Original research theory: How Androgenetic Alopecia is a manifestation of insulin resistance and its connections with CVD & PCOS

[randomuser1]

Dear forum,

over many months I have combined a lot of puzzle pieces - all of which were already known separately in hair loss research but never combined - to form a new theory of how hair loss happens exactly. The theory provides a full explanation starting from (several) root causes all the way to why hair follicles degrade, otherwise known as a pathogenesis model.

The very short version is:
- androgenetic alopecia really is an early manifestation of insulin resistance, but there are both direct and indirect forms of insulin resistance - which is why it was not found yet
- androgenetic alopecia shares 3 of the 4 different root causes of female PCOS (polycystic ovary syndrome)
- androgenetic alopecia can be halted with dietary and lifestyle changes, but not reversed (I myself achieved a small but visible amount of regrowth in the vertex by following the recommendations covered later in the document, but zero regrowth in the temples. I don't think regrowth can be reliably achieved unfortunately without drugs.)

The document which you can find attached to this post also covers the following topics:
- why androgenetic alopecia is statistically correlated with atherosclerosis and cardiovascular disease and what this has to do with DHT and even shorter lifespans of men compared to women
- why androgenetic alopecia is statistically correlated with prostate hyperplasia and cancer
- how diet causes shiny forehead and oily scalp (sebum) experienced by many balding people
- the role of DHT in microvascular damage (which explains why DHT is not the root cause of balding but still an effective bottleneck to target in order to prevent balding)
- why there is calcification in balding scalps - it really is because of the same mechanisms that cause atherosclerosis
- photos from genetically identical (monozygotic) twins which have balded at very different rates, showing genetic predisposition is only half the story
- a study from China (a country which underwent rapid diet and lifestyle changes in a very short period) showing that only one third of balding Chinese today had a family history of balding, further underlining that genes are only half the story
- how exactly scalp tension (which many consider to be an esoteric hypothesis) plays a role: by pushing the post-inflammatory tissue recovery towards a fibrotic, rather than non-fibrotic, remodeling response

The whole thing is - I believe at least - rather elegant because it manages to combine a lot of conflicting theories and aspects (DHT, scalp tension, calcification, correlations with diabetes/metabolic syndrome) into one explanation that has "use" for all of them.
None of this stuff is new in isolation but I hope the theory can provide a consistent explanation that makes all the puzzle pieces fit together into one coherent view.

Unfortunately the document is quite long (could still be longer but so as not to exaggerate I left out the precise roles of PGD2/PGE2). I hope someone will find it helpful. The document is under a free license so anyone can share it in whichever way they'd like to whomever they'd like and wherever they'd like, if they'd like to. It is my hope that it'll help some people halt their balding progress and keep the hair they still have, even without medication.

If anything is unclear at all or if anyone has critical questions or remarks I'm happy to respond.

Hope someone will find it helpful or interesting - even if only a bit!

 

[balda]

Impressive!
You are a hero )

There are tons of points would like to ask you to comment.
At first let me to say that i find your conclusions have something in common with observations (which i find pretty legit) that been mostly known and shared as "gh15" regimen many years ago.

What's in common:
triggers: basic metabolic issues (incl. blood sugar spikes)
damages: calcification, fibrosis
treatments: minerals + vitamins + some extra supplements

https://immortalhair.forumotion.com/t10092-supposed-regrowth-protocol

 

[randomuser1]

Interesting, never heard of it before! Unfortunately the original resources (apparently there was a website gh15.org at one point) all seem to be gone.
I don't agree with everything I could gather from the IH forum thread you linked (like heavy metals or excessive estrogen), but most of the things I do agree with. I'm wondering which ideas the protocol was based on (I guess whoever created the protocol didn't arrive at similar conclusions as I did just like that without some research), but the original reasoning seems to be no longer available on the net.

Anyway, feel free to shoot your questions and I'll do my best to answer.

 

[balda]

Let's try to list the injuring factors-related processes (the both damaging and treating):
- pro-calcification
- pro-fibrosis
- anti-calcification
- anti-fibrosis

How do you think, which of that points make full hair regrowth so difficult to achieve?
Are the damaging processes so active that they fully overcome all positive results from the treatments?
Or the treatments by itself are so weak and are not affecting the injuries?
And which factor is probably more "blocking" - calcification or fibrosis?

 

[randomuser1]

It is hard to list them in isolation because pro-fibrotic and pro-calcification processes are partially overlapping (namely the ones related to insulin resistance). Only some are "exclusive", like scalp tension which is "only" pro-fibrotic.
If I still had to list them, it would be as follows:

Calcification (damaging):
- Primary insulin resistance
-- High carb/sugar intake
-- Insufficient physical exercise
-- insufficient magnesium (because of its effects on ATP generation)
- Secondary insulin resistance: Cortisol
-- Lack of sleep or inconsistent sleep
-- Stress
-- Overexercise (especially if below average BMI)
-- Crash diets, prolonged caloric deficit
- Secondary insulin resistance: Inflammation
-- Smoking
-- Omega-6 PUFAs
-- oxidized fatty acids
-- partially hydrogenated fatty acids
- impaired calcium metabolism
-- insufficient magnesium
-- insufficient vitamin D3
-- insufficient vitamin K2

Fibrosis (damaging):
- all of the ones listed under "Calcification (damaging)"
- scalp tension
- insufficient magnesium (because of its effects on muscle stiffness)

Calcification (healing):
- elimination of insulin resistance risk factors (primary and secondary)
-- exercise
-- diet
-- sleep
-- stress
-- stopping to smoke
- magnesium, vitamin D3, K2
- omega-3

Fibrosis (healing):
- Wounding plus massages plus magnesium (need all three together)
- Retinoids plus massages plus magnesium (need all three together)

How do you think, which of that points make full hair regrowth so difficult to achieve?
Are the damaging processes so active that they fully overcome all positive results from the treatments?
Or the treatments by itself are so weak and are not affecting the injuries?

There are several problems that make regrowth very difficult or impossible: The body's repair mechanisms usually do not reverse to "pristine" tissue. De-calcification show that it takes years to achieve even small improvements in blood supply calcification. I have listed a few studies in the PDF in the section "Vascular calcification reversal" on page 64 of version 0.4 of the PDF. But the calcification in our scalps does not only affect the blood supply but also the dermis through overspill. Additionally, central blood supply calcification "only" narrows blood vessels. The blood vessels in our scalp are capillaries. They can be fully destroyed by calcification, not only be narrowed. So central blood supply decalcification is already slow. On the scalp, it will be even slower or maybe even impossible.

Same for fibrosis. It's similar to trying to reverse scar tissue. It takes some pretty strong treatments (like topical retinoids) and takes a long time. But these are surface scars. In Androgenetic Alopecia, we are basically dealing with below-surface scar tissue. How do we resolve this? If we can resolve it at all it would need an elimination of scalp tension (massages plus magnesium) and, additionally, we also need to trigger tissue recreation (e.g. through wounding or retinoids).
By the way, my theory why some people had success with microneedling and some didn't is because some had higher and some had lower scalp tension. With tension, new tissue (after wounding) becomes fibrotic. Without tension, new tissue becomes non-fibrotic. Same with retinoids. But retinoids probably have trouble getting deep into the skin as well, so there are two issues with retinoids.

All in all, recovery/repair/regrowth is much, much more difficult than prevention.

And which factor is probably more "blocking" - calcification or fibrosis?

No idea to be honest.

 

[feelsbad]

What about fermented foods? Good or bad?

Relatedly, curious for your thoughts on how the gut microbiome affects hair loss/growth. Some probiotics have shown slight potential to increase hair growth, for example.

Lastly, is any form of magnesium more beneficial than others?

 

[Kojakjr]

So what’s the cure?

 

[Capone]

I noticed zero scalp Itch when I just eat meat and do fasting from breakfast to lunch.. soon as I touch carbs, bread, sugar.. it starts

 

[Carbons]

I noticed zero scalp Itch when I just eat meat and do fasting from breakfast to lunch.. soon as I touch carbs, bread, sugar.. it starts

Yeah, my hair loss got really bad during a time when I was stressed and eating sh*t food and drinking lots of soda. Back then the soft drink was in shitty plastic bottles full of endocrine disruptors and obviously the sugar was terrible. Now my hair is too sh*t and have to buzz it, but it's mostly stopped progressing and I eat mostly meat/veg.

I definitely find this theory interesting, I remember as a kid sometimes getting sugar "sweats", like a greasy nose from too much sugar. God knows what damage I did to my cells.

 

[randomuser1]

So what’s the cure?

Long story short: Regrowth likely not possible. The only thing you can do is halt further hair loss progression.
How would you do this? By eliminating all forms of insulin resistance, both primary (diet/exercise) and secondary (sleep, stress, avoiding overexercise, and a few others).

What about fermented foods? Good or bad?

Relatedly, curious for your thoughts on how the gut microbiome affects hair loss/growth. Some probiotics have shown slight potential to increase hair growth, for example.

Lastly, is any form of magnesium more beneficial than others?

Fermented foods are likely good but their effects will not be big. Targeting insulin resistance is the most important thing you can do. This will also heal your gut microbiome as a side effect cause a cleaner diet (with fewer saccharides and fast carbs) feeds different gut bacteria that a high glycemic diet does. Same with probiotics: They are likely helpful but only to a small extent. The most important thing is to eliminate insulin resistance. Probiotics can help but only a little.

I noticed zero scalp Itch when I just eat meat and do fasting from breakfast to lunch.. soon as I touch carbs, bread, sugar.. it starts

Yes, that is likely the same root cause. The other alternative to not touching carbs, bread, sugar would be a healthy dose of exercise on a regular basis. I recommend 3 sessions per week: 2 resistance (gym) of 60 to 90 minutes duration, 1 endurance (running, cycling and the like) of 30 to 40 minutes duration. Resistance exercise depletes main muscle glycogen, endurance depletes liver glycogen and visceral fat.

Also please note that meat consumption is much better than carb/sugar consumption for hair but not optimal. Beyond approx 2g of protein per kg of body weight per day, protein contributes to carb metabolism too. Uric acid and IGF-1 can contribute to insulin resistance as well. My recommendation is to follow a slow-carb WFPB diet. "Slow carbs" are carbs that are digested very slowly, like veggies, brown whole-grain rice (or comparable), hard-boiled potatoes, tubers, beans, lentils etc. - essentially "main carb sources" with a low glycemic index (GI).

Yeah, my hair loss got really bad during a time when I was stressed and eating sh*t food and drinking lots of soda. Back then the soft drink was in shitty plastic bottles full of endocrine disruptors and obviously the sugar was terrible. Now my hair is too sh*t and have to buzz it, but it's mostly stopped progressing and I eat mostly meat/veg.

I definitely find this theory interesting, I remember as a kid sometimes getting sugar "sweats", like a greasy nose from too much sugar. God knows what damage I did to my cells.

This hits all the marks. Stress raises cortisol, which counteracts insulin and hence contributes to IR. Soda - a sugary beverage - is a major IR contributor. And the greasy nose happens for the same reasons as acne or the well known "balding shiny scalp". Carbs and sugar are at the root of the androgen boost. These androgens then cause sebum overproduction as well as balding. Same as with women with PCOS: In women with PCOS, insulin resistance/carbs/sugar cause hyperandrogenicity.

I strongly believe that the high androgen levels in balding men have the same root cause as the high androgen levels in women with PCOS, where it is already confirmed by many studies: insulin resistance.
The different PCOS types correspond to the different insulin resistance (IR) root causes:
PCOS type 1 ("insulin resistant PCOS"): Primary IR, aka diet and exercise
Adrenal PCOS: Different forms of cortisol issues (stress, lack of sleep, inconsistent sleep, overexercise, crash diets, being underweight)
Inflammatory PCOS: Smoking, PUFA foods, and a few others

We already know what causes high levels of androgens (aka testosterone and DHT) in women with PCOS: the different forms of insulin resistance. I am convinced that the root causes for men are the same.

 

[balda]

"Long story short: Regrowth likely not possible. " @randomuser1
- OOPS :/

There are many non-structured a-la questions:
- Cause of calcification or fibrosis, mostly?
- There are photos (attached) that related to the "baldtruthtaIk:eldarlmario" protocol. No matter if it's "mature" hair or not... they are supposed to be nourished by the skin's blood supply somehow, right?

An example of a kind of "positive" feedback. Could it be taken as a potential example of regrowth?
"This is my third bottle, taking as directed. This is strange but at about two months new hair started growing where bald spots have been for well over 20 years. It's still filling in. I don't know if it is the Ionic. Boron or not, but that is the only thing I did different. I don' care if I have hair on top or not.
I am a 71 year old male. Strange."

 

[feelsbad]

Modern Native Americans have high rates of diabetes due to Western diet but typically still quite good hair. Curious for your thoughts on this. Must be down to genetics

 

[healthyjoe]

Let's try to list the injuring factors-related processes (the both damaging and treating):
- pro-calcification
- pro-fibrosis
- anti-calcification
- anti-fibrosis

How do you think, which of that points make full hair regrowth so difficult to achieve?
Are the damaging processes so active that they fully overcome all positive results from the treatments?
Or the treatments by itself are so weak and are not affecting the injuries?
And which factor is probably more "blocking" - calcification or fibrosis?

@balda What is the eldarlmario" protocol and how to that guy in your attached pic get frontal regrowth? From what exactly?

 

[Joxy]

Androgenetic Alopecia has very little in common with diet or lifestyle. It is very complex genetic ’disease’ and many genetic variations contribute for Androgenic Alopecia.

 

[randomuser1]

Androgenetic Alopecia has very little in common with diet or lifestyle. It is very complex genetic ’disease’ and many genetic variations contribute for Androgenic Alopecia.

Have you even had a look at the PDF I posted in the opening post?

If what you say were true, then all genetically identical twins should be balding at the same speed. Have a look at pages 7 and 8. There I included photos from studies that compared the balding rates of monozygotic, so genetically identical, twins. They are in very different stages of balding. If it is only genetic, this should be impossible. (study 1: Koyama et al.: “Eleven pairs of Japanese male twins suggest the role of epigenetic differences in androgenetic alopecia”, DOI: 10.1684/ejd.2012.1898, study 2: Gatherwright et al.: “The contribution of endogenous and exogenous factors to male alopecia: a study of identical twins”, DOI: 10.1097/PRS.0b013e3182865ca9).
Secondly, in China, only about one third of currently balding men had a family history of balding. If it was genetic, there should be parents or grandparents who also lost their hair for most people balding today. (source: C. Yang et al.: “Epidemiological survey of androgenetic alopecia in Golmud area of Qinghai province”).

Modern Native Americans have high rates of diabetes due to Western diet but typically still quite good hair. Curious for your thoughts on this. Must be down to genetics

Yes, definitely. I believe that genes and diet/exercise/lifestyle contribute roughly 50% to average balding rates. The reason for this "roughly 50%" is the study by Hagenaars et al.: "Genetic prediction of male pattern baldness", which builds a baldness prediction model based on genes. This model arrives at "only" 56% predictive power of balding progression state (none/mild/severe) from genes. So the other 44% must be down to something else.
However, there is one interesting aspect here: Just because average balding rates are roughly 50/50 determined by genes and by diet/exercise/lifestyle, this does not mean that an individual cannot significantly slow down or halt their balding process. Genes confer a vulnerability to balding processes but the balding processes only happen if certain diet/lifestyle/exercise factors are present. In other words, the genetic vulnerability only manifests if certain diet/exercise/lifestyle factors are present. So it is possible for you to have the "balding genes" and not go bald if you avoid risk factors. On the other hand, there are lucky people out there who have none of the balding genes and, no matter how bad their diet/exercise/lifestyle, will not go bald.

I believe this plays out roughly like this (taken from the chapter "Hereditary components of Androgenetic Alopecia" in the PDF):

Androgenetic Alopecia genes\Lifestyle risk factors	No controllable risk factors	Few controllable risk factors	Medium controllable risk factors	Many controllable risk factors
No Androgenetic Alopecia genes	No hair loss​	No hair loss​	No hair loss​	No hair loss​
Few Androgenetic Alopecia genes	No hair loss​	Slow hair loss​	Medium hair loss​	Medium hair loss​
Medium Androgenetic Alopecia genes	No hair loss​	Medium hair loss​	Medium hair loss​	Rapid hair loss​
Many Androgenetic Alopecia genes	No hair loss​	Medium hair loss​	Rapid hair loss​	Rapid hair loss​

"Controllable risk factors" indicates how many of the diet/exercise/lifestyle risk factors are active.

"Long story short: Regrowth likely not possible. " @randomuser1
- OOPS :/

There are many non-structured a-la questions:
- Cause of calcification or fibrosis, mostly?
- There are photos (attached) that related to the "baldtruthtaIk:eldarlmario" protocol. No matter if it's "mature" hair or not... they are supposed to be nourished by the skin's blood supply somehow, right?

An example of a kind of "positive" feedback. Could it be taken as a potential example of regrowth?
"This is my third bottle, taking as directed. This is strange but at about two months new hair started growing where bald spots have been for well over 20 years. It's still filling in. I don't know if it is the Ionic. Boron or not, but that is the only thing I did different. I don' care if I have hair on top or not.
I am a 71 year old male. Strange."

I should have been a little more specific: "Regrowth [from avoiding the risk factors that lead to balding in the first place] likely not possible."
Maybe medical advances will bring us regrowth at one point in the future, but I don't think it will be possible with single-target protocols, simply for the fact that there is both fibrosis and blood vessel damage at play.
You will find a few people on the Internet that achieve regrowth with rather mild single-target protocols. But the important thing about these is: These protocols can often not be replicated by the vast majority of people. Two examples: microneedling and vitamin D. There are a few documented cases where microneedling regrew basically all hair, and a few well documented cases where vitamin D regrew all hair. But there are good reasons that most people cannot replicate them. Because there are sometimes individual deficiencies that present in the same pattern as Androgenetic Alopecia but are not Androgenetic Alopecia.

Vitamin D regrowth is the easiest to explain. Vitamin D is essential for calcium metabolism. If someone were to have "only" a strong vitamin D insufficiency (and not full-blown Androgenetic Alopecia from the different forms of insulin resistance), this can manifest as Androgenetic Alopecia-pattern hair loss because blood supply to the scalp will be hindered by calcium deposits. But this is not the same as what I believe to happen in most Androgenetic Alopecia cases: Complete blood supply destruction and dermal calcium infiltration. Simple calcium deposits can be solved with high doses of vitamin D. "Real" Androgenetic Alopecia (with blood supply destruction and dermal calcium infiltration) cannot. But the hair loss pattern looks the same. So while there are a few people that regrew all their hair with vitamin D alone, this won't work for most people.
You will find similar cases of people regrowing all their hair on something but often this cannot be translated to the vast majority of people with Androgenetic Alopecia.

About the specific protocol you mentioned: He seems to target androgens at the same time (according to what I found on BTT) so I cannot really say if the boron is doing anything.

 

[Joxy]

@randomuser1

False theory. I know many, many people who are drug or alcoholic addicts with very bad lifestyle, but they have perfect hair line. Androgenic Alopecia is mostly affected by genetics. You can change your diet habits, your lifestyle, but that will not back your hair at all.

 

[balda]

@Joxy False logic.
The author is not disagree with "Androgenic Alopecia is mostly affected by genetics".
He provides a model of the pathology. And based on the model he highlights potential ways to TRY to affect the pathology. Do you have an alternative pathology model? Saying "genes are behind it" brings no insights of into the pathology "mechanics".

 

[balda]

@healthyjoe

Sorry, haven't dove into that protocol, just added to my notes. Try to search by:
"
Valproic acid, Calicipotriol and Tretinoin tri-axis:
- Valproic acid => CD34(UP) but CD200(DOWN)
- Calcipotriol => CD200(UP) but CD49F(DOWN)
- Tretinoin=> CD49F(UP) but CD34(DOWN)
"

@randomuser1
Concerning that "frontal regrowth": how that "mini-hairs" are grown with fibrosis/calcification? Or "mini-hairs" are ok with that? Of that boy treated fibrosis/calcification somehow, probably, partly?

 

[Kojakjr]

May be off topic… But minoxidil, & the other “chemicals” are probably too harsh to regrow hair adequately. I’m incorporating stem cell topicals & natural oils/herbs which are starting to turn the tide.

 

[balda]

@randomuser1
Would be nice to answer the question why anti-calcification and anti-fibrotic treatments doesn't lead to bold regrowth? the treatments don't revert calcification and fibrosis? or there are another issues except that ones? does it make sense to try to adjust the protocols with the treatments? or to try another treatments addressing calcification and fibrosis?

...or if there is no chance to revert c/f, that is the model behind it? what makes them "irreversible"?

...or there is something else? another "morphological" changes that are not reflected in the provided model?