Welcome to the huberman Lab podcast, where we discuss science and science based tools for everyday life. I'm Andrew huberman and I'm a professor of neurobiology and Ophthalmology at Stanford school of medicine.
Today we are discussing hair. Hair is
a topic that occupies the minds of many people. There are people that are losing their hair and want to Holt or reverse that loss of hair. And today we will talk about all the
ways that science has taught us.
We can slow or even reverse hair loss. I confess that researching. Today's topic was a particular joy for me not because I'm obsessed
with hair. My nor hair of others
but because hair turns out to be fascinating from the perspective of cellular biology and stem
cells which is a topic that I've long been interested
in. And
that for much of my career, I focused on in the context of development. So when your brain and your nervous
system, develop it develops from a small
batch of cells that turns into many, many
Millions of cells. And it does that by cell replication,
something that we call the cell cycle, and we'll talk a little bit about this. And so called
mitosis today, I promise not to get into too much detail, but what makes hair so very
interesting from a biological
standpoint is that every hair? Every single individual strand of hair has its own little stem cell Niche. Meaning its own little pocket down there
in the follicle, in
which specific stem cells. Give rise to those hairs for different.
Durations of time depending
on the hair where it is on your body Etc. So for instance, the
hairs on your head will undergo ongoing growth for 4 to 6 or even 8 years. So we're you to not cut your hair, it would continue to grow one. Single hair would continue to grow. I
guess we could say all the hairs will continue to grow for
up to eight years. That is very different from, for instance, your eyebrows, which have a much shorter period of hair growth.
Last
On the order of months. That's why you don't see people with eyebrows that extend down to their waist. But you can't see people with hair on their head that extends down to their waist, if they don't
cut it. Now that discrepancy illustrates for us just how incredible hair
follicles and the stem cells that reside within hairs are and their
enormous potential to give rise to these things that we call
hairs which are simply proteins
of varying lengths. So today, we are going to address what determines the length of a
hair.
Or rather. What determines? How long a hair continues to grow before it? Ceases growing and eventually falls
out. We're going to talk about what regulates those stem cells. What allows them to continue to produce hair or cease producing hair? And as we do that, you will learn all the biology in clear. Simple terms regardless of your background, that will really set the stage for understanding. What will also talk about which is how to
slow hair loss or halt, hair loss entirely or even reverse.
Hair loss. So we will talk about
hormone-related hair loss in both men and women. We will talk about some of the mechanical and stress-related influences on hair loss and we will talk about the chemical and mechanical approaches to halting and reversing hair loss. Everything from minoxidil to do tasks deride to Ketoconazole to micro-needling to thyroid estrogen, igf-1 Pathways again, all made very clear,
regardless of whether or not you have a background in biology or
Not.
I will also dispel some of the common myths about balding and hair replacement. If you've heard for instance that you inherit your patterns of balding from your mother's father, that is not true. Although it is true that you do inherit certain genes that influence whether or not you have a predisposition to balding, in
particular parts of your head and believe you're not even particular parts of your body
but it is not the case that you can simply find a
photo of your mother's father,
say it at age 50.
Our age 60 or 75 and determine whether or not you'll have the exact same pattern of hair loss. So that's a myth that I'd like to dispel right here and now and I will dispel some of the other myths
about hair loss, Hair Replacement and hair, regrowth as well. Before we begin, I'd like to emphasize that this podcast
is separate from my teaching and research roles at
Stanford. It is however, part of my desire and effort to bring
zero cost to Consumer information about
science and science related tools to the general public in keeping with that theme. I'd like to thank the sponsors of today's podcast. Our
first sponsor is Helix sleep Helix sleep makes mattresses and pillows. That are the absolute highest quality talked many times before. On this podcast, about the fact that sleep is the foundation of mental health, physical health, and performance Helix, understands that everybody sleep needs are slightly different, so if you go to their website, you can take a brief quiz and that quiz will ask you questions. Such as do you
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go to Helix sleep.com huberman for up to three hundred fifty dollars off. And to free pillows today's episode is also brought To Us by H VM n Ketone IQ Ketone IQ is a ketone supplement that increases blood ketones. I want to be very clear that I like most people have heard of the
ketogenic diet, but I like most people do not follow a ketogenic diet. That is, I'm not in ketosis.
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H VM n Ketone IQ does I take Ketone IQ prior to doing really focused cognitive work? So I take it once in the afternoon. Anytime I'm going to prepare for a podcast or do a
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Running again, that's because Ketone IQ by raising blood. Ketones is really a brain fuel. If you're interested in trying Ketone IQ, go to hvm n.com and use the code huberman to get 20% off. Again, that's hvm n.com and use the code huberman to get 20% off. Today's episode is also brought To Us by rokka. Rokka makes eyeglasses and sunglasses that were designed with the
biology of the visual system in mind.
I've spent a lifetime working on the biology, the visual system, and I can tell you that, your visual system has to contend with an
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a.com enter the code huberman at checkout. Okay, let's talk about
hair and in researching this episode, by talking to experts, in the biology of hair, and the stem cells that exist in, all of us, that give rise to our hair
growth, and the pigmentation in our hair. And in talking to experts, who understand how to Halt, and even reverse hair, loss, that there is a tremendously
interesting, biology surrounding hair,
but there's also an incredible psychology.
A around hair,
in fact, most people who experience even marginal hair loss undergo pretty severe anxiety. Now, I confess this is not something I can relate to. I am losing my hair in certain places. I'm
47 years old. I've got a couple patches up front where there's very minimal hair. I think that as will later learn in this episode, reflects a higher density of DHT. Dihydrotestosterone receptors at that particular location as opposed to elsewhere in my
scalp but keeping my hair is not something that I've
About much of my life. And yet, as I was researching this episode, I remembered an
anecdote from my childhood
where my father told me and I think it was because I had was stressing about something and I was
trying to get to sleep and he said, don't stress calm down. And here's why if you stress too much, it can actually make your hair fall out. In fact, I have a
cousin who lay down one night stressed and woke up the next morning
and all of his hair was on his pillow and
And I'll never forget that
story. I think he was trying to get me to stress
less and I don't know if that story made me stress, less or not,
but in any event I don't know that that story is true. I'm not going to challenge the authenticity of
that story. I didn't have a chance to reach out to my father and ask him to verify or
not. But as will soon. Learn, it is true that our psychological well-being can impact both the coloration or lack thereof and the growth rates of our hair. That's a real thing.
And the reverse is also true, which is that as hair starts to thin
or fall out or change color.
Many people experience intense anxiety or even depression. This was not something I was really aware
of perhaps that's just because I've always kept my hair pretty short anyway, I was assumed that my hair started to really fall out of just shave my
head but that's me. And that's not
most people out there. I think most people would
loathe to lose their hair and in fact, given the enormous
number probably up,
In the high billions of dollars and euros, and other currency. Of course, that people invest in, trying to Halt, a reverse, their hair loss.
It's clear that hair is very, very important to people. What we know is that by age 50, approximately 50 percent of all men and women will have experienced significant enough hair loss, that they start to notice it, and a large percentage up to 85% of those. People will experience some sort of anxiety
that leads them to go out.
And try and either halt or reverse that hair loss. Now,
why at age 50? Well, an important Point arises from that, which is that the hair loss is not occurring between the 49th and 50th birthday. Hair loss is on going from about age 30 to age 50. It's only by age 50, however, that about 50% of people out
there, start to notice that hair loss and this is typically because they'll, you know, they'll be in a
bathroom or looking at a mirror
and the lighting will be bright enough.
That it permeates the the sort of outer boundary of their hair and they'll notice that their hair is thinning in a particular location. That's usually how the sort of thing
happens. So again, our psychological states can
impact our patterns of hair growth or
loss and, of course, patterns of hair growth, but more typically, hair loss and hair graying can
really impact psychological state. So
this is a subject that people take intense interest in. And today we're going to talk about how hair normally grows. Why it grows at the rate
and
Or the
duration that it happens to and then as we talk about ways to intervene with that hair loss, those biological mechanisms will come up because they really provide a nice framework for
explaining why certain treatments work more or less well, or why certain treatments might have certain side effects or total lack of side
effects. It will also highlight a really key theme that will come up several times. In today's
podcast, which is that there are both
mechanical and chemical approaches to slowing and reversing hair loss.
It's mechanical approaches would be things as simple as massaging. The scalp, but mechanical changes to the scalp can cause either hair loss
or facilitate hair growth. This is why things like
micro-needling are so
prominent in the context of trying to reverse hair loss,
but again, there are also chemical approaches to trying to
Halt, a reverse hair loss. And this relates to the fact that
the hair growth itself is strongly regulated by hormones, such as estrogen thyroid hormone.
Insulin-like growth factor and that other
hormones in particular, the androgens so things like
testosterone but mainly its derivatives like dihydrotestosterone are very much involved in setting the stage for hair growth by controlling how big or small that pool of stem
cells. That gives rise to hair growth is. So
if any of the terms I just use are confusing to you. Don't worry
I will make all of those very clear in a moment. It's actually all pretty straightforward and
simple and so I'd like to just start
By talking about what hair is, how
it grows, why it stops growing and why hair normally
falls out. Let's talk about the
biology of hair and in doing
so I also want to talk about stem cells. Now, keep in mind that when you hear the word stem cells, you only like most people think about the sorts of cells that people are getting injected into their face
to get rid of wrinkles or give them new skin or to give them more hair. If it's injecting the scalp or
into a joint to repair a joint or muscle
those stems,
Those are what we call exogenous stem cells. Exogenous meaning from outside the body.
The stem cells that we're going to talk about today are so called endogenous stem cells
cells that we all make, that can give rise to other cells, and that's really the definition of a stem cell.
Stem cells are present in all of us from the very beginning of life. So and sperm meets egg
that cell which we think of as the
egg starts to duplicate
and incorporates the DNA from the sperm and the Egg, of course,
starts to duplicate. And then those cells give rise to
Two more cells, and more cells. And the ability of all those cells to replicate, and create more cells are because those cells really are stem
cells.
Now, at some point,
we are a completed body plan. As the biologists say, we end up with a brain and a
spinal cord and Limbs and fingers and livers and guts and all the things that we need in order to be a functioning human being. Even though we're a baby at that time, we haven't grown
up. We have all the bits that we're going to have for our entire
life. At that point, many of the stem cell.
Galatians disappear for instance past puberty and probably earlier you don't get many more new brain cells. You get a few but you don't get many more new brain cells because the brain doesn't have many stem cell populations. Whereas other organs in your body, maintain little pockets of stem cells were some cases. Many, many stem cells that can give rise to more and more of
that tissue across the lifespan
and hair is one such tissue. So, if we take a look at hair, what we
find is that
That indeed, there are these things that we call hairs,
but there are also stem cells and the stem
cells are actually, what, give rise to the errors that we see on the head of our scalp where that we see on the surface of our body.
So, right off the bat, you should know that every single hair that you have is there because you have a stem cell
population that is giving rise to that particular hair.
So, let's take a step
back or rather. I should
say, let's zoom in on one hair and the stem cell.
Population that gives rise to that hair
because in doing. So you're going to learn all the different components that you can tap into. If your goal is
to Halt, the loss of hairs or to replace hairs that have already been lost, okay? So if we were to
just zoom in at the level of one hair, what you would find is that that hair
has what typically is called a hair root. So that's the portion below the skin.
And when we say below the skin, it means that it Dives down into a narrow Trench.
Which is in the so-called
epidermis, which is this outer layer of
skin. It also has a shaft. The
shaft is the part that grows out above the skin. So what you see on somebody's head or you see on their on their arm, or when you see an eyebrow, you're seeing the shaft of the
hair. The root, of course, goes below the skin.
What most people don't realize, however, is that down at the base of the route. There's actually a little cave, a little pocket. So if you were to look at this it would look like a little bulb, a little round area with a bunch of stuff in it, right below the root. And within that little cave, there are stem cells. There are populations of cells that have the ability to divide. We
call this mitosis. It's a process by which cells can actually divide and take
DNA with them. And then, give rise to other cells, we call
Those cells, that that divide and move
out, we call those daughter cells, we call the cells that give rise to them,
progenitor cells, but they are effectively
stem cells. That give rise to these what we call daughter cells.
Those daughter cells, then become the various types of cells
that make up the hair.
So when you see a hair, you're not seeing something that grows throughout the lifespan. You're seeing something that's going to be born down there in that little cave, then is going to grow. It's actually going to stack up.
On top of itself and that's because hairs are made up of a protein called keratin. They're bunch of different kinds
of keratins depending on what kind of hair you're
looking at, but these are little proteins that stack up on top of one another and they're structured in a way that makes them pretty darn durable. I mean, it's possible of course to pull a hair
out, but if you've ever tried to tear a hair in particular, the care like one from the face or even a one off the top of your head, it's actually a pretty,
tensile, strong little thing. And that's because keratins stack up on top of one another and bind to one another.
With a really strong bond. So what you end up with is a bunch of protein,
stacked up on top of one another. And that's the actual
hair, Okay? So we've got the hair shaft, the hair root, and then we got the stem cells down there, in that pocket, that give rise to the various cells that make up the actual hair. We also have down there in that little cave, which by the way,
is actually called the hair bulb if you really want to know the technical name because it's shaped like a bulb.
We have not just stem cells but we have cells that give rise to the pigment of the hair.
That create what's
called melanin. Now some people
have very blond hair. Very light hair. Some people have darker hair but everybody unless they have What's called the albino mutation,
where the hairs are truly white, they lack all melanin and this is pretty rare condition, although it
does happen. Most people have some degree of melanin in their hairs because there are little pockets of Maryland in producing cells. Melanin is just a protein that some she gets injected into the Keratin into the hair and it gives it it's
Her color.
Now, there are a couple other components about the hair that you need to know about, especially if you're interested in
reversing hair loss or reversing greying of hair.
One of those components is a little gland. So next to every hair root within the dermal, layer of the skin. So this is below the epidermis. There is a gland called a sebaceous gland and the sebaceous gland makes oily stuff in the oily stuff is called
sebum, and on the name, sort of evoke something kind
of gross, but sebum is actually really.
Cool. And really important the sebum gets injected
or seeps rather into the
area right around the hair as the hair
starts to approach the surface, where it goes from essentially route to
shaft and the sebum does two things. First of all, it forms a little bit of a seal right at the place where the hair exits, the skin. And that seal is very important actually for waterproofing of your skin. So we don't often think of ourselves as
waterproof because we are so accustomed to water.
Landing on our skin and and rolling
off, but that's because of some of the oily properties of our skin. It's also true that our skin
is pretty densely packed with cells,
but in the absence of sebum, we would
not be as waterproof as we are.
Now, as I mentioned sebum has two important properties. The other important property of sebum is that it actually is a strong antibacterial and antimicrobial, most people don't realize. It's the oils of your skin provide a lot of immune boundary so that things don't get into the hair.
Root or the region around it and infect our skin. So sebum, while the name is sort of unattractive, to be honest, is actually performing some essential roles. Both for waterproofing and for our immune
system function, protecting us from various kinds of infection,
we're going to return to sebum later as it turns out. Sebum is also very important as it relates to psoriasis and as it relates to, some of the fungal components that can
cause hair loss. Okay? So just going to file that away.
There's another important component of the region
Found hairs, which is the erector, pili muscle, the erector, pili muscle is a muscle that lies diagonally, between that bulb portion of the hair or a little bit above it, goes up to the surface of the skin. The erector pili muscle is a muscle that contracts when we get cold or when we get scared. So if you've ever had goosebumps,
that's because the erector
pili muscle contracts, pulling the skin at the surface down around the
little hair, follicles.
Or at least where the hairs meet the the surface of the skin. And so those little bumps are actually where little micro hair is reside. And the dimples between them are
the dimples that occur when this arrector pili muscle pulls
down. Now, why would this muscle exist and what has a
couple of important functions? One of the functions is that when it pulls down it causes as the name suggests, the hairs to stand up, maybe not perfectly vertical but they when you hear, oh, I was so frightened. My hair stood up on end that's because the
Errors become erect, they stand up now. Why would this happen when we get cold it happens because when the hair stand up, are can be trapped between those hairs and can actually warm our body, this is not so much the case. If you have very light hair on your skin, if you're a very hairy person, this is going to be a more robust aspect of your physiology and yes, this is why dogs, like Huskies can go out in the snow and still remain warm when they
get cold, their hairs,
actually stand up a bit on end because the
Action of these arrector, pili muscles
trapping air in there. And then their body, warms the hair trapped beneath the hair and it, sort of like
they've got a blanket on made by the interface between the hair, the air and their
skin. So just to recap all the components of hair and the different things around it, that are going to be relevant for understanding how to replace hair
that's lost. We have the hair itself which
has the shaft that sticks
out over. The skin goes a little bit
into the skin but basically sticks out over the skin,
Have the root portion which goes down into the skin and goes through the epidermis and into the dermis then we have this bulb like region down at the bottom down at the bottom of that bulb. We have stem cells that actually give rise to the actual hair and we have pigmented cells. That pigment
that hair
in addition. And this is very important. There are capillaries that go into
that bulb region down at the bottom of the hair
and that can serve and support the stem cells.
The melanin producing
cells, which are called
melanocytes. So the melanin producing cells in the stem cells, get a lot of blood flow that allows them to keep providing new
hair or the proteins that make up hair
and the pigment that goes into those hairs. And those little capillaries deliver not just nutrients and things of that sort. But they also deliver oxygen, because it turns out that the whole process of
growing more hair is a very active process. Now, as
soon as you hear oxygen and you hear that, the growth is inactive.
Us that should qu2. Why? So many of the stories around how to keep your hair and regrow hair
involve statements. Like
don't wear a hat it'll
make your hair fall out or if you want your hair to grow
back, don't wear hats or massage your scalp or
increase blood flow or why some people
will suggest that people take peppermint oil for instance or Menthol type, oils of different kinds and massage them into the scalp things that make the scalp tingle or there will be light therapies designed to what
What to increase blood flow to the scalp? The whole rationale, there is that you're trying to increase blood flow to the stem cell in the melanocyte populations
that support the hairs and that actually create the
hairs. Now, whether or not those approaches work, will touch on a little bit later. I'll just give you a little bit of a hint right now, which is that while no single one of those approaches that I described is known to regrow hair in a very robust way because of the requirement for oxygen and
It's and because it's such an active process for the stem cells and
melanocytes to grow and darken the hairs that grow out of your skin, it
is true that manipulations or treatments that increase blood flow to those regions, can at least slow
the loss of hair or
can even extend the duration over which hairs continue to grow. So if you've heard things like, don't wear a hat if you want to maintain your hair or massage your scalp, if you want your hair to grow faster. In some
A sense. That's true, but none of those manipulations on their own is going to
robustly enhance the rate of of your hair growth.
Those things are designed to be done in conjunction with some other treatments that have been shown in many. Many clinical studies to increase the rate and duration of hair growth. So now you have in mind, a picture of what's happening at the level of
individual hairs. And if you're
anything like me, you're
probably thinking. Wow. There's a lot going on down there. Just
below the surface of the skin and indeed there is but really the things
Think about or that stem cell
population that actually give rise to the hair proteins, so that actually create the hair,
the melanocytes that darken that hair, that give it pigment that sebaceous gland and the oil sebum that provides some important
antimicrobial and other properties to that General
region, and that arrector, pili muscle, that arrector pili muscle. As I mentioned earlier, is important for creating Goosebumps and it's important for keeping Huskies warm in cold environments, but it's doing some other really important.
Things
as well. And we'll talk about those as time goes on this episode.
Right. Now, what I want to do is just talk for a moment about how
hairs actually grow and why they grow the way they do. This is
extremely important toward understanding Hair Replacement and slowing hair
loss.
There are three basic phases
of growth of a
hair. The first phase is the phase in which the stem cells down in that bulb, give rise to
The
cells that make up the proteins of the hair. So the
actual growth of the hair and keep in mind that the hair is actually growing from the
bottom up. You might think, of course, it's growing from the bottom of, every one knows
that, but a lot of people think that the hair starts growing right at the surface of the skin, that's not the way it works. The hair is actually growing from deep within the root and stacking up and then eventually extends
out across the top of the skin
that growth phase is called the anagen phase.
A nage.
N
and this, for some people will ring a bell, because if you've ever been interested in weightlifting or even if you're an endurance, Runner you'll hear about things that are anabolic that promote growth. So Anna of growth or
catabolic that promote breakdown.
So the first phase of hair growth is called the anagen phase and it's a period of varying duration depending on which hair on the body were talking about. So the antigen or the growth phase for her.
On the head, as I mentioned earlier, is anywhere from two to eight years for most people, it's going to be about 6 years. What this means is that if we were to just
not cut our hair, just let our hair grow for
228 years that hair would eventually grow to a
length that it was at its maximum and then would stop growing. So
we can say that the anagen phase of hairs on the scalp is
228 years, right? The group, the duration of the growth phase
contrast that for
Instance, with the duration of the anagen,
phase 4, hairs of the eyebrows, the hairs of the eyebrows
grow about four point two millimeters per month, Believe It or Not, people have measured this sort of thing. Now, that's an
average. So some people are going to have eyebrows that I'm grow much longer per month. I'm somebody who for instance, has mostly the same
length eyebrow hairs, but every once in a while, I
get one of those eyebrow hairs that like really seems to be heading off my head. It like really wants out of there and so it's
Longer than the rest. What does that mean? Does it mean that it grew? Faster.
Maybe but chances are the stem cell
population in that particular eyebrow. Follicle for that one. Eyebrow hair
is longer than it is for the others. This is really important. I'm trying to illustrate two principles at once here. The first principle is that different
hairs on your body, including the hairs on your scalp, have a growth phase of different duration. This is why the hairs on your head can grow very, very
a long as they have a very long antigen or growth phase and the hairs on your
eyebrows. Will only grow for a few months before they actually fall out
and then have to undergo
replication of the stem cells to give you new eyebrow hair to then
grow.
What's important here is not just that there are differences in the duration of the growth
phase. But rather that the rate of hair growth
is not something that tends to differ within a
given body region, right? You'll hear
people say, oh, my hair grows really, really fast. Other
people will say, oh, my hair grows really, really slowly.
That is probably not the case. Well, there could be slight differences in the rate of growth, that is the addition of more keratin to the
actual hairs. So creation of more hair.
More quickly. Almost certainly what's happening is that the duration of the anagen phase in some people is just
much longer than it is in other people and we don't realize
this and we tend to think more in terms of how fast hair grows because if you were to just look at somebody's hair, you'd say, oh, you know, they're all more or
less, the same length. I mean, some people's bangs are shorter than the back because they cut them but if they were to just grow their hair, you'd say oh it's all more or less, the same length. But if
we were to zoom in with a microscope, we would see that there are a lot of hairs down there in between the
The other hairs that are very, very short or even tiny. Tiny tiny, and those are coming in as the other ones are finishing, their anagen phase,
okay? So that's the antigen or growth
phase. After the Energon, phase
comes the catagen phase, again, this resembles the word catabolic or the breakdown
phase during the catagen phase, the hair is actually receding not from the top down to the skin surface and then into the
root. But the other way
it's actually receding from that.
Old region up toward the surface.
And that catagen phase is going to also be of
different duration, depending on which area of the
body you're in, and it will vary a little bit
depending on who you are being from person to person. We'll talk about the influences on the antigen and catagen phase in a moment. Why is it important that
it actually receives from the inside out? Well, that's important. Because as it does that there's actually a change in that bulb region down below. Because normally there's an interface, there's a
Conversation that's occurring between the stem cell population the melanocytes in the hair itself and they support each other. And remember there's blood vessels going into
that area or rather capillaries that are feeding that area as well.
After the catagen phase, comes the telogen phase, which means rest the telogen phase is a period in which no new hair proteins, are being added by those stem cells and during that telogen phase, that bulb down there at the bottom instead of being nice and oval. And and really having a lot of space in it, with all these different things, like stem cells starts to pinch off from the, from the little tube that comes down from the surface of the skin. That normally would have a hair in it. It starts to pinch off and at some
Like many hair follicles, pinch off that bulb region, and it recedes and
dies. And when it recedes and dies, the
stem cell population in the melanocytes, go with it. In other words, there is no longer a population of stem cells to give rise to more hair
after that, telogen phase and there's no longer melanocytes to pigment the hair. And in fact, the hair isn't there anymore. So there's no hair even to pigment after that, telogen phase. Unless
it's a hair of a particular types of
Such as
the hair on your scalp which
can then re-enter the cell cycle and get back into an antigen phase and regrow more hair from stem cells. Okay, so there are three critical stages of
the life cycle of a hair that are relevant to today's conversation. There's the anagen phase
during which the hair grows. There's the catagen phase during
which the hair actually starts to recede and die at the proteins actually disappearing from the bottom up.
And then we have the teal Widgeon phase which is the phase in which the
So population is what's called a semi quiescent semi quiet
or completely quiet isn't where it's not active at all.
Those three
phases make up the life cycle of a hair,
keeping in mind that for some hairs, they can re-enter the life cycle and go back into the anagen phase. If there's stem cells there and if there is oxygen there and if there is sufficient blood support and and this is a very important and if there are the
appropriate hormonal signals to support growth and there is a reduction or an absence in the hormone signals that actually trigger
that tillage Enphase I
make this point now because much of the rest of today's discussion is going to focus on why particular hormones such as dihydrotestosterone cause hair loss. And why inhibiting things like, dihydrotestosterone can support the preservation of hair that you have and the regrowth of hair to make a long story, very short. And
Get into some additional details, that are relevant and that I hope you'll stick around to listen to
dihydrotestosterone, which is the derivative of testosterone causes changes in that bulb region, where the stem cells, reside it shortens, or
halts the anagen, phase of hair growth
and it extends and promotes the catagen and telogen phase. So when we hear that oh you know dihydrotestosterone makes
your hair fall out or
estrogen makes your hair grow.
There are real chemical, or we should say, biochemical, legitimate
reasons as to why that is.
But it all comes back to this three phases
of hair growth. The antigen growth phase, the catagen catabolic or hair loss, phase and the telogen phase, which is a rest period in which the hairs can either come back. If it re-enters, the anagen phase, or maybe it's over for
good hormones, are the accelerator and the
brake on each one of those phases. I'd like to take a quick break and acknowledge one of our sponsors athletic.
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So now you have in mind the anatomy of the
hair and the area from, which it grows on the stem cells. Etc, fact, that there's
capillary Innovation,
delivering oxygen and blood flow
to the stem cells, that give rise to the hair. And that there are these three critical phases of hair growth, antigen catagen and telogen.
Now, let's talk about the accelerators on hair
growth, and the brakes on hair growth.
There are many accelerators on hair growth. But the first one that I really want to underscore is blood flow itself, which equates to the delivery of nutrients and oxygen. This is very important and it explains a lot of the treatments
for halting and reversing hair loss.
For instance, one of the longest standing
treatments for halting and reversing hair loss is so called.
Still
minoxidil sometimes
also referred to by the brand name. Rogaine
was actually a drug that was
developed to treat
hypertension. So this is a cardiac drug that lowers blood pressure and it does that by causing vasodilation. It allows more blood flow, not just to the hairs on your scalp, but two,
hairs everywhere on your body.
And indeed, most people don't realize this, but minoxidil won't just slow the loss of
hair from your scalp. It is also effective at slowing, the loss of hair.
Elsewhere in your body. How does it do that?
Well, you now know one of the major ways, it does that, it does that by extending the anagen phase. So it basically makes that phase a bit longer. Does it make it much much longer which is why for most people who are losing their hair quickly or who
have already lost their hair,
minoxidil alone is not going to be a sufficient
treatment. However
minoxidil has been shown to be effective at slowing rates of
hair loss and people that are starting to experience some
hair loss. All
Getting to dosages and things of that sort a little bit later. But right now, I just want to really focus
on the logic of why people would take this drug, which is
lowering hypertension
at all as it relates to hair loss, right. That might seem like kind of crazy until you understand the anatomy and the growth of hairs which you now do.
So that's what minoxidil is doing. It's
creating more blood flow to the hairs,
which because minoxidil does have this positive
effect. Least most people would like to slow their rates of hair loss on their
scalp. Anyway, it
Was you that blood flow and delivery of oxygen and other nutrients from the blood is pretty critical if not very critical for
the support of the hair growth cycle itself. Now
again, we haven't talked at all about the sorts of chemicals or the signals within the
body such as hormones that actually direct the growth of hairs here. We're just
talking about a mechanical change,
allow more blood flow to the region and thereby extend the anagen phase, which is exactly what happens with Minoxidil now.
Minoxidil does have
Other
effects. And this is why dosing of minoxidil
becomes a little bit complicated and can be a little bit tricky to troubleshoot it. Can greatly lower blood pressure or lower blood pressure. Just a little bit depending on how sensitive somebody is to that particular
drug. So, oftentimes Physicians will start people on minoxidil dosages that are very low. Ideally, that would be the case and
then ratchet it up. In order to figure out where the minimal effective, dose of the kind of critical threshold is beyond which they start experiencing some pretty uncomfortable side.
Such as swelling of the ankles or headaches or dizziness these, things can happen
with the use of Rogaine AKA minoxidil.
Minoxidil has also been associated with increases in the hormone prolactin. Prolactin is a hormone that's released from the pituitary. It is a hormone that acts also as a bit of a neurotransmitter, like many hormones and it tends to be antagonistic or in opposite to dopamine. So, dopamine is a neurochemical what's actually in Iran.
Modulator meaning it modulates, the activity of a bunch of neural circuits in the brain. It
also controls the release of various
hormones in the body.
Dopamine is almost always associated with states of motivation, Pursuit and drive. It has a little bit of a kind of feel-good element to it, which is why a lot of people think dopamine is associated with reward and pleasure, but it's really about energy,
motivation and drive,
dopamine and prolactin are. As I mentioned before, antagonistic to one another, they're in sort of a push-pull. So, people who take
Bill, especially if they're very sensitive to it. Or they take dosages that are too high will experience increases in prolactin that in turn can cause things like reductions in libido. Reductions in overall feelings of
well-being apathy and in some cases where the elevations and prolactin are more
extreme they can experience for
instance, increase in male breast tissue gynecomastia or even small bits of milk, letdown things of that, sort
in women who take minoxidil
The side effects are much like the ones in experienced in men. So there can be swelling edema of the tissues because if you get too much vasodilation and to Too Much lowering of blood pressure, that's not good headaches. Dizziness and so on, so dosing, a minoxidil is really important. If somebody's going to use Minoxidil in order to try and slow or reverse hair
loss. And again, it
mainly is going to be used to
slow rates of hair loss, not to actually reverse hair loss.
The really key thing is to get that dosage, right?
So the ranges of
Still that you'll see suggested and that people use out, there are vast.
And I should also mention
that there are two major routes by which people get minoxidil to the hair. Follicle one is to take it systemically as a pill where it goes into the general
circulation. The other is to take it topically as a
cream. There are
prescription and non-prescription forms of
minoxidil, just to further complicate things,
but the ranges of oral
minoxidil that you'll see out there and that people take
range anywhere from 0.25 milligrams.
He's all the way up to
5 milligrams per day. So that's an enormous range is like a 20-fold range.
The topical minoxidil is also found in various concentrations. The typical concentration is going to be a five percent concentration that people will use once per day, topical treatment with Minoxidil at
five percent. Concentration
is thought to just stay at the scalp, but we now know that it can go systemically can get into the general, bloodstream. Why? That issue made?
Sense to you because when you put something on your scalp, I've already told you these
little pits. These little tubes that go down to those bulb, Region's below the skin that have direct access to the blood supply. So when you massage something into your scalp, it not only has the opportunity
to get into your general circulation. It often does especially if it's something that's very water soluble and that way you can get into the capillaries and into the general bloodstream, although
topical treatments of which were going to discuss a number.
A of them today don't tend to get into the general circulation as
robustly as taking something by way of pill or capsule.
Okay? So minoxidil works by way of increasing blood flow to the stem cell Niche below the hair. The dosage ranges of the oral. Minoxidil are tremendous, 0.25 milligrams, all the way up to 5 milligrams. Once per day, the dosage range of the topical Solutions, tends to be a little bit more confined, typically, it's a 5% solution and it's recommended that people.
Use it one time daily. Maybe twice daily. It's also important. By the way, if
you're going to take this route that you actually leave that Solution on the scalp for 3 to 5 minutes, this is important
and should make complete sense as to why it's
important. You can't just rub the stuff into your head and then rinse it off and expect it to be absorbed. It actually needs to seep down into those hair follicles and access the
niche. How do people
arrive at the correct dosage for minoxidil? Well,
for better for worse, really in.
Some cases it's accomplished by finding out
that you have an unwanted side effect. Like dizziness or swelling of your ankles or enema or I
would hope this wouldn't be the case, but something that
suggests there's hyperprolactinemia you could get a blood test to measure your prolactin or you, perhaps notice a drop in libido or some
lethargy, these sorts of things that are common to
reduce levels of dopamine increased levels of prolactin, I would hope that if
people are working with a physician or if they're not,
Minoxidil that they would start with the
lowest possible dose. So for oral minoxidil, that would be Point, 2 5 mg, and then increase it as needed rather than jumping in right at 5 mg
because some of those side effects, in particular, the fluid
retention and the hyperprolactinemia can be pretty uncomfortable and can disrupt a lot of aspects of life that most all of us consider desirable.
Okay? So we're really focusing right now on treatments, that relate to the critical requirement for hair stem cells to
Give blood flow in order to receive oxygen and
nutrients to get the hair to grow. And that's really what minoxidil is about. It's
also what, all of those anecdotes you
here are all about like massaging, the scalp or
putting red light on the scalp. Although red light might do some other things in General Heating or lighting of the scalp or massaging of the scalp is really designed to increase
blood flow to the scalp. Now, the reason
minoxidil works at all is because
Is going to increase blood
flow around the clock and that's because people are taking it topically and it's seeping into the general
circulation or at least his stangs somewhat restricted to the hair cell Niche or they're taking it orally and it
makes it to that hair cell Niche below the follicle, when we massage our scalp. However,
that's a transient thing. You like a massage my scalp
right now? I'm no doubt increasing blood flow to certain areas. I'm probably decreasing blood flow to the area as I'm pushing down on, but it's all temporary.
I don't know.
Many people that can
massage their scalp enough during the day or long enough. During the day rather that it would
sufficiently increase blood flow. With that said, it is clear that increasing blood flow to the scalp by way of reducing hypertension, which is effectively accomplished by
broadening by expanding the blood vessels and
capillaries is an effective way to at least hold onto the hair that you have. Is it going to completely halt hair loss? If you have a strong genetic bias towards hair loss,
No, is it going to
reverse hair loss very unlikely that it will, but it
can slow hair loss or even maintain the hair that you have. So if we were to take a
step back and ask ourselves, what other sorts
of drug treatments are out there, besides minoxidil that, increase blood
flow, and that might increase
the rates of hair growth or more likely, increase maintenance of hair that one already has by increasing blood flow to
the niche. And nowadays, there are more and more doctors who are familiar with this.
Fireman for blood flow, understand the mechanisms
by which minoxidil works
and understand the vast desire out there
for people to hold onto the hair, they have and regrow
hair, and they are prescribing things like low dose, tadalafil. So 2.5 mg, 25 mg to dalla Phil to dalla. Phil was initially discovered as a drug to treat prostate
health. It was a drug that we now know can
increase blood flow to the prostate and thereby offset, some of the issues
associated with an aging
prostate.
Higher doses of tadalafil.
Sometimes also referred to as the by its brand name, which is Cialis, are used to treat
erectile dysfunction. But at the dosages that are used to increase blood flow to the prostate. And that now, a number of
doctors are using to increase blood flow, not just to the prostate, but to all regions of the body, including the
scalp, such as 2.5, 25 milligrams to Dow fill, so this is something that I think deserves attention, because it falls under the umbrella of increasing blood
flow to the hair.
Our stem cell niche in order to maintain hair,
it is not something that most doctors are going to be familiar
with, as the way to reverse hair loss because it won't do that.
But the use of low-dose to develop fill too slow rates of
hair loss is
very much in a logical mechanistic sense. Exactly the same as the
logic of using minoxidil to slow rates of hair loss. It's all about increasing blood flow to support the stem cell Niche below, the hair
follicle, the critical requirement for
Low oxygen and nutrients to the stem cell Niche. Is
also why you hear a lot.
Nowadays about the use of PRP platelet, rich
plasma for trying to offset hair loss or even reverse hair loss.
We're going to do an entire episode about PRP. It is pretty controversial in certain circles and well, accepted in other circles. A couple of key things to understand about PRP. First of all, it is being used in multiple tissues for different purposes in different clinics. So, for instance,
Board certified physicians in the United States, Canada and Europe are doing PRP injections into ovaries to try and expand the number of healthy
follicles and eggs so that people can conceive later in life or even earlier in life. If they don't have any follicles,
people are getting PRP injections into their joints in order to try and support joint health. People are getting PRP injections into just about every tissue. You can think of however PRP despite what you may have heard is
Not stem cells. Somebody tells you they're injecting stem cells. They're either outside the US Canada or northern Europe or they're
injecting something else. So you want to really look into that the
safety issues. There are subject totally
deserving of an entire episode. I'm not necessarily opposed to the
future of stem cells as a treatment, but keep in mind that stem cells are
cells. That can give rise to lots of other cell types and they are cells that divide and replicate and there's a name for that when it happens in the adult body, when you don't
At that and that's called
cancer tumors are
overproduction of cells from stem cells. When those stem cells, ordinarily should be quiet
isn't okay. So keep in mind the difference between stem cells and PRP PRP. Platelet
rich. Plasma again is legal in the US and many other places
because it involves drawing somebody's blood spinning it down at a particular speed which separates out different components within the blood, then taking the platelets and re-injecting those in a solution back.
Into the person's body. So platelet-rich plasma or PRP is platelet,
enriched plasma from that person, but the basis of PRP is really to encourage nutrient delivery to a particular region in the body. Using somebody's own
platelets because those platelets are enriched for various nutrients. So
people are getting PRP injections
into their scalp. Those are not stem cell injections. Those are PRP injections into the
scalp with some moderate success. These are very expensive treatment.
Moments. They tend to be transiently successful. I'm
sure there are people out there who are going to say, PRP worked
fabulously. Well for me, that might be the case. I'm not going to dispute that and I'm happy for you. Although there are not sufficient, clinical data to
suggest PRP as a treatment right now, especially given the cost many thousands of dollars, many, many treatments. It's also the case that the PRP
injections, when they work might work for reasons, independent of the platelets, what I mean by that? Well soon, we're going to talk about.
Out a different type of treatment, which is a mechanical manipulation of the hair
follicle typically on the scalp. Because that's typically where people want to regrow hair. I don't know many people who are trying to maintain or accelerate or regrow their back hair. For instance, they might be out there, but I don't think there are a lot of them or their leg hair for that matter, almost
always, it's going to be scalp hair. And one way that people are doing that is through mechanical, stimulation
of the hair follicle and the stem cell Niche. Using what's called micro needling
micro-needling
Young as the name suggests is taking a bunch of little needles. Either in a little stamp so a little square or nowadays. Typically it's a roller. So it looks like a paint roller except it's got tons of little needles in
rows, all over that
roller those needles range in length from half a millimeter to 2.5.
Mm, okay, mm.
And one rolls out over
the scalp, and if you're thinking ouch, that probably hurts indeed, it can
hurt a little bit or a lot depending on the thickness.
And the length of those
needles micro-needling has been shown to do two things. It has been shown to reactivate semi
quieten populations of stem cells. That are in that telogen phase. Putting them back in anagen phase and thereby stimulate more hair growth.
It has also in this is I think the best use of micro needling, it is also been shown to be a very effective augment for some of the hormone based hair regrowth
tools and pharmacology that we're going to talk about in a
You minutes.
So micro needling and PRP have something very critical in
common, which is the needle, the actual injection into the skin. And for
those of you that are hearing this and thinking why would disrupting the skin with needles actually
support hair growth or regrowth went that just damage the follicle.
Well, this gets into some of the, I think interesting
if not fascinating aspects of our biology,
which is that all of the cells in our body really can respond to both chemical and mechanical cues.
And when we hear needle injected in the skin, we think that
must be damaging everything, causing all sorts of
inflammation. But turns out that low levels of inflammation caused by things like micro needling, or PRP injections, or even the introduction of any kind of fluid. For instance, saline fluid injected into a region can cause changes in the cells in that region. Causing, for instance, stem cell populations that were waning to reactivate again causing tissue.
Collagen phase follicles that have melanocytes and stem cells that are dying off but not completely gone to re-enter the cell cycle. So micro-needling procedures PRP injections things like minoxidil, they all kind of center around this same general theme of increasing blood flow, increasing oxygen, delivery of nutrients or in the case of micro needling. Increasing inflammation, just enough at that local site that certain Cascades of
Go function that relate to proliferation of stem cells or maintenance of stem. Cell populations are kicked off. Its we're like reminding the cells in that area that they need to stay alive in order to replenish whatever is
lost. So sometimes a wound can actually induce some healing. Although I do want to point out that the micro part of micro needling is absolutely key and this should be obvious to you when you think about scars. I don't know about you but I've never seen a scar with hair
growing out of it.
Or if there was, it was probably like one hair, but if you've ever seen a
scar for someone had their appendix out, or someone had a brain surgery, you see that scar because there is
no hair growing out of it. So the micro portion of micro needling is extremely important. We are not talking about causing significant damage to a tissue in order to activate that stem cell population, we're talking about causing micro damage and micro levels of inflammation to stimulate growth. For
those of you that are interested in using micro needling or
Micro-needling in
combination with chemical treatments, like minoxidil or some of the other treatments will talk about in a little bit
like finasteride and caffeine. Yes, Believe It or Not. Caffeine, is being used to regrow hair very
interesting getting to that in a moment. But if you're interested in using micro needling alone, or in combination with some of these other treatments, there's a wonderful review that was just published this last year, wonderful? Because it's very comprehensive, not so wonderful, not to the fault of the authors because most of the studies out there on micro-needling are not
Not superb. There are ways of gauging the strength of a study
mainly related
to their duration, whether or not there were control groups Etc. But the review itself has excellent. The title of the review is micro-needling and its
use in hair loss disorders. A systematic review. We will
provide a link to this in the show. No captions. And this review did a very good job of highlighting, both the strengths and drawbacks of the
various studies looking at micro
needling. It also explored the use of micro needling in both men and women and a various ages.
And it does appear to be the case that micro-needling shows some positive benefit in both men and women. Regardless of age, especially when
used in combination with the various other treatments that were talking
about, I was also able to glean from this review and some of the papers describe within it that needle lengths of about 1, mm to 2.5. Mm seem to be more effective than shorter needle
lengths. So if you're scared
of the needles and the needle length, keep in mind that done properly micro-needling shouldn't be too painful.
Painful some people experience little bit more pain than others but it's not
considered a very painful
procedure. It is however a procedure that can cause some bleeding of the scalp and that bleeding of the scalp can be very apparent especially if it's in the front of the
head as opposed to in the top of the head and hidden by some hair or if you're already quite bald in a given region.
So keep that in mind. I suppose one
could wear a hat or a wig or something of that sort if they were really self-conscious about it. But the
micro-needling itself is causing a physical disruption.
Into the scalp, some degree of bleeding inflammation.
And again, all of that is part of the process by which micro-needling can actually improve hair growth. And of course, there's healing that occurs of the bleeding and the damage to the
follicle. This is a transient thing but understanding the Cosmetic implications in the
short term as well as in the long-term is certainly worth knowing
one thing that's very clear is that the combination of micro needling and minoxidil treatment together is far more effective
than either of those treatments alone.
In addition the
Nation of micro-needling and minoxidil has been shown to be effective in recovering. What are called Dead zones. So, these are regions of the
scalp that are either completely bald, or mostly bald,
for which there is essentially, no stem cell population there, and the combination of minoxidil plus micro needling is somehow able to
recover those stem cell populations and allow new hair to grow. Although the growth of that hair in those Dead Zone regions, can take a very long time. 32 even 50 weeks,
neither
All treatment alone nor micro-needling alone has been shown to be effective in recovering, these
so-called dead zones when those treatments are done
separately. So this I would say is a strong reason to consider
combining micro-needling and minoxidil as opposed to just doing minoxidil or just micro-needling.
I should also mention that minoxidil treatment. If you pursue it
is likely something that you are going to have to do for the rest of your life. If
you want to hold onto the hair growth that you obtained with Minoxidil,
or if you
To maintain the hair that you are already maintaining with Minoxidil. Some people have been successful in, taking
minoxidil maintaining some hair growth or even stimulating some hair
growth and then coming off
minoxidil. But most everyone who goes on minoxidil has to stay on minoxidil
because when they see staking minoxidil,
even if they're doing other
treatments, they lose the hair that they gained with Minoxidil. So, that is an important consideration. The decision to go on minoxidil is likely a decision to be on minoxidil for the rest of your life.
I'd like to
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Like to try element, you can go to drink element, that's LMN t.com huberman to claim a free element sample pack with your purchase again that drink element LMN t.com hubermann. So as you're probably starting to realize there's a relationship between mechanical stimulation
of the follicle and blood
flow, both of which turn out to be critical for maintaining hair. And for stimulating hair growth, not surprisingly, then an increasingly common treatment
for hair loss
is Botox.
Botox is
A brand name for what is otherwise known
as botulinum
neurotoxin. What is botulinum? Neurotoxin well botulinum neurotoxin sometimes, just called botulinum for short is a toxin that's a bacterial
toxin that serves to cut the protein that leads to synaptic
vesicle release. What in the world did I just say
Well when your nerve cells communicate with one another, they do that by way of electricity, but the electricity within those nerve cells, those neurons triggers, the release of
Calls from neurons into the synapse, little gap between neurons and the release of those chemicals allows. The next neuron to be chemically active or in some cases it will
suppress the electrical activity of that. Next neuron
botulinum neurotoxin serves to cut a protein present in neurons, so that neurons cannot release the chemicals that
cause other neurons to be active. So, this actually is pretty serious. If you were to get botulinum neurotoxin injected into your muscle, you would be
Paralyzed. Because the nerves that control contraction of the muscles would not be able to control the release of that chemical onto the muscle, which makes it contract
botulinum neurotoxin is commonly
used in what's called Botox, Botox is something. Most people are familiar with because people get
injected in and around their wrinkles because many
wrinkles are triggered by not just loss of tensile strength in the skin.
But rather the nerves around the
In an, in the skin are hyper contracted, which causes wrinkles. So for instance, I have crow's feet, I like to think that's because I've laughed a lot and smiled a lot, and it's probably also because I've squinted a
lot in my lifetime. I have crow's feet because the nerves there have pinch the skin on either side of my
eyes and that's given me little creases there that are sometimes referred to as crow's
feet, Botox, injections can be applied to the scalp in order to relieve tension of the scalp.
And in hearing that, it should be obvious.
Obvious, why Botox is being used to try and offset hair loss.
It's decreasing the squinting if you will or the tensile nature of the
scalp skin, so that more blood flow can arrive at that stem cell follicle area. So, Botox treatment to the scalp is actually becoming pretty common.
There are a couple of requirements with this Botox treatment. First of all, it has to be done by somebody who's really skilled. There are numerous images online and websites online of so-called
Talks fails where people have gotten too much Botox, or the injections have been done too deep. We're not at the correct locations on people's face or scalp and it can give them droopy scalp or droopy eyes. All sorts of cosmetic nightmares can occur with botox.
The second thing to understand is that Botox does
eventually wear off that botulinum neurotoxin doesn't stick around forever and provided, it's done correctly at the correct dosages. It doesn't actually kill the neurons that cause that tension of the Skin. So Botox injections, have to be done repeatedly.
The efficacy of
Botox for
offsetting hair loss is not clear. There aren't a lot of large-scale, clinical studies on this just
yet. But it does seem to be at least one reasonably, safe alternative to things
like minoxidil. Although,
I think if one were to just want to increase blood flow to the scalp things like low dose to Dallas fill, which doesn't seem
to carry any of the side effects that minoxidil can carry. We talked about those side effects earlier, that would probably
be the better. Alternative Botox is a fairly invasive procedure but some people opt for Botox treatment.
In fact there is a syndrome called cutest virtus Jai Radha.
Some of you have probably seen this, it's more
typical in men although it does occur in women. It literally means a lumping of the skin on the
scalp or gyri of the scalp gyri or gyrus pertains to the Latin word me. So it means bump or knee.
And so any time you hear
the word Jireh in Neuroscience or in biology you're talking about a bump
sometimes, see people will have ridges in the back or it
looks as if
If the skin was pushed together, kind of like the, a sharp, a dog. But on the scalp
people, with cutest, verdict is Jai Radha. Almost
always experience pattern hair loss.
Now, part of the reason for that is cuticles. Virtus Jai Radha is also associated with some Androgen or testosterone related hormone issues that we'll talk about in a little bit. But in addition to that it has been shown that relieving, some of
those Jai Radha by
injections of Botox to allow
those folds to sit flatter a
Effective. It can lead to less of those gyri. Those
bumps and can improve hair growth in those regions. Even if those people don't take on any additional treatments to address the hormone
issues. So that's really how people arrived at this understanding. That Botox might be a good treatment in general for reducing the kind of squinting of the scalp that can occur and the resulting hair loss in those regions.
I'd now like to turn our attention to the
chemical variables that control the duration of
the growth phase.
Of hair, the duration of that catagen phase,
which is when that are essentially recedes from the inside
out and the quiescent, or semi quiescent telogen phase, there are a couple of key
chemical players here that we should all be aware
of. First of all, the growth factor, igf-1, insulin growth factor 1, which is produced
by the liver but that
receives stimulation from the brain and pituitary to be released is a strong
Regulator of hair growth and we can think of it as the
accelerator on hair growth.
So it does that by extending that antigen or growth phase
for longer. It doesn't necessarily
speed up growth but it extends
it for a longer period of
time. In addition cyclic, A and P,
which is part of what's called a second messenger. Pathway. In fact, cyclic amp is a second messenger is also a key player in stimulating growth of the hair. Follicle
now cyclic GMP does many different things.
In many different cell types in the body. It really acts as the name suggests as a messenger between signals that arrive at the surface of cells and transmitting or conveying those signals to things that happen deep within the cells, such as the turning on and
off of various genes.
So when you hear second messenger, don't let that confuse you or overwhelm, you just understand that the whole process of getting signals from the outside of
cells into
the center of cells and controlling gene expression. For instance,
causing a stem cell to continue to give off daughter cells or causing a hair cell to
continue growing for longer. That whole process is a
bit like a Bucket Brigade of handing off water or a bucket from one component to the next or a long a chain. It's like an assembly line. I think that's probably the simplest way to think about it.
So for sake of this discussion, igf-1 is known to
increase the growth of hair by extending that anagen phase as is cyclic GMP.
So those are going to be considered the accelerators at least in this
Conversation,
the brakes on
hair. Growth are
going to be the things that either shorten the anagen phase or that extend the catagen
phase or this quiescent phase, which is the telogen phase
and the two major breaks on hair growth. That we want to think about our pde, which is a phosphodiesterase, anytime you hear Ace, it's likely to be an enzyme and tgf-beta to, right? So this is a particular growth factor that
Somewhat counter-intuitively doesn't stimulate growth. It actually
stimulates lack of growth or shortens
growth. So with all of that in mind and please do also keep in mind that you don't need to remember all those specific terms. Just understand that there are some factors like insulin growth, factor one that act as accelerators on growth
and there are factors that act as brakes on growth.
We can start to think about why, for instance,
half of all people by age, 50 start to lose their hair.
Well, they start to lose their hair because of something called.
Androgen related. Alopecia which translates, English means testosterone and testosterone derivative induced hair loss. This is true in men and women, so hearing that you should probably be wondering the following thing,
young men have higher levels of testosterone than old men, right? Well, the answer is yes, although some older men in their 40s 50s, even 80s maintain testosterone levels similar, to many men in their 20s. But most
don't
It's a downward slope
starting at about age 40 how steep that downward slope is depends
women to have testosterone. In fact, women have higher levels of
testosterone than they do estrogen. That's right. A
healthy woman has higher levels of
testosterone than she does estrogen,
however, women on
average have lower testosterone than most men. Okay, so they still have far more estrogen and far
less testosterone than most men, but the level of testosterone that they have
have within their body is higher than the level of estrogen. They have androgens such as testosterone and its derivatives such as dihydrotestosterone, which will be much the topic of what we're getting into next inhibit, igf-1, and cyclic, a MP.
Again androgens such as dihydrotestosterone, inhibit prevent the action of igf-1 and cyclic A and P which you just learned a few moments
ago act to extend the antigen or growth phase of hair
which then raises the question. Well, if young people both male and female have
higher levels of testosterone than they do when they're older, why would people lose their hair when they're older and not younger? Ah, the answer lies in the conversion of testosterone to dihydrotestosterone.
Low testosterone
testosterone. Most people have heard of dihydrotestosterone or DHT is made from testosterone. There's an enzyme, called 5-alpha
reductase, the converts testosterone into dihydrotestosterone in both men and women,
dihydrotestosterone, a binds to the
Androgen receptor at
five times the Affinity of testosterone. So it is the most powerful Androgen in humans and it is responsible
for a number of things that we all really want and like
Jazz,
mental vigour physical, Vigor strength, healing capacity, Drive libido and on and on. So DHT itself is not a bad. So if we take a step back
and we acknowledge testosterone levels are higher in males and females at younger ages as opposed
to older, but as they get older, there's more 5-alpha
reductase activity which is converting more of that testosterone to dihydrotestosterone and dihydrotestosterone inhibits hair growth by reducing igf-1 and cyclic GMP.
Well,
Then we should all be aboard, why it is that by age
50 about 50% of people experience pattern hair
loss. That is Androgen
dependent alopecia,
okay? But translated to normal English is pattern hair loss and in a moment, you'll understand why some people lose
their hair from the crown region. I'm in the back of the head or back in top of the
head. Whereas other people lose their
hair in the front of their head in the flanks. Right on either side of the midline or maybe
The midline in front all together and
that's because different people depending on their genetic lineage have different patterns of
Androgen receptors on their scalp and the pattern of Androgen receptors that you
inherit indeed does come from your mother's
side.
So this is what gave rise to
the myth that if you want to know, if you're going to go bald or not, just look at your mother's father, doesn't quite work that way. In fact, if you think about the logic, you should really look at your mother's mother. If you want to know,
your pattern of Androgen receptors on your scalp.
However, most women don't lose as
much hair from their scalp
or they have ways of covering up the hair
loss in their scalp because their hair is just generally longer or they're using other
approaches so that you never really get a clear picture of what the Androgen
dependent hair loss was in your grandmother.
Okay. Now we don't want to go too far down, the genetics rabbit hole
because as you know you can't select your parents
anyway. But if you want to know why, for instance, I'm
losing a bit of hair on either.
Our side of the midline in the front. It almost certainly has
to do with the fact that have a higher density of Androgen receptors there as opposed to say on the crown of my head. Where for whatever reason, my hair seems to grow, thickest other people lose hair on the crown in the back and top but not in the front and some people lose it all over. Now you understand why hair loss occurs in certain regions of the body? You
should also understand that the Androgen receptors on the face are also what a responsible for Beard growth and this
Is where it can get a little bit tricky
but a lot of things will start to make sense. If you can understand this and internalized, this
if you have a high density of Androgen receptors on your face, well then as your DHT levels, go up with age, you will
be able to grow a thicker and thicker beard. In fact, it is
rare to see someone who can grow a thick beard in their youth, but not so much as they get
older. In fact, the reverse tends to be true.
So the pattern of Androgen receptors differs between the
scalp and the face, and the back, okay, on your back, you have Andrew
Receptors and their DHT stimulates hair growth. So if you know, someone who has a very hairy back, or if you have a very hairy back, that means you have a high density of Androgen receptors on your back. If you have a beard and that beard is thick. Well, then you have a high density of Androgen receptors on your face. However, a
high density of Androgen receptors anywhere on your scalp is going to predispose those regions to Androgen dependent
alopecia or hair loss. In those particular regions, which
is going to allow us to
understand why all of the rest of the treatments for
Halting hair
loss. And for stimulating hair,
growth, almost all of those Center on inhibiting, either DHT directly, or
5-alpha reductase the conversion of testosterone to DHT.
So now, I'd like to discuss the ways that one can chemically, adjust, certain things within the
hair. Growth pathway, things like igf-1, pde tgf-beta, Etc. In order to stimulate hair growth or halt hair
loss. The first thing on this list is actually going to be pretty
surprising to a
Review and that's caffeine.
We all think of caffeine is a stimulant that we drink.
I certainly drink coffee in yerba mate. It gives you energy drink, things of that sort. Caffeine, does many things besides stimulate our central nervous system and make us feel less sleepy. However,
one of the things that caffeine does is it is a fairly potent, pde inhibitor.
By being a potent pde inhibitor it in directly
stimulates igf-1 why? Well, because pde can suppress igf-1, and by ingesting caffeine
or by applying topical caffeine ointment or cream to the scalp. You can suppress, pde sufficiently enough to increase, igf-1 and increase some hair growth, or at least
maintain hair growth in that region.
This may come as a shock. It might
Seemed a little bit esoteric or even going outside the margins of typical treatments. But head-to-head, topical caffeine application can be as
effective as minoxidil application
without actually
lowering things, like blood pressure, and potentially increasing prolactin. And some of the other - let's call them - because they are side effects of minoxidil. So
caffeine, ointments and caffeine present, in various hair
treatments, and creams, Etc is starting to become a more prominent female.
There, I will include a
reference to caffeine and its uses for offsetting hair loss. Keep in mind that topical caffeine ointments shouldn't
necessarily be applied every single day, so this is the sort of thing. You might do three
times a week. The concentration of caffeine in different environments. Varies tremendously, most of the studies of caffeine on the stem cell niches that control hair growth and extension of the anagen, phase of hair
growth have been performed in vitro in a dish. Although, there are
some clinical studies exploring this. They are not nearly as extensive in
Number or
duration as the studies of minoxidil, because this approach just hasn't been
around quite as long. However, when comparing side effects of minoxidil cost of
minoxidil comparing the efficacy of caffeine in minoxidil. I
think caffeine as a topical treatment for offsetting her loss stands as a pretty good choice. If you're going to start exploring
this pathway and there's no reason to think that if you were to try the caffeine ointment and it didn't work for you or you didn't like it for some reason or you needed to stop it. For some reason that you couldn't stop it safely because it doesn't carry all the other and
Blood pressure related effects and prolactin IMI effects that minoxidil
does. So if you look out there into the hair maintenance and hair replacement
literature, you look at the treatments that are being sold. Don't be surprised to see caffeine there
and also don't be surprised when I tell you what I'm about to tell you now which is no, you can't simply just
drink more caffeine in order to accomplish the goal of offsetting hair
loss. It is true that when you ingest caffeine, it goes systemically. However, you have so many adenosine
receptors throughout your body, those are dentist.
These receptors and the
parking of caffeine. In those adenosine receptors is the
main way in which caffeine exerts, its stimulatory effects, making you feel less sleepy. So it does that because then adenosine can't have its effects which are to make you
sleepy. Well, those adenosine receptors soak up so much of the caffeine that you would ingest orally that very, very
little would make it to the scalp and two the hair follicles, at the concentrations that you would want. So that's why you have to rely on the application of these caffeine ointments.
Three times a week. Keep in mind that no one has really explored the dosages of caffeine in these arguments
in a systematic way, we're still in the early
stages of all this, but I do think it's important to mention caffeine because of the lower incidence of side effects at least reported side effects and the general safety margins and the head-to-head
essentially comparable efficacy with Minoxidil because minoxidil has a bunch of other issues.
Now, keep in mind that both minoxidil and caffeine are generally used as a
preventative for reducing hair loss over.
Time, they are not expected and they do. Not as far as we know,
create new hair
growth to any sufficient degree. If
any of you have used caffeine
ointments or minoxidil and observed new hair growth. That was robust. Please put that in the comment section. I be curious about those
experiences, but as far as I know, in from the clinical literature that I read, there's no examples of that one other point about caffeine, it does appear. That caffeine can not only in directly stimulate igf-1 in the anagen phase of hair cell growth.
Way of reducing pde and
tgf-beta. But it also seems to reduce
apoptosis, which is naturally occurring cell death of that stem cell Niche.
We've been talking a lot about the antigen or growth phase of hair. We also talked about the cattigan where the recession of that hair from the inside out. But remember that third phase, the telogen phase, where that whole bulb down at the bottom of the bulges, it's
called gets pinched off. And the whole thing dies and takes the stem cells off to the Grave with it. It appears that caffeine can offset the death of that Niche and potentially maintain the
the stem cell population longer making
caffeine a really good choice to think about in conjunction with the various chemical treatments aimed at directly
attacking the DHT pathway that we'll talk about next.
So there's one very direct way to increase hair growth, and maintain the hair that
you have on your head. And that's to increase, igf-1,
that can be accomplished through prescription drugs, such as growth hormone and things that stimulate the release of growth
hormone and igf-1 keep in mind growth.
Mona's released from the anterior pituitary, during the first hours of
sleep, especially when you haven't eaten anything for the two hours prior to
sleep and especially when you get regular
bedtimes, yes, this is a real thing. If you
are going to sleep at variable bedtimes, especially if you go to sleep much later than your usual habitual bedtime, you will
miss that growth hormone pulse that normally occurs in the first two to three hours of sleep. This is not mean that you need to be neurotic about getting to sleep at the exact same time every night. There's probably a plus or minus
It's 30 minute
window and it doesn't mean that you can't
stay out late or have a bad night's sleep. Every once in a while we get woken up, your hair isn't going to fall out. My dad story, notwithstanding, your hair isn't can all fall out because of
that, but you do want to try and get that natural growth hormone release each night. And as I mentioned there are prescription
approaches and those are
growth hormone itself and things like Sur mer,
Ellen, which is a peptide, the increases growth hormone. It's actually a secrete. Agog, it causes the
Chretien of growth hormone and thereby increases in igf-1, this is well-documented
both growth hormone and igf-1, as I mentioned
are available by
prescription, they are not without their
side effects. So they do cause growth of all
tissues. They do increase height and children. They increase bone mass and density, they can increase mainly fat loss not so much muscle size, but they
can increase leanness
and they increase hair growth. They can increase
turnover of skin. They can make skin look more
youthful. All these things sound wonderful.
And yet
they also have problems because they can increase growth of small tumors that normally might
be eliminated. So there is an increased
cancer risk with growth hormone treatments, and igf-1 or anything that increases igf-1 such as Sir Morel and I / Merlin any of the peptides that you hear about
nowadays, that said, a number of people are using summer Ellen as an
indirect way to increase igf-1, and thereby to increase hair growth. It does seem to be fairly effective in doing
that, especially when done in conjunction with other treatments that.
Talk about but keep in mind, these are prescription
drugs and they do carry their own
risks. The other thing about stimulating, the natural production of igf-1
is that as its name suggests insulin growth factor 1,
it is insulin-dependent in many ways, if not for its accretion then for its action at
the hair follicle and stem cell.
So one of the things you really want to pay attention to is to avoid being insulin
resistant, or rather you want to try to be insulin sensitive. So if you're carrying a lot of excess body fat, if you're obese,
Nice. Or if you have
type 2, diabetes, mean your insulin resistant. You're going to want to deal with
that. There are number of prescription treatments to deal with that. Nowadays, people are very excited about all the
glp-1 agonists. But in addition to that regular, cardiovascular exercise and resistance exercise,
making sure that your body fat percentage is not in excess of where it needs to be, and everyone has a slightly different idea of where it needs to be both cosmetically and for health. So that's a conversation between you and your doctor and you and you
frankly. But you want to avoid being
Insulin resistant because being insulin resistant and being obese can
indeed lead to hair loss. And there are many people out there who are
not obese. Who nonetheless are experiencing hair thinning and hair loss. Because they are insulin
resistant by way of reduced, igf-1 activity.
There are a few supplements of these are over-the-counter supplements, such as myo-inositol
taking it dosages of about 900 mg before sleep. Which by the way, can also assist in sleep
or things like berberine or metformin, which are known to
To improve insulin, sensitivity, each and every one of these has its own
profile of positive and negative effects. The
lowest number of side effects is associated with 900, mg
myo-inositol taken about 30 minutes before sleep most because it can make people a little bit
drowsy and it does Aid sleep in some really great ways, but really exercise and maintaining a healthy.
Nutritional program are also going to be key. You just can't discard those
berberine which is a substance made from tree bark. Is sometimes called the poor man's metformin met.
And being the equally effective prescription version of
berberine or put differently. Berberine is the non prescription, but equally effective
version of Metformin, keep in mind that both berberine and
Metformin dramatically reduce blood sugar levels. And so, if you're not going to take them with carbohydrates, it can lead to some feelings of discomfort. That's why I'm not a fan of them. But if your goal is to really improve insulin sensitivity, they are considered very potent tools on the list of things that can
do that. The other thing that's really important for maintaining
her hair growth. This anagen phase is that you need sufficient iron. This is because iron and ferritin
play a key role in the cell growth Pathways that go from the stem cells to the stimulation of keratin within the hair itself. Don't have time to go into this pathway and a lot of detail
but you can have your blood levels of iron
measured this turns out to be pretty important because you don't just want to start popping iron supplements. Because too much iron, can be toxic to little
means you're anemic for women, the levels of iron
That you want are somewhere between 25 and 100 and 4 men, somewhere between 30 and 150. Fortunately, the tests or the blood test for
iron are usually a
very inexpensive, add to
your current blood panel. So if you're going in for a blood panel for LDL HDL, and a typical things, or if you're doing the more, elaborate hormone
testing, which I do recommend people, do if they
can afford it or if their insurance covers, it do ask for an iron test as well. And if your iron is low, you may need to supplement your iron if your iron is too high, that's not good either but iron plays.
A key role in the anagen
phase of hair growth. So you want to make sure you at least have sufficient iron. And if you don't you want to make sure that you're getting it from nutrition and or supplementation. Okay? So earlier, we were talking about dihydrotestosterone, dihydrotestosterone, just to jog, your memory
is a form of testosterone that can bind the Androgen receptor at five
times, the Affinity of regular testosterone.
Both men and women have a lot of testosterone relative to estrogen just so happens. That men tend to have more testosterone than women do overall, but both men and women, as they age convert, more of the testosterone, they have to dihydrotestosterone and dihydrotestosterone, does two things that are bad for hair maintenance and hair growth. First of all, it shortens, the anagen phase that growth phase. So whatever hair is going to grow is going to occur over a shorter period of time. Second of all.
Because of the presence of Androgen receptors on the stem cell Niche area. And around it, it actually
miniaturize has the follicle and the stem cell niche.
In other words, it makes the population of cells. That
give rise to more hair
protein
smaller and can eliminate it altogether. And that is why anything that reduces 5-alpha.
Reductase is going to reduce DHT, is going to maintain or extend the growth phase. The anagen phase of hair growth and is going to offset or
ENT some of the
tillage in Phase the pinching off and the removal of that stem cell Niche.
Now, one substance that we know can inhibit 5-alpha reductase, although it does it
pretty weekly is saw palmetto, which is an extract of the saw palmetto Barry to be honest. I don't know how this was initially. Discovered, if anyone knows, please put it in the show, no captions.
When I looked online, I found a bunch
of conflicting stories about who was the first person to start? Extracting the extract of these saw palmetto berries. So I have no idea which one
Those is true. Maybe somebody can tell me
the good thing about saw palmetto treatment is that it is known to have very few. If any side effects there might be some side effects in about 1% of people. But it's
not associated with a lot of side effects.
It's also known that when taken at about 300 milligrams per day and
here, it doesn't have to be that strict most of the studies that I explored involved. Taking anywhere
from 200 to 500 milligrams of saw palmetto but most of them
focused on about 300 milligrams of salt Palmetto per
day.
Divided into two or
three doses, why? Well, as a relatively short half-life, meaning it's going to get cleared from the bloodstream. And more importantly, its biological action is going to be very short lived. So if you can get
ahold of 50 or 100 mg capsules, or
tablets of saw palmetto and divide those
up, take them in the morning afternoon and evening or even just in the morning and evening to achieve a total of about
300 milligrams per day
that's going to very likely help you hold on to some of the hair that you would have. Otherwise
Maybe even grow some new hair
and I say, maybe give you some new hair growth because saw palmetto is not known to be a particularly robust treatment
for the reversal of hair loss.
It's known to have some effect but it's generally taken in
conjunction with a bunch of other things.
And so it's really hard to tease out. Just what
amount of hair growth or prevention of hair loss is due to sell Palmetto
specifically, but I mention it here because the mechanism of action is logical and fairly well known which is this
week effect.
It in reducing 5-alpha reductase and thereby reducing DHT.
So again because it has relatively low side effects even though it's not super effective and because it's fairly low cost and
it's available over the counter, I felt it was important to include.
Now, as soon as people hear
things like saw palmetto Barry, they're probably also thinking, oh boy, here come all the herbals.
Now, keep in mind that there are, some herbal compounds that have pretty
robust biological effects. We talked before in are optimizing testosterone episodes about things like,
On golly and Fidelity, aggressive
switch taken and correct dosages. And in the
correct, way can be pretty potent for increasing luteinizing hormone and free testosterone, not going to have huge effects. Not like taking exogenous, anabolic steroids,
but they can have real effects. And so herbal compounds, can be potent. However, I do acknowledge that there is a vast
Market out there of herbal compounds and plant based compounds that people are arguing. Mostly the people who sell them are arguing can increase hair growth, and there are
some decent studies.
Of these things. The hard part about studying, these, herbal compounds
and these plant-derived compounds for increasing hair growth is that they are often taken in combination with one another. In fact, most of
the hair growth supplements,
that involve these herbal compounds and plant compounds include 5 or
10, sometimes even more things
altogether. So, teasing out which ones are effective and which dosages are effective, is nearly impossible. They're just too many
variables, so you will hear, for instance, that green tea, extract racy.
Pumpkin oil,
zinc. Curcumin, that all of these things can increase hair growth. Perhaps the only thing on that list, that makes logical sense with
respect to the biochemistry, is that
curcumin is known to. In some people be a potent
inhibitor of 5,000 reductase and DHD so much, so that I can personally say, for me, I
once took curcumin in turmeric. It's also
called in high dosage. This is about a gram 22, G capsules and I felt absolutely terrible. I mean,
It's just Dreadful. I don't care if it allowed me to keep my hair forever. I would rather lose all my hair three times over. Well, I guess that means it would have grown back. I'd
rather lose all my hair. Let's just put it that way. Then ever, take curcumin or turmeric
in high dosages again
and in saying that I know that many people take turmeric and curcumin and really like, it's
anti-inflammatory properties and don't experience any side effects. I just happened to be particularly sensitive to curcumin by way of this DHT pathway, and I know this by way of blood work. So I'm never going near that stuff again.
That said a lot of these herbal compounds and Cocktails probably will have some minor marginal infinitesimally small somewhere in that range effect on
maintaining hair growth or in
stimulating new hair growth. It's just that there really aren't
clinical studies to support any one of them and
that's why I singled out saw palmetto is one of the few for
which the biochemical pathway of inhibiting file for
reductase and the low incidence of side effects. And the fact that many people have used it with some degree of success.
Success makes it a standalone. I wouldn't say recommendation.
But a consideration, another commonly
discussed and use
commercial compound for offsetting hair loss and stimulating.
Hair growth is Ketoconazole, sometimes this is known as
Nizoral. Where Nizoral is the brand name of a shampoo
Ketoconazole is an
antifungal that was initially developed to treat dandruff and severe psoriasis.
So Ketoconazole has been shown to be effective in increasing hair number. It's also
Been shown to be effective in increasing hair diameter, which is somewhat surprising. Because one of the common side effects of Ketoconazole is drying, Shinning and brittle hair. So what's going on? There is a little unclear will return to that
in a moment. The
mechanism of action for Ketoconazole is pretty interesting. Remember earlier, we were
talking about the sebaceous gland and the production of sebum that oily stuff, whose very name seems to evoke discussed in certain
people. Well, Ketoconazole can disrupt some of the fungal growth that frankly we
all have.
Have on our scalp all the time. I know this is a surprise to many of you, but you are constantly bombarded with viruses, bacteria and funguses all the time, but we managed to battle those off with her immune system, either
by physical barriers such as an oil barrier, like the sebum
or through antimicrobial
action. So chemical approaches our immune system, the sebum
Etc
Ketoconazole acts as an antifungal that in some way seems to reinforce the properties of sebum at keeping out other fungal.
Infections
and the net effect at least as far as we know is a mild
reduction in DHT. Now
exactly how this happens isn't really clear. What is clear is that the use of Ketoconazole shampoos two to four times per week with a scalp contact time of about 3. To 5 minutes, has been shown to
give about an 80% response rate of maintaining hair that would otherwise be lost. So, that's pretty
dramatic 80%. What is less clear is whether or not Ketoconazole shampoo?
Actually stimulate new hair growth. But as you're probably starting to realize this is always a bit of a tough thing to disentangle maintenance of hair that you would have
lost versus new hair growth,
certainly that's an easy thing to
disambiguate. If you have a patch of scalp where there is absolutely no hair, these so-called dead zones that you can
resurrect certain treatments, but what about
areas of your scalp where the hair is thinning. So, for instance, on the top of your head, this is
where many women will first
experience pattern, hair loss, Allo,
Shh Is Right at their midline, you know, if especially if they have a part right there, they'll start to notice that under very bright light. Fluorescent lights. In particular. They'll notice that thinning of their hair their, or in the forehead region.
They'll start using Ketoconazole shampoo again. The typical recommendation is two to four times per week with
scalp, contact time of three to five minutes and really rubbing it in and then rinsing it out. You don't need to be super vigorous. But you want to make sure that it gets down into the follicle and around the follicles. Not just sitting on top of the hair, which is going to be
Be especially important for people who have long hair to really massage it in.
Well, they will experience a growth of hair in that particular region that almost certainly we're due to miniaturization of
the hair follicle and reduction of the total population of stem cells in that follicle as opposed to complete loss of the stem cell population.
The reason we say this is that there's no reason to think that
Ketoconazole can actually stimulate igf-1 or activate growth itself. It's probably offsetting some of the reductions in the anagen phase.
And some of the exacerbation of the telogen
phase. Now if you decide to use Ketoconazole as an
approach to offsetting hair loss, it's
very important that you get a hold of a
shampoo. That's at least two percent concentration of Ketoconazole. This is important,
because a lot of the ones that are available out there, especially
online, we're going to be one percent or lower.
So, you want to try and obtain a Ketoconazole shampoo of two
percent or higher concentration of Ketoconazole, because it has other things in it. Of course,
I should mention that there are occasional side effects with kitakata,
Has all the rates of side effects from the meta-analyses and reviews that I read. We're somewhere between
one and eight percent of people will experience some side effects, but those side effects tend to be pretty mild things, like irritation of the
scalp, things like Finning, and brittleness of the hair that sometimes
can be offset by using shampoos that contain things like biotin. I know many people are probably curious about biotin, which is a protein that can be incorporated into the Keratin
whether or not different Biotin and Rich shampoos can really enhance the toll
Amount of biotin that gets incorporated into the hair isn't clear. But it is clear
that having sufficient biotin around
is important. So
if you get a little bit extra from your shampoo can imagine how that would quote unquote tap off the amount of biotin in that hair? And there are people out there saying that biotin enriched, shampoos have done wonders for them. Who knows I'm not going to dispute their experience,
so if you're going to use Ketoconazole, keep in mind that the more typical brand names that are out there,
you know, which ones they
are, oftentimes don't have
2%. Or if they do have two percent, they can
be very drying and lead to brittle hair.
There are
newer and now fortunately a greater variety of Ketoconazole containing shampoos,
we as a podcast and I
don't have any affiliation to any of these,
but I will provide a link to a couple of the more prominent ones that are known to have two percent
concentration of Ketoconazole as well as some other things in them known to offset some of that dryness and brittleness that Ketoconazole, shampoos can trigger.
So by now, I think it will be abundantly clear. Why
inhibiting 5-alpha reductase and thereby reducing
DHT should increase hair
growth because of the negative impact that DHT has on the hair follicle,
the major player. In this whole story around
inhibiting, 5-alpha reductase and reducing DHT to maintain or increase hair. Growth is going to be finasteride and it's close cousin due to asteroid. Finasteride is effective.
Reducing DHT because of its actions in reducing the type to
isoenzyme or isoform of 5-alpha reductase. It turns out there's three different isoforms or what are sometimes called,
ISO enzymes of
5-alpha reductase. This is getting pretty far down in the weeds, but I
think most of you just need to know. Is that finasteride?
Reduces DHT. That's the net product of
finasteride and in doing so it can increase hair count by as much as 20%,
pretty remarkable, if you think about
it in addition, finasteride
Ament done properly, which will Define in a moment. Can reduce hair loss in,
90% of all people that take it, that is near staggering. I mean there aren't many Pharmaceuticals out there that have that kind of efficacy, really
dramatic. And in addition, it's known to increase hair thickness by about twenty to thirty percent overall,
so not just create new growth of
hairs and thicker hairs, but whatever hair you do happen to have
on your head, it can further thicken those.
So the finasteride story is one
Think of General
success. I mean it really seems to improve hair growth and help you hold onto the hair that you have
the issue with finasteride is twofold. First of all, it is known to have some pretty significant side effects if it's not dosed properly. And in particular populations
of people and this is because there is a
wide variation in the amount of the different ISO enzymes that people make.
This is why I brought up the iso enzymes earlier,
some people make more of isoenzyme
One and three some
people make more of isoenzyme 2 and 3
and every variation thereof. So when people take finasteride, some people are very strong responders
and they achieve
really effective hair regrowth and maintenance of hair other people less effective, although still pretty impressive. But the
catalog of side effects that people experience at a given dose varies widely. So there's a lot of trial and error that has to take place.
Also should point out that finasteride comes in to make
Your forms. There's an oral form and there's a topical form. So this is not unlike our discussion of minoxidil earlier.
Topical finasteride is typically taken in one percent solution or ointment and rubbed into the head sometimes. It's now also incorporated into shampoos but typically it's put into a solution that people rub into their head and it is thought that the 1% Solutions are equivalent to one milligram of systemic finasteride. We need to take a step back and ask. Why was
Master I developed in the first place. Well finasteride, as a fairly potent 5, Alpha reductase inhibitor, it's great at lowering DHT. It was developed for treatment of prostate enlargement and various issues of the prostate that are associated with elevated, DHT, that occurs with age. The
topical finasteride is, were designed with the hope that the finasteride would make it into the hair follicle and would inhibit DHT there
and allow for more growth of the hair, which
apparently it does. But not
make it into the systemic circulation or at least not a concentration. Sufficient enough to cause
As many side effects, as with the oral
dosing. Now, the problem is, it does make it
into systemic circulation.
The issue is also that topical application of finasteride is harder to dose than
oral finasteride.
Not saying you should be taking oral rather than topical finasteride. But keep in mind that the dosages of finasteride that have been shown to be
effective for reducing hair, growth
cover an enormous range. So as low as point 0, 1 mg per day and as high
as five
mg per day, which is a just staggering range.
Now in trying to simplify the problem of how much
finasteride to take either by way of oral tablet. Or by way of topical solution, we can
get a bit of Leverage on this by thinking about how much DHT reduction occurs as a function of dose and their finasteride shows this really interesting what's called logarithmic distribution. What it means is that for a dosage of .01, mg of finasteride,
You're going to achieve approximately 50% reduction
in DHT and that's systemic DHD. So this is a blood draw measuring your DHD. Then taking
.01 milligrams of finasteride again. .01, very low dose of
finasteride or appeared a
couple weeks measure people's DHT and their blood again and you see that it's reduced by 50%. However, at increasing dosages of Point 2. Mg 1 mg 5 milligrams.
Of oral finasteride per day, over the same period of time. The increase, or I should say the reduction in dihydrotestosterone, doesn't increase linearly, it's not that you go from 50% to 60% to 75% to 100% with each increasing dose. It
tapers off it kind of flattens out. It
tends to increase a little bit but it's sort of a gradual slope increasing as you head from point, 2
mg out 25 mg.
So what this means is that given that
Reducing DHT can
cause very side effects, sexual side effects, reductions in either sexual function, or sexual drive, as well as overall
drive and motivation. Sometimes even some depressive symptoms that everything points to taking the lowest effective dose of finasteride and starting with a very
low dose of finasteride because
low doses of finasteride. Even at that point 0 1 mg taken orally daily.
Are already leading to a
50% reduction in dihydrotestosterone and thereby taken for a long enough
period of time,
should offset hair loss and stimulate hair growth.
One of the problems, however, is that people will start taking finasteride at a low dose, you know, Point 1 mg or Point 2 mg, maybe even .01 mg and there will be a reduction in their DHT. But because of the long duration of that antigen phase, they don't see a lot of change
in hair growth in the first month or even
In two
months. And so what they end up doing is increasing their
dosage and then they start to see hair growth but then they start to experience more side effects.
Now, the side effects of oral finasteride are
serious enough and common enough in people that take finasteride
that the topical Solutions were developed. But there are two one needs to exercise caution. Because if we are going to translate between
topical, finasteride, and oral finasteride,
with the understanding that topical finasteride can actually make it into the systemic circulation. We need to look at what's been shown in clinical studies, which
That for instance
taking 1 ml of point two five percent finasteride applied to the scalp. This is a
very typical recommendation
translates to the same thing. That would be achieved with two point five milligrams
of oral
finasteride and when I say translates to the same thing, what I mean is it leads to the same concentrations in the blood. Now consider that point 2 mg Point 2 milligrams
of finasteride in the blood is known
to be effective in
generating new hair growth and maintaining hair
that one already has when they start the
treatment. So if you think that the topical finasteride Tsar actually creating lower overall systemic concentrations of finasteride that is not necessarily the case again, 1
ml of topical finasteride 8.25% leads to a
2.5 mg concentration in the blood. When the effective dose within the bloodstream by taking it orally, as a pill is point 2 milligrams.
That might not seem like a big deal to you, although it is a big deal, right? We're trying to point five milligrams versus point to, but it is a huge deal when you consider that the
side effects of finasteride
increase, as you increase the
concentration of finasteride in the bloodstream. So where does this leave? Us should
people who are interested in taking finasteride, take the oral form at low dose, or take the topical form and simply try
and apply it less often, or guess at what, their systemic concentration of finasteride is
Well, it's going to vary from person to person. Some people are very sensitive to finasteride and not in the Good
Sense, the side effects just really show up quickly and they tend to be dramatic other people, not so
much. The dosage recommendations that I was able to arrive at based on the clinical studies and frankly in
discussion with some doctors who prescribe
finasteride, where the following point five milligrams to 1 milligram of
finasteride as a tablet per day.
Seems to be an effective and pretty
Safe, starting place for most people. Now,
some people will find that even that point 5 milligram dosage is just going to
cause side effects that are not going to work for them. And they're going to either have to reduce their dosage of finasteride, or move to the topical or maybe cease taking finasteride altogether,
but for many
people out there that's going to be pretty well, tolerated.
The key thing here is that one is going to have to wait some period of time to see whether or not
any hair growth occurs. It is a naive and
frankly foolish approach based on what we know
about.
About the duration of that anagen, phase of the hair
to do. One of these treatments, wait a week or two and then decide to up your dose.
Now, it is not foolish to reduce your dose if you're experiencing bad side effects
but to Simply increase your dose because you're not getting results quickly enough. That's not going to be the best approach. I
really encourage people who are going to explore the finasteride route, to think of this as a long-term project and to really ratchet up slowly if at all
starting initially with a low
dose taken for a long period of time. Maybe even as long as 25 weeks.
Before considering going up any further. Certainly, as I mentioned before, if you need to go down further, that's not going to be a problem, at least not in terms of reducing side effects. I mean, not going to get additional hair growth, but you're certainly not going to increase your side effects, if you reduce your dose. However, I will talk a little bit later about post finasteride syndrome, which is
something that's getting increasing attention nowadays. That's something that
occurs after people have taken finasteride for an extended period of
time. Now, some of you have perhaps heard,
and I'll just tell you right here that the
topical forms of finasteride,
I'd are associated
with far less side effects. Now that might come a surprising given that topical application of finasteride can lead to systemic distribution of finasteride
but the numbers that are out there right now it's that topical finasteride is associated with 30 to 50% fewer side effects or 30 to 50 percent less severe side
effects than oral finasteride. Now, there are
several things probably
responsible for that one, is that people tend to ratchet up their dose of oral finasteride pretty
quickly. But keep in mind that the
Dose of finasteride in the blood
is point 2 mg. Earlier I said the typical topical finasteride Solutions are 0.25 percent. People are taking 1, MB, that equates to two point. Five milligrams. And so it seems like a massive overdosing. Ah, but here's the discrepancy and here's where we can arrive at some reasonable recommendations. If you decide that finasteride is right for you, you get a prescription. I would hope that you're monitoring
your DHT levels and other hormone levels that would be ideal and working with it.
Doctor, please
point five milligrams to 1 milligram per day of oral
finasteride. Seems to be the best starting place
for topical finasteride. It's going to be that one milliliter a point two five percent that we talked about earlier but that's taken only one time per week and you can
fully expect that right after the application. You will have higher levels of finasteride in your bloodstream and therefore lower levels of DHT and that that will alter across.
The week most people are not going to be able to measure their DHT on a day-by-day or even weekly basis. It's just too
expensive and labor-intensive but I think those dosing regimens ought to get people into more or less the same category of optimizing hair maintenance and
hair growth. While minimizing finasteride side effects.
One point about finasteride taken, either alone, or in combination, is that in recent years, really? In the last five or so years, there's been increasing discussion about so-called post fine.
Master, I'd syndrome
now, post finasteride syndrome is indeed a new phenomenon in the sense that finasteride has been prescribed for a very long period of time for treatment of the prostate at dosages
of about five milligrams per day, right? That's a very high dose, sometimes
lower but as high as five milligrams per day, and for many years, there was no
discussion about this post finasteride syndrome.
What is post? Finasteride syndrome, post finasteride syndrome is when typically its males, this is where it's been
Bribed will take finasteride. Any
range of dosages from one milligram 25 milligrams per day. They're either doing this for prostate or more. Likely, they're doing it to offset hair loss and increase hair
growth, and then they stop taking
finasteride, for whatever reason, Financial or it wasn't working for them, or the side effects were not to
their liking, and they start to experience some very severe.
What can only be called syndrome?
Affects such as very reduced libido, very reduced.
Erectile function, very reduced mood to the point of depression, even suicidal depression. So this is pretty scary stuff, especially since it's occurring at an age. When most of these things are not typically occurring in males, they can occur, but they're not typical younger males in their 20s and 30s and early 40s. So we have to ask ourselves what's going on here. After all, people have taken finasteride for the prostate at fairly High dosages without this post finasteride syndrome. When they've stopped. Now, these young males are taking finasteride. They're coming off an asteroid in there getting
Very severe, very debilitating post finasteride syndrome. This has become a kind of Hot
Topic enough, so that medical doctors have been prescribing finasteride. For a very long time. Have
been forced to address this. I think, at first, they were sort of perplexed and thought, I don't know, this might be psychosomatic, whatever that means. I mean, as a neuroscientist who works on Mind, Body Connection. We know that nothing is truly psychosomatic. Everything is of the mind and
body. But the point is that enough medical attention has been placed on post finasteride syndrome and trying to unravel, exactly what that is.
Is where there are now a few General conclusions about what might be going on. First of all, it seems that younger males
taking finasteride in particular, High
dosages to improve hair growth or offset hair loss. Seems to be one of the key variables. We're not seeing this post finasteride syndrome as much
in older males. In fact, it seems to occur more in males, in their 20s and 30s than males in their 40s and older. So, that's
one thing, and it may relate to the ways in which dihydrotestosterone, we know,
Has a very key role in
early embryonic development. It's actually what's responsible for the male genitalia. It's also responsible for certain things in female development, but mainly in utero, it's responsible for male development and development, the penis in particular, and then around the time of puberty dihydrotestosterone acts again in, what's called, it's activating effects
to further. Increase growth of the genitalia increase, the
musculature, bone growth, Etc, and increased libido, and a number of other things. It's probably
Lee also involved in the activation of puberty. It's certainly not the
only hormone involved in the activation of male puberty
but it's certainly one of the key players.
So dihydrotestosterone has these
known early roles in embryonic development and in puberty. But what
post finasteride syndrome seems to indicate is that dihydrotestosterone is likely having further
effects on male maturation, in particular, maturation
of the hypothalamus and areas of the brain that continue well into ones 20s and maybe even once 30s and he
I just want everyone to keep in mind that we tend to think about development as childhood teenage years,
young adulthood adulthood but really development never stops. Development is something that starts at conception and birth. Of
course and then extends
all the way out until the point when we die. So even if we live to be in our late
90s or achieve 100 years of age development, is occurring that entire time and these different hormones, such as
dihydrotestosterone are having different impact for across the lifespan and in different ways.
Across the
lifespan. So there isn't a clear conclusion about what
post finasteride syndrome is really all about. But it points to the fact that DHT is likely to be
involved in development of the brain and the Brain to genital axis. Because
I mentioned that because so many of the side effects that are associated with this post finasteride syndrome, seem to Center on sexual side effects. Although there are also the depressive side effects. Of course, those can be related to one another in either direction. So while I do understand that loss of one's hair or potential loss of
His hair can be particularly troubling and anxiety,
provoking, even cause
depression. In some cases, I am sensitive to that. You also want to be sensitive to the fact that some of these treatments such as finasteride, can carry very, serious side effects. Even if you come off them AKA post finasteride syndrome, as long as we're talking about finasteride and this General pathway of 5-alpha reductase inhibition and thereby
DHT inhibition and on and on
topics and themes and nomenclature. You are now
very familiar with. We have to talk about
Out do tester. I'd do tasks deride is yet another molecule similar to finasteride. But remember those three isoforms of the 5-alpha reductase enzyme? Well, it inhibits all three. Mainly type 1 and type 2, but also type 3 and it does it very potent lie. So as a consequence, the typical dosage of oral do tasks. Dried, get this point five milligrams to two point. Five milligrams taken orally.
Works to 25 times faster than typical finasteride at inducing hair regrowth and reduces DHT by get this 95%. So it just near flatlines DHT and that can occur at concentrations as low as point five milligrams. Although you will see prescriptions and people taking to task ride anywhere from 0.5 milligrams. All the way to two point five milligrams orally, now not surprisingly due to asteroid is associated with a lot of side effects.
Related to the DHT pathway so things like reduction in sex, drive reduction, and overall
drive. It also tends to
impact, other hormone Pathways so increases in estrogen prolactin, that's why gynecomastia male growth of male
breast tissue, sometimes occurs when people take to task dried. And so you're probably asking why would anyone take to
task tried? Why not? Just take finasteride and wait for that hair growth?
Well, the answer is that. People are often very impatient and it turns out that do tasks deride Works
about 225.
Five times faster than finasteride. So some people don't want to wait a full 30 weeks or 40 weeks or 50 weeks or more in order to grow their hair back. And they're very concerned about the hair loss that's occurring. So, they will take what I hope would be a very low dose of due to asteroid.
I realize that there are ways to take to task dried, that can be safer offset. Some of these side effects. But by my reading of the literature, if one is going to try to mildly inhibit the DHT pathway things like saw palmetto
things, like
Go
caffeine which has some effect on the Androgen pathway.
But as we talked about earlier tickles, other Pathways things like Ketoconazole mild reduction in Androgen receptor, Pathways in the follicle and very direct because it's applied directly to the scalp. Things like that are going to be the best route for mild reductions in DHT as an attempt to maintain hair or grow hair.
Whereas if one really wants a potent
stimulus for increasing hair growth, that's very likely going to be finasteride and hopefully low enough dosages.
Finasteride and hopefully a patient enough patient person that they are willing to wait the duration of time required for that, hair growth to come back because they understand that that Energon phase takes some time.
Now the Holy Grail of all this hair stuff is in understanding that. No one specific
treatment is Magic and in fact
there are now a number of good meta-analyses comparing the various treatments we talked about today alone or in combination and we can summarize that pretty easily by saying that combination treatment.
Is that involve a mechanical stimulus and a chemical stimulus
are always going to be better than either one alone
and within the mechanical category, the stimulus that seems to work. Best is
micro-needling. So the
combination of micro needling and finasteride can lead to some pretty robust and
impressive hair regrowth so much so that people that were we'd only describe them as pretty bald, or bald can regrow significant amounts of hair. I've never seen examples of people who were completely bald.
And lacking all scalp hair to grow back. A full head of hair but the combination of micro needling and finasteride is probably the most effective way to go. And if you're going to do that there's no reason why you couldn't also use Ketoconazole. Shampoo could also use salt
Palmetto. There's no reason to think that these things collide with one another although anytime you're inhibiting a DHT
pathway or whether or not you're increasing or decreasing any hormone pathway for that matter, you want to be careful about layering and too many different treatments because you don't want your DHT level to go too low. I mean let's keep in mind.
And that even if you take a very low dose of finasteride and reduce your DHT and don't have side effects, may be just the mere addition of salt Palmetto which leads to a slight reduction in DHT combined. With some
caffeine ointment would be
sufficient enough to start inducing. Some of the low DHT Associated side effects. So you really have to see for you and that's one of the major issues in this whole field of hair
growth and regrowth is that people are highly individual in their
response and in their side effect profile to these various treatments but there's an enormous
strange there. And unfortunately, there's
no way to
know a priori before doing these treatments, what your response is going to be in terms of side effects, or you're simply going to have to explore. And I would hope that you would explore starting with minimal possible effective dosages and to do that in coordination with a medical professional. So you could really evaluate these things that the level of blood and cosmetic changes.
And in fact that's a pretty good motivator for thinking about the different treatments that we talked about today, everything from mechanical
treatments, simple as massage, which we've all heard about.
For which there really aren't a lot of data for supporting hair growth. But
certainly things like micro-needling which is a mechanical
stimulus for which there are pretty good data that it can improve hair growth. Also things like saw palmetto a week, DHT antagonist.
Also things like Ketoconazole shampoo which again is a week,
DHT antagonist, and operates through some other Pathways as well
to stimulate hair growth. My suggestion is that anyone young old male female, who's thinking about embarking on various treatments
for
For offsetting hair loss and
stimulating. Hair growth. Consider both mechanical approaches and the approaches that attack the chemical Pathways that can
stimulate hair growth and can inhibit the Inhibitors of hair growth.
In fact, that's the reason why we spent so much time on the biology of hair growth and what shuts down hair growth
early on in today's episode
and then systematically went through each of the various treatments that relies on. And in some cases hinges entirely on either a mechanical stimulus
or a chemical
Emulous in order to exert its effects.
My goal today was not to overwhelm you with a ton of biology
About Hair. Although we did Cover a lot of biology of hair and stem cells and hair
growth. My goal in describing all that was really for you to be able to hear about various treatments whether or not
it's lasers or PRP or finasteride do test ride or
whatever is coming next that were sure to hear
about soon online and from the medical community and
to be able to place those into bins related to their known or potential mechanisms and
then to be able to step back and evaluate which if any of those treatments might be right for you. If you're learning from and are
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