Recently, a reader and hair loss sufferer named “James K” sent me a very interesting e-mail pertaining to destroying androgen receptors. I have pasted most of his e-mail content towards the bottom of this post. Note that the androgen receptor is also known as NR3C4. Other options include looking into androgen receptor antagonists or androgen receptor silencing.
Destroying Androgen Receptors to Stop Hair Loss
Scientists know that male pattern hair loss (androgenetic alopecia) is caused by two factors that both need to be true:
The present of high levels of dihydrotestosterone (DHT), a derivative of testosterone, in the bloodstream and scalp. 5-alpha reductase enzyme activity is what converts testosterone to dihydrotestosterone.
The presence of a high level of androgen receptors on the scalp. Balding is a direct result of DHT binding to these receptors and then miniaturizing hair follicles. Many people can have high levels of DHT, but lack the androgen receptor (AR) gene. In those cases, they will not go bald. Finasteride drastically reduces DHT from binding to 5α-receptors, resulting in increased hair growth for many people.
Follicle sensitivity to the damaging effects of androgens varies by person. The number of androgen receptors on a scalp’s dermal papilla cells also varies from individual to individual. Research seems to suggest that genetic predisposition to AGA is polygenic in nature and there is no individual gene that is responsible for male or female pattern hair loss. Note that some sources seem to term “androgen receptors” as “DHT receptors”.
On a related note, eunuchs who are castrated never suffer from male pattern baldness. Their DHT levels are negligible for their whole lives. Also of interest is the androgen insensitivity syndrome intersex condition. I bet some blog readers wish they had such a problem.
Going back to “James K”, his main question pertained to why scientists have not done more research into destroying the androgen receptors on the scalp?
Or somehow destroying the androgen receptor gene? While we await CRISPR based gene modification, other techniques such as NdAgo have so far been a bust or overhyped.
How to Destroy Androgen Receptors?
I will quote “James K” in this section:
“I think that a cure would be to destroy these androgen receptors on the scalp, thereby making their sensitivity to androgens irrelevant. Androgen receptors are heat-liable and can be destroyed by trypsin.
Trypsin is possibly safe for topical application, but has the side effects of pain and burning. From a study on rats, trypsin causes hair cells to die and regrow slower, as it changed their gene expression.
Perhaps a safer/weaker version of this can be developed for hair loss? What do you think?”
My Thoughts
I am surprised that there is not much more research on this available online. Is it possible to destroy androgen receptors on the scalp without killing the actual hair follicles? Or is this nonsensical, with the only future solution being a genetic one? i.e., deactivating the AR gene responsible for hair loss?
Update: Someone sent me a link to research on silencing the androgen receptor.
Technique utilized: Follicular unit extraction (FUE) is significantly more expensive per graft in comparison to follicular unit transplantation (FUT). The latter is also known as strip hair transplantation.
Number of grafts extracted and implanted during the procedure: Prices per graft tend to decline as you get larger sessions, although not all surgeons offer a sliding scale.
Country where the surgery is taking place: See Hair Transplant Cost By Country. Developing countries usually offer much lower rates for all types of cosmetic procedures, including hair transplants. However, beware of the dangers of getting hair transplants abroad. Also add your airfare, accommodation, visa application and other fees to the total if applicable.
National chains versus private clinics: Chains with numerous locations (e.g., Bosley) will tend to be cheaper. However, this may depend on branch location and surgeon too.
Whether you are willing to come in at short notice in case of cancellation by others: Flexibility on your part can mean lower prices.
Whether you suffer from male pattern baldness, or female pattern hair loss, or other less common forms of hair loss.
Granting rights to photo use: If you are will to let the surgeon use your before and after photos publicly, you can often get a discount. You could also negotiate better rates if willing to show your results to local patients in your city; go to conferences with the surgeon as a patient case display; or maybe even become a clinic representative in your particular region.
How Much Does a Hair Transplant Cost?
Hair transplant cost per graft (counting via magnification).
In the table further below, you can find hair restoration surgery per graft prices that I found on surgeon websites. Note that some sites quote per hair or per follicle hair transplant prices. These will often be a fraction of per graft prices. However, this is misleading, since a typical graft can contain 1, 2, 3 or even more hair follicles. On average, one graft has approximately 2.5 follicles.
These prices can often change, and some surgeons are willing to negotiate them downwards. Especially if you are able to come in at the last minute if someone else cancels. Or if you have extensive baldness and are considering FUT or FUE hair transplant megasessions involving thousands of grafts. Many will also discount a second hair transplant procedure. Some surgeons are also willing to cover expenses such as airfare and accommodation.
Note that a few of these prices may no longer be accurate, so it is always best to directly consult a surgeon for the latest pricing data. The table rows are sorted by surgeon last name. There are thousands of experienced hair transplant surgeons around the world. However, I am only including a few of the most well known ones who also have official pricing data available on their sites.
Body hair transplant (BHT) prices are generally significantly higher than regular scalp hair FUE transplant prices and are not included in the table below. In most FUE mega-sessions, body hair is a small or even nonexistent factor. Also to be noted is that some surgeons offer lower FUE prices for patients that are willing to shave their donor area prior to the procedure. ARTAS robot assisted hair transplants can also influence pricing.
Many of the below listed per graft hair transplant prices are converted to US dollars based on prevailing exchange rates. You can use this currency converter to get the rates in your preferred currency.
Hair Restoration Prices by Country
Hair transplant surgery in a developed country will typically cost anywhere from $10,000 to $25,000 depending on number of grafts. The corresponding cost for the same number of grafts in a poorer developing country will be anywhere from as low as $2,000 to a high of $10,000. Although cost per graft for hair transplants is usually much lower in developing countries compared to developed countries, one needs to account for other expenses. These include airfare, visa fees, accommodation costs, and miscellaneous expenses such as taxi and bus fares.
There are nowadays excellent hair transplant surgeons operating in quite a few developing countries. However, in general, the number of inexperienced below par surgeons is more prevalent in developing countries than in developed countries due to weakly enforced regulatory systems. Moreover, if you have any kind of bad result or injury or infection in a poor country, you will have a much lesser chance of getting reimbursed or being able to successfully file and a lawsuit.
That said, going to an experienced, well reviewed accredited hair transplant surgeon in countries such as India, Thailand or Turkey can be a great option. You will usually save a lot of money in the process. I am impressed by some of the surgeons in those countries, although there are way too many scammers out there too. Even middle income cities such as Dubai and Istanbul have become major hair transplant tourism centers in recent years.
It should be noted that newer FUE practicing surgeons can be subpar even in developed countries. They often rely on their past strip/FUT surgery experience and good reputation to make it seem like their FUE practice is just as great. In the end, bad results are definitely not the sole domain of poorer developing countries. Moreover, surgeons in all countries can often exaggerate graft count extraction totals. Technicians everywhere can also damage grafts due to fatigue, insufficient training and more.
Note that both the FUE and FUT techniques tend to differ among various surgeons. Among the variances include: different punch sizes; robotic versus manual extractions; type of storage medium used; lateral slit versus sagittal slit versus coronal slit; surgical tool differences (e.g., ARTAS, NeoGraft, manual versus motorized FUE, punch types); and more. Some surgeons even have their own trademarked acronyms for their particular version of the FUE or FUT technique. In many cases, these trademarks are just marketing gimmicks.
Hair Transplant Cost Comparison Table
I do not update the below hair transplantation cost by surgeon table regularly, so some prices may no longer be accurate. For non-American doctors, local currency exchange rates versus the US dollar fluctuate daily. I am only including well known ISHRS member hair transplant surgeons in the below list who also publish official per graft pricing data on their sites. Some surgeons and clinics will also include airfare, hotel accommodation, PRP treatment, medications, airport pickup, daily taxi and more as part of a package deal.
Exclusively FUE practice. Prices converted from Euros.
I will update the above hair transplant cost by surgeon table every year.
Insurance Coverage for Hair Restoration
Note that hair transplant costs will never be covered by most health insurance plans. These procedures are almost always considered to be cosmetic surgeries rather than medical necessities. If your hair loss is due to an accident such as a fire or workplace injury to the scalp, insurance companies might be more willing to help you.
Many surgeons offer financing plans such as CareCredit and other payment arrangements for those who want to pay in monthly installments.
Price Calculator
On many hair restoration surgeons’ websites, you can find built-in online hair transplant cost per graft calculators. Prices are usually available in local currencies as well as the US dollar and the Euro. Since rates per graft are tiered and decline once you exceed certain graft totals, a calculator is a very useful tool. A surgeon can also advise you on how many grafts will be needed after you send him/her your thinning hairline and scalp photos. Many will also offer video consultation.
