hello rob.
If the scalp is fibrosis, is it impossible for hair to regrow, so I know that fibrous tissue is not likely to correct itself. Do you have any idea about this?
How can fibrous connective tissue start working again? I wonder.

I was doing the massages 20min twice daily, and I noticed that maybe I was shedding too much (30-50 hairs per season).
Now I’ve reduced the amount of time (3 min warming, 4 pinching, 4 pressing, 3 strettching and now I have 10-15 hairs falling out per season. Do you think that this routine is ok? Should I change it or I must follow it?

Thanks,

Arthur

Hey Faixan,

It’s not necessary – as people have reported hair improvements with and without sebum release. At the same time, increased sebum production is often reported – especially in the first few months of massaging. In the long-run, massagers report that sebum production decreases. But there’s a lot of individual variance and I wouldn’t worry too much about this happening (or not happening).

Best,
Rob

Hey Kevin,

First, awesome study find. I hadn’t seen this before, so I appreciate you sharing the link with me.

In regard to your questions–

1. Fibrous septae are not synonymous with fibrosis. “Septae” are structures that are sheet-like and used to separate out components of tissue. If you’re a chef – or you’ve ever done culinary work with larger parts of an animal – you’ve undoubtedly encoutered fibrous septae in an attempt to separate out organs, muscle, etc. In any case, an increase in this tissue is probably suggestive of remodeling in the fascia-like material of the scalp – or the galea aponeuritca. It’s great that this ultrasound study exists because it adds onto the (very limited) knowledge we can glean from scalp biopsies – which represent a much smaller area.

2. We have no idea. But hypothetically and mechanistically, I believe the answer is yes. Fascia remodeling is a passive and long-term process. It can be influenced with the right exercises (we have a 20-minute video about this – along with technique demonstrations to do so – inside our membership).

3. I don’t have enough context of this conversation to comment. But truth is always nuanced. For instance, isotretinoin – when applied topically – can enhance the effects of topical minoxidil because it increases activity of sulfotransferase (the enzyme needed to turn minoxidil from its pro-drug to active form). On the other hand, isotretinoin – when taken orally – is linked to telogen effluvium. As far as “anything that skins the thin… is bad for androgenetic alopecia” – this comment isn’t true in the absolutes. Skin contains many structural components, with each component having a different relationship to androgenic alopecia.

In general, I try to avoid most public hair loss forums for the reasons above. It’s difficult to get a nuanced productive conversation going when everyone is anonymous, the boards are poorly moderated, people don’t contextualize their statements, and users don’t reference their sources.

Best,
Rob

Hey Hans,

Thanks for reaching out!

Blood (serum) levels of DHT do matter, but when it comes to male pattern hair loss, what matters most are DHT levels in the scalp tissue. This is why there are some studies showing conflicting results of DHT levels and male pattern hair loss. We’ve got an article about this here.

There’s also tissue-specific effects with certain herbal extracts and DHT. For instance, saw palmetto seems to have a negligible impact on serum levels of DHT, but an appreciate impact on prostate levels of DHT.

As far as a reason for why DHT increases – this is even more complicated! Genetics obviously plays a huge role, but it’s also not the only thing going on. For instance, there’s evidence that inflammation can also increase 5-AR activity (and thereby DHT levels) in tissues – and that this inflammation can come from a variety of sources: microbial, tension-related, hypoxia-related, etc.

Best,
Rob

I still don’t understand the mechanics of it, do DHT levels matter at all or is it just about follicle sensitivity and lowering DHT wouldn’t actually help with shedding? If I lowered the serum DHT would the DHT in the scalp also be reduced? Do you think there is an underlying issue that caused the elevation of T and DHT in the first place?

Thanks

this is an interesting study from may 2020 :

https://www.researchgate.net/publication/341058183_MR_Imaging_of_Hair_and_Scalp_for_the_Evaluation_of_Androgenetic_Alopecia

It’s basically a comparison between healthy and mpb MRI scalps. In the bald scalps, they found the presence of “fibrous septa in the hypodermis”.

1. Is fibrous septa in the hypodermis fibrosis ? If not, are they related ?

2. Does mechano-stimulation (massages and/or dermarolling) have a positive or negative effect against fibrous septa in the hypodermis ?

3. On a hairloss forum, some guy’s theory is this :”fibrotic and hard, slicky look in severe Androgenetic Alopecia = the bony layer expanding at the expense of the loose, cartilagenous layer,anything that thins the skin and destroys cartilage- is bad for Androgenetic Alopecia and tretinoin does exactly that.” Wouldn’t mechano stimulation be bad in this case because it could damage the cartilage ?

I would be really interested to know your opinion about all this, please.

Thank you very much.

Best regards,

Kevin