What is the future of androgenetic alopecia?
As you already know, if you are getting bald right now there are a number of treatments. On the one hand, drugs that block 5 alpha reductase (finasteride and dutasteride) which is currently considered the best treatment for men and a drug that acts on the molecular pathway, Wings de media Catrina pathway, which is minoxidil. Probably the best drug for women.
Given the current situation, we are going to talk about what is going to happen in 5 years. We will move on to the next stage, which is composed of:
1) Drugs that go directly against the male hormone receptor (pyruramide and derivatives) or molecules that are able to act as an antagonist or partial agonist on the receptor. In other words, molecules that will block the "bad" effect of the male hormone on the hair. We will have to make sure that this does not cause adverse problems.
2) Drugs, which I personally believe have less of a chance, that block other alternative pathways for hair growth. These could be prolactin or prosagglandin pathways or other betacaterin analog pathways.
In summary, I think the next five years is going to be at the androgen receptor level.
We are now going to make one more leap to what will come in 10 to 20 years. It's what we call gene therapy. In case there are any health professionals, biologists... when I coin the term gene therapy, I do not mean gene editing. That is, I don't mean being able to edit your genes, I mean modifying genetic material that is circulating in your blood that is capable of promoting or causing alopecia.
What does this mean?
The more research there is in medicine and biology, the more discoveries we make. Each of us has genes, which in turn are a combination of different base pairs (letters), which is different in each of us. That causes us individually to have a series of different products (proteins). Let's go back to basic biology. You have two types of genetic material, genetic material that actually contributes (exons), i.e. information that is going to translate proteins, and genetic material that does not contribute (introns). And this information is very outdated. It seems that there is material in our blood (base pairs) that are circulating without translating proteins, such as the messenger arn, but with the capacity to modify our internal systems. Causing, among others, autoimmune pathologies or cancer.
This month, it has been determined that there are a series of these genetic materials circulating in our blood that are related to alopecia. The next breakthrough is going to be beyond hormones. We are still in the we should say hormonal phase of treatment and the next one will be genetic treatment of alopecia.
This genetic material is in our blood and can serve as a target for treatment or prognosis. Imagine you are 12 years old and your parents are bald, and they want to know if their son is going to go bald too and do something about it. At present I can only see clinical variables, but not whether they have genes that will generate that alopecia. Currently it is not something that is feasible or easy to do. In 20 years, if we have correctly identified what genetic material circulating in our blood is related to this problem, we will be able to see this predisposition in an analysis and tell the 14-year-old the probability of going bald. Additionally, as we know that he has these genetic materials that are causing his male hormone receptor to be more sensitive, or that his hairs are more defective and break easily or that he has a higher production of sex hormones... we will be able to block the action of that genetic material. We will be able to partially or completely prevent alopecia. However, this situation will not occur for another 20 years. Remember, we are currently in the hormonal era, i.e. all treatments are aimed at blocking or trying to modulate hormonal action. Of course, hair cloning will be the great alternative. We will see how far each of the alternatives goes. I hope you have learned something today and remember, there is always treatment for alopecia. The most important thing is a good diagnosis.