madman
Super Moderator
Abstract
Background: Although there are some studies in the literature reporting that autologous and homologous platelet-rich plasma (PRP) can be used in the treatment of androgenic alopecia (AGA), there is no study examines estrogen concentration of prepared PRP.
Objective: We aimed to determine the presence of estrogen in PRP and to investigate the effect of estrogen concentration of PRP on AGA treatment, in this study.
Methods: Between 2017-2018, 30 male patients with hair loss complaints were included in this prospective study. Autologous PRP was injected into patients in Group 1. Homologous PRP with high estrogen levels was injected into the patients in Group 2. PRP was injected into both groups 4 times in 0, 1st, 3rd, and 6th months. The obtained photographs were evaluated and the hair densities of each patient at controls were calculated.
Results: The mean estrogen level measured in PRP was statistically significantly higher in Group 2. In both groups, the increase in hair density was observed from the first month, but this increase was statistically significantly higher in all controls in Group 2. In Group 2, there was a statistically significant increase in the 1st and 3rd months compared with the previous control, but there was no difference between the 6th and 12th months and the 3rd month.
Conclusions: It has been determined that an increase in hair density is higher and earlier in the group that used estrogen-rich PRP than in the group that use autologous. We think that estrogen-rich PRP may be used in the treatment of AGA in the presence of an appropriate donor.
Androgenic alopecia (AGA) is characterized by a reduction in the number of androgen-sensitive hair follicles secondary to high levels of dihydrotestosterone (DHT), increased 5-α reductase activity, and increased androgen receptor expression.1 Testosterone typically enters papillae, outer root sheath (ORS), and sebaceous gland cells where it is converted into DHT by 5-α reductase activity. Then, DHT binds to the androgen receptors and activates the synthesis of proteins harmful to the follicle, and disrupts the normal hair growth cycle. As a result, the hair cycle changes to shorten the anagen phase, resulting in premature regression of the hair during the catagen and telogen phases.2
Platelet-rich plasma (PRP), which is one of the treatment options of AGA, is the concentrated form of human platelets in small amounts of plasma. Platelets contain many growth factors such as fibroblast growth factor (FGF), platelet growth factor (PDGF), transforming growth factor-beta (TGF-β), vascular endothelial growth factor (VEGF), etc.3 It is thought that the effect of PRP on alopecia treatment is based on the principle of increasing cell rejuvenation through these growth factors. It increases angiogenesis, epithelization, cell division, and macrophage chemotaxis.4 Considering the hair cycle physiology, PRP as a treatment method focuses on increasing the molecular cell growth mechanisms and preventing the onset of apoptotic processes.
Estrogen is one of the female reproductive hormones. In addition to its activities in human physiology, it is well-known that estrogen plays some important roles in the human hair cycle. Although the mechanism of female-type hair loss has not been fully resolved, it is thought that the almost discontinuation of ovarian estrogen production during the postmenopausal period causes changes in hair growth characteristics.6 It has been suggested that the number of follicles at the telogen phase is higher than the number at the anagen phase in the postmenopausal period.7 It has been shown that ligands acting on estrogen receptor suppresses the proliferation of endothelial cells and prostate cancer cells which proliferate DHTdependent and also act as DHT antagonists.8
Although there are some studies in the literature, that report autologous and homologous PRP can be used in the treatment of AGA,9 little is known about the estrogen concentration of the prepared PRP.
In this study, we aimed to both determine the presence of estrogen in PRP and investigate the effect of estrogen concentration of PRP on AGA treatment.
This study will pave the way for a significant change in AGA treatment. The treatment models used to date have PRP and estradiol coexistence. In our study, this association was found to be more effective and a value related to the concentration of estradiol that the compound should contain was obtained. In the future, this compound may be commercially available.
Microscopic examination is the gold standard for determining hair thickness and quality. However, any kind of biopsy material was not used to be taken in our study. The lack of taking a biopsy to evaluate the results can be considered one of the limitations of our study. Furthermore, the half-life of the local effects of estrogen on hair follicles could not be evaluated in our study. This can be added to the list of disadvantages of the study, also.
To summarize, the use of e-rhPRP not only reduces the androgenic effects in hair follicles and stops hair loss, but also by the growth factors it contains it stimulates the development of new hair follicles.
CONCLUSION
In conclusion, autologous and estrogen-rich homologous PRPs have been shown to be effective in the treatment of AGA. It has also been determined that an increase in hair density is higher and earlier in the group used e-rhPRP than in the group using aPRP. We think that e-rhPRP may be used in the treatment of AGA in the presence of an appropriate donor.
Background: Although there are some studies in the literature reporting that autologous and homologous platelet-rich plasma (PRP) can be used in the treatment of androgenic alopecia (AGA), there is no study examines estrogen concentration of prepared PRP.
Objective: We aimed to determine the presence of estrogen in PRP and to investigate the effect of estrogen concentration of PRP on AGA treatment, in this study.
Methods: Between 2017-2018, 30 male patients with hair loss complaints were included in this prospective study. Autologous PRP was injected into patients in Group 1. Homologous PRP with high estrogen levels was injected into the patients in Group 2. PRP was injected into both groups 4 times in 0, 1st, 3rd, and 6th months. The obtained photographs were evaluated and the hair densities of each patient at controls were calculated.
Results: The mean estrogen level measured in PRP was statistically significantly higher in Group 2. In both groups, the increase in hair density was observed from the first month, but this increase was statistically significantly higher in all controls in Group 2. In Group 2, there was a statistically significant increase in the 1st and 3rd months compared with the previous control, but there was no difference between the 6th and 12th months and the 3rd month.
Conclusions: It has been determined that an increase in hair density is higher and earlier in the group that used estrogen-rich PRP than in the group that use autologous. We think that estrogen-rich PRP may be used in the treatment of AGA in the presence of an appropriate donor.
Androgenic alopecia (AGA) is characterized by a reduction in the number of androgen-sensitive hair follicles secondary to high levels of dihydrotestosterone (DHT), increased 5-α reductase activity, and increased androgen receptor expression.1 Testosterone typically enters papillae, outer root sheath (ORS), and sebaceous gland cells where it is converted into DHT by 5-α reductase activity. Then, DHT binds to the androgen receptors and activates the synthesis of proteins harmful to the follicle, and disrupts the normal hair growth cycle. As a result, the hair cycle changes to shorten the anagen phase, resulting in premature regression of the hair during the catagen and telogen phases.2
Platelet-rich plasma (PRP), which is one of the treatment options of AGA, is the concentrated form of human platelets in small amounts of plasma. Platelets contain many growth factors such as fibroblast growth factor (FGF), platelet growth factor (PDGF), transforming growth factor-beta (TGF-β), vascular endothelial growth factor (VEGF), etc.3 It is thought that the effect of PRP on alopecia treatment is based on the principle of increasing cell rejuvenation through these growth factors. It increases angiogenesis, epithelization, cell division, and macrophage chemotaxis.4 Considering the hair cycle physiology, PRP as a treatment method focuses on increasing the molecular cell growth mechanisms and preventing the onset of apoptotic processes.
Estrogen is one of the female reproductive hormones. In addition to its activities in human physiology, it is well-known that estrogen plays some important roles in the human hair cycle. Although the mechanism of female-type hair loss has not been fully resolved, it is thought that the almost discontinuation of ovarian estrogen production during the postmenopausal period causes changes in hair growth characteristics.6 It has been suggested that the number of follicles at the telogen phase is higher than the number at the anagen phase in the postmenopausal period.7 It has been shown that ligands acting on estrogen receptor suppresses the proliferation of endothelial cells and prostate cancer cells which proliferate DHTdependent and also act as DHT antagonists.8
Although there are some studies in the literature, that report autologous and homologous PRP can be used in the treatment of AGA,9 little is known about the estrogen concentration of the prepared PRP.
In this study, we aimed to both determine the presence of estrogen in PRP and investigate the effect of estrogen concentration of PRP on AGA treatment.
This study will pave the way for a significant change in AGA treatment. The treatment models used to date have PRP and estradiol coexistence. In our study, this association was found to be more effective and a value related to the concentration of estradiol that the compound should contain was obtained. In the future, this compound may be commercially available.
Microscopic examination is the gold standard for determining hair thickness and quality. However, any kind of biopsy material was not used to be taken in our study. The lack of taking a biopsy to evaluate the results can be considered one of the limitations of our study. Furthermore, the half-life of the local effects of estrogen on hair follicles could not be evaluated in our study. This can be added to the list of disadvantages of the study, also.
To summarize, the use of e-rhPRP not only reduces the androgenic effects in hair follicles and stops hair loss, but also by the growth factors it contains it stimulates the development of new hair follicles.
CONCLUSION
In conclusion, autologous and estrogen-rich homologous PRPs have been shown to be effective in the treatment of AGA. It has also been determined that an increase in hair density is higher and earlier in the group used e-rhPRP than in the group using aPRP. We think that e-rhPRP may be used in the treatment of AGA in the presence of an appropriate donor.
