The technological race against baldness: from a present with finasteride to the future of 3D printed hairs

The war for shiny lustrous hair, in addition to being populated, has never ceased. Fortunately, the state of the art against hair loss has reached an unprecedented level. And the best could be yet to come.

Stem cells, 3D printing and the best laboratories in the world have remedied what thousands of hair growth vendors have been claiming to be able to combat. But it was not magic, but science, the tool we needed to win this war against alopecia.

The war against alopecia, what weapons do we have?

If the marketers and healers had known about the substances we know today to combat baldness, they probably would not have earned their name so hard. Of the concoctions and ointments that promised to delay the fall and promote hair growth, today only the joke remains.

However, what less people know is that there really are effective medicines. Specifically, there are two molecules (and their derivatives) capable of such magic: finasteride and monoxidil. Starting with the first, this molecule takes more than two decades, according to this monograph from the prestigious SciElo, used in different pharmacological areas, especially in the treatment of benign prostatic hyperplasia.

But, curiously, the same mechanism that serves to protect us against cancer helps preserve hair. Finasteride is a non-hormonal antiandrogenic drug derived from steroids. In other words, it acts on the metabolic pathway of testosterone, which is extremely important in many physiological aspects. Specifically, it inhibits the 5-alpha-reductase enzyme that transforms testosterone into dihydrotestosterone, its active molecule.

And how important is it to hair? Although we do not fully understand the mechanism that works, we do know that dihydrotestosterone is behind the loss of function of hair follicles. By controlling it, we also prevent many of these follicles from becoming inactive, leading to hair loss. This property has been described since the 1990s and is one of the most effective treatments to prevent, but not to treat, hair loss.

On the other hand, monoxidil is an antihypertensive vasodilator drug. But it has also been used, at least since the 1970s, as Peter Conrad recounted in his book "The Medicalization of Society", to treat alopecia. Unlike finasteride, minoxidil is applied topically and its mechanism of action is not yet known, although it is suspected to be related to follicle irrigation.

This treatment has also been shown to be enormously effective, producing a regeneration within three to six months from the start of use. Still, despite its benefits, neither finasteride nor minoxidil are 100% effective or almighty treatments.

Indeed, there are many people who do not work for physiological or metabolic reasons. In addition to that, these medications have to be administered "for life", since they are not a cure, but a permanent application that keeps the death of hair follicles under control.

On the other hand, although they are safe, especially monoxidil, some evidence suggests the moderate use of finasteride since in the long term it can present complications in the event of the appearance of cancer or other problems related to the prostate. For all this, we continue in this arms race and go on a journey.

Turkey, the hair capital

In addition to being the border between Europe and Asia, Turkey has become famous in recent decades for its hair recovery operations. Although it is not, far from it, the only place where they are made, nor does it have to be the best.

Today we can find "complete" travel packages: five-star hotel, excursions, interpreter, all-inclusive and, of course, hair reimplantation treatment

But its prices and a well-known opportunistic streak has managed to attract the world's attention. Today we can find "complete" travel packages: five-star hotel, excursions, interpreter, all-inclusive and, of course, hair reimplantation treatment.

How does it work? In 1959, Norman Orentreich presented to the New York Academy of Sciences a method of successfully removing small pieces of entire skin, with their hair follicles, and transplanting them to other parts of the skin. Although his work is far from the modern and cutting-edge systems of today, the truth is that it was a brutally interesting approach, since it was the first time that alopecia had been reversed for life.

Currently, much more precise knowledge of how to extract, implant, and growth patterns is used in clinics. There are several techniques, of which the newest employ a tiny extractor that pulls out hair units, each with several hair follicles. This is done manually or by a specialized robot, capable of processing hundreds or thousands of hair units in a short time. The use of these arms ensures the least invasive process possible. The hairs are obtained from the lateral areas and the crown of the head.

Once removed, the hair units are prepared for grafting. To perform them, special needles are used to make holes where these extracted follicles are inserted. All of this is done under sedation. The result, if the follicle grasps well, can be very satisfactory. But the opposite can also happen and not end properly. With this technique, the hair can be preserved for a very long time, although it could eventually be affected by epidermal metabolism. However, this is not normal, and hair grafts are commonly permanent. But, still, it is not enough.

Stem cells to replace hair

Despite the fact that the hair transplant technique is being quite successful, as we said, it does not always work well. In some cases, the tissue simply fails to maintain the follicle, rejects it, or other problems occur.At other times, the result is simply not entirely satisfactory, aesthetically speaking.

When recovering the follicles, the hairs may not be completely suitable for the area they have to cover. This brings us to the next point: getting the perfect hair. Someone came up with the idea of ​​creating lab hair. Considering that its function is relatively simple, compared to other "organs" of the body, it seems somewhat simple.

We no longer have to do "laboratory hair", but it is the stem cells that do it for us

Nothing could be further from the truth. "Making a hair" is not an easy thing. We better leave it to the cells. And, in fact, that is the last and great idea that the transplant technique is turning towards: using stem cells.

Reprogrammed stem cells are cells that have been bathed in a special cocktail of hormones to return them to their prime totipotent state. In other words, they have been returned to their original state, before differentiating into a skin, liver, muscle, or any other cell. Once converted into a stem cell, we can turn it back into whatever we want. For example, in complete and healthy follicular units.

Cell therapy uses these types of cells to restore damaged tissues with stem cells capable of replacing their dead partners. This, for example, could be used to repair dead hair follicles. In this way we no longer have to do "laboratory hair", it is the stem cells that do it for us. But there is still one last detail.

The rise of "hair farms"

To make these stem cells available in the proper way, useful for our needs, we have to arrange them in a special way. This is important for stem cells to receive the signal that they must become hair follicles. To date, the attempt to clone weight-bearing hair cells has not worked.

The reason, explained Robert Bernstein, a dermatologist specializing in hair transplantation in New York, was something as simple as, by growing the tissue on a plate, the cells expand. This is important because, as we said, the cells are not capable of emitting and receiving the adequate signal that tells them that they must become "factories" of hair.

However, by keeping the follicular units in a special way, in clusters, together, voilà! cells begin to differentiate successfully into hair follicles, as researchers at the Sanford-Burnham Medical Research Institute in California discovered.

But how do we get cells to stay the way we need to? Here comes the missing piece in the equation: thanks to 3D printing. In a recent and very interesting study published in the prestigious journal Nature, an international team of researchers showed that they could use 3D printing to generate a biomimetic mold of a special tissue capable of keeping cells in the proper arrangement so that they differentiate into hair follicles. .

As they are cells from the patient's skin, what would be done with this technique, essentially, is to generate hairs of the highest quality, which will hardly cause rejection (since the cells can be programmed to be even more receptive to implantation) and without the need to extract them from another part of the body.

This, the researchers say, will lead to the formation of the first "hair farms", some places arranged in clinics where, in a special petri dish, pieces of hair tissue are cultivated à la carte, specially designed and arranged thanks to the latest techniques in cell reprogramming and 3D printing. And this is how technology could help, for the first time in history, put an end to the age of baldness.

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