Male Pattern Hair Loss: Finding the Truth Beyond Hormones

It is no exaggeration to say that the history of male pattern baldness treatment is a war against ‘DHT (dihydrotestosterone).’ Since it was discovered that DHT attacks hair follicles and causes hair loss, modern medicine has focused on suppressing the production of this hormone with drugs such as finasteride and dutasteride. This was clearly an effective treatment for many patients and remains the standard treatment today.

However, after treating hair loss patients for a long time, I had a fundamental question: “Is the absolute amount of DHT really the key to the problem?” If so, how can we explain the phenomenon of a sharp increase in the incidence of hair loss not in the 20s when male hormone secretion peaks, but in middle-aged people whose testosterone levels gradually decrease? Through this reflection, I concluded that the paradigm for hair loss should change from ‘amount of hormones’ to ‘sensitivity of hair follicles.’ And we discovered that the most important key to determining the sensitivity is ‘chronic inflammation of the scalp.’ Through this article, I would like to talk about the new direction and philosophy I pursue in treating male pattern hair loss.

1. The paradox of DHT: Who is the real culprit?

The generally known mechanism of male pattern hair loss is as follows: the male hormone testosterone is converted to DHT by 5-alpha reductase, and this DHT binds to the androgen receptor in the hair follicle, causing the hair follicle to atrophy and shortening the hair growth period. According to this logic, the more DHT there is, the more severe the hair loss should be. However, when we look at clinical practice and our lives, there is a 'paradox' that cannot be explained by this hypothesis alone.

As previously mentioned, DHT levels in men tend to naturally decrease with age, but the prevalence of hair loss increases rapidly with age. Severe hair loss is also common in men whose blood DHT levels are in the normal range or rather low.

This suggests that the switch to hair loss is not the amount of 'bullet' (DHT), but the 'sensitivity' of the androgen receptors distributed around the hair follicles, which are the 'target site', is a much more decisive factor. Even if exposed to the same amount of DHT, people whose receptors are sensitive will experience rapid hair loss, while people who are less sensitive will not be affected much.

2. Main culprit that increases receptor sensitivity: ‘Chronic scalp inflammation’

So what makes these androgen receptors so sensitive? Of course, genetic predisposition is an undeniable innate factor. It is an obvious fact that people with certain genes are more susceptible to hair loss. But I am convinced that on top of this genetic 'blueprint' there is an acquired 'catalyst' that amplifies the sensitivity of the receptors. And the most powerful catalyst is ‘chronic inflammation of the scalp.’

When chronic inflammation exists on the scalp (seborrheic dermatitis, folliculitis, psoriasis, etc.), our body's immune system secretes various inflammatory cytokines to defend against it. These substances disrupt the metabolic processes of hair follicle cells and increase oxidative stress, worsening the environment around the hair follicles. In this state of confusion, androgen receptors become abnormally activated and become hypersensitive to even small amounts of DHT.

In other words, a vicious cycle of ‘inflammation → increased receptor sensitivity → promotion of DHT binding → hair follicle miniaturization’ is formed. This is why I consider improving scalp inflammation and correcting its root cause (stress, eating habits, lifestyle patterns, etc.) to be of utmost importance when treating hair loss. When the scalp, which is the soil, becomes healthy and the embers of inflammation are extinguished, excessive activity of androgen receptors can also naturally stabilize.

3. New treatment paradigm: beyond hormone suppression to receptor stabilization

Conventional hair loss medications work by inhibiting DHT production. Although this is an effective method, because it artificially intervenes in the metabolic process of male hormones, there are always concerns about unwanted side effects such as decreased sexual function or lethargy in some patients.

But what if we could directly lower the sensitivity or activity of androgen receptors even without reducing the amount of DHT? This will be a revolutionary approach to treating hair loss. Since the hair loss process can be selectively blocked while maintaining normal hormone levels, you can be much free from concerns about side effects.

This is the major direction of treatment I pursue. The treatments I develop and use focus on controlling scalp inflammation, improving circulation, and normalizing the environment around the hair follicles by providing nutrients directly to the hair follicles. This reduces the sensitivity of oversensitive androgen receptors, slowing down hair loss and helping hair recovery.

Of course, my research and treatment are still at an incomplete stage. My ultimate goal is to discover new substances that can directly and safely regulate the activity of androgen receptors and develop them into therapeutic agents. I am still constantly working towards that goal.

4. Hope beyond genes: the potential of epigenetics

Many people give up and say, “Hair loss is hereditary and can’t be helped.” You cannot change the DNA base sequence itself inherited from your parents. However, 'Epigenetics', a recent hot topic in the medical world, offers us new hope. Epigenetics is a study that studies how our lifestyle habits or environmental factors can control the ‘expression’ of genes without changing the DNA base sequence.

This means that even if we were born with a hair loss gene, we can control the timing and intensity of when that gene is switched on depending on what we eat, how we manage stress, and what treatments and care we receive. Of course, a clear epigenetic method related to hair loss has not yet been discovered, but there is still progress. Therefore, there is no need to be afraid in advance that you will also lose hair just because your parents or grandparents are losing hair, and even if hair loss occurs, it can be improved through 'treatment and management.'

In conclusion, male pattern hair loss is a complex phenomenon that cannot be explained by a single hormone called ‘DHT’. I will continue to pioneer a path toward more fundamental and safe treatments by looking beyond the forest of hormone levels to the trees of 'androgen receptors' and 'scalp inflammation'.