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Thinning hair is a common problem for gentlemen of all ages. Male pattern baldness is not only a sign of aging, but it can also effect a man's confidence and overall productivity. Studies show that Alopecia affects 20% of men by age 20 and increases by 10% per decade. This means that over half of men aged 50 suffer from baldness.
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To get a better understanding of male pattern hair loss, it helps to understand hair growth.
Hair growth is split into three phases: anagen, catagen, and telogen:
Anagen is the growth phase. Hairs remain in this phase for 2 to 6 years. The longer it lasts, the longer the hair grows. Normally, around 80 to 85 percent percent of the hairs on the head are in this phase.
Catagen lasts only 2 weeks. It allows the hair follicle to renew itself.
Telogen is the resting phase. The follicle lies dormant for 1 to 4 months. Normally between 12 and 20 percent of hairs are in this phase.
After this, anagen begins again. The existing hair is pushed out of the pore by the new growth and naturally sheds.
Male pattern hair loss happens when the follicles slowly become miniaturized, the anagen phase is reduced, and the telogen phase becomes longer.
The shortened growing phase means the hair cannot grow as long as before.
Over time, the anagen phase becomes so short that the new hairs do not even peek through the surface of the skin. Telogen hair growth is less well-anchored to the scalp, making it easier to fall out.
As the follicles become smaller, the shaft of the hair becomes thinner with each cycle of growth. Eventually, hairs are reduced to vellus hairs, the type of soft, light hairs that cover an infant and mostly disappear during puberty in response to androgens.
STRATEGIC TARGETS USED TO SLOW HAIR LOSS
First target The first target is androgenic: the aim is to slow the production of dihydrotestosterone (DHT) by 5α-reductase. This metabolite is more active than testosterone (supplied by the blood) since it has a greater affinity for the androgen receptors located, in particular, on the dermal papilla (ANDERSSON S., 2001). DHT acts by atrophying the hair follicle and, according to a recently advanced hypothesis (SAWAYA et al., 2001), through a pro-apoptotic mechanism via caspase 3.
Two isoforms of 5a-reductase are present in the skin but the α1 form seems to be more active at facial level (cf. acne) and in the hair follicle at dermal papilla level, while the α2 form is reported to be more present at inner and outer root sheath level (BAYNE et al., 1999).
L’Oréal's team (GERST, 2002), in a structure/activity relationship study, showed that the specific inhibitors of α2-reductase were not active on cultured hair follicles, unlike specific α1-reductases or mixed α1- and α2-reductases.
The use of a mixed 5α1- and 5α2-reductase inhibitor such as finasteride (a drug originally developed for prostatic hypertrophy because of its action on 5α2-reductase) enabled a considerable reduction in hair loss in patients presenting with a markedly receded hairline. A 47% increase in hair in the anagen phase was thus obtained after 1 year through simple inhibition of 5α-reductase (VAN NESTE et al., 2000).
This effect is considered due to a local decrease in DHT levels (50%). DHT is thus present at the concentration found in the normal scalp (DALLOB et al., 1994).
Second target The second target is the blood: good capillary perfusion is the mechanism advanced to explain the unexpected success of a peripheral vasodilator, Minoxidil®, originally used as an antihypertensive. Its interesting side effect, fresh growth of hair, was discovered through clinical use of the drug to treat hypertension.
While the effect related to enhanced capillary perfusion should not be minimized, it is now known that Minoxidil® also acts by maintaining active proliferation of the already differentiated keratinocytes in the follicle (BOYERA N, 1997).
Third target In addition to the hyper-proliferative effect of Minoxidil® (concentration less than 100 µM), a pro-differentiating effect at a higher dose (of the order of a millimole) has been reported. This effect may be obtained in long-term treatment with local accumulation in the follicles. As a result, hair loss is retarded. The hyper-proliferative and pro-differentiating effect thus constitute the 3rd target.