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Minoxidil for Male Pattern Baldness: Effective Treatment Options and Insights

by alexxlab

What causes male pattern hair loss. How does minoxidil work for treating baldness. Is minoxidil an effective treatment for male pattern baldness. What are the side effects of using minoxidil. How long does it take to see results from minoxidil. Are there alternatives to minoxidil for treating hair loss.

Understanding Male Pattern Baldness: Causes and Symptoms

Male pattern baldness, also known as androgenetic alopecia, is a common condition affecting millions of men worldwide. But what exactly causes this type of hair loss? Male pattern baldness is primarily driven by genetic factors and hormonal changes, particularly the sensitivity of hair follicles to dihydrotestosterone (DHT), a byproduct of testosterone.

The typical progression of male pattern baldness follows a predictable pattern:

  • Receding hairline, often starting at the temples
  • Thinning of hair on the crown (top) of the head
  • Gradual expansion of bald areas, potentially leading to complete baldness on top of the head

While male pattern baldness is not a health threat, it can significantly impact self-esteem and quality of life for many men. Fortunately, treatments like minoxidil have shown promise in managing this condition.

The Science Behind Minoxidil: How Does It Combat Hair Loss?

Minoxidil, originally developed as a treatment for high blood pressure, was serendipitously discovered to have hair growth-promoting properties. But how does it work to combat male pattern baldness?

Minoxidil acts as a potassium channel opener, increasing blood flow to hair follicles. This improved circulation is believed to:

  1. Stimulate hair follicles, promoting hair growth
  2. Increase the size of hair follicles, leading to thicker hair strands
  3. Prolong the anagen (growth) phase of the hair cycle

Additionally, minoxidil is thought to upregulate vascular endothelial growth factor (VEGF), a protein that stimulates the growth of blood vessels. This further enhances blood supply to hair follicles, potentially reversing miniaturization and promoting hair regrowth.

Types of Minoxidil Formulations

Minoxidil is available in two primary formulations:

  • Topical solution (liquid): Applied directly to the scalp, typically in 2% or 5% concentrations
  • Foam: A newer formulation that some users find easier to apply and less likely to cause irritation

The choice between these formulations often comes down to personal preference and individual response to treatment.

Efficacy of Minoxidil: What Results Can Men Expect?

Does minoxidil truly deliver on its promise to combat male pattern baldness? Clinical studies and real-world experience suggest that minoxidil can be effective for many men, though individual results may vary.

In controlled studies, minoxidil has been shown to:

  • Slow or stop hair loss in a majority of users
  • Promote hair regrowth in some individuals
  • Increase hair density and thickness

However, it’s important to note that minoxidil is most effective for:

  1. Men in the early stages of hair loss
  2. Hair loss on the crown of the head (vertex)
  3. Younger men (those who start treatment before age 40 tend to see better results)

Men should also be aware that minoxidil requires consistent, long-term use to maintain its effects. Discontinuation of the treatment typically results in a return to the natural progression of hair loss.

Potential Side Effects and Considerations When Using Minoxidil

While minoxidil is generally considered safe for most men, it’s crucial to be aware of potential side effects and considerations before starting treatment. What are the most common side effects associated with minoxidil use?

  • Scalp irritation or itching
  • Dryness or flaking of the scalp
  • Initial shedding of fine hairs (usually temporary)
  • Unwanted hair growth on areas other than the scalp (if the solution drips or is transferred)

In rare cases, more serious side effects may occur, such as:

  • Rapid heartbeat
  • Chest pain
  • Dizziness or fainting
  • Swelling of hands or feet

If any of these severe side effects occur, it’s important to discontinue use and consult a healthcare professional immediately.

Considerations for Using Minoxidil

Before starting minoxidil treatment, men should consider the following:

  1. Commitment to long-term use: Results take time and consistency is key
  2. Cost: Minoxidil is an ongoing expense
  3. Potential for initial shedding: Some men may experience temporary increased hair loss when starting treatment
  4. Interaction with other hair products: Some styling products may affect minoxidil absorption

It’s always advisable to consult with a dermatologist or healthcare provider before starting any new hair loss treatment.

Combining Minoxidil with Other Hair Loss Treatments: Enhanced Results?

Can combining minoxidil with other hair loss treatments lead to better results? Many experts believe that a multi-pronged approach to treating male pattern baldness can be more effective than using minoxidil alone.

Common combinations include:

  • Minoxidil + Finasteride: This oral medication works by blocking DHT production
  • Minoxidil + Low-level laser therapy (LLLT): Light therapy devices may enhance blood flow and stimulate hair growth
  • Minoxidil + Platelet-rich plasma (PRP) treatments: Injections of growth factors from your own blood may boost hair growth

While these combinations show promise, it’s crucial to consult with a healthcare professional before combining treatments, as they may interact or have compounded side effects.

The Role of Diet and Lifestyle

In addition to medical treatments, certain lifestyle factors may influence the effectiveness of minoxidil and overall hair health:

  1. Balanced diet rich in proteins, vitamins, and minerals
  2. Stress management techniques
  3. Adequate sleep
  4. Avoiding harsh chemical treatments and excessive heat styling

By addressing these factors alongside minoxidil treatment, men may see improved results in their fight against hair loss.

Alternative Treatments for Male Pattern Baldness: Beyond Minoxidil

While minoxidil is a popular and effective treatment for many men, it’s not the only option available. What other treatments exist for those seeking alternatives or additional approaches to combat male pattern baldness?

  • Finasteride: An oral medication that blocks DHT production
  • Hair transplantation: Surgical procedure to move hair from areas of thick growth to balding areas
  • Scalp micropigmentation: A cosmetic procedure that creates the appearance of a fuller head of hair
  • Low-level laser therapy (LLLT): Light-based treatment that may stimulate hair growth
  • Platelet-rich plasma (PRP) therapy: Injections of growth factors derived from the patient’s own blood

Each of these alternatives has its own set of pros and cons, and their effectiveness can vary from person to person. It’s important to research thoroughly and consult with a hair loss specialist to determine the best approach for individual needs and circumstances.

Emerging Treatments on the Horizon

The field of hair loss treatment is constantly evolving, with new therapies and technologies under development. Some promising areas of research include:

  1. Stem cell therapies
  2. Exosome treatments
  3. Gene therapy approaches
  4. Novel topical and oral medications

While these treatments are still in various stages of research and development, they offer hope for even more effective solutions to male pattern baldness in the future.

The Psychological Impact of Hair Loss and Treatment

Male pattern baldness is not just a physical condition; it can have significant psychological effects on those experiencing it. How does hair loss impact men’s mental health and self-esteem?

Common psychological effects of male pattern baldness include:

  • Decreased self-confidence
  • Anxiety in social situations
  • Depression
  • Feelings of loss of control or aging
  • Impact on romantic relationships and dating

For many men, starting a treatment like minoxidil can provide a sense of empowerment and control over their hair loss. However, it’s important to manage expectations and understand that results may vary.

Coping Strategies and Support

In addition to medical treatments, there are several strategies men can employ to cope with the psychological impact of hair loss:

  1. Seeking support from friends, family, or support groups
  2. Focusing on overall health and wellness
  3. Exploring different hairstyles or grooming techniques
  4. Considering professional counseling or therapy
  5. Practicing self-acceptance and positive self-talk

Remember, hair loss does not define a person’s worth or attractiveness. Many men find that embracing their changing appearance can be liberating and empowering.

The Future of Hair Loss Treatment: What’s Next for Minoxidil and Beyond?

As research in the field of hair loss continues to advance, what can we expect for the future of treatments like minoxidil and beyond? Several exciting developments are on the horizon:

  • Enhanced delivery systems for topical treatments
  • Combination therapies that target multiple aspects of hair loss
  • Personalized treatment plans based on genetic testing
  • Advanced hair cloning and regeneration techniques

These advancements hold the promise of more effective, tailored treatments for male pattern baldness. However, it’s important to note that bringing new treatments to market is a lengthy process involving rigorous testing and regulatory approval.

The Role of Genetics in Future Treatments

As our understanding of the genetic factors contributing to male pattern baldness improves, we may see more targeted therapies emerge. Potential areas of development include:

  1. Gene therapy to correct hair loss-related genetic mutations
  2. Treatments that target specific molecular pathways involved in hair growth and loss
  3. Personalized medicine approaches that take into account an individual’s genetic profile

While these approaches are still in early stages of research, they represent exciting possibilities for the future of hair loss treatment.

In conclusion, while minoxidil remains a cornerstone treatment for male pattern baldness, the field continues to evolve. From improved formulations of existing treatments to cutting-edge therapies on the horizon, men struggling with hair loss have reason to be optimistic about future treatment options. As always, it’s crucial to stay informed, consult with healthcare professionals, and make decisions based on individual needs and circumstances.

What is male pattern hair loss, and can it be treated?

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Topical minoxidil in early male pattern baldness

Clinical Trial

. 1985 Aug;13(2 Pt 1):185-92.

doi: 10.1016/s0190-9622(85)70157-0.

E A Olsen, M S Weiner, E R Delong, S R Pinnell

  • PMID:

    3900155

  • DOI:

    10.1016/s0190-9622(85)70157-0

Clinical Trial

E A Olsen et al.

J Am Acad Dermatol.

1985 Aug.

. 1985 Aug;13(2 Pt 1):185-92.

doi: 10. 1016/s0190-9622(85)70157-0.

Authors

E A Olsen, M S Weiner, E R Delong, S R Pinnell

  • PMID:

    3900155

  • DOI:

    10.1016/s0190-9622(85)70157-0

Abstract

One-hundred twenty-six healthy men with early male pattern baldness completed a 12-month double-blind, controlled trial of 2% and 3% topical minoxidil. Subjects were initially randomly assigned to use placebo or 2% or 3% topical minoxidil. After 4 months of study, the placebo group was crossed over to 3% topical minoxidil. Both objective measurement of hair growth by counting of vellus, terminal, and total hairs in a vertex target balding area and subjective assessment by subject and investigator were done. Treatment of subjects with topical minoxidil for 4 months resulted in a statistically significant increase in terminal hair growth in comparison with placebo therapy. In addition, subjects initially treated with placebo, when crossed over to topical minoxidil, showed a significant increase in the number of terminal hairs. No subject had a net hair loss in the target area during the study. These results indicate that topical minoxidil can increase terminal hair growth in early male pattern baldness.

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Action of minoxidil against baldness, against hair loss and for hair growth

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Learn more about how Rogaine

® Foam with Minoxidil 5% works.

Foam Regaine contains a 5% solution of minoxidil 1 , which is considered the first line drug in the treatment of hereditary baldness – androgenetic alopecia 7 . Exactly how minoxidil works when applied topically is not completely known. According to the instructions for medical use of the drug, minoxidil in the composition of the foam Regaine ®1 :

  • dilates the blood vessels of the scalp and improves blood flow around the hair follicles;
  • promotes the formation of vascular endothelial growth factor, a substance that is believed to increase the permeability of small vessels, which indicates a high metabolic activity in anagen – the phase of active hair growth.

Rogaine Foam ® is clinically proven to treat androgenetic alopecia 1 2,3,4 . Nine out of ten men 4 and 81. 5% of women 5 note that with regular external use of minoxidil, hair loss stops within two months, and new ones appear in place of vellus and previously lost hair 4.5 . The best effect of the drug is noted at the initial stage of the disease and with moderate androgenetic alopecia 1 .

How to use Regaine® correctly

The drug is approved for use from 18 years of age and has contraindications 1 – it is important to consider them. Therefore, before using Regaine ® , read the instructions for its medical use and consult a specialist. How to use Rogaine®? 1

  • Apply Rogaine Foam ® with clean, dry hands to dry scalp, not hair. This can increase the effectiveness of the drug, as it will be easier to reach the hair follicles.
  • Since the foam may dissolve on contact with warm skin, rinse your fingers with cold water and dry them before squeezing it out.
  • Spread the foam evenly over the areas of baldness and use your fingertips to gently rub it into the skin.

Men are recommended to perform the procedure twice a day (morning and evening), women – once a day. If you use the product more often, the result of treatment will not be affected 1 .

Within 4 hours after application of Rogaine 9 Foam0020 ® do not wash your hair or blow dry your hair. You can comb during treatment as usual. However, before styling, you must wait until the foam is completely dry, and then use styling products 1 .

In order not to provoke hair loss in androgenetic alopecia and to get the effect of treatment 6 , do not wear hair with strong tension – tight buns, tails or braids 1 .

When using Rogaine 9 foam0020 ® it is also important to remember the following 1 :

  • It must be applied regularly. You can not take breaks in treatment when the first results appear – this can lead to the resumption of hair loss.
  • The recommended single dose of the drug is 1 gram (half a measuring cap).
  • Do not worry if your hair falls out more during the first 2-6 weeks of therapy. This is a temporary phenomenon associated with the peculiarity of the action of minoxidil. It stimulates the transition of hair follicles from a state of rest to a phase of active growth.
  • If Rogaine ® does not produce results in men within 4 months and in women within 6 months, treatment with the drug should be discontinued.

References:

Minoxidil – sentence or hope?

Minoxidil (2,4-pyrimidinodiamine-6-(1-piperidinyl)-3-oxide) – white powder, soluble in water, propylene glycol and ethanol – is a vasodilator antihypertensive agent that, when applied topically, can slow or stop hair loss and stimulate new hair growth hair.

The era of minoxidil did not begin with the discovery of its unique property to stimulate hair growth. The drug began to be used in the mid-1950s as a regenerating agent in the treatment of gastric ulcer. Much later, after lengthy studies aimed at studying the hemodynamic effects of minoxidil in patients with hypertension, the inexorable side effect in the form of hypertrichosis, including on the balding areas of the scalp, forced researchers to seriously study the “side” phenomenon. The topical application of minoxidil on the scalp for the first time made it possible to realize a long-standing human dream – the possibility of stimulating hair growth.

How does it work?

The study of the effects of minoxidil showed that the relaxing effect on vascular smooth muscle is carried out by opening potassium channels (KATP) that are sensitive to ATP [1, 2]. KATPs are widely present in cells of various tissues, including cells of the myocardium, pancreas, vascular smooth muscles, and the central nervous system, where they serve as mediators between intracellular metabolic changes and the electrical activity of the cell membrane [3]. Potassium channels capture metabolic changes in the cell: at a high energy level, ATP cells inhibit the opening of potassium channels; in case of depletion of energy reserves, they open [4]. KATP cell sites are heteromultimers built from a small subunit of the potassium channel family and a large sulfonylurea receptor (SUR1, SUR2A or SUR2B) that binds sulfonylurea and ATP. The potassium channel opener exhibits its activity by binding to sulfonylurea receptors [5].

In 2001, M. Li et al. [6] reported that human dermal papilla cells induce mRNA expression for the same sulfonylurea receptor SUR2B that is expressed in vascular smooth muscle cells. During the polymerase chain reaction with reverse transcriptase, the authors found mRNA for adenosine receptors A1, A2A, A2 B, as well as the sulfonylurea receptor SUR2B. It was found that adenosine also causes an increased release of the vascular endothelial growth factor (VEGF) signaling protein, and there is no VEGF response to minoxidil administration after pharmacological blockade of adenosine A1 and A2 receptors. The authors suggested that the binding of minoxidil to the sulfonylurea receptor stimulates the release of ATP, which is rapidly converted to adenosine and activates adenosine signaling pathways of metabolism. Thus, one of the possible mechanisms of VEGF stimulation by minoxidil was proposed [6].

VEGF is a homodimeric highly glycated protein, mitogenic only for endothelial cells; its level rises in tissues where angiogenesis is actively taking place; at this time, expression of its receptors is observed on target endothelial cells in nearby blood vessels [7]. The angiogenic factor VEGF has recently been recognized as the main mediator of the growth and cyclic functioning of the hair follicle (HF) [8]. VEGF is found in keratinocytes of the outer epidermal sheath of the root (PEVC) and in the fibroblasts of the hair papilla [9-eleven]. The early stages of anagen are accompanied by increased expression of VEGF and restoration of vascularization of the dermal papilla of the follicle [8]. Therefore, one of the likely reasons for the stimulation of hair growth by minoxidil is its activation by VEGF.

At the same time, there are individual differences in the severity of the hypotensive effect of minoxidil, its relaxing effect on smooth muscles and hair restoration.

Sulfonated minoxidil. The sulphonated metabolite of minoxidil, minoxidil sulfate [12, 13], which is 10–15 times more effective than minoxidil, has the effect of rapid relaxation of vascular smooth muscles. The conversion of minoxidil to minoxidil sulfate is catalyzed by sulfotransferase enzymes. Minoxidil sulfotransferase activity was found in rat and human liver homogenates, platelets, in mouse and rat whisker follicles, in their epidermal keratinocytes and epithelial sheath of the hair root, and in HF in the scalp of short-tailed macaques [12, 14-20].

To date, five cytosolic sulfotransferase genes have been found in humans that encode three classes of enzymes responsible for the sulfonation of phenols, catecholamines, estrogens, and hydroxysteroids. At the same time, for four sulfotransferases, mRNA expression was found in human epidermal keratinocytes [21]. In the outer shell of the VF root, the conversion of minoxidil to the active form of minoxidil sulfate occurs with the help of endogenous sulfotransferase enzymes [22-24]. Interesting observations were made by A. Buhl et al. [25]. It turned out that the activity of sulfotransferase in the scalp of men who responded to the administration of minoxidil was higher than that of men who did not respond to it. Later, individual differences were found in the activity of sulfotransferases contained in the scalp, which correlated with their concentration in platelets [26].

Due to the long treatment time required for a therapeutic response (6 months), combined with the variable efficacy of minoxidil in the general patient population, the possibility of predicting the effectiveness of treatment by preliminary determination of the biomarker sulfotransferase in the human scalp is very relevant.

A colorimetric assay method for detecting sulfotransferase activity in epilated human hair was proposed by A. Goren et al. [27]. The reaction to convert minoxidil to minoxidil sulfate was coupled to the production of paranitrophenol, which could be quantified using optical absorption at 405 nm. The study found a correlation between sulfotransferase activity in epilated hair and response to minoxidil in a mixed cohort of male and female patients. The analysis showed 95% sensitivity and 73% specificity for predicting response to minoxidil treatment in androgenetic alopecia. Further study of the effectiveness of predicting response to minoxidil treatment in a well-defined group was carried out by J. Roberts et al. [28]. Female patients with androgenetic alopecia (AGA) used minoxidil 5%. The authors obtained similar results: the ability to predict the effectiveness of treatment with 5% minoxidil in women with a sensitivity of 93% and a specificity of 83% ( p <0.005).

Unfortunately, at present, this type of examination is not included in the range of screening tests when examining patients with AGA. However, in the future, its introduction into the algorithm for examining patients will make it possible to differentiate treatment taking into account individual sensitivity to minoxidil.

Use of minoxidil in the treatment of androgenetic alopecia

Hair loss in androgenetic alopecia is the result of the implementation of the genetic program of certain HF cells growing in the forehead, crown and crown, which can be enhanced or weakened by various external and internal influences both on HF cells and perifollicular tissues, and on the body in in general. At the same time, the basis for the development of androgenetic alopecia is the genetic sensitivity of HF to androgens.

The effectiveness of minoxidil in hair restoration in AGA has been convincingly proven in many double-blind and placebo-controlled randomized clinical trials, which has led to the consideration of minoxidil as the main drug for the treatment of male and female hair loss.

In accordance with international standards for the treatment of AGA, minoxidil is administered externally to women and men at a concentration of 2 and 5%, respectively. To evaluate the effectiveness of treatment, at least 6 months of regular use of the lotion 2 times a day are required [29]. After topical application, minoxidil accumulates in the upper layer of the epidermis, and then gradually spreads throughout the body. The half-life after cessation of topical application is 22 hours. With oral administration, the half-life is 1.5 hours. Minoxidil is excreted in the urine; 95% of minoxidil is eliminated within 4 days after application [30].

Minoxidil and ketoconazole. Certainly, the genetic sensitivity of HF to androgens is the basis for the development of androgenetic alopecia, but this does not explain some of the points associated with the development of AGA, in particular, the presence of a moderate nonspecific infiltrate in the perifollicular zone, consisting mainly of immunocompetent T-lymphocytes [31] . The cause of such inflammation in the first place may be bacteria that colonize the infundibular zone of the follicle, such as Propionibacterium spp. ., Staphylococcus spp. , Malassezia spp. or other members of the transient microflora.

A group of researchers led by C. Piérard-Franchimont [32] suggested that ketoconazole (CKZ) can be studied in AGA, since it is active against fungi Malassezia spp. and bacteria of the genus Staphylococcus , which are part of the microflora of the scalp. In order to study the effect of the antimicrobial effect of 2% CCZ on the state of AGA, comparative studies were carried out in two groups of patients who used CCZ 2% as part of a shampoo, but without combination with minoxidil, and who used a regular (non-medical) shampoo in combination with a solution of minoxidil 2%. The results of the study showed that hair density, size and proportion of anagen follicles were almost equally improved in both groups (CPC treated and minoxidil treated), hair greasiness decreased more in the CPC group. Based on comparative data, the authors conclude that the action of CCZ can have a significant impact on the course of AGA and that Malassezia spp . may play a role in the inflammatory response.

Why foam? Despite the fact that patients tolerate treatment with minoxidil lotion satisfactorily, including at a concentration of 5%, sometimes there are complaints of itching, irritation, dandruff, local intolerance, which is most likely due to the fact that topical minoxidil contains propylene glycol is a potential skin irritant causing sensitization in 2.3–3.5% [33, 34]. At the same time, some patients complain about the lotion running off quickly on the skin, the inability to maintain hair styling, and their rapid contamination. The need to apply the lotion twice a day is considered by some to be impractical, which generally negatively affects user compliance and the effectiveness of therapy.

These product acceptability and tolerability issues suggest that there is a need for both men and women to use minoxidil that is formulated without propylene glycol and is more convenient to use.

The efficacy and safety of minoxidil 5% topical foam twice daily was shown in a study in men with AGA [35]. The results of a randomized, placebo-controlled 16-week study using 5% minoxidil foam showed that 70.6% of 180 patients with AGA experienced an increase in hair growth compared with 42.4% of 172 placebo participants. The incidence of pruritus was 1.1% in the minoxidil 5% foam group, which was significantly lower than the 6% observed in an earlier study using minoxidil 5% lotion twice daily for 16 weeks [36]. Based on the results of these studies, in 2006 the US Food and Drug Administration approved minoxidil 5% foam for use in men with AGA.

In 2011, a randomized, blind study of minoxidil 5% foam versus minoxidil 2% lotion was published in the Journal of the American Academy of Dermatology. The study involved 114 women with AGA aged 23-75 years: participants of the 1st group used 2% minoxidil lotion 2 times a day, the 2nd group – 5% minoxidil in the form of foam 1 time per day. The duration of treatment was 24 weeks. The results of the study showed that a single application of minoxidil 5% foam once a day is as effective in stimulating new hair growth as two applications of minoxidil 2% lotion, increasing the amount of hair in the problem and adjacent areas, respectively, by 16.2 at the end of the study. and 19.6% in women randomized to minoxidil 5% foam compared to 13.8 and 17.8% increases in the same areas in women randomized to minoxidil 2% lotion. Among other effects of 5% foam, the authors note good tolerance, rare occurrence of itching and dandruff. Reduction of unpleasant side effects and other aesthetic and practical benefits provides the use of foam once a day [37].

Minoxidil is not a verdict, but a hope

A meta-analysis of several clinical studies has shown that 13-20% of patients with AGA have a moderate increase in hair growth with 2% minoxidil monotherapy. In comparison, the same meta-analysis showed that 5–10% of patients treated with placebo experienced similar hair regrowth [38–41]. Minoxidil 5% is also used in the treatment of female AGA. Results from clinical studies suggest that 5% minoxidil is more effective than 2% minoxidil based on mean change in non-vellus hair [42]. In addition, clinical studies in men show that approximately 40% of patients have hair growth when using 5% minoxidil [35].

In general, the use of minoxidil in AGA in some cases supports fading-prone hair growth, and is especially effective in the early stages of baldness. In the absence of such a powerful external stimulus as minoxidil, a sensitive follicle is unlikely to retain the ability to regularly convert the spinous hair shaft. The cessation of the functional activity of the follicle inexorably leads to its morphological degradation: reduction and subsequent fibrosis. That is why the regular use of minoxidil is an optimistic circumstance, as it helps to maintain the density of hair, including those whose growth would be impossible without minoxidil. Termination of treatment – voluntary or forced – will not lead to irreversible hair loss in AGA, but will only return them to independent physiological extinction – to inevitable regression, since the accelerated aging program, embedded in the genes of sensitive follicles, was not stopped, but only slowed down its move.