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Nick
asked: "Mr. Kozol, Based on your previous responses
to questions, you state that the DHT produced within the body
is more important (causes more harm to the hair) than locally
produced DHT in MPB. The makers of Revivogen state "A: The
blood levels of DHT may play a minor role in Androgenetic
Alopecia but it is the locally produced DHT which plays the
major role. If you look at any physiology text book (such
as Guyton's Medical Physiology) you can see that the majority
of DHT production takes place at the site where it exerts
its effects. Also there is a high concentration of type 2
isoenzyme within the hair follicle itself and a higher concentration
of the type 1 form within the scalp and sebaceous glands which
feed into the hair follicle. Together they can produce more
DHT locally than what blood brings to the hair follicle. Also
most researchers now believe that it is the locally produced
DHT that is involved in Androgenetic Alopecia rather than
the circulatory DHT. Finally there is new evidence about effectiveness
of topical inhibition of DHT on hair growth by Dr. Christiano
which provides support for this theory. Can you please comment
on this? Thank you and Best Regards, Nick"
 Aaron
J. Kozol, R.Ph answered: "Nick, Thanks for the questions.
There is no doubt that local and systemic DHT both play some
role in MPB. Some researchers have shown significant results
by inhibiting only local DHT while others have shown results
inhibiting systemically. My past answers were not intended
to rank systemic DHT as the bigger enemy. DHT, no matter where
it is produced, will most likely have deleterious effects
on the hair follicle. The disadvantage to only inhibiting
DHT production locally is that DHT produced in other areas
may still be presented to the receptor in the follicle. If
it were entirely true that circulating DHT levels do not affect
MPB, then we would not expect to see hair loss from anabolic
steroid use. Also, we would expect a topical DHT inhibitor
such as azelaic acid to be more successful than finasteride.
Not suprisingly, anabolic steroids do potentiate hair loss
for some people. Azelaic acid does work well for some people,
but in my experience is a bit less effective than oral finasteride.
Topical finasteride appears to be ineffective. The only conclusion
I can draw at this point is that DHT - no matter where it
is produced - may exert negative effects upon susceptible
follicles. I do feel that topical DHT inhibitors have something
to offer, but I don't believe you maximize their potential
unless you inhibit DHT systemically or block the receptor
as well. Aaron Kozol, RPh MTTS www.hairlosspharmacy.com
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