.Oda Y, Hu L, Bul V, Elalieh H, Reddy JK, & Bikle DD (2012). Coactivator MED1 ablation in keratinocytes results in hair-cycling defects and epidermal alterations. The Journal of investigative dermatology, 132 (4), 1075-83 PMID: 22189783
8.Luderer HF, Gori F, & Demay MB (2011). Lymphoid enhancer-binding factor-1 (LEF1) interacts with the DNA-binding domain of the vitamin D receptor. The Journal of biological chemistry, 286 (21), 18444-51 PMID: 21471213
