Very interesting article. With your flow diagram model outlined above, I can see it all starts with the genetic factors / DHT leading to an increase in scalp tension. This would explain why only people with chronically tight scalps can lose hair in a way related to AGA right? I’ve often thought why wouldn’t other people lose their hair through this mechanism, as how can my scalp be more tight than anyone else’s. And also there must be a relationship (as you have researched on) between the factor of epigenetics as I have started to lose my hair in a similar pattern my dad is, but this only started in his 40s, and I am 28 (gradually over the last few years).

In my head, the factor which holds most true, is that I’m sure DHT may bind to people’s follicles who do not show any hair fall, and so ultimately only those genetically sensitive see hair fall related to DHT.. what are your thoughts here?

Thanks for reading, Tom.

I am trying a multi pronged approach to help fix the hair loss since a few days, and I believe it is working, but will wait for some more time to give you confirmed results. I would like to have your inputs on them.

1) I am using dry cupping(aka chinese cupping/hijamah) which involves applying oil to the hair and using a small plastic/glass cup with a vacuum (I use a small hand operated vacuum device) daily to the balding/thinning patches. This is to improve blood circulation, and also relax the scalp muscles with a massage like effect due to the vacuum pull. I think this gives me better results than massaging, probably due to the ‘pull’ force on blood that is much more compared to the normal blood pressure pull available due to a massage or a head stand :/.

2) Adding supplements to my diet like Biotin, B vitamins, Iron, collagen, calcium + VitD3 , and enough protein to ensure that the right nutrients are available.

3) Adopting an Intermittent fasting eating plan to help reduce inflammation.

Please can you advise me on the above approach, and/or if you see any concerns with it.

Thanks,
Armaan

Hey Tarek,

It seems like the effects of DHT, at least in regard to the development of fibrosis, are highly dependent on the expression of androgen receptors and the degree of DHT that binds to those androgen receptors. This process may also involve androgen receptor co-factors (like the Hic-55 co-factor), and unfortunately, we don’t yet have enough research to extrapolate the mouse models studying these interactions to men with AGA. In short: while these differences might explain why men with higher “DHT sensitivity” seem to see higher rates of prostate enlargement, atherosclerosis, and pattern hair loss… we don’t yet have great evidence to answer your question yet beyond the “genetic predisposition + environment” blanket answer.

Botox into the forehead might help, but to achieve full scalp relaxation, you really need to target all scalp perimeter muscles. This usually requires 100-150 units of Botox, and unfortunately, it gets expensive!

Best,
Rob

I would assume serum dht levels would leech into the follicles and skin and cause fibrosis all over the body? Or am I wrong?

Would getting botox in my forehead only help?

Hey Kainan,

I believe Tom Hagerty’s exercises can improve AGA outcomes, but not for the reasons he ascribes on his website.

Tom Hagerty suggests that his alternation exercises (done for 5-20 minutes per day) help strengthen the scalp perimeter muscles and, during their engagement, improve blood flow to the scalp… thereby improving hair loss. These exercises have anecdotally helped a lot of people, but my issues with this mechanistic explanation are that the effects of improved blood flow are likely too short-lived to have any measurable impact on our hair.

Take minoxidil, for example. One of its suspected mechanisms is improved blood flow. Minoxidil’s half-life is 22 hours, and it’s recommended to be applied twice-daily so that its effect is constantly happening. Now compare this to the Tom Hagerty exercises: 5-20 minutes of improved blood flow… maybe some lingering effects 10-20 minutes after the exercise. It just doesn’t seem to add up that this mechanism alone would explain its helpfulness for our hair.

Now think of something else the Tom Hagerty exercises do. Over a series of months, they teach us to become aware of our scalp perimeter muscles, and specifically, how to relax them when we’re not doing the exercises. Almost anyone who’s tried the Tom Hagerty exercises for a series of months reports that their scalp feels more relaxed during their time away from the exercises, and that they have better control over these muscle groups. In this case, the anecdotes of the exercises make sense – because the relaxation of these muscles sustains improved blood flow for much longer than the actual exercise intervals.

Long-story short: it’s likely not that the TH exercises engage these muscles and thereby improve blood flow to the scalp and thereby improve our hair loss. Rather, it’s likely that the TH exercises teach us how to control these muscles and intuitively relax them outside of the exercises… leading to more sustained blood flow improvements and thereby better hair.

Best,
Rob

There is a guy from hair loss is reversible website his name is Tom haggerty. Tom haggerty maintained his hair throughout his entire life by the alternating contraction of the frontalis and occipitalis muscles. Isn’t this article contradicting Tom haggerty’s scalp exercise.
I hope you understand what I mean, and sorry for the language English isn’t my native language.

Thank you very much for your reply !

Hey Maxime,

The overwhelming amount of research (at least right now) suggests that micro-wounding can actually improve scar tissue! I know that’s paradoxical, as scars are a consequence of an inflammatory stimulus. But our propensity to scar is actually determined by wound size and the growth factors, hormones, and signaling proteins upregulated during the repair process. With small acute wounds over old scars, we can actually leverage a set of substances that help to improve / partially diminish that pre-existing scar tissue during the repair process. However, if the wounds are too large, a different set of substances are upregulated and, resultantly, we might see scarring. So, it’s all about finding the right wound-healing balance.

It’s this set of principles that partially explain why massaging, microneedling, and platelet-rich plasma therapy (PRP) can help improve our hair.

I don’t know English very well and I struggle understanding the conclusion about the “scar tissues” that would cause the hair to fall.

I bought a microneedling device, would this help reducing these scar tissues ? Or may it worsen the situation ?

Thank you !