A Review of male pattern baldness Research.

[S Foote.]

Some interesting points made, I will respond in detail over the weekend.

 

[Python]

Some interesting points made, I will respond in detail over the weekend.

Seems like no one likes your 90's theories in here :|

 

[S Foote.]

Hey, S Foote. This is a post off another message board from a topic regarding your writings. Curious to see what you will say about it.

That makes sense, electrical stimulation can contract muscle fibres in the vessels increasing pumping.

I think the best thing we have to increase lymphatic efficiency is actually DHT. I think we only get the opposite effect in the scalp, because of too much DHT in the wrong place. Its a normal effect of fluid dynamics in complex systems.

- - - Updated - - -

Regarding casts and hair here is a recent report and opinion on why hair grew:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3756205/

Thanks for the link.

This has been a subject for speculation, buts lets consider the options.

People speculate about inflammation as the cause of both hair loss and hair growth. We see the same thing here. But no one tries to explain the pathway involved. In this case the effect is just in the area of cast pressure. If this was causing inflammation, you would expect this to spread out at least a little into the tissue just outside. But this does not happen.

What we do know based on follicle physics, is that external pressure distorts follicles increasing their production area.

- - - Updated - - -

Anyway... there is no efficient method, good enough, to improve lymph drainage.. at least not noninvasive. Remember detumescence? It was pretty big deal on immortal hair forum for a while. I did it on my temples and front for months. Also, i remember there was one user who managed to flatten all the "swells and ridges," made his scalp super loos... he could basically pick the top of the scalp with 2 fingers and lift it for 2 cm... If that didnt relive the pressure on follicles, i dont know what could.. I have to add I noticed considerable amount of vellus hair, unfortunately nothing cosmetically.

- - - Updated - - -

OK. this is something you might be intersted ...

http://www.ijdvl.com/article.asp?is...e=6;spage=542;epage=544;aulast=Salido-Vallejo


Another thing... S Foote, your hypothesis should be easily "confirmed" with histopathological examination.

Thanks for the link, ill take a look later. As far as massage is concerned.

I think this highlights a practical problem in trying to reduce tissue fluid pressure with massage alone. You can move fluid out of the tissue, and stretch it until its very loose with massage. But unless you deal with the fluid feed and drainage issues, the fluid pressure around the follicles will always return.

On the question of the tissue histology in male pattern baldness, there are studies of a rare scalp disorder in humans that i think tells the story here. This is Lipedematous scalp, and lipedematous alopecia.

http://www.scielo.br/scielo.php?pid=S0365-05962010000100012&script=sci_arttext&tlng=en

This is when there is a thickening and edema of the subcutaneous tissue below the follicles, for unknown reasons. Lipedematous alopecia is the same condition, but involves hair loss and follicle miniaturisation. Tissue testing confirms tissue conditions we also see in the male pattern baldness scalp quote:

"It can be discrete, including edema, thickening of subcutaneous tissue, hyperkeratosis, sparse, perifollicular or perivascular inflammatory infiltrate, follicular alterations, ectatic lymphatic vessels, and reduction in the number of follicles".

The noted difference when lipedematous scalp leads to hair loss, is local damage to the lymphatic vessels. This is noted in another study on the subject.

http://www.ncbi.nlm.nih.gov/pubmed/17903063

"significance of lymphangiectatic vessels in development of alopecia in this condition".

The most significant study here for us, concerns two men who had scalp examinations relating to male pattern baldness. Both men were found to also have signs of lipedematous scalp. The question is how many other men with male pattern baldness would also show these signs, if this was specifically tested for?

http://www.ncbi.nlm.nih.gov/pubmed/16638399

Finasteride made a slight difference in hair growth here, but did not change the symptoms of the associated lipedematous scalp. The author concluded that this relationship was therefore coincidental. But given the other studies that demonstrate a link with the local lymphatic efficiency and hair growth, i think this confirms DHT is effecting lymphatic drainage. Finasteride reduces the effect of DHT in the scalp, increasing lymphatic drainage and improving hair growth.

This study and the fact that in itself this is not enough to reverse the situation, demonstrates we need to address the other side of the equation. It is the fluid feed or blood supply that generates and maintains edema in tissues. Increasing the drainage can restore the balance, but the real treatment effect would come from reducing the fluid feed.

We know we have a lot of blood feeding the scalp, because scalp injuries bleed so much. This and the good gravity assisted venous drainage back into the main circulation, gives good flow through circulation in the scalp. Under normal circumstances this along with good lymphatic drainage, results in low tissue fluid pressure and good hair growth.

But if anything reduces the drainage, the high level blood feed becomes a problem. Reduced lymphatic drainage increases the tissue fluid pressure acting on the veins, restricting these adding to the problem. The high blood feed cannot escape quickly enough, and feeds the growing edema.

We don't need all this blood feeding the scalp, this is a by product of the complex system that evolved to service the human brain. It has never been an issue of blood supply to the follicle itself, as the scalp ligature procedure demonstrates. This significantly reduces scalp blood supply, and reports quote: "The condition of the hair follicle is strikingly improved".

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2536995/

Again i think you need to look at the hard data in studies, and not necessarily the authors opinion on how this happens. In this case reducing scalp blood supply alone, resulted in less hair loss and significant improvements in cell populations in follicles in this particular condition. In 1300 cases followed, there are no adverse effects reported relating to reducing scalp blood supply.

This study really needs to be done in the male pattern baldness scenario. In my opinion this kind of procedure combined with increasing the drainage aspect, could be the answer to male pattern baldness.

 

[Armando Jose]

http://www.ammrf.org.au/innerspace/img12.html
http://www.ammrf.org.au/innerspace/images/display-web/13Q-Light-PaulRigby-434px.png

Bad hair day? Grease factories are at work in your skin. Three sebaceous glands surround the hair follicle and will empty their greasy globules (white) onto the hair – the round pink thing in the centre of the follicle.
Visualised using light microscopy by A/Prof. Paul Rigby, University of Western Australia.
Size: the biggest sebaceous gland is 225 micrometres wide.

http://www.lab.anhb.uwa.edu.au/mb140/corepages/integumentary/Images/sebaceous010tc.jpg
http://www.lab.anhb.uwa.edu.au/mb140/corepages/integumentary/integum.htm



Skin, hairy - trichrome, H&E
Sebaceous glands will be present in all types of skin other than thick skin. Their numbers should correlate with the number of hair follicles. If your section does not contain hair follicles you are unlikely to see a good sebaceous gland. Sebaceous glands are usually embedded in the dermis. Although they empty into the hair canal of the hair follicle, this point will only be visible for a few of them because of the thinness of the sections. It should however be possible to follow the fate of the secretory cells. Deep in the sebaceous glands cells are smaller with intact nuclei. Cell size increases with the accumulation of sebum as the cells are gradually displaced towards the opening of the gland into the hair follicle. The nuclei condense, become darker and irregularly shaped.



http://thumb7.shutterstock.com/disp...enter-and-many-sebaceous-glands-223918201.jpg





http://www.ijtrichology.com/articles/2012/4/3/images/IntJTrichol_2012_4_3_154_100069_u2.jpg





http://bernsteinmed.wpengine.netdna-cdn.com/images/logic-1.jpg








Maybe sebaceous gland lobules can have a role in this issue.....
"I think this highlights a practical problem in trying to reduce tissue fluid pressure with massage alone. You can move fluid out of the tissue, and stretch it until its very loose with massage. But unless you deal with the fluid feed and drainage issues, the fluid pressure around the follicles will always return."

 

[fghj]

OK Armando.

In male pattern baldness the scalp thickening is already recognised. Here is a discussion relating to this.

http://www.hairlosstalk.com/interact/archive/index.php/t-70994.html

The scalp tightness, and lack of movement we also know about. If you know where to look, you can actually see where the frontal swelling starts in male pattern baldness.

We know that frontal hair loss in male pattern baldness starts from the front receding back. According to this mechanism, this means so does the swelling. You can see the point on the forehead where this starts. The usual point in most men is a horizontal raised ridge, that develops about halfway between the eyebrows and original hairline. As this swelling increases upwards and reaches the hairline, the recession starts.

Hi S Foote. Thanks for your ideas. They are very interesting.

This is my first post here. My previous post somehow disapeared in the Detumescence-thread. I wrote some ideas about the massage approach and swelling. Pershaps this is also somehow interesting for you.
http://immortalhair.forumandco.com/...ce-therapy-dedicated-volunteers-wanted#116607

Best wishes and thanks for sharing and discussing your ideas.


--- edit

my Post didn't disapear. It was only waiting for the mods...
http://www.hairlosstalk.com/interac...air-Regrowth?p=1219660&viewfull=1#post1219660

 

[S Foote.]

Hi S Foote. Thanks for your ideas. They are very interesting.

This is my first post here. My previous post somehow disapeared in the Detumescence-thread. I wrote some ideas about the massage approach and swelling. Pershaps this is also somehow interesting for you.
http://immortalhair.forumandco.com/...ce-therapy-dedicated-volunteers-wanted#116607

Best wishes and thanks for sharing and discussing your ideas.

Thanks for your comments, I will take a look at your link,

There are often comments on the forums about people wanting a more layperson friendly explanation of scientific arguments. So I am going to post a new thread with my efforts to do this with my argument.

 

[beholder]

Hello, S Fote., Armando Jose,

I was just writing this yesterday in a private message.. perhaps I have found a link between your "drainage scenario" and the Armando Jose's sebaceous glands. In male pattern baldness androgens cause sebaceous glands hyperplasia as the glands abnormally enlarge at the same time as the follicule shrinks. So we end up with very small follicules producing thin short hairs and enlarged sebaceous glands producing a lot of sebum. This however may not be the whole story of what is really going on if we look at it closely:

My theory is that the sebum reservoir gets bigger from sebum accumulation, which in turn makes more area for the sebum producing cells to replicate. If there is more cells producing sebum, there is more sebum and it makes the sebum chamber even bigger, and it has more place for sebum cells -- this is a vicious cycle.
Similar but completely unrelated thing happens for people with ingrown toenail problem: the toenail skin gets inflamed from bacteria, it swells and new skin cells kind of get accustomed to the new skin size and happily continue growing on enlarged part. This causes even more irritation and more inflammation as the nail is solid and cannot back off. Also a lot more dead skin cells are produced which are good ground for hungry bacteria causing even more inflammation. This problem goes on for years and stays, it is a chronic condition. This is how we could also view the sebaceous glands hyperplasia problem, a chronic condition which needs to be addressed.

So I reckon that perhaps if I achieved some apoptosis of the sebum producing cells, I could make the sebaceous glands smaller and generally, they would make less sebum. And vice versa of course. Accutane (a retinoid) could do the trick. Massage may help as well, I have already started. I will keep researching this.

As for the massage itself, I have put a thin transparent plastic bag over my hair and used a wooden massage roller like this one:
http://www.walkinbackrub.co.uk/Wooden-back-massager---Acu--massage-roller/39.htm
The plastic bag is perfect, it keeps my hair from being stuck in the roller while it retends any fluids on the skin from evaporating as well (I am using this after putting ketoconazole shampoo and ascorbic acid on my head, to increase absorption). Works perfectly. NEVER have I had my skin massaged so thoroughly with so much reddening and stinging from the ascorbic acid. I am anxious to see what this will do to me in 1-2 months.

 

[S Foote.]

Hello, S Fote., Armando Jose,

I was just writing this yesterday in a private message.. perhaps I have found a link between your "drainage scenario" and the Armando Jose's sebaceous glands. In male pattern baldness androgens cause sebaceous glands hyperplasia as the glands abnormally enlarge at the same time as the follicule shrinks. So we end up with very small follicules producing thin short hairs and enlarged sebaceous glands producing a lot of sebum. This however may not be the whole story of what is really going on if we look at it closely:

My theory is that the sebum reservoir gets bigger from sebum accumulation, which in turn makes more area for the sebum producing cells to replicate. If there is more cells producing sebum, there is more sebum and it makes the sebum chamber even bigger, and it has more place for sebum cells -- this is a vicious cycle.
Similar but completely unrelated thing happens for people with ingrown toenail problem: the toenail skin gets inflamed from bacteria, it swells and new skin cells kind of get accustomed to the new skin size and happily continue growing on enlarged part. This causes even more irritation and more inflammation as the nail is solid and cannot back off. Also a lot more dead skin cells are produced which are good ground for hungry bacteria causing even more inflammation. This problem goes on for years and stays, it is a chronic condition. This is how we could also view the sebaceous glands hyperplasia problem, a chronic condition which needs to be addressed.

So I reckon that perhaps if I achieved some apoptosis of the sebum producing cells, I could make the sebaceous glands smaller and generally, they would make less sebum. And vice versa of course. Accutane (a retinoid) could do the trick. Massage may help as well, I have already started. I will keep researching this.

As for the massage itself, I have put a thin transparent plastic bag over my hair and used a wooden massage roller like this one:
http://www.walkinbackrub.co.uk/Wooden-back-massager---Acu--massage-roller/39.htm
The plastic bag is perfect, it keeps my hair from being stuck in the roller while it retends any fluids on the skin from evaporating as well (I am using this after putting ketoconazole shampoo and ascorbic acid on my head, to increase absorption). Works perfectly. NEVER have I had my skin massaged so thoroughly with so much reddening and stinging from the ascorbic acid. I am anxious to see what this will do to me in 1-2 months.

Thanks for your input.

I agree with your thoughts about sebaceous gland enlargement in male pattern baldness. I think it is the increased local tissue fluid pressure that "swells" these glands. Tissue fluid is the raw material for any glandular secretion, and increasing this will swell the glands.

I think the role of DHT in the body demonstrates this principle. We know changing amounts of DHT swell or shrink both prostate and mammary glands.

The difference in hair follicles is because they are a pocket, open to the atmosphere. Increased fluid pressure around follicles, will shrink them. I think a good analogy for people is to think about inflating a balloon with a certain amount of air pressure. The balloon will reach a certain size. Do the same thing under water, and the balloon will be much smaller because of the increased external pressure.

I think that the increased sebum production in male pattern baldness is just one of the effects, and not the cause.

 

[beholder]

There have been multiple people before talking about DHT-laden sebum spilling from sebaceous glands to nearby follicles effectively causing them to "get infected" with DHT which continues the downward spiral for more and more sebaceous cells that way. I am not sure if it's just a scientific superstition or not.. Perhaps sebaceous cells do load/spill DHT to nearby tissues.

 

[2young2retire]

cool

 

[Jacob]

That makes sense, electrical stimulation can contract muscle fibres in the vessels increasing pumping.

I think the best thing we have to increase lymphatic efficiency is actually DHT. I think we only get the opposite effect in the scalp, because of too much DHT in the wrong place. Its a normal effect of fluid dynamics in complex systems.

- - - Updated - - -






Thanks for the link.

This has been a subject for speculation, buts lets consider the options.

People speculate about inflammation as the cause of both hair loss and hair growth. We see the same thing here. But no one tries to explain the pathway involved. In this case the effect is just in the area of cast pressure. If this was causing inflammation, you would expect this to spread out at least a little into the tissue just outside. But this does not happen.

What we do know based on follicle physics, is that external pressure distorts follicles increasing their production area.

- - - Updated - - -



Thanks for the link, ill take a look later. As far as massage is concerned.

I think this highlights a practical problem in trying to reduce tissue fluid pressure with massage alone. You can move fluid out of the tissue, and stretch it until its very loose with massage. But unless you deal with the fluid feed and drainage issues, the fluid pressure around the follicles will always return.

On the question of the tissue histology in male pattern baldness, there are studies of a rare scalp disorder in humans that i think tells the story here. This is Lipedematous scalp, and lipedematous alopecia.

http://www.scielo.br/scielo.php?pid=S0365-05962010000100012&script=sci_arttext&tlng=en

This is when there is a thickening and edema of the subcutaneous tissue below the follicles, for unknown reasons. Lipedematous alopecia is the same condition, but involves hair loss and follicle miniaturisation. Tissue testing confirms tissue conditions we also see in the male pattern baldness scalp quote:

"It can be discrete, including edema, thickening of subcutaneous tissue, hyperkeratosis, sparse, perifollicular or perivascular inflammatory infiltrate, follicular alterations, ectatic lymphatic vessels, and reduction in the number of follicles".

The noted difference when lipedematous scalp leads to hair loss, is local damage to the lymphatic vessels. This is noted in another study on the subject.

http://www.ncbi.nlm.nih.gov/pubmed/17903063

"significance of lymphangiectatic vessels in development of alopecia in this condition".

The most significant study here for us, concerns two men who had scalp examinations relating to male pattern baldness. Both men were found to also have signs of lipedematous scalp. The question is how many other men with male pattern baldness would also show these signs, if this was specifically tested for?

http://www.ncbi.nlm.nih.gov/pubmed/16638399

Finasteride made a slight difference in hair growth here, but did not change the symptoms of the associated lipedematous scalp. The author concluded that this relationship was therefore coincidental. But given the other studies that demonstrate a link with the local lymphatic efficiency and hair growth, i think this confirms DHT is effecting lymphatic drainage. Finasteride reduces the effect of DHT in the scalp, increasing lymphatic drainage and improving hair growth.

This study and the fact that in itself this is not enough to reverse the situation, demonstrates we need to address the other side of the equation. It is the fluid feed or blood supply that generates and maintains edema in tissues. Increasing the drainage can restore the balance, but the real treatment effect would come from reducing the fluid feed.

We know we have a lot of blood feeding the scalp, because scalp injuries bleed so much. This and the good gravity assisted venous drainage back into the main circulation, gives good flow through circulation in the scalp. Under normal circumstances this along with good lymphatic drainage, results in low tissue fluid pressure and good hair growth.

But if anything reduces the drainage, the high level blood feed becomes a problem. Reduced lymphatic drainage increases the tissue fluid pressure acting on the veins, restricting these adding to the problem. The high blood feed cannot escape quickly enough, and feeds the growing edema.

We don't need all this blood feeding the scalp, this is a by product of the complex system that evolved to service the human brain. It has never been an issue of blood supply to the follicle itself, as the scalp ligature procedure demonstrates. This significantly reduces scalp blood supply, and reports quote: "The condition of the hair follicle is strikingly improved".

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2536995/

Again i think you need to look at the hard data in studies, and not necessarily the authors opinion on how this happens. In this case reducing scalp blood supply alone, resulted in less hair loss and significant improvements in cell populations in follicles in this particular condition. In 1300 cases followed, there are no adverse effects reported relating to reducing scalp blood supply.

This study really needs to be done in the male pattern baldness scenario. In my opinion this kind of procedure combined with increasing the drainage aspect, could be the answer to male pattern baldness.

SFoote..if you're still around..wondering what you think about this: http://www.cosmeticsdesign-europe.c...nd-suggests-pine-cone-extract-may-be-the-cure

 

[FuianoMonster]

So my theory is right. male pattern baldness is a disease of the scalp, not of the follicle.
Balding follicles and terminal follicles are the same. It's the scalp that miniaturizes them.

 

[Ventures]

So my theory is right. male pattern baldness is a disease of the scalp, not of the follicle.
Balding follicles and terminal follicles are the same. It's the scalp that miniaturizes them.

then why hair transplanted from occipital region to temples and frontal part of scalp don't tend to fall out and minituarise.

 

[Dench57]

So my theory is right. male pattern baldness is a disease of the scalp, not of the follicle.
Balding follicles and terminal follicles are the same. It's the scalp that miniaturizes them.

Hair transplants.

 

[S Foote.]

Hair transplants.

In my opinion the assumptions made about hair transplantation, are the reason for the dead end hair loss research has been in for years. What we now know about tissue engineering and scaffolds to grow new tissue in-vivo, explains the variable results of hair transplantation far better than any difference in the follicles.

I talk about this in my review article here.

https://www.academia.edu/17570665/A...nt_Hair_Research_and_an_Overlooked_Connection.

I know the people on the forums just want to see effective treatments, but this is not going to happen by wishful thinking, facts have to be faced.

There is a basic flaw in the historic and current hair follicle research. These published studies all break a fundamental scientific rule.

It is a basic rule in scientific studies, to take into account the recognised factors of influence in the field. Otherwise the study is not valid and can be misleading. For example a study about changes in planetary orbits that ignores a relevant law of gravity, would be rejected on this basis. Yet it seems the published studies about hair follicles can get away with this kind of blatant omission.

We should remind ourselves of the question we want an answer to. This is what is the cause of the restricted growth of hair follicles within the dermal tissue? Any valid study about a restriction in tissue growth must take account of all the recognised tissue growth restricting factors. Current hair follicle research fails to do this. The key point here is "within the dermal tissue".

Any normal tissue growth in-vivo is subject to the normal spatial growth controls governed by the resistance of the surrounding tissue., only cancer cells can avoid this growth control. Yet nowhere in the current papers about hair follicle growth is there any reference to this recognised growth control.

There are technical grounds here for the retraction of hair follicle growth restriction papers, that fail to take account of normal spatial growth controls. I have recently contacted retraction watch about this, to raise awareness of the current flaw in these papers.

These flawed and misleading papers also create a danger to the public health. The proof of this is right here on these forums. Every time there is a study that finds another "associated" factor with hair loss, there is a mad scramble to get drugs from the internet to treat this latest factor.

We have seen this happen many times on the forums, and after some dangerous self medication and expense, has anyone ever grown any really significant hair?

 

[NewUser]

In my opinion the assumptions made about hair transplantation, are the reason for the dead end hair loss research has been in for years. What we now know about tissue engineering and scaffolds to grow new tissue in-vivo, explains the variable results of hair transplantation far better than any difference in the follicles.

Yes, I agree with you S. Foote. Hair transplants are not the answer for everyone imo. Look at the results for celebrities and the best hair transplant results that money can buy. Elton John, Micky Rourke, James Nesbitt etc might look less bald than they used to, but their coifs still look anywhere from thin in the front to ratty and thin all over. Some of them would actually look better with a plain old rug on top than the less sparse look. I've read that so little is known about the human body that it is compared to our unexplored ocean depths and even deep space. Big pharma has enjoyed decades' worth of 20 and 30-year patent protections on old drug discoveries, and some of which were discovered by publicly-funded research in the beginning, anyway.
.

 

[hwezdarik]

Yes, I agree with you S. Foote. Hair transplants are not the answer for everyone imo. Look at the results for celebrities and the best hair transplant results that money can buy. Elton John, Micky Rourke, James Nesbitt etc might look less bald than they used to, but their coifs still look anywhere from thin in the front to ratty and thin all over. Some of them would actually look better with a plain old rug on top than the less sparse look. I've read that so little is known about the human body that it is compared to our unexplored ocean depths and even deep space. Big pharma has enjoyed decades' worth of 20 and 30-year patent protections on old drug discoveries, and some of which were discovered by publicly-funded research in the beginning, anyway.
.

Old guys who had pretty much nothing on their heads to start with and thus their hair transplants look shite. Look at Brandon Flowers, Brandon Urie or Ben Affeck and their hair transplant results (brilliant) - Possibly being on finasteride as well.

 

[NewUser]

Old guys who had pretty much nothing on their heads to start with and thus their hair transplants look shite. Look at Brandon Flowers, Brandon Urie or Ben Affeck and their hair transplant results (brilliant) - Possibly being on finasteride as well.

With or without finasteride their "dht-resistant" hair will become thinner as they age, too. If you think your hair won't matter to you when your 50 and 60, think again.

 

[hwezdarik]

With or without finasteride their "dht-resistant" hair will become thinner as they age, too. If you think your hair won't matter to you when your 50 and 60, think again.

By the time I am 50.. Everyone will be a NW0

 

[NewUser]

I hope so too. And I hope all the potential norwood zeros decide not to pay a lot of money to get butchered between now and then.