Possible Treatments

[garethbale]

Keeping this theory in perspective, Dr. Bernstein has a great page devoted to hair loss myths:

"Myth: Hair loss is caused by decreased blood flow to the scalp

Fact: When your hair is growing, it does require a significant amount of blood flow. Once you lose your hair, not as much blood is needed and the blood flow to the scalp decreases. Therefore, a decreased blood flow to the scalp is not the cause of hair loss, but a result of it."

Hair transplants can be very frustrating, particularly for young patients with large areas of thinning hair... You replace 4,000 hairs and a few years later lose 1,000 native hairs. I would say about 90% of Dr. Cole's patients visit the forums and only around 3% post. I encourage everyone getting results from topicals/derma rolling topicals, etc. to document their progress with photos and share them.

Chuck

If that's the case why do vasilodators assist in regrowing hair? isn't it because they're attracting blood flow to the follicle?

[DesperateOne]

If that's the case why do vasilodators assist in regrowing hair? isn't it because they're attracting blood flow to the follicle?

Wrong, better vasilodators don't work to regrow hair, minox works so other way we don't know yet.

[moore]

If that's the case why do vasilodators assist in regrowing hair? isn't it because they're attracting blood flow to the follicle?

http://en.wikipedia.org/wiki/Minoxidil

Mechanism and clarification of potential efficacy
The mechanism by which minoxidil promotes hair growth is not fully understood. Minoxidil contains the nitric oxide chemical moiety and may act as a nitric oxide agonist. Similarly, minoxidil is a potassium channel opener, causing hyperpolarization of cell membranes. Minoxidil is less effective when there is a large area of hair loss. In addition, its effectiveness has largely been demonstrated in younger men who have experienced hair loss for less than 5 years. Minoxidil use is indicated for central (vertex) hair loss only. Minoxidil is also a vasodilator. Hypothetically, by widening blood vessels and opening potassium channels, it allows more oxygen, blood, and nutrients to the follicle. This may cause follicles in the telogen phase to shed, which are then replaced by thicker hairs in a new anagen phase.

I don't want to sound inaccurate, but I think the vasodilation effect is not the (main) actual reason why minoxidil (and maybe others) are working.

AFAIK Minoxidil barely elongates the anagen, but does not affect the underlying cause of atrophy.
The result is more visible hair just because they are taking longer to complete a cycle, but their cycle is hampered by androgen receptors anyway. And to be fair, more blood I guess means more androgens, so you are just bringing more damage than healing.
And, to conclude, that's why hair on the top of the scalp may be thinning, while the occipital area is covered with shiny and healthy-looking hair.

[burtandernie]

Does anyone know what happened to ascj 9? They just finished phase 2 B studies for acne and people used to always mention it and I have not seen anyone mention it anytime recently. Its a strong AA much like CB is it just because they are not going after alopecia with it? Just like CB it seems ascj 9 is only going after acne not hair loss even though it would work for both. The study showed good improvement in acne and showed no sides just like CB. There are lots of powerful safe AAs like this the problem is financially, no company seems to care to get approval and put it out.

http://www.androscience.com/artman/publish/news/index.shtml

[HairBane]

Does anyone know what happened to ascj 9? They just finished phase 2 B studies for acne and people used to always mention it and I have not seen anyone mention it anytime recently. Its a strong AA much like CB is it just because they are not going after alopecia with it? Just like CB it seems ascj 9 is only going after acne not hair loss even though it would work for both. The study showed good improvement in acne and showed no sides just like CB. There are lots of powerful safe AAs like this the problem is financially, no company seems to care to get approval and put it out.

http://www.androscience.com/artman/p...ws/index.shtml

Very little information out there about its efficacy and safety. Unknown half life. Kind of user unfriendly, stains stuff yellow. Some people are apparently trying it though and claiming to see results.

[walrus]

http://en.wikipedia.org/wiki/Minoxidil
I don't want to sound inaccurate, but I think the vasodilation effect is not the (main) actual reason why minoxidil (and maybe others) are working.

Correct, the mechanism of minoxidil action is not fully understood.

The myth of hair loss being caused my lack of blood flow gets spread because it is easy to understand and it makes sense to a lot of people. However, there is no evidence to support it.

[burtandernie]

I thought I remembered people saying minox upregulates or increases "good" prostaglandins which was part of why it helped increase hair growth, but like most things I dont think anyone knows.

[DepressedByHairLoss]

A 2012 MPB study determined the most common cause of hair loss in men—results from elevated amounts of a lipid called prostaglandin D2 (PGD2). The researchers also identified a receptor molecule—a protein called GPR44—that binds with PGD2 on the surface of cells in the hair follicle. Such binding is needed to produce the condition of limited hair growth that is symptomatic of AGA.

PGD2 is among other things a potent inhibitor of platelet aggregation.

PRP (platelet rich plasma) treatment on the other hand, (to varying degrees) increases the hair shaft diameter of miniaturized hair.

Consider what Rogaine does. Although minimally effective, it dilates blood vessels and increases blood flow. Other than that, researchers don't know why it is slightly effective in improving hair growth. A negative related to healthy hair growth cited in a study written by Dr. Sharon Keene is cigarette smoking. As you know smoking constricts blood vessels.

Perhaps hair miniaturizes in MPB because the concentration of Prostaglandin D2 (in green) starves the follicle of necessary blood platelet growth factors.

35YrsAfter also posts as CITNews and works at Dr. Cole's office
forhair.com
Cole Hair Transplant
1070 Powers Place
Alpharetta, Georgia 30009
Phone 678-566-1011
email 35YrsAfter at chuck@forhair.com
The contents of my posts are my opinions and not medical advice
Please feel free to call or email me with any questions. Ask for Chuck

I actually think I actually appreciate your posts infinitely more than the doctor that you work for. Minoxidil is a weak vasodilator that causes minimal hair growth. How about introducing a strong vasodilator that could theoretically induce maximum hair growth. Seems like common sense to me.

[cichlidfort]

http://en.wikipedia.org/wiki/Minoxidil
Mechanism and clarification of potential efficacy
The mechanism by which minoxidil promotes hair growth is not fully understood. Minoxidil contains the nitric oxide chemical moiety and may act as a nitric oxide agonist. Similarly, minoxidil is a potassium channel opener, causing hyperpolarization of cell membranes. Minoxidil is less effective when there is a large area of hair loss. In addition, its effectiveness has largely been demonstrated in younger men who have experienced hair loss for less than 5 years. Minoxidil use is indicated for central (vertex) hair loss only. Minoxidil is also a vasodilator. Hypothetically, by widening blood vessels and opening potassium channels, it allows more oxygen, blood, and nutrients to the follicle. This may cause follicles in the telogen phase to shed, which are then replaced by thicker hairs in a new anagen phase.

I don't want to sound inaccurate, but I think the vasodilation effect is not the (main) actual reason why minoxidil (and maybe others) are working.

AFAIK Minoxidil barely elongates the anagen, but does not affect the underlying cause of atrophy.
The result is more visible hair just because they are taking longer to complete a cycle, but their cycle is hampered by androgen receptors anyway. And to be fair, more blood I guess means more androgens, so you are just bringing more damage than healing.
And, to conclude, that's why hair on the top of the scalp may be thinning, while the occipital area is covered with shiny and healthy-looking hair.

I've always thought this. If there is more blood flow, wouldn't that also mean that there's more androgen contact too? Kind of defeats the purpose. I've used minox for 3 years and it's done NOTHING for me.

[35YrsAfter]

I've always thought this. If there is more blood flow, wouldn't that also mean that there's more androgen contact too? Kind of defeats the purpose. I've used minox for 3 years and it's done NOTHING for me.

IMO identical twin studies are important. For some men, minoxidil appears to have little or no benefit. On the other hand it is possible minoxidil only kept a major shed or miniaturization somewhat at bay. Without an identical twin brother who does nothing about his MPB to compare with, effectiveness of hair loss medications can be difficult to track.

Related to blood, I believe that blood rich in platelet growth factors can minimally reverse miniaturization. The challenge is continuing to improve effectiveness of these treatments.

Couple of observations:
1.) In some strip surgeries, butchered FUE, and legacy 4mm plug surgery, we sometimes see diffuse thinning of the donor areas. I believe it's related to severing blood vessels and the resulting diminished blood supply. One man came to us to repair a necrotic scar the size of an ear. When his strip was closed, blood supply was cut off resulting in death of tissue. Needless to say, once the area healed after the strip, it was completely devoid of hair for a couple of years before the results of his FUE hair transplant repair surgery improved things.

2. Massage improves blood circulation. Consider full blown MPB where the remaining hair at the back and sides of the head appear to grow normally. When we sleep, these areas come in contact with the pillow, not usually the top of your head.

Just to be clear, excellent blood circulation is NOT the cure for MPB. In other words you could improve your circulation by taking warfarin (Coumadin), commonly used to treat blood clots and lose hair because warfarin has a side effect of hair loss. Perhaps warfarin like PGD2 found on miniaturized follicles is among other things a potent inhibitor of platelet aggregation.

It appears that getting blood platelet growth factors to benefit miniaturized hairs could be at least one of the keys to reversing miniaturization due to MPB.

I encourage patients planning for hair transplant surgery to consider ACell and PRP during their surgery. Although there is some benefit to stand-alone ACell/PRP treatments they are a bit pricey. The photo below demonstrates one of the better results from stand-alone ACell PRP treatments and I post this to encourage young guys in particular with thinning hair. Thinning hair can often be improved.

Dr. Greco - Florida video
Dr. Cole - Atlanta video

35YrsAfter also posts as CITNews and works at Dr. Cole's office
forhair.com
Cole Hair Transplant
1070 Powers Place
Alpharetta, Georgia 30009
Phone 678-566-1011
email 35YrsAfter at chuck@forhair.com
The contents of my posts are my opinions and not medical advice
Please feel free to call or email me with any questions. Ask for Chuck

[walrus]

Consider full blown MPB where the remaining hair at the back and sides of the head appear to grow normally. When we sleep, these areas come in contact with the pillow, not usually the top of your head.

Do you have any evidence to support this claim? Otherwise it sounds like just another 'wearing a hat causes hair loss' type old wives tale.

http://onlinelibrary.wiley.com/doi/10.1111/cup.12286/abstract

The following paper suggests that the patterning results from the 'programmed' distribution of prostaglandins. Nothing to do with what way your head touches the pillow.

[35YrsAfter]

Do you have any evidence to support this claim? Otherwise it sounds like just another 'wearing a hat causes hair loss' type old wives tale.

http://onlinelibrary.wiley.com/doi/10.1111/cup.12286/abstract

The following paper suggests that the patterning results from the 'programmed' distribution of prostaglandins. Nothing to do with what way your head touches the pillow.

Just an interesting observation... Not a claim at all. Who knows for how many centuries people have slept on their side, stomach and back. Epigenetic inheritance is an unconventional discovery. It goes against the idea that inheritance happens only through the DNA code which passes from parent to child. It means that a parent's experiences, in the form of epigenetic tags, can be passed on to future generations.

As unconventional as it seems, there's little doubt that epigenetic inheritance is a reality. Epigenetic inheritance explains some strange patterns of inheritance geneticists have been puzzling over for decades.

This begs the question, why then don't women lose hair to the degree men do? Most likely there is more than one factor contributing to male pattern baldness. One might think it's just DHT, but without DHT a man won't grow body hair.

35YrsAfter also posts as CITNews and works at Dr. Cole's office
Cole Hair Transplant
Atlanta
Phone 678-566-1011
The contents of my posts are my opinions and not medical advice
Please feel free to call or email me with any questions. Ask for Chuck

[walrus]

Who knows for how many centuries people have slept on their side, stomach and back.

More like millions of years.

Epigenetic inheritance is an unconventional discovery. It goes against the idea that inheritance happens only through the DNA code which passes from parent to child. It means that a parent's experiences, in the form of epigenetic tags, can be passed on to future generations.

Seems like we are jumping around here. There is no evidence (or reason to think) that MPB is linked to epigenetic inheritance.

This begs the question, why then don't women lose hair to the degree men do?

PGD2 is thought to be a testosterone dependant transcript.

Most likely there is more than one factor contributing to male pattern baldness. One might think it's just DHT, but without DHT a man won't grow body hair.

Of course, this has been known for a long time. PGD2 for example.

[35YrsAfter]

Constructive Suggestions/Ideas Needed

More like millions of years.

Consider a mother and father who are heavily into fitness The mother trains to become an olympic-level gymnast and the father is like the legendary Charles Atlas, the self proclaimed 97 pound weakling who successfully built his body through diet and hard work in the gym. When in peak shape they have children.
Question... Would it take millions of years worth of fitness dedicated future generations, before their descendants are born more muscular and possess above average sports aptitude?

Seems like we are jumping around here. There is no evidence (or reason to think) that MPB is linked to epigenetic inheritance.

I wasn't referring to MPB related hair loss having epigenetic origin. I was referring to the possibility that retention of the "fringe" in men could possibly be related to those areas receiving stimulation for countless generations during sleep. When you think about it, the areas a Norwood 6 or 7 go bald, normally receive very little movement/stimulation during an entire lifetime. Dr. Greco in Florida has done a lot of PRP treatments. Although these treatments have peaks and valleys, he states that the platelet growth factors over several years time, "ratchet" forward, improvement in hair shaft diameter. The role of DHT in MPB is without question an established fact. I'm not questioning that. I am saying that DHT isn't to hair what "Roundup" is to grass. Studies I have read indicate that without DHT, a man won't grow a beard or body hair and at the same time retain a pre-teen head of hair.
[/QUOTE]

In particular, I want to see more effective treatments for guys in their twenties. I personally experienced thinning in my early twenties and it's like having life fast forwarded to middle age, even old age. Pissing matches are only good for their entertainment value. I'm looking for young men willing to post their results, and share their ideas and impression of various treatments and strategies.

Sad but true, all of the current approved treatments for hair loss due to MPB were developed to treat other disorders. Hair loss sufferers have been getting the scraps off the table, basically. I really don't think figuring this out is a difficult as everyone makes it out to be.

I'm hoping for cost effective treatments to help young guys maintain their hair. Ideas welcome like... Since PGD2 is among other things a potent inhibitor of platelet aggregation, could Thrombospondin therapy of some kind counteract the effect of PGD2? If it did, would hair growth improve? has there been any investigation into this?

35YrsAfter also posts as CITNews and works at Dr. Cole's office
Cole Hair Transplant
1070 Powers Place
Alpharetta, Georgia 30009
Phone 678-566-1011
The contents of my posts are my opinions and not medical advice
Please feel free to call or email me with any questions. Ask for Chuck

[hellouser]

Consider a mother and father who are heavily into fitness The mother trains to become an olympic-level gymnast and the father is like the legendary Charles Atlas, the self proclaimed 97 pound weakling who successfully built his body through diet and hard work in the gym. When in peak shape they have children.
Question... Would it take millions of years worth of fitness dedicated future generations, before their descendants are born more muscular and possess above average sports aptitude?

Michael Jordan's two sons have been pretty underwhelming with basketball, lol.