🔢 Key Takeaways
- Hair loss is influenced by various factors, including genetics, hormones, stress, and mechanical factors. Effective treatments may include minoxidil, dutasteride, microneedling, and hormone-related therapies, but there's no guarantee that hereditary hair loss is solely inherited from a particular relative.
- Our mental health can affect the health and color of our hair. Half of people aged 50 or over experience significant hair loss and often feel anxious, but mechanical and chemical methods can help slow or reverse it. Hair growth is regulated by hormones and stem cells are responsible.
- Stem cells in the hair bulb are responsible for creating hair and pigment. Knowledge of hair structure can aid in preventing hair loss or finding hair replacement solutions.
- Understanding how hair works can help prevent hair loss and gray hair. Melanin gives color, sebum protects our skin, erector pilly muscle warms our body, capillaries deliver nutrients, and hats should be avoided.
- By increasing blood flow to the scalp and supporting the stem cell and melanocyte populations, hair loss can be slowed and the growth phase of hair can be extended. Different hairs on the body have varying growth phases.
- Hair growth is determined not only by growth rate, but also by the duration of the antigen phase, which varies from person to person. Hormones can affect growth by shortening or halting the antigen phase, leading to hair loss.
- Minoxidil is a medication that increases blood flow to the hair follicles and can slow down hair loss. However, it has side effects and should be started at low doses and carefully monitored by a physician.
- Minoxidil increases blood flow to the scalp, allowing stem cells responsible for hair growth to function better. Finding the right dosage is key, and reducing hypertension can also be helpful in maintaining hair growth.
- Increasing blood flow to the hair stem cell niche and providing regular nourishment to the scalp are important in maintaining healthy hair. Utilizing low-dose tadalafil or platelet-rich plasma injections and mechanical stimulation through microneedling can encourage nutrient delivery and promote hair growth.
- Microneedling can activate dormant hair cells and improve hormone-based hair regrowth. The procedure causes minor tissue damage, promoting hair growth. Ideal needle length is 1-2.5 mm and bleeding and inflammation are normal side effects.
- Combining microneedling with minoxidil is effective for hair loss, but minoxidil must be used for life. Botox injections can also help, but low-dose tadalafil may be a better alternative for increasing blood flow without side effects.
- Accelerators like IGF one and cyclic amp help hair growth, while enzymes like pde and growth factor TGF beta two hinder it. Androgens like testosterone and dihydro inhibit accelerators, causing hair loss. The latter is the main reason for hair loss with age.
- Testosterone is important for mental and physical health, but as people age, the conversion of testosterone can lead to hair loss. The pattern of androgen receptors on the scalp inherited from the mother's side determines hair loss. Caffeine can help maintain and stimulate hair growth.
- Applying caffeine ointments can offset hair loss with fewer side effects, but drinking caffeine doesn't work. Use around three times a week, and promote new growth with IGF-1 and good sleep habits.
- Prescription treatments for hair growth have potential side effects, and insulin sensitivity plays a crucial role. Simple lifestyle changes, such as exercise and nutrition, along with supplements and regular iron level checks can improve hair health.
- Low levels of iron and high levels of testosterone can cause hair loss, but taking about 300 milligrams of SA Palmetto per day can help maintain hair and potentially promote new growth. Curcumin may also be effective.
- Saw Palmetto and ketoconazole have been shown to inhibit hair loss and maintain hair growth. Using a shampoo with 2% ketoconazole two to four times a week can help prevent hair loss with minimal side effects.
- Shampoos with biotin can improve scalp irritation, thinning, and brittleness. Medications like ketoconazole and Finasteride can help inhibit DHT and promote hair growth, but should only be used under the guidance of a healthcare professional due to potential side effects and dosing variability.
- Start with a low dosage of 0.01 milligrams daily, wait for visible results before increasing dosage, and exercise caution with topical solutions as systemic circulation can occur.
- Both oral and topical forms of Finasteride can cause severe side effects, including post Finasteride syndrome. Consult with a doctor and monitor hormone levels if considering Finasteride.
- Dihydrotestosterone (DHT) plays a role in male development and can affect the hypothalamus in the brain. Dutasteride can reduce DHT but may cause side effects. Combination treatments, like microneedling and finasteride, can be more effective for hair regrowth.
- When it comes to hair loss treatments, it's important to work with a medical professional and not layer too many treatments. Each person's response is unique and mechanical treatments like microneedling show promising results in hair growth stimulation.
📝 Podcast Notes
Understanding Hair Loss and Ways to Slow or Reverse It
Hair is fascinating from a biological standpoint due to the presence of stem cells in each individual hair follicle, which determines the length and growth duration of hair. Hormones, mechanical and stress-related factors, and genetics can all contribute to hair loss, but science has taught us ways to slow or even reverse it, including the use of minoxidil, dutasteride, ketoconazole, microneedling, and hormone-related therapies. Contrary to popular belief, hair loss patterns cannot be inherited solely from one's mother's father, as other factors also play a role. Hair loss can cause severe anxiety in many people, indicating the significant psychological impact that hair has on our self-image.
The Connection Between Psychological Well-being and Hair Growth
Our psychological well-being can impact the color and growth rate of our hair, and the reverse is also true. By age 50, approximately 50% of all men and women will have experienced significant enough hair loss that they start to notice it, and up to 85% of those people will experience anxiety, leading them to seek ways to halt or reverse hair loss. Hair growth is strongly regulated by hormones such as estrogen, thyroid hormone, insulin-like growth factor, and androgens. Mechanical approaches, like massaging the scalp or microneedling, as well as chemical approaches, can slow or reverse hair loss. The stem cells responsible for hair growth are endogenous, meaning they are present in all of us from the very beginning of life.
Understanding the Science Behind Hair Growth and Loss
Every single hair we have is there because we have a stem cell population that gives rise to that particular hair. Stem cells exist in a little pocket called the hair bulb, located at the base of the hair root, where they have the ability to divide and create more cells that become the various types of cells that make up the hair. Hairs are made up of a protein called keratin, which stacks up on top of one another and is structured in a way that makes them durable. These stem cells also create cells that give rise to the pigment of the hair, creating what's called melanin. Understanding the components that create hair may help with halting hair loss or replacing lost hair.
The Components and Functions of Hair
Understanding the components and functions of hair is essential for those interested in reversing hair loss or gray hair. Melanin, a protein that gives hair its darker color, is injected into the keratin. The sebaceous gland produces sebum, which not only seals the hair exit and waterproofs our skin but also serves as an antibacterial and antimicrobial to protect our immune system from infections. The erector pilly muscle contracts when we get cold or scared, causing hairs to stand up and trap air to warm our body. Capillaries deliver nutrients and oxygen to the stem cells and melanin-producing cells to support hair growth. Protecting hair from oxygen deprivation is important for hair growth, so avoid wearing hats too often.
Increasing Blood Flow to the Scalp Can Slow Hair Loss and Support Hair Growth
While there is no one approach that can robustly regrow hair, manipulations or treatments that increase blood flow to the scalp can slow hair loss and extend the duration over which hairs continue to grow, according to neuroscientist Andrew Huberman. The stem cell and melanocyte populations in the scalp are key to hair growth and these manipulations can help support their oxygen and nutrient requirements. The hair growth phase, or antigen phase, varies in duration depending on which hair on the body you are talking about, with hairs on the head having a growth phase of two to eight years, while eyebrows have a growth phase of a few months.
Understanding the Three Phases of Hair Growth
Hair growth is not solely determined by how fast hair grows, but also by the duration of the antigen phase. While slight differences in the rate of growth may occur, the length of the antigen phase varies from person to person and within different body regions. After the antigen phase comes the catagen phase, where the hair recedes and dies, followed by the telogen phase, where no new hair proteins are added. Hormones such as dihydro testosterone can affect hair growth by shortening or halting the antigen phase and promoting the catagen phase. Understanding the three phases of hair growth is crucial in understanding hair loss and regrowth.
Understanding the Use of Minoxidil for Hair Loss
Blood flow, which delivers nutrients and oxygen to the hair, is a critical factor in hair growth. Minoxidil, a drug originally used to treat hypertension, is effective at slowing rates of hair loss by creating more blood flow to the hair follicles, extending the antigen phase. However, it can have side effects such as reducing libido, inducing apathy, and causing dizziness. Dosing is crucial, with physicians starting people on low doses and increasing to figure out what the critical threshold is beyond which they experience side effects. Minoxidil mainly slows hair loss, not reverses it, and is used when hair loss is starting to occur.
Understanding how Minoxidil works for hair growth.
Minoxidil, whether taken orally or topically, works by increasing blood flow to the stem cells that are responsible for hair growth. Oral doses can range from 0.25 milligrams to 5 milligrams per day, while topical solutions are typically 5% concentration and used once or twice daily. It's important to leave the solution on the scalp for three to five minutes to allow it to penetrate the hair follicles. Finding the correct dosage can be achieved by starting with the lowest possible dose and increasing as needed. Increasing blood flow to the scalp by reducing hypertension can slow hair loss or maintain the hair that one already has. Other drug treatments that increase blood flow may also help in maintaining hair growth.
Effective methods for promoting hair growth
Increasing blood flow to the hair stem cell niche is important in maintaining healthy hair. Low-dose tadalafil, which is used to increase blood flow to the prostate, can also be used to slow rates of hair loss by increasing blood flow to the scalp. Platelet-rich plasma injections (PRP) are another way to encourage nutrient delivery to the scalp using a person's own platelets, but they are expensive and the clinical data is not yet sufficient to recommend it as a treatment. Mechanical stimulation of the hair follicle using microneedling is another method being used to promote hair growth.
Microneedling for Hair Growth: A Revolutionary Treatment?
Microneedling can stimulate hair growth by reactivating semi-quiescent stem cells, and boosting the effects of hormone-based hair regrowth tools and pharmacology. Microneedling causes low levels of inflammation which, along with increased blood flow, oxygen delivery, and nutrients, can initiate biological functions related to stem cell proliferation and maintenance. The micro portion of microneedling is crucial, as causing only minor damage to the tissue through microscopic levels of bleeding and inflammation leads to new hair growth. The ideal needle length is found to be between 1-2.5 millimeters, and the procedure is generally not considered painful, but may cause bleeding and inflammation.
Combining Microneedling with Minoxidil and Alternatives for Hair Loss Treatment
Combining microneedling with minoxidil is more effective than either treatment alone for recovering bald regions without stem cell populations. However, using minoxidil means committing to its use for the rest of one's life to maintain hair growth, as stopping its use could cause hair loss. Botox, which is used to relax muscles and reduce wrinkles, can also be injected into the scalp for hair loss treatment by relieving tension on the skin and increasing blood flow to the follicles. While the efficacy of Botox for hair loss is not clear, it is a safe alternative to minoxidil, but low-dose tadalafil may be a better alternative for increasing blood flow without side effects.
Botox injections as a treatment option for scalp bumps and hair loss
There is a syndrome called cutis ticus gy ratta that results in skin lumps or bumps on the scalp, which generally causes pattern hair loss. Botox injections can be a treatment option to reduce this issue and improve hair growth in those regions. The growth factor IGF one and cyclic amp act as accelerators on hair growth by extending the growth phase, while enzymes like pde and growth factor TGF beta two act as brakes on hair growth by shortening the growth phase. Androgens such as testosterone and its derivatives like dihydro, testosterone inhibit the action of accelerators like IGF one and cyclic amp, leading to hair loss. The conversion of testosterone to dihydro is the main reason why people lose hair when they get older.
Understanding Testosterone and Hair Loss
Testosterone is an important hormone responsible for mental and physical strength, vitality, healing capacity, drive, and libido in both men and women. However, as people age, the conversion of testosterone to dihydro testosterone (DHT) by the enzyme five alpha reductase can cause androgen dependent alopecia or pattern hair loss. The pattern of androgen receptors on the scalp, inherited from the mother's side, determines where hair loss occurs. A high density of androgen receptors on the face stimulates beard growth, while a high density on the scalp predisposes certain regions to hair loss. Caffeine is a potent PDE inhibitor that can stimulate hair growth or maintain hair growth by suppressing PDE and increasing IGF one.
Topical Caffeine for Hair Loss Prevention
Topical caffeine application, through ointments and hair treatments, has been shown to be an effective option for offsetting hair loss. Compared to minoxidil, it has fewer reported side effects and doesn't carry the risk of lowering blood pressure or increasing prolactin. It's important to note that drinking more caffeine won't have the same effect, as oral consumption doesn't allow for effective absorption to the scalp and hair follicles. Applying caffeine ointments around three times a week is the recommended approach, but dosages haven't been explored systematically yet. While both minoxidil and caffeine can prevent hair loss, they don't promote significant new hair growth. Caffeine can also help maintain the stem cell population longer, potentially offsetting the hair bulb dying off during the tillen phase. Additionally, increasing IGF-1 through prescription drugs like growth hormone can promote new hair growth. Regular sleep patterns and avoiding eating prior to sleep can also help stimulate growth hormone release.
The Importance of Natural Growth Hormone and Insulin Sensitivity for Hair Growth
Natural growth hormone release is important for healthy hair growth, but prescription treatments that increase growth hormone and IGF one have side effects like increased cancer risk. Insulin growth factor one is also important for hair growth and is insulin-dependent, so it's crucial to be insulin sensitive and avoid being insulin resistant, which can lead to hair loss. Over-the-counter supplements like Myan Acetol, berberine, and metformin can improve insulin sensitivity, but maintaining a healthy lifestyle with exercise and nutrition is equally important. Additionally, iron levels play a key role in hair growth pathways, so it's important to have blood levels of iron measured and supplement accordingly.
Importance of Iron and SA Palmetto for Hair Growth
Iron is important for hair growth, and low levels can lead to hair loss. Testosterone shortens the hair growth phase and can cause miniaturization of hair follicles. Reducing five alpha reductase can offset these effects, and Saul Palmetto is known to weakly inhibit this enzyme. Taking about 300 milligrams of SA Palmetto per day in divided doses can help hold onto hair and potentially even promote new hair growth. However, herbal hair growth supplements are often taken in combination with other compounds, making it difficult to determine their effectiveness. Curcumin is a potent inhibitor of five alpha reductase and may be the only logical herb for promoting hair growth.
Saw Palmetto and Ketoconazole for Hair Loss
One herbal compound that has been shown to have a biochemical pathway for inhibiting hair loss is Saw Palmetto, due to the low incidence of side effects and success with hair growth. Another compound that has been effective in maintaining hair and increasing hair diameter is ketoconazole, which acts as an antifungal to reinforce the properties of sebum, reducing DHT levels. While its ability to stimulate new hair growth is unclear, using a shampoo with a minimum concentration of 2% ketoconazole two to four times per week has shown an 80% response rate in maintaining hair that would otherwise be lost, with mild side effects present in one to 8% of users.
The Role of Biotin and Medications in Hair Growth
Biotin, a protein that can be incorporated into the hair's keratin, is important for healthy hair growth. Shampoos with biotin may offset scalp irritation, thinning, and brittleness. Ketoconazole shampoos can help hair growth by inhibiting five alpha reductase and reducing DHT, which can negatively impact hair follicles. The most effective drug for reducing DHT and improving hair growth is Finasteride. However, it can have significant side effects and dosing requirements vary widely. Topical Finasteride can be effective, but dosing can be challenging, and it may still make it into systemic circulation. Overall, seeking the guidance of a healthcare professional is recommended when using these treatments.
How to Safely Use Finasteride for Hair Growth
Taking the lowest effective dose of Finasteride is crucial to avoid potential side effects such as reduced sexual function or depressive symptoms. A dosage of 0.01 milligrams taken orally daily can lead to a 50% reduction in dihydro testosterone, which can offset hair loss and stimulate hair growth if taken for a long enough period of time. However, one should exercise caution as the effects may not be visible in the first month or two. Increasing the dose to see faster results can lead to more side effects, and it is essential to wait for an extended period before considering increasing the dosage. Topical solutions can also lead to systemic circulation, and the same caution regarding dosage still applies.
Risks and Side Effects of Finasteride
When considering Finasteride for hair loss or other conditions, it's important to understand the potential risks and side effects. Topical forms of Finasteride are associated with fewer and less severe side effects than oral forms, making them a good starting point. However, both forms of Finasteride can lead to a condition called post Finasteride syndrome, which can cause severe physical and emotional symptoms, particularly for younger males taking high doses of the drug. Medical attention is being focused on understanding this condition, but for those considering Finasteride, it's important to consult with a doctor and monitor hormone levels to minimize the risk of side effects.
The Impact of Dihydrotestosterone and Treatments for Hair Regrowth
Dihydrotestosterone (DHT) is a hormone involved in embryonic development and activation of male puberty. Post Finasteride Syndrome has indicated that DHT likely has further effects on male maturation, particularly in the maturation of the hypothalamus in areas of the brain. Development never stops, and hormones such as DHT have different impacts throughout one's lifespan. Dutasteride inhibits all three isoforms of the five alpha reductase enzyme and reduces DHT by 95%, but is associated with side effects such as reduction in sex drive and increased estrogen prolactin. Combination treatments that involve a mechanical and chemical stimulus, such as microneedling and finasteride, are often more effective than either alone for hair regrowth.
Approaching Hair Loss Treatments with Caution
When considering treatments for hair loss and hair growth, it is important to approach it with caution and to work with a medical professional to evaluate the effectiveness and assess any potential side effects. It is possible to combine treatments like using Ketoconazole shampoo and Saw Palmetto, but it is important not to layer too many treatments that could lead to a significant reduction in DHT levels, causing low DHT associated side effects. Each individual's response and side effect profile to the various treatments are highly individual, so it is necessary to explore minimal possible effective dosages and consult with a medical professional to evaluate any blood and cosmetic changes. Mechanical treatments like microneedling also show promising results in stimulating hair growth.
- Microneedling and Its Use in Hair Loss Disorders: A Systematic Review (Dermatology and Therapy)
- Caffeine and Its Pharmacological Benefits in the Management of Androgenetic Alopecia: A Review (Skin Pharmacology and Physiology)
- The effectiveness of combination therapies for androgenetic alopecia: A systematic review and meta-analysis (Dermatologic Therapy)
- Differential effects of caffeine on hair shaft elongation, matrix and outer root sheath keratinocyte proliferation, and transforming growth factor‐β2/insulin‐like growth factor‐1‐mediated regulation of the hair cycle in male and female human hair follicles in vitro (British Journal of Dermatology)
- The structure of people’s hair (PeerJ)