Male pattern baldness or androgenetic alopecia is a result of the inherent susceptibility of the hair follicles of some patients to shrinkage due to androgen hormones. This results in hair thinning and hair loss in a very high number of men and women in their lifetimes. In men, male pattern baldness manifests as progressive thinning and balding at the temples and the dome of the head. In women, androgenetic alopecia causes diffuse thinning on the crown of the head, leading to widening parting and thin, frizzy hair.
Male pattern baldness is caused by a genetic predilection, but environmental factors may also play a role in its development. Some of the factors which play a role in male pattern baldness are listed below:
- Hormones – Male pattern baldness is affected by the dihydrotestosterone hormone. Dihydrotestosterone is a metabolic product of the conversion of free testosterone by 5-alpha reductase. DHT causes the progressive shrinkage of hair follicles which may eventually lead to their becoming dormant.
- Ageing – Due to changes in hormonal levels as a person ages, onset of baldness with age may also take place.
- Genetics – Baldness is dependent on several genetic factors.
- Metabolic syndrome – Premature baldness may be caused by an interplay of several factors such as glucose uptake, insulin resistance, androgen levels and other genetic factors. These must be carefully investigated while evaluating male pattern baldness.
Male baldness hair regrowth is a problem that clinicians and cosmetologists have been investigating for a long time. Some of the therapies available for male baldness hair regrowth are as follows:
- Minoxidil – Minoxidil is a topical solution that has shown to be a promising way of bringing about male baldness hair regrowth. Regular application of minoxidil two times a day has shown to cause regrowth of hair from the dormant follicles.
- Finasteride – Finasteride is a drug which when taken orally can inhibit hair follicle shrinkage and results in slowing the progression of male pattern baldness in patients.
- Platelet rich plasma treatment – Over the last few years, platelet rich plasma treatment has emerged as a promising option for male baldness hair regrowth. PRP treatment involves the separation of platelet rich plasma from the patient’s own blood and its microinjection into the balding areas of the scalp. The growth factors and proteins present in the plasma then regenerate the shrinking hair follicles and result in improved hair growth.
Male pattern baldness can cause anxiety and self-consciousness. However, due to advancements in regenerative medicine and drug development, male baldness hair regrowth is no longer as elusive a goal as before. An experienced dermatologist or cosmetic surgeon can definitely enable male baldness hair regrowth and slow the progression of male pattern baldness.
The QR 678 ® therapy in Androgenetic Alopecia:
The QR 678 ® therapy is a proprietary, first in class hair fall & hair regrowth therapy, which has revolutionized the treatment of hair fall in alopecia. This formulation was invented in India & has been named QR678 inspired by the new generation ubiquitous presence of “Quick Response“ QR code. 678 in Morse Code signifies “there is no answer”. This formulation has been named QR678® to signify a “Quick Response to a disease which earlier had no answer”.
Clinical Trial Data
QR678® has been through a Phase III open label, prospective, single arm interventional CLINICAL Trial, in which 1000 patients with androgenetic alopecia were given mesotherapy administration into the scalp skin. The treatment regimen comprised 8 mesotherapy sessions, 3 to 4 weeks apart, till 8 sessions were completed. Hair pull test was performed, before every session. Videomicroscopic & global images were taken at baseline, fourth session, eighth session, & 2 months after the completion of the 8 sessions. Relevant safety assessments through physical examination, questionnaires & appropriate laboratory examination were conducted throughout the study.
The treatment was effective in improving the appearance of scalp hair & slowing the loss of hair in men & women with patterned hair loss. Improvement in hair growth with therapy was evident as early as after 4 sessions for all measured endpoints. At one year, a statistically significant increase in total hair count (P=0.002) continued to be seen. After 8 sessions, global photographs showed improvement from baseline for 71% patients, a decreased score for 10% patients, & no change in score for 19% patients.
The findings of this study suggest that the beneficial clinical effects of this therapy are similar in men & women, across different age groups, & in patients irrespective of the presence of metabolic disorders like diabetes, hypertension, hypercholesterolemia etc. Moreover, results indicate that therapy was also effective in controlling hair loss in 14 post hair transplant patients. There was a negative correlation between the duration & stage of hair loss, & the degree of improvement.
Haematology & serum biochemical analysis were performed at baseline, sessions 4, 8 & then 2 months post the 8th session. There was no significant change in the biochemical values from the administration of QR 678.
Effects of QR 678 in androgenetic alopecia in comparison to topical minoxidil:
Existing medical therapy used in androgenetic alopecia include the use of topical minoxidil and oral finasteride tablets.
The most important clinical trial evaluating the efficacy of minoxidil in androgenetic alopecia was performed in the USA – https://clinicaltrials.gov/ct2/show/NCT00151515
This clinical trial though was not neutral and was industry (Johnson & Johnson, manufacturer & patent holder for minoxidil) sponsored.
The primary purpose of the study was to evaluate the efficacy of a topical 5% minoxidil formulation in males for the treatment of male pattern hair loss. The secondary purpose was to evaluate the safety of a topical 5% minoxidil formulation in males when used twice daily for the treatment of pattern hair loss and to obtain the safety data on the investigational product when used twice daily for up to one year.
In August 1988, the US FDA finally approved minoxidil for treating baldness in men under the trade name “Rogaine”. The agency concluded that although “the product will not work for everyone”, 39% of the men studied had “moderate to dense hair growth on the crown of the head”.
Minoxidil is generally well tolerated, but common side effects include burning or irritation of the eye, itching, redness or irritation at the treated area, and unwanted hair growth elsewhere on the body. Dandruff is a common problem as is Temporary hair loss. Manufacturers note that minoxidil-induced hair loss is a common side effect and describe the process as “shedding”.
We believe that minoxidil works well to stop or reduce hair fall in a majority of people, but does not work as well at hair regrowth. Regular usage of minoxidil leads to compliance issues & most people do not use minoxidil in the recommended twice a day usage pattern, used in clinical trials.
As the QR678® has no real side effects & cause hair growth, especially in minoxidil resistant cases, it is an interesting alternative to minoxidil & is preferred by a large number of patients.
Effects of QR 678 in androgenetic alopecia in comparison to oral finasteride:
Three double-blind, randomized, placebo-controlled Phase III studies of finasteride were conducted in 1879 men ages 18–41 years with mild to moderate AGA. Two of the studies enrolled men with predominantly vertex hair loss and one study enrolled men with predominantly frontal (anterior mid-scalp) hair loss. Finasteride 1 mg or matching placebo tablets were taken once daily for 24 months in the vertex studies and for 12 months in the frontal study. All three studies demonstrated that finasteride treatment led to a significant improvement in hair growth and slowing of further hair loss progression, while placebo-treated men showed significant hair loss.
The net improvement in hair count (finasteride vs. placebo) was 14% at 1 year and 16% at 2 years. Only 17% of men receiving finasteride lost hair based on hair count during the 2-year studies, compared with 72% of men receiving placebo. These data demonstrated that finasteride slowed the progression of hair loss.
The problem though was that drug-related adverse events reported by ≥1% of men receiving finasteride 1 mg in the first year were decreased libido (reported by 1.8% of men on finasteride vs. 1.3% on placebo), erectile dysfunction (reported by 1.3% of men on finasteride vs. 0.7% on placebo) and ejaculation disorder (1.2% of men on finasteride vs. 0.7% on placebo). Approximately 1% (1.2%) of men receiving finasteride discontinued treatment due to these adverse events (compared with 0.9% of men in the placebo group) with resolution occurring after discontinuation of drug.
We believe that finasteride works well to stop or reduce hair fall in a majority of people, but does not work as well at hair regrowth. Regular usage of finasteride leads to compliance issues & most people do not use finasteride continuously, because of the side effects it has on male sexuality.
As the QR678® has no real side effects & cause hair growth, especially in minoxidil & finasteride resistant cases, it is an interesting alternative to finasteride & is preferred by a large number of patients.
Synergistic use of QR 678® & minoxidil & finasteride in androgenetic alopecia:
In patients with advanced hair fall & advanced alopecia, we have used the QR 678® in combination with topical minoxidil lotion & oral finasteride tablets and seen additive & synergistic effects.
Hair transplant in Androgenetic Alopecia & effects of QR 678®
Hair transplant therapy like Follicular Unit Extraction (FUE) & Follicular Unit Transplantation (FUT) are used in advanced alopecia. But, hair transplants are invasive. The market for hair transplantation is dwarfed by the immense market for products that treat hair loss without surgery.
The major challenge for hair transplant is that only the occipital scalp hair (hair at back of scalp) is Dihydrotestosterone (DHT) resistant. This is the area from where donor hair is taken for the balding areas, in a hair transplant surgery. The problems with this approach are mainly two-fold:
- A limited amount of donor hair
- The continued falling of the hair located at the frontal & vertex areas of the scalp, as the androgenetic alopecia progresses.
Resultantly, the hair transplants need repetition & supportive medical therapy (minoxidil & finasteride) to maintain the initial results.
While the QR 678® can assist to reduce the chances of hair transplantation in early alopecia by arresting hair fall & causing hair growth, the QR 678® also works well to support the existing hair & the transplanted hair post hair transplant surgery.
Best treatment for Androgenetic Alopecia
Combination therapy using the QR 678® hair growth therapy, topical minoxidil, oral finasteride & hair transplant surgery where required may give the best results for androgenetic alopecia & male pattern baldness.
Androgenetic Alopecia, Hair Loss/Fall Treatment for Men and Women Before After Photos-
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