Vertex Overload: A Thermo Mechanical and Metabolic Framework for Androgenetic Alopecia

The paper proposes a new "Vertex Overload Framework" for understanding androgenetic alopecia (AGA), suggesting that hair loss at the vertex and frontal scalp is due to a combination of mechanical, thermal, and metabolic factors, rather than solely androgen activity. It highlights that balding areas differ in androgen receptor density, microvascular perfusion, and mechanical tension, among other factors. The vertex is seen as a stress node where chronic mechanical and thermal stress leads to local hypoxia and inflammation, causing hair follicles to shrink as a defensive adaptation. Androgens are viewed as co-mediators in this stress response. The framework suggests that reducing mechanical tension and improving microcirculation could enhance traditional anti-androgen treatments, offering a more comprehensive explanation for the pattern and persistence of AGA.