welcome to the huberman Lab podcast where we discuss science and science-based tools for everyday life I'm

Andrew
huberman and I'm a professor of (1)neurobiology....... and Ophthalmology at Stanford school of medicine today we are
discussing hair hair is a topic that occupies the minds of many people there (2).are...... people that are losing their hair and
want to Halt or reverse that loss of hair and today we will talk about all the (3).....ways.. that science has taught us we can
slow or even reverse hair loss I confess that researching today's topic was a particular joy for (4)...me.... not because I'm
obsessed with hair mine or the hair of others but because hair turns out to be fascinating from the perspective of
(5)..seller.cellular.... biology and stem cells which is a topic that I've long been interested in and that for much of my career
I've focused on (6)...in.... the context of development so when your brain and your nervous system develop it develops from a
small batch of cells that turns into (7)...many.... many trillions of cells and it does that by cell replication something that we
call the cell cycle and we'll talk a little bit (8)...about.... this and so-called mitosis today I promise not to get into too much
detail but what makes hair so very interesting from a biological (9)..stempoint.standpoint.... is that every hair every single
individual strand of hair has its its own little stem cell Niche meaning its own little pocket down (10)....there... in the follicle
in which specific stem cells give rise to those hairs for different durations of time depending on the hair where it (11)..is.....
on your body Etc so for instance the hairs on your head will undergo ongoing growth for four to six or even eight years
(12)..so..... were you to not cut your hair it would continue to grow one single hair would continue to grow I guess we could
say (13)...all.... the hairs will continue to grow for up to eight years that is very different from for instance your eyebrows
which have a much (14)....shorter... period of hair growth lasting on the order of months that's why you don't see people with
eyebrows that extend down to their waist (15)...but.... you can see people with hair on their head that extends down to their
waist if they don't cut it now that discrepancy illustrates (16)..for..... us just how incredible hair follicles and the stem cells
that reside within hairs are and their enormous potential to give rise to these (17)...scene.things... that we call hairs which are
simply proteins of varying length so today we are going to address what determines the length of a (18)...hair.... or rather
what determines how long a hair continues to grow before it ceases growing and eventually falls out we're going to talk about
(19)..what..... regulates those stem cells what allows them to continue to produce hair or cease producing hair and as we do
that you will learn (20)...all.... the biology in clear simple terms regardless of your background that will really set the stage for
understanding what we'll also talk about which (21)...is.... how to slow hair loss or halt hair loss entirely or even reverse hair
loss so we will talk about hormone related hair loss (22)..in..... both men and women we will talk about some of the
mechanical and stress related influences on hair loss and we will talk about (23)....the... chemical and mechanical approaches
to halting and reversing hair loss everything from minoxidil to dutasteride to Ketoconazole to microneedling to thyroid
estrogen igf-1 pathway (24).....again.. all made very clear regardless of whether or not you have a background in biology or
not I will also dispel some of the (25)..common..... myths about balding and hair replacement if you've heard for instance that
you inherit your patterns of balding from your mother's father that is (26)...not.... true although it is true that you do inherit
certain genes that influence whether or not you have a predisposition to balding in particular (27)..part.parts.... of your head
and believe it or not even particular parts of your body but it is not the case that you can simply (28)..find..... a photo of your
mother's father say at age 50 or age 60 or 75 and determine whether or not you'll have the exact (29)... in.same... pattern of
hair loss so that's a myth that I'd like to dispel right here and now and I will dispel some of the (30)....other... myths about hair
loss Hair Replacement and hair regrowth as well before we begin I'd like to emphasize that this podcast is separate from
(31)....my... teaching and research roles at Stanford it is however part of my desire and effort to bring zero cost to Consumer
information about science (32)....and... science related tools to the general public in keeping with that theme I'd like to thank
the sponsors of today's podcast our first sponsor (33)..is..... Helix sleep Helix sleep makes mattresses and pillows that are the
absolute highest quality I've talked many times before on this podcast about the (34)...fact.... that sleep is the foundation of
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to 350 off and two free pillows today's episode is also brought To Us by hvmn Ketone IQ Ketone IQ is a ketone
(44)...supplement.... that increases blood ketones I want to be very clear that I like most people have heard of the ketogenic
diet but I like (45)...most.... people do not follow a ketogenic diet that is I'm not in ketosis however most people don't realize
that you can still benefit from (46)...increasing.... your blood ketones which is what hvmn Ketone IQ does I take Ketone IQ
prior to doing really focused cognitive work so I take (47)..it..... once in the afternoon anytime I'm going to prepare for a
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of cognitive demand and that's because ketones are the brain's preferred use of fuel (49)...even.... if you're not following a
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huberman to get 20 off today's episode is (52)....also... brought To Us by Roca Roca makes eyeglasses and sunglasses that
were designed with the biology of the visual system in mind I've spent (53)..a..... lifetime working on the biology of the visual
system and I can tell you that your visual system system has to contend with an (54)...enormous.... number of challenges for
you to be able to see clearly throughout the day so for instance when you go from a shady area (55).to...... a well-lit area your
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(62)..can..... go to roca.com that's roka.com enter the code government to save 20 off your first order again that's roka.com
enter the code huberman at (63)..checkout..... okay let's talk about hair and in researching this episode by talking to experts in
the biology of hair and the stem cells that (64)...exist.... in all of us that give rise to our hair growth and the pigmentation in
our hair and in talking to experts who understand (65)..how..... to Halt and even reverse hair loss that there is a tremendously
interesting biology surrounding hair but there's also an incredible psychology around hair (66)...in.... fact most people who
experience even marginal hair loss undergo pretty severe anxiety now I confess this is not something I can relate to (67)....I...
am losing my hair in certain places I'm 47 years old I've got a couple patches up front where there's very minimal hair I
(68)...think.... that as we'll later learn in this episode reflects a higher density of DHT dihydrotestosterone receptors at that
particular location as opposed to Elsewhere (69)..in..on... my scalp but keeping my hair is not something that I've fretted
about much of my life and yet as I was researching this (70)..espisode..... I remembered an anecdote from my childhood
where my father told me and I think it was because I was stressing about something and (71)...I.... was trying to get to sleep
and he said don't stress calm down and here's why if you stress too much it can actually (72)....make... your hair fall out in
fact I have a cousin who lay down one night stressed and woke up the next morning and all (73)..of..... his hair was on his
pillow and I'll never forget that story I think he was trying to get me to stress less I (74)...don....'t know if that story made me
stress less or not um but in any event I don't know that that story is true I'm (75)..not..... going to challenge the authenticity of
that story I didn't have a chance to reach out to my my father and ask him to (76)..verify..... or not but as we'll soon learn it is
true that our psychological well-being can impact both the coloration or lack thereof and the (77)...growth.... rates of our hair
that's a real thing and the reverse is also true which is that as hair starts to thin or fall (78)...out.... or change color many
people experience intense anxiety or even depression this was not something I was really aware of perhaps that's just because
(79)...I....'ve always kept my hair pretty short anyway I always assumed that my hair started to really fall out I'll just shave my
head but (80)...that....'s me and that's not most people out there I think most people would loathe to lose their hair and in fact
given the enormous (81)...number.... probably up in the high billions of dollars and euros and other currency of course that
people invest in trying to Halt or reverse (82)..their..... hair loss it's clear that hair is very very important to people what we
know is that by age 50 approximately 50 percent of (83)...all.... men and women will have experienced significant enough
hair loss that they start to notice it and a large percentage up to 85 percent (84)..of..... those people will experience some sort
of anxiety that leads them to go out and try and either halt or reverse that hair loss (85)...now.... why at age 50 well an
important Point arises from that which is that the hair loss is not occurring between the 49th and (86)..50th..... birthday hair
loss is ongoing from about age 30 to age 50. it's only by age 50 however that about 50 percent of people (87)...out.... there
start to notice that hair loss and this is typically because they'll you know they'll be in a bathroom or looking in a
(88)..mirror..... and the lighting will be bright enough that it permeates the the sort of outer boundary of their hair and they'll
notice that their (89)...hair.... is thinning in a particular location that's usually how the sort of thing happens so again our
psychological states can impact our patterns of (90)...hair.... growth or loss and of course patterns of hair growth but more
typically hair loss and hair graying can really impact psychological state so (91)..this..... is a subject that people take intense
interest in and today we're going to talk about how hair normally grows why it grows at (92)...the.... rate and for the duration
that it happens to and then as we talk about ways to intervene with that hair loss those biological (93)..medical. mechanisms....
will come up because they really provide a nice framework for explaining why certain treatments work more or less well or
why certain treatments (94)..might..... have certain side effects or total lack of side effects it will also highlight a really key
theme that will come up several times (95)...at.in... today's podcast which is that there are both mechanical and chemical
approaches to slowing and reversing hair loss mechanical approaches would be things as (96)...simple.... as massaging the
scalp but mechanical changes to the scalp can cause either hair loss or facilitate hair growth this is why things like
(97)...micro.... needling are so prominent in the context of trying to reverse hair loss but again there are also chemical
approaches to trying to Halt (98)....the.or.. reverse hair loss and this relates to the fact that the hair growth itself is strongly
regulated by hormones such as estrogen thyroid hormone (99)....insulin...-like growth factor and that other hormones in
particular the androgens so things like testosterone but mainly its derivatives like dihydrotestosterone are very much involved
(100)..in..... setting the stage for hair growth by controlling how big or small that pool of stem cells that gives rise to hair
growth is (101)..so..... if any of the terms I just use are confusing to you don't worry I will make all those very clear in a
moment (102)....that.it..'s actually all pretty straightforward and simple and so I'd like to just start by talking about what hair
is how it grows why it (103)..stops..... growing and why hair normally falls out let's talk about the biology of hair and in
doing so I also want to talk about (104)...stem.... cells now keep in mind that when you hear the word stem cells you probably
like most people think about the sorts of cells (105)...that.... people are getting injected into their face to get rid of wrinkles or
give them new skin or to give them more hair if (106)...th?.it...'s injected in the scalp or into a joint to repair a joint or a
muscle those stem cells are what we call exogenous stem (107)...cells.... exogenous meaning from outside the body the stem
cells that we're going to talk about today are so-called endogenous stem cells cells that we (108)..all..... make that can give
rise to other cells and that's really the definition of a stem cell stem cells are present in all of (109)...us.... from the very
beginning of life so when sperm meets egg that cell which we think of as the egg starts to duplicate it
(110)..includes..incorporates... the DNA from the sperm and the Egg of course starts to duplicate and then those cells give
rise to more cells and more (111)...cells.... and the ability of all those cells to replicate and create more cells are because those
cells really are stem cells now at some (112)..points..... we are a completed body plan as the biologists say we end up with a
brain and a spinal cord and Limbs and fingers (113)...and.... livers and guts and all the things that we need in order to be a
functioning human being even though we're a baby at (114)...that.... time we haven't grown up we have all the bits that we're
going to have for our entire life at that point many of (115)...the.... stem cell populations disappear for instance past puberty
and probably earlier you don't get many more new brain cells you get a few but (116)...you.... don't get many more new brain
cells because the brain doesn't have many stem cell populations whereas other organs in your body maintain little
(117)...pockets.... of stem cells or in some cases many many stem cells that can give rise to more and more of that tissue
across the (118)...lifespan.... and hair is one such tissue so if we take a look at hair what we find is that indeed there are these
things (119)..that..... we call hairs but there are also stem cells and those stem cells are actually what give rise to the hairs that
we see (120)...on.... the head of our scalp or that we see on the surface of our body so right off the bat you should know that
(121)....every... single hair that you have is there because you have a stem cell population that is giving rise to that particular
hair so let's (122)..take..... a step back or rather I should say let's zoom in on one hair and the stem cell population that gives
rise to that (123)..hair..... because in doing so you're going to learn all the different components that you can tap into if your
goal is to Halt the (124)...loss.... of hairs or to replace hairs that have already been lost okay so if we were to just zoom in at
the level of (125)...one.... hair what you would find is that that hair has what typically is called a hair root so that's the portion
below the skin (126)...also..and.. when we say below the skin it means that it Dives down into a narrow trench which is in the
so-called epidermis which is (127)..?..this... outer layer of skin it also has a shaft the shaft is the part that grows out above the
skin so what you see (128)...on.... somebody's head or you see on their on their arm or when you see an eyebrow you're
seeing the shaft of the hair the (129)...root.... of course goes below the skin what most people don't realize however is that
down at the base of the root there's actually a (130)...little.... cave a little pocket so if you were to look at this it would look
like a little bulb a little round area with (131)...a.... bunch of stuff in it right below the root and within that little cave there are
stem cells there are populations of cells that (132)..have..... the ability to divide right we call this mitosis it's a process by
which cells can actually divide and take DNA with them and (133)...then.... give rise to other cells we call those cells that that
divide and move out we call those daughter cells we call the cells (134)..that..... give rise of them progenitor cells but they are
effectively stem cells that give rise to these what we call daughter cells those daughter (135)...cells.... then become the
various types of cells that make up the hair so when you see a hair you're not seeing something that grows
(136)....throughout... the lifespan you're seeing something that's going to be born down there in that little cave then is going to
grow it's actually going (137)....to... stack up on top of itself and that's because hairs are made up of a protein called keratin
they're a bunch of different kinds (138)...of.... keratins depending on what kind of hair you're looking at but these are little
proteins that stack up on top of one another and (139)...there.they...'re structured in a way that makes them pretty darn durable
I mean it's possible of course to pull a hair out um but if (140)...you....'ve ever tried to tear a hair in particular thick hair like
one from the face or even a one off the top of your (141)..head..... it's actually a pretty tensile strong little thing and that's
because keratins stack up on top of one another and bind to one another (142)....with... a really strong bond so what you end
up with is a bunch of proteins stacked up on top of one another and that's (143)...the.... actual hair Okay so we've got the hair
shaft the hair root and then we've got the stem cells down there in that pocket (144)...that.... give rise to the various cells that
make up the actual hair we also have down there in that little cave which by the (145)..way..... is actually called the hair bulb
if you really want to know the technical name because it's shaped like a bulb we have not (146)...just.... stem cells but we
have cells that give rise to the pigment of the hair that create what's called melanin now some people have (147)..very.....
blonde hair very light hair some people have darker hair but everybody unless they have What's called the albino mutation
where the hairs are (148)...too..truly.. white they lack all melanin and this is pretty rare condition although it does happen
most people have some degree of melanin in their (149)..hair..... because there are little pockets of melanin producing cells
melanin is just a protein that essentially gets injected into the Keratin into the hair (150)..and.... it gives it its darker color now
there are a couple other components about the hair that you need to know about especially if (151)..you.....'re interested in
reversing hair loss or reversing graying of hair one of those components is a little gland so next to every hair root
(152)....within... the dermal layer of the skin so this is below the epidermis there is a gland called a sebaceous gland and the
sebaceous gland (153)...is.makes... oily stuff and the oily stuff is called sebum I know the name sort of evokes something
kind of gross but sebum is actually (154)...really.... cool and really important the sebum gets injected or seeps rather into the
area right around the hair as the hair starts to approach (155)..to..the... surface where it goes from essentially root to shaft and
the sebum does two things first of all it forms a little bit of (156)...the.a... seal right at the place where the hair exits the skin
and that seal is very important actually for waterproofing of your skin so (157)..we..... don't often think of ourselves as
waterproof because we are so accustomed to water Just landing on our skin and and rolling off but (158)..that.....'s because of
some of the oily properties of our skin now it's also true that our skin is pretty densely packed with cells but (159)...in.... the
absence of sebum we would not be as waterproof as we are now as I mentioned sebum has two important properties the other
(160)...important.... property of sebum is that it actually is a strong antibacterial and anti-microbial most people don't realize
this the oils of your skin provide (161)....a... lot of immune boundary so that things don't get into the hair root or the region
around it and infect our skin so sebum (162)....now.while.. the name is sort of um unattractive to be honest is actually
performing some essential roles both for waterproofing and for our immune system (163)...function.... protecting us from
various kinds of infection we're going to return to sebum later because it turns out sebum is also very important as
(164)...a..it.. relates to psoriasis and as it relates to some of the fungal components that can cause hair loss okay so just going
to file (165)..that..... away there's another important component of the region around hairs which is the erector pili muscle the
erector pili muscle is a is a (166)..muscle..... that lies diagonally between that bulb portion of the hair or a little bit above it it
goes up to the surface of the (167)...skin.... the erector pulley muscle it's a muscle that contracts when we get cold or when we
get scared so if you've ever had goosebumps (168)...that....'s because the erector pili muscle contracts pulling the skin at the
surface down around the little hair follicles or at least where the hairs (169)...meet.... the the surface of the skin and so those
little bumps are actually where little micro hairs reside and the dimples between them are (170)....that.the .. dimples that
occur when this erector pili muscle pulls down now why would this muscle exist well it has a couple of important functions
(171)...one.... of the functions is that when it pulls down it causes as the name suggests the hairs to stand up maybe not
perfectly vertical (172)...but.... they when you hear oh I was so frightened my hair stood up on end and that's because the hair
has become erect they (173)....stand... up now why would this happen when we get cold it happens because when the hairs
stand up error can be trapped between those (174)...hairs.... and can actually warm our body this is not so much the case if
you have very light hair on your skin if you're (175)...a.... very hairy person this is going to be a more robust aspect of your
physiology and yes this is why dogs like Huskies can (176)..go..... out in the snow and still remain warm when they get cold
their hairs actually stand up a bit on end because the contraction (177)..of..... these erector pili muscles trapping air in there
and then their body warms the hair trap beneath the hair and it's sort of like (178)...they....'ve got a blanket on made by the
interface between the hair the air and their skin so just to recap all the components of (179)...hair.... and the different things
around it that are going to be relevant for understanding how to replace hair that's lost we have the hair (180)...itself.... which
has the shaft that sticks out over the skin goes a little bit into the skin but basically sticks out over the skin (181)...we.... have
the root portion which goes down into the skin it goes through the epidermis and into the dermis then we have this bulb-like
(182)...regine?.region... down at the bottom bottom down at the bottom of that bulb we have stem cells that actually give rise
to the actual hair (183)...and.... we have pigmenting cells that pigment that hair in addition and this is very important there are
capillaries that go into that bulb region (184)...down.... at the bottom of the hair and that can serve and support the stem cells
the melanin producing cells which are called melanocytes so (185)...if..the.. melanin producing cells in the stem cells get a lot
of blood flow that allows them to keep providing new hair or the proteins (186)...that.... make up hair and the pigment that
goes into those hairs and those little capillaries deliver not just nutrients and things of that sort (187)...but.... they also deliver
oxygen because it turns out that the whole process of growing more hair is a very active process now as soon (188)...as.... you
hear oxygen and you hear that the growth is an active process that should cue you to why so many of the stories
(189)..around..... how to keep your hair and regrow hair involve statements like don't wear a hat it'll make your hair fall out or
if you (190)...want.... your hair to grow back you know don't wear hats or massage your scalp or increase blood flow or why
some people will suggest (191)....that... people take peppermint oil for instance or Menthol type oils of different kinds and
massage them into the scalp things that make the scalp (192)....tingel.tingle.. or there will be light therapies designed to what
to increase blood flow to the scalp the whole rationale there is that you're trying (193)..to..... increase blood flow to the stem
cell and the melanocyte populations that support the hairs and that actually create the hairs now whether or (194)...not....
those approaches work we'll touch on a little bit later I'll just give you a little bit of a hint right now which is (195)..that.....
while no single one of those approaches that I described is known to regrow hair in a very robust way because of the
requirement (196)....for... oxygen and nutrients and because it's such an active process for the stem cells and melanocytes to
grow and darken the hairs that grow (197)...out.... of your skin it is true that manipulations or treatments that increase blood
flow to those regions can at least slow the loss of (198)..hair..... or can even extend the duration over which hairs continue to
grow so if you've heard things like don't wear a hat if you (199)...want.... to maintain your hair or massage your scalp if you
want your hair to grow faster in some sense that's true but none of (200)...those.... manipulations on their own is going to
robustly enhance the rate of of your hair growth those things are designed to be done in (201)...juntion.. conjunction.. with
some other treatments that have been shown in many many clinical studies to increase the rate and duration of hair growth so
now (202)...you.... have in mind a picture of what's happening at the level of individual hairs and if you're anything like me
you're probably thinking wow (203)....there...'s a lot going on down there just spin it low the surface of the skin and indeed
there is but really the things to (204)....think... about are that stem cell population that actually give rise to the hair proteins so
that actually create the hair the melanocytes that darken (205)....that... hair that give it pigment that sebaceous gland and the
oil sebum that provides some important antimicrobial and other properties to that General region (206)...and.... that erector
Peli muscle that erector pili muscle as I mentioned earlier is important for creating Goosebumps and it's important for
keeping Huskies warm (207)...and..in.. cold environments but it's doing some other really important things as well and we'll
talk about those as time goes on this episode right (208)..now..... what I want to do is just talk for a moment about how hairs
actually grow and why they grow the way they do (209)...this.... is extremely important toward understanding Hair
Replacement and slowing hair loss there are three basic phases of growth of a hair the first phase (210)...is.... the phase in
which the stem cells down in that bulb give rise to the cells that make up the proteins of the hair (211)...so.... the actual
growth of the hair and keep in mind that the hair is actually growing from the bottom up now you might think (212)..of.....
course it's growing from the bottom of everyone knows that but a lot of people think that the hair starts growing right at the
(213)...surface.... of the skin that's not the way it works the hair is actually growing from deep within the root and stacking up
and then (214)..eventually..... extends out across the top of the skin that growth phase is called the antigen phase a-n-a-g-e-n
and this for some people will ring (215)...a.... bell because if you've ever been interested in weight lifting or even if you're an
endurance Runner you'll hear about things that are anabolic (216)..that..... promote growth so Anna of growth or catabolic
that promote breakdown so the first phase of hair growth is called the antigen phase and (217)..it.....'s a period of varying
duration depending on which hair on the body we're talking about so the antigen or the growth phase for hairs (218)....on...
the head as I mentioned earlier is anywhere from two to eight years for most people it's going to be about six years what
(219)...it. this... means is that if we were to just not cut our hair just let our hair grow for two to eight years that hair
(220)...would.... eventually grow to a length that it was at its maximum and then would stop growing so we can say that the
antigen phase (221)...of.... hairs on the scalp is two to eight years right the growth the duration of the growth phase contrast
that for instance with the (222)...duration.... of the antigen phase for hairs of the eyebrows the hairs of the eyebrows grow
about 4.2 millimeters per month Believe It or Not (223)..pe?..people... have measured this sort of thing now that's an average
so some people are going to have eyebrows that um grow much longer per (224)...month.... um I'm somebody who for
instance has mostly the same length uh eyebrow hairs but every once in a while I'll get one of (225)..those..... eyebrow hairs
that like really seems to be heading off my head it like really wants out of there and so it's much longer (226).than...... the rest
what does that mean does it mean that it grew faster maybe but chances are the stem cell population in that particular
(227)...eyebrow.... follicle for that one eyebrow hair is longer than it is for the others this is really important I'm trying to
illustrate two principles (228)...at.... once here the first principle is that different hairs on your body including the hairs on
your scalp have a growth phase of different (229)....torration... this is why the hairs on your head can grow very very long
because they have a very long antigen or growth phase and (230)..the..... hairs on your eyebrows will only grow for a few
months before they actually fall out and then have to undergo replication of the (231)..stem..... cells to give you new eyebrow
hair to then grow what's important here is not just that there are differences in the duration of (232)..the..... growth phase but
rather that the rate of hair growth is not something that tends to differ within a given body region right you'll
(233)...feel..hear.. people say oh my hair grows really really fast other people will say oh my hair grows really really slowly
that is probably not (234)...the.... case well there could be slight differences in the rate of growth that is the addition of more
keratin to the actual hairs so (235)...creation.... of more hair more quickly almost certainly what's happening is that the
duration of the antigen phase in some people is just much longer (236)...than.... it is in other people and we don't realize this
and we tend to think more in terms of how fast hair grows because (237)...if.... you were to just look at somebody's hair you'd
say oh you know they're all more or less the same length I mean some (238)..people.....'s bangs are shorter than the back
because they cut them but if they were to just grow their hair you'd say oh it's all (239)..more..... or less the same length but if
we were to zoom in with a microscope we would see that there are a lot of (240).hairs...... down there in between the other
hairs that are very very short or even tiny tiny tiny and those are coming in as the (241)...other.... ones are finishing their
antigen phase okay so that's the antigen or growth phase after the antigen phase comes the catagen phase again this
(242).resembles...... the word catabolic or the breakdown phase during the catagen phase the hair is actually receding not
from the top down to the skin (243)....surface... and then into the root but the other way it's actually receding from that bulb
region up toward the surface and that catagen phase (244)....is... going to also be of different duration depending on which
area of the body you're in and it will vary a little bit depending (245)...on.... who you are meaning from person to person we'll
talk about the influences on the antigen and catagen phase in a moment why is (246)..it..... important that it actually recedes
from the inside out well that's important because as it does that there's actually a change in that bulb (247)...region.... down
below because normally there's an interface there's a conversation that's occurring between the stem cell population the
melanocytes and the hair itself and (248)...they.... support each other remember there's blood vessels going into that area or
rather capillaries that are feeding that area as well after the catagen (249)...phase.... comes the telogen phase which means rest
the telogen phase is a period in which no new hair proteins are being added by those (250)....stem... cells and during that
telogen phase that bulb down there at the bottom instead of being nice and oval and and really having a (251)....lot... of space
in it with all these different things like stem cells starts to pinch off from the from the little tube that comes (252)...out.. down..
from the surface of the skin that normally would have a hair in it it starts to pinch off and at some point many (253)...hair....
follicles pinch off that bulb region and it recedes and dies and when it recedes and dies the stem cell population and the
melanocytes (254)...peel..go.. with it in other words there is no longer a population of stem cells to give rise to more hair after
that telogen phase (255)...and.... there's no longer melanocytes to pigment the hair and in fact the hair isn't there anymore so
there's no hair even to pigment after (256)..that..... telogen phase unless it's a hair of a particular type such as the hair on your
scalp which can then re-enter the cell cycle (257)....and... get back into an antigen phase and regrow more hair from stem
cells okay so there are three critical stages of the life cycle (258)..of..... a hair that are relevant to today's conversation there's
the antigen phase during which the hair grows there's the catagen phase during which the (259)...hair.... actually starts to
recede and die right the proteins actually disappearing from the bottom up and then we have the telogen phase which is
(260)...the.... phase in which the stem cell population is what's called a semi quiescent semi-quiet or completely quiescent
where it's not active at all those (261)....three... phases make up the life cycle of a hair keeping in mind that for some hairs
they can re-enter the life cycle and go (262).back...... into the antigen phase if there's stem cells there and if there's oxygen
there and if there is sufficient blood support and and this (263)..is..... a very important and if there are the appropriate
hormonal signals to support growth and there is a reduction or an absence in the (264)...hormone.... signals that actually
trigger that telogen phase I make this point now because much of the rest of today's discussion is going to focus (265).....on..
why particular hormones such as dihydrotestosterone cause hair loss and why inhibiting things like dihydrotestosterone can
support the preservation of hair that you have (266)...and.at.... the regrowth of hair to make a long story very short and then
we'll get into some additional details that are relevant and that (267)..I..... hope you'll stick around to listen to
dihydrotestosterone which is the derivative of testosterone causes changes in that bulb region where the stem cells
(268)...rezise ?..reside.. it shortens or halts the antigen phase of hair growth and it extends and promotes the catagen and
telogen phase so when we hear (269)..that..... oh you know dihydro testosterone makes your hair fall out or estrogen makes
your hair grow there are real chemical or we should say (270)...biochemical.... legitimate reasons as to why that is but it all
comes back to this three phases of hair growth the antigen growth phase the (271)...catagen.... catabolic or hair loss phase and
the telogen phase which is a rest period in which the hairs can either come back if it (272)...re....-enters the antigen phase or
maybe it's over for good hormones are the accelerator and the break on each one of those phases I'd like (273)....to... take a
quick break and acknowledge one of our sponsors athletic greens athletic greens now called ag-1 is a vitamin mineral
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I'm delighted that they're sponsoring the podcast the reason I (275)...start.... taking athletic greens and the reason I still take
athletic greens once are usually twice a day is that it gets to be the (276)...fobiodic..probiotics.. that I need for gut health our
gut is very important it's populated by gut microbiota that communicate with the brain the immune system (277)..and.....
basically all the biological systems of our body to strongly impact our immediate and long-term health and those probiotics
and athletic greens are optimal (278)...and.... vital for microbiotic health in addition athletic greens contains a number of
adaptogens vitamins and minerals that make sure that all of my foundational (279)..nutrtions... nutritional.. needs are met and
it tastes great if you'd like to try athletic greens you can go to athleticgreens.com huberman and they'll give you (280)....5...
free travel packs that make it really easy to mix up athletic greens while you're on the road in the car on the plane
(281)....etcetera... and they'll give you a year's supply of vitamin d3k2 again that's athleticgreens.com huberman to get the five
free travel packs and the year (282)..supply..... of vitamin D3 K2 so now you have in mind the anatomy of the hair and the
area from which it grows and the (283)..stem..... cells Etc the fact that there's capillary innervation delivering oxygen and
blood flow to the stem cells that give rise to the hair and (284)...if..that.. there are these three critical phases of hair growth
antigen catagen telogen now let's talk about the accelerators on hair growth and the breaks (285)...on.... hair growth there are
many accelerators on hair growth but the first one that I really want to underscore is blood flow itself which
(286)...aquait.equates... to the delivery of nutrients and oxygen this is very important and it explains a lot of the treatments for
halting and reversing hair (287)...loss.... for instance one of the longest standing treatments for halting and reversing hair loss
is so-called minoxidil minoxidil sometimes also referred to by the (288)...brand.... name Rogaine was actually a drug that was
developed to treat hypertension so this is a cardiac drug that lowers blood pressure and it (289)...does.... that by causing
vasodilation it allows more blood flow not just to the hairs on your scalp but to hairs everywhere on your body (290)...and....
indeed most people don't realize this but minoxidil won't just slow the loss of hair from your scalp it is also effective at
slowing (291)...a..the.. loss of hair elsewhere in your body how does it do that well you now know one of the major ways it
does that (292)....it... does that by extending the antigen phase so it basically makes that phase a bit longer it doesn't make it
much much longer which (293)....is... why for most people who are losing their hair quickly or who have already lost their
hair minoxidil alone is not going to be (294)..a..... sufficient treatment however minoxidil has been shown to be effective at
slowing rates of hair loss in people that are starting to experience some (295)..hair..... loss I'll get into dosages and things of
that sort a little bit later but right now I just want to really focus on (296)...the.... logic of why people would take this drug
which is lowering hypertension at all as it relates to hair loss right that might seem (297)..a.like.... kind of crazy until you
understand the anatomy and the growth of hairs which you now do so that's what minoxidil is doing it's (298)..creating.....
more blood flow to the hairs which because minoxidil does have this positive effect at least most people would like to slow
their rates (299)...of.... hair loss on their scalp anyway it tells you that blood flow and delivery of oxygen and other nutrients
on the blood is pretty (300)...critical.... if not very critical for the support of the hair growth cycle itself now again we haven't
talked at all about the sorts of (301)....chemicals... or the signals within the body such as hormones that actually direct the
growth of hairs here's we're just talking about a mechanical change (302)...allows.... more blood flow to the region and
thereby extend the antigen phase which is exactly what happens with Minoxidil now minoxidil does have other
(303)..effects.... and this is why dosing of minoxidil becomes a little bit complicated and can be a little bit tricky to
troubleshoot it can greatly (304)...lower.... blood pressure or lower blood pressure just a little bit depending on how sensitive
somebody is to that particular drug so oftentimes Physicians will (305)...start.... people on minoxidil dosages that are very
low ideally that would be the case and then ratchet it up in order to figure out (306)....where... the minimal effective dose or
the kind of critical threshold is beyond which they start experiencing some pretty uncomfortable side effects such as you
(307)...know.... swelling of the ankles or headaches or dizziness these things can happen with the use of Rogaine AKA
minoxidil now minoxidil has also been (308)...associated.... with increases in the hormone prolactin prolactin is a hormone
that's released from the pituitary it is a hormone that acts also as a (309)...bit.... of a neurotransmitter like many hormones and
it tends to be antagonistic or an opposite to dopamine so dopamine is a neurochemical it's actually (310)....a...
neuromodulator meaning it modulates the activity of a bunch of neural circuits in the brain it also controls the release of
various hormones in (311)..the..... body dopamine is almost always associated with states of motivation Pursuit and drive it
has a little bit of a kind of feel-good element (312)...to.... it which is why a lot of people think dopamine is associated with
reward and pleasure but it's really about energy motivation and drive (313)...Dopamine.... and prolactin are as I mentioned
before antagonistic to one another they're in sort of a push-pull so people who take minoxidil especially if (314)..they.....'re
very sensitive to it or they take dosages that are too high will experience increases in prolactin that in turn can cause things
like (315)..reductions..... in libido reductions in overall feelings of well-being apathy and in some cases where the elevations
in prolactin are more extreme they can experience (316)..for..... instance increase in male breast tissue gynecomastia or even
small bits of milk let down things of that sort in women who take minoxidil (317)...the.... side effects are much like the ones
in experienced in men so there can be swelling edema of the tissues because if you get (318)...too.... much vasodilation and
two too much lowering of blood pressure that's not good headaches dizziness and so on so dosing of minoxidil is really
(319)....important... if somebody's going to use Minoxidil in order to try and slow or reverse hair loss and again it mainly is
going to be (320)..used..... to slow rates of hair loss not to actually reverse hair loss the really key thing is to get that dosage
right so the (321)...ranges.... of minoxidil that you'll see suggested and that people use out there are vast and I should also
mention that there are two major (322)...rounds..routes.. by which people get minoxidil to the hair follicle one is to take it
systemically as a pill where it goes into the general (323)...circulation.... the other is to take it topically as a cream there are
prescription and non-prescription forms of minoxidil just to further complicate things but (324)...the.routes... ranges of oral
minoxidil that you'll see out there and that people take range anywhere from 0.25 milligrams all the way up to five
(325)...milligrams.... per day so that's an enormous range that's like a 20-fold range the topical minoxidil is also found in
various concentrations the typical concentration (326)...of..is.. going to be a five percent concentration that people will use
once per day topical treatment with Minoxidil at five percent concentration is thought (327)...to.... just stay at the scalp but we
now know that it can go systemically it can get into the general bloodstream why that is (328)...should.... make complete
sense to you because when you put something on your scalp I've already told you these little pits these little tubes that
(329)..go..... down to those bulb regions uh below the skin that have direct access to the blood supply so when you massage
something into your (330)...scalp.... it not only has the opportunity to get into your general circulation it often does especially
if it's something that's very water soluble and (331)..that..... way can get into the capillaries and into the general bloodstream
although topical treatments of which we're going to discuss a number of them (332)...today.... don't tend to get into the
general circulation as robustly as taking something by way of pill or capsule okay so minoxidil works by (333)...way.... of
increasing blood flow to the stem cell Niche below the hair the dosage ranges of the oral minoxidil are tremendous 0.25
milligrams all (334)...the.... way up to five milligrams once per day the dosage range of the topical Solutions tends to be a
little bit more confined typically (335)...there..it..'s a five percent solution and it's recommended that people use it one time
daily maybe twice daily it's also important by the way if (336)..you.....'re going to take this route that you actually leave that
Solution on the scalp for three to five minutes this is important and should make complete sense as to why it's important you
can't just rub the (1)..stuff..... into your head and then rinse it off and expect it to be absorbed it actually needs to seep down
into those hair follicles (2)..and..... access the niche how do people arrive at the correct dosage for minoxidil well for better
for worse really in some cases it's accomplished (3)..by..... finding out that you have an unwanted side effect like dizziness or
swelling of your ankles or edema or I would hope this wouldn't (4)....be... the case but something that suggests there's
hyperprolactonemia you could get a blood test to measure your prolactin or you perhaps notice a drop (5)..of...in.. libido or
some lethargy these sorts of things that are common to reduce levels of dopamine increase levels of prolactin I would hope
that (6)..if..... people are working with a physician or if they're not in taking minoxidil that they would start with the lowest
possible dose so for (7)...all..oral.. minoxidil that would be 0.25 milligrams and then increase it as needed rather than jumping
in right at five milligrams because some of those (8).side...... effects in particular the fluid retention and the
hyperprolactinemia can be pretty uncomfortable and can disrupt a lot of aspects of life that most (9)...all.... of us consider
desirable okay so we're really focusing right now on treatments that relate to the critical requirement for hair stem cells to
(10)..receive..... blood flow in order to receive oxygen and nutrients to get the hair to grow and that's really what minoxidil is
about it's also (11)..what..... all of those anecdotes you hear are all about like massaging the scalp or putting red light on the
scalp now the red light (12)...might.... do some other things in General Heating or lighting of the scalp or massaging of the
scalp is really designed to increase blood flow (13)...to.... the scalp now the reason minoxidil works at all is because it is
going to increase blood flow around the clock and that's because (14)...people.... are taking it topically and it's seeping into
the general circulation or at least it stings somewhat restricted to the hair cell Niche or (15)...they....'re taking it orally and it
makes it to that hair cell niche below the follicle when we massage our scalp however that's a transient (16)...thing.... you
know I can massage my scalp right now I'm no doubt um increasing blood flow to certain areas I'm probably decreasing
blood flow (17)....in..to. the areas I'm pushing down on but it's all temporary I don't know many people that can massage their
scalp enough during the day (18)....or... long enough during the day rather that it would sufficiently increase blood flow with
that said it is clear that increasing blood flow to (19)..the..... scalp by way of reducing hypertension which is effectively
accomplished by broadening by expanding the blood vessels and capillaries is an effective way to (20)...at.... least hold on to
the hair that you have is it going to completely halt hair loss if you have a strong genetic bias (21)...to.. towards.. hair loss no
is it going to reverse hair loss very unlikely that it will but it can slow hair loss or even maintain (22)..the..... hair that you
have so if we were to take a step back and ask ourselves what other sorts of drug treatments are out (23)...there.... besides
minoxidil that increase blood flow and that might increase the rates of hair growth or more likely increase maintenance of
hair that one (24)...only..already.. has by increasing blood flow to the niche and nowadays there are more and more doctors
who are familiar with this requirement for blood (25)..flow..... understand the mechanisms by which minoxidil works and
understand the vast desire out there for people to hold on to the hair they have (26)...and.... regrow hair and they are
prescribing things like low dose tedalophyll so 2.5 milligram to five milligram to dalaphil tadalophil was initially discovered
as (27)..a..... drug to treat prostate health it was a drug that we now know can increase blood flow to the prostate and thereby
offset some (28)...of.... the issues associated with an aging prostate higher doses of tidalophil sometimes also referred to as
the by its brand name which is Cialis (29)...we..are.. used to treat erectile dysfunction but at the dosages that are used to
increase blood flow to the prostate and that now a number (30)...of.... doctors are using to increase blood flow not just to the
prostate but to all regions of the body including the scalp such as (31)....2.....5 to 5 milligrams to Dallas so this is something
that I think deserves attention because it falls under the umbrella of increasing blood flow (32)...to.... the hair stem cell niche
in order to maintain hair it is not something that most doctors are going to be familiar with as (33)..the..... way to reverse hair
loss because it won't do that but the use of low-dose tetralophyll to slow rates of hair loss is very (34)...much.... in a logical
mechanistic sense exactly the same as the logic of using minoxidil to slow rates of hair loss it's all about increasing
(35)..blood..... flow to support the stem cell Niche below the hair follicle the critical requirement for blood flow oxygen and
nutrients to the stem cell (36)...niche.... is also why you hear a lot nowadays about the use of PRP platelet-rich plasma for
trying to offset hair loss or even reverse (37)...hair.... loss we're going to do an entire episode about PRP it is pretty
controversial in certain circles and well accepted in other circles a (38)...couple.... of key things to understand about PRP first
of all it is being used in multiple tissues for different purposes in different clinics so (39)....for... instance board certified
physicians in the United States Canada and Europe are doing PRP injections into ovaries to try and expand the number of
(40)..how..healthy... follicles and eggs so that people can conceive later in life or even earlier in life if they don't have any
follicles people are (41)...getting.... PRP injections into their joints in order to try and support joint health people are getting
PRP injections into just about every tissue you (42).can...... think of however PRP despite what you may have heard is not
stem cells somebody tells you they're injecting stem cells they're either outside (43)...the.... U.S Canada or northern Europe or
they're injecting something else so you want to really look into that the safety issues there are the (44)...subject.... totally
deserving of an entire episode I'm not necessarily opposed to the future of stem cells as a treatment but keep in mind that
(45)...stem.... cells are cells that can give rise to lots of other cell types and they are cells that divide and replicate and there's a
(46)...name.... for that when it happens in the adult body when you don't want that and that's called cancer tumors are
overproduction of cells from (47)..stem..... cells when those stem cells ordinarily should be quiescent okay so keep in mind
the difference between stem cells and PRP PRP platelet-rich plasma (48)..again..... is legal in the U.S and many other places
because it involves drawing somebody's blood spinning it down at a particular speed which separates (49)...out.... different
components within the blood then taking the platelets and re-injecting those in a solution back into the person's body so
platelet-rich plasma or (50)...PRP.... is platelet enriched plasma from that person but the basis of PRP is really to encourage
nutrient delivery to a particular region in the (51)...body.... using somebody's own platelets because those platelets are
enriched for various nutrients so people are getting PRP injections into their scalp those are not (52)...stem.... cell injections
those are PRP injections into the scalp with some moderate success these are very expensive treatments they tend to be
transiently successful (53)...I....'m sure there are people out there who are going to say PRP worked fabulously well for me
that might be the case I'm not (54)...GOING.... to dispute that and I'm happy for you although there are not sufficient clinical
data to suggest PRP as a treatment right now especially (55).....giving.given. the cost many thousands of dollars many many
treatments it's also the case that the PRP injections when they work might work for reasons (56)...independent.... of the
platelets what do I mean by that well soon we're going to talk about a different type of treatment which is a
(57)...mechanical.... manipulation of the hair follicle typically on the scalp because that's typically where people want to
regrow hair I don't know many people who (58)....are... trying to maintain or accelerate or regrow their back hair for instance
they might be out there but I don't think there are a (59)...lot.... of them or their leg hair for that matter almost always it's
going to be scalp hair and one way that people are doing (60)..that..... is through mechanical stimulation of the hair follicle
and the stem cell Niche using what's called microneedling micro needling as the name suggests is (61)..taking..... a bunch of
little needles either in a little stamp so a little square or nowadays typically it's a roller so this looks like (62)..a..... paint roller
except it's um got tons of little needles in rows all over that roller those needles range in length from half a
(63)...05..millimeter... to 2.5 millimeters okay millimeters and one rolls that over the scalp and if you're thinking ouch that
probably hurts indeed it can hurt (64)...a.... little bit or a lot depending on the thickness and the length of those needles
microneedling has been shown to do two things it (65)....has... been shown to reactivate semi-quiescent populations of stem
cells that are in that telogen phase putting them back in antigen phase and thereby stimulate (66)...more.... hair growth it is
also and this is I think the best use of microneedling it has also been shown to be a very (67)...effective.... augment for some
of the hormone-based hair regrowth tools and pharmacology that we're going to talk about in a few minutes so microneedling
and (68)...PRP.... have something very critical in common which is the needle the actual injection into the skin and for those
of you that are hearing (69)...that..this.. and thinking why would disrupting the skin with needles actually support hair growth
or regrowth wouldn't that just damage the follicle well this gets (70)....into... some of the um I think interesting if not
fascinating aspects of our biology which is that all of the cells in our body (71)....really... can respond to both chemical and
mechanical cues and when we hear needle injected in the skin we think ah that must just be (72)...damaged..damaging..
everything causing all sorts of inflammation but it turns out that low levels of inflammation caused by things like micro
needling or PRP injections (73)...we..or.. even the introduction of any kind of fluid right for instance saline fluid injected into
a region can cause changes in the cells in (74)..that..... region causing for instance stem cell populations that were waning to
reactivate again causing telogen phase follicles that have melanocytes and stem cells that (75)...are.... dying off but not
completely gone to re-enter the cell cycle so microneedling procedures PRP injections things like minoxidil they all kind of
center (76)...around.... this same general theme of increasing blood flow increasing oxygen delivery of nutrients or in the case
of microneedling increasing inflammation just enough at (77)...that.... local site that certain Cascades of biological function
that relate to proliferation of stem cells or maintenance of stem cell populations are kicked off (78)...sort.... of like reminding
the cells in that area that they need to stay alive in order to replenish whatever is lost so sometimes a (79)...wound.... can
actually induce some healing although I do want to point out that the micro part of microneedling is absolutely key and this
should (80)...be.... obvious to you when you think about scars I don't know about you but I've never seen a scar with hair
growing out of (81)...it.... or if there was it was probably like one hair but if you've ever seen a scar for someone had their
appendix out or (82)....some..someone. had a brain surgery you see that scar because there is no hair growing out of it so the
micro portion of micro needling (83)...is.... extremely important we are not talking about causing significant damage to a
tissue in order to activate that stem cell population we're talking about (84)....causing... micro damage and micro levels of
inflammation to stimulate growth for those of you that are interested in using micro needling or micro needling (85)...in....
combination with chemical treatments like minoxidil or some of the other treatments we'll talk about in a little bit like
finasteride and caffeine yes (86)...believe.... It or Not caffeine is being used to regrow hair very interesting get into that in a
moment but if you're interested in using (87)..micro..... needling alone or in combination with some of these other treatments
there's a wonderful review that was just published this last year wonderful because (88)...this..it..'s very comprehensive not so
wonderful not to the fault of the authors because most of the studies out there on microneedling are not superb (89)..there.....
are ways of gauging the strength of a study mainly relate to their duration whether or not there were control groups Etc but
the (90)...review.... itself is excellent the title of the review is microneedling and its use in hair loss disorders a systematic
review we will provide a (91)....link... to this in the show note captions and this review did a very good job of highlighting
both the strengths and drawbacks of the (92)...very...various. studies looking at microneedling it also explored the use of
microneedling in both men and women and of various ages and it does appear (93)...to.... be the case the microneedling
shows some positive benefit in both men and women regardless of age especially when used in combination with the
(94)...every..various.. other treatments that we're talking about I was also able to glean from this review and some of the
papers described within it that (95)....needle... lengths of about one millimeter to 2.5 millimeters seem to be more effective
than shorter needle lengths so if you're scared of the needles (96)....and... the needle lengths keep in mind that done properly
microneedling shouldn't be too painful some people experience a little bit more pain than others (97)...but.... it's not
considered a very painful procedure it is however a procedure that can cause some bleeding of the scalp and that bleeding of
(98)...the.... scalp can be very apparent especially if it's in the front of the head as opposed to in the top of the head and
(99)..heading..hidden... by some hair or if you're already quite bald in a given region so keep that in mind I suppose one could
wear a (100)..hat..... or a wig or something of that sort if they were really self-conscious about it but the micro needling itself
is causing a physical (101)...dicruption..disruption.. into the scalp some degree of bleeding inflammation and again all of that
is part of the process by which microneedling can actually improve (102)...hair.... growth and of course there's healing that
occurs of the bleeding and the damage to the follicle this is a transient thing but understanding (103)..the..... Cosmetic
implications in the short term as well as in the long term is certainly worth knowing one thing that's very clear is that
(104)...the.... combination of microneedling and minoxidil treatment together is far more effective than either of those
treatments alone in addition the combination of microneedling and (105)...minoxidil.... has been shown to be effective in
recovering what are called Dead zones so these are regions of the scalp that are either completely (106)..bald..... or mostly
bald for which there is essentially no stem cell population there and the combination of minoxidil plus microneedling is
somehow able to (107)...recover.... those stem cell populations and allow new hair to grow although the growth of that hair in
those Dead Zone regions can take a (108)..very..... long time 30 to even 50 weeks neither minoxidant treatment alone nor
micro needling alone has been shown to be effective in recovering these (109)...so....-called dead zones when those
treatments are done separately so this I would say is a strong reason to consider combining microneedling and minoxidil as
(110)...suppose..opposed.. to just doing minoxidil or just microneedling I should also mention that minoxidil treatment if you
pursue it is likely something that you are (111)...going.... to have to do for the rest of your life if you want to hold on to the
hair growth that you obtain with (112)...minoxidil.... or if you want to maintain the hair that you are already maintaining with
Minoxidil some people have been successful in taking minoxidil maintaining (113)..some..... hair growth or even stimulating
some hair growth and then coming off minoxidil but most everyone who goes on minoxidil has to stay on (114)...minoxidil....
because when they cease taking minoxidil even if they're doing other treatments they lose the hair that they gained with
Minoxidil so that is (115)....it..an. important consideration the decision to go on minoxidil is likely a decision to be on
minoxidil for the rest of your life I'd like (116)...to.... just take a brief break and thank one of our sponsors which is element
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probably starting to realize there's a relationship between mechanical stimulation of the follicle and blood flow both of which
turn out to (126)....... critical for maintaining hair and for stimulating hair growth not surprisingly then an increasingly
common treatment for hair loss is Botox Botox is the (127)....... name for what is otherwise known as botulinum neurotoxin
what is botulinum neurotoxin well botulinum neurotoxins sometimes just called botulinum for short is a (128)....... that's a
bacterial toxin that serves to cut the protein that leads to synaptic vesicle release what in the world did I just say (129).......
when your nerve cells communicate with one another they do that by way of electricity but the electricity within those nerve
cells those neurons (130)....... the release of chemicals from neurons into the synapse the little gap between neurons and the
release of those chemicals allows the next neuron (131)....... be chemically active or in some cases it will suppress the
electrical activity of that next neuron botulinum neurotoxin serves to cut a protein (132)....... in neurons so that neurons
cannot release the chemicals that cause other neurons to be active so this actually is pretty serious if you (133)....... to get
botulinum neurotoxin injected into your muscle you would be paralyzed because the nerves that control contraction of the
muscles would not be (134)....... to control the release of that chemical onto the muscle which makes it contract botulinum
neurotoxin is commonly used in what's called Botox Botox (135)....... something most people are familiar with because
people get it injected in and around their wrinkles because many wrinkles are triggered by not just (136)....... of tensile
strength in the skin but rather the nerves around the skin and in the skin are hyper contracted which causes wrinkles so
(137)....... instance I have crow's feet I like to think that's because I've laughed a lot and smiled a lot and it's probably also
because (138).......'ve squinted a lot in my lifetime I have crow's feet because the nerves there have pinched the skin on either
side of my eyes (139)....... that's given me little creases there that are sometimes referred to as crow's feet Botox injections can
be applied to the scalp in order (140)....... relieve tension of the scalp and in hearing that it should be obvious why Botox is
being used to try and offset hair loss (141).......'s decreasing the squinting if you will or the tensile nature of the scalp skin so
that more blood flow can arrive at that stem (142)....... follicle area so Botox treatment to the scalp is actually becoming pretty
common there are a couple requirements with this Botox treatment first of (143)....... it has to be done by somebody who's
really skilled there are numerous images online and websites online of so-called Botox fails where people (144)....... gotten
too much Botox or the injections have been done too deep or not at the correct locations on people's face or scalp and
(145)....... can give them droopy scalp or droopy eyes all sorts of you know cosmetic nightmares can occur with botox the
second thing to understand (146)....... that Botox does eventually wear off that botulinum neurotoxin doesn't stick around
forever and provided it's done correctly at the correct dosages it doesn't (147)....... kill the neurons that cause that tension of
the skin so Botox injections have to be done repeatedly the efficacy of Botox for offsetting (148)....... loss is not clear there
aren't a lot of large-scale clinical studies on this just yet but it does seem to be at least (149)....... reasonably safe alternative to
things like minoxidil although I think if one were to just want to increase blood flow to the scalp things (150)....... low-dose
todala film which doesn't seem to carry any of the side effects that minoxidil can carry we talked about those side effects
earlier (151)....... would probably be the better alternative Botox is a fairly invasive procedure but some people opt for Botox
treatment in fact there's a syndrome (152)....... cutus verticus gyrata some of you have probably seen this it's more typical in
men although it does occur in women it literally means (153)....... lumping of the skin on the scalp or gyri of the scalp gyri or
gyrus pertains to the Latin word knee so it means (154)....... or knee and so anytime you hear the word Gyra in Neuroscience
or in biology you're talking about a bump sometimes see people have (155)....... in the back or it looks as if the skin was
pushed together kind of like the a Sharpay dog but on the scalp (156)....... with cutus verticus chirata almost always
experience pattern hair loss now part of the reason for that is cuticus verticus girata is also associated (157)....... some
Androgen or testosterone related hormone issues that we'll talk about in a little bit but in addition to that it has been shown
(158)....... relieving some of those gyrata by injections of Botox to allow those folds to sit flatter a is effective it can lead to
less (159)....... those gyri those bumps and can improve hair growth in those regions even if those people don't take on any
additional treatments to address (160)....... hormone issues so that's really how people arrived at this understanding that Botox
might be a good treatment in general for reducing the kind (161)....... squinting of the scalp that can occur and the resulting
hair loss in those regions I'd now like to turn our attention to the (162)....... variables that control the duration of the growth
phase of hair the duration of that catagen phase which is when that hair essentially recedes (163)....... the inside out and the
quiescent or semi quiescent telogen phase there are a couple of key chemical players here that we should all (164)....... aware
of first of all the growth factor igf-1 insulin growth factor one which is produced by the liver but that receives stimulation
from (165)....... brain and pituitary to be released is a strong regulator of hair growth and we can think of it as the accelerator
on hair (166)....... so it does that by extending that antigen or growth phase for longer it doesn't necessarily speed up growth
but it extends it for (167)....... longer period of time in addition cyclic amp which is part of what's called a second messenger
pathway in fact cyclic amp is a (168)....... messenger is also a key player in stimulating growth of the hair follicle now cyclic
amp does many different things in many different cell (169)....... in the body it really acts as the name suggests as a messenger
between signals that arrive at the surface of cells and transmitting (170)....... conveying those signals to things that happen
deep within the cells such as the turning on and off of various genes so when you (171)....... second messenger don't let that
confuse you or overwhelm you just understand that the whole process of getting signals from the outside of cells (172).......
the center of cells and controlling gene expression for instance causing a stem cell to continue to give off daughter cells or
causing a (173)....... cell to continue growing for longer that whole process is a bit like a Bucket Brigade of handing off water
or a bucket from (174)....... component to the next or along a chain it's like an assembly line I think that's probably the
simplest way to think about it (175)....... for sake of this discussion igf-1 is known to increase the growth of hair by extending
that antigen phase as is cyclic amp so (176)....... are going to be considered the accelerators at least in this conversation the
brakes on hair growth are going to be the things that (177)....... shorten the antigen phase or that extend the catagen phase or
this quiescent phase which is the tillogene phase and the two major breaks (178)....... hair growth that we want to think about
are pde which is a phosphodiesterase okay anytime you hear Ace it's likely to be an (179)....... and TGF beta 2 all right so this
is a particular growth factor that somewhat counterintuitively doesn't stimulate growth it actually stimulates lack of (180).......
or shortens growth so with all of that in mind and please do also keep in mind that you don't need to remember all (181).......
specific terms just understand that there are some factors like insulin growth factor one that act as accelerators on growth and
there are factors (182)....... act as brakes on growth we can start to think about why for instance half of all people by age 50
start to lose (183)....... hair well they start to lose their hair because of something called Androgen related alopecia which
translates English means testosterone and testosterone derivative induced (184)....... loss this is true in men and women so
hearing that you should probably be wondering the following thing young men have higher levels (185)....... testosterone than
old men right well the answer is yes although some older men in their 40s 50s even 80s maintain testosterone levels similar
(186)....... many men in their 20s but most don't it's a downward slope starting at about age 40. how steep that downward
slope is depends (187)....... too have testosterone in fact women have higher levels of testosterone than they do estrogen that's
right a healthy woman has higher levels of (188)....... than she does estrogen however women on average have lower
testosterone than most men okay so they still have far more estrogen and far (189)....... testosterone than most men but the
level of testosterone that they have within their body is higher than the level of estrogen they have (190)....... such as
testosterone and its derivatives such as dihydrotestosterone which will be much the topic of what we're getting into next
inhibit igf-1 and (191)....... amp again androgens such as dihydrotestosterone inhibit prevent the action of igf-1 and cyclic
amp which you just learned a few moments ago act (192)....... extend the antigen or growth phase of hair which then raises
the question well if young people both male and female have higher levels (193)....... testosterone than they do when they're
older why would people lose their hair when they're older and not younger ah the answer lies in (194)....... conversion of
testosterone to dihydrotestosterone testosterone most people have heard of dihydrotestosterone or DHT is made from
testosterone there's an enzyme called five Alpha (195)....... they convert testosterone into dihydro testosterone in both men
and women dihydrotestosterone binds to the Androgen receptor at five times the Affinity of testosterone (196)....... it is the
most powerful Androgen in humans and it is responsible for a number of things that we all really want and like (197)....... as
mental Vigor physical Vigor strength healing capacity Drive libido and on and on so DHT itself is not bad so if we take
(198)....... step back and we acknowledge testosterone levels are higher in males and females at younger ages as opposed to
older but as they get (199)....... there's more five Alpha reductase activity which is converting more of that testosterone to
dihydrotestosterone and dihydrotestosterone inhibits hair growth by reducing igf-1 and (200)....... amp well then we should all
be aboard why it is that by age 50 about 50 percent of people experience pattern hair loss (201)....... is Androgen dependent
alopecia okay but translate it to normal English is pattern hair loss and in a moment you'll understand why some people
(202)....... their hair from the crown region I'm in the back of the head or back and top of the head whereas other people lose
(203)....... hair in the front of their head in the flanks right on either side of the midline or maybe in the midline in front
(204)....... and that's because different people depending on their genetic lineage have different patterns of Androgen receptors
on their scalp and the pattern of Androgen (205)....... that you inherit indeed does come from your mother's side okay so this
is what gave rise to the the myth that if you (206)....... to know if you're going to go bald or not just look at your mother's
father it doesn't quite work that way in fact (207)....... you think about the logic you should really look at your mother's
mother if you want to know your pattern of Androgen receptors on (208)....... scalp however most women don't lose as much
hair from their scalp or they have ways of covering up the hair loss in their (209)....... because their hair is just generally
longer or they're using other approaches so you never really get a clear picture of what the Androgen (210)....... hair loss was
in your grandmother okay now we don't want to go too far down the genetics rabbit hole because as you know (211)....... can't
select your parents anyway but if you want to know why for instance I'm losing a bit of hair on either side of (212).......
midline in the front it almost certainly has to do with the fact that I have a higher density of Androgen receptors there as
(213)....... to say on the crown of my head where for whatever reason my hair seems to grow thickest other people lose hair
on the (214)....... in the back and top but not in the front and some people lose it all over now you understand why hair loss
occurs (215)....... certain regions of the body you should also understand that the Androgen receptors on the face are also what
are responsible for Beard growth (216)....... this is where it can get a little bit tricky but a lot of things will start to make sense
if you can understand (217)....... and internalize this if you have a high density of Androgen receptors on your face well then
as your DHT levels go up with (218)....... you will be able to grow a thicker and thicker beard in fact it is rare to see someone
who can grow a thick (219)....... in their youth but not so much as they get older in fact the reverse tends to be true so the
pattern of Androgen (220)....... differs between the scalp and the face and the back okay on your back you have Androgen
receptors and their DHT stimulates hair growth (221)....... if you know someone who has a very hairy back or if you have a
very hairy back that means you have a high (222)....... of Androgen receptors on your back if you have a beard and that beard
is thick well then you have a high density of (223)....... receptors on your face however a high density of Androgen receptors
anywhere on your scalp is going to predispose those regions to Androgen dependent (224)....... or hair loss in those particular
regions which is going to allow us to understand why all the rest of the treatments for halting (225)....... loss and for
stimulating hair growth almost all of those Center on inhibiting either DHT directly or five Alpha reductase the conversion of
testosterone (226)....... DHT so now I'd like to discuss the ways that one can chemically adjust certain things within the hair
growth pathway things like igf-1 (227)....... TGF beta Etc in order to stimulate hair growth or halt hair loss the first thing on
this list is actually going to be (228)....... surprising to a number of you and that's caffeine we all think of caffeine as a
stimulant that we drink I certainly drink coffee (229)....... yerba mate the occasional energy drink things of that sort caffeine
does many things besides stimulate our central nervous system and make us feel (230)....... sleepy however one of the things
that caffeine does is it is a fairly potent pde inhibitor by being a potent pde inhibitor it (231)....... stimulates igf-1 why well
because pde can suppress igf-1 and by ingesting caffeine or by applying topical caffeine ointment or cream to the scalp
(232)....... can suppress pde sufficiently enough to increase igf-1 and increase some hair growth or at least maintain hair
growth in that region this may (233)....... as a shock it might seem a little bit esoteric or even outside the margins of typical
treatments but Head to Head topical caffeine (234)....... can be as effective as minoxidil application without actually lowering
things like blood pressure and potentially increasing prolactin and some of the other negative (235).......'s call them negative
because they are side effects of minoxidil so caffeine ointments and caffeine present in various hair treatments and creams
Etc is (236)....... to become a more prominent theme out there I will include a reference to caffeine and its uses for offsetting
hair loss keep in (237)....... that topical caffeine ointments shouldn't necessarily be applied every single day so this is the sort
of thing you might do three times a (238)....... the concentration of caffeine in different ointments varies tremendously most
of the studies have caffeine on the stem cell niches that control hair growth (239)....... extension of the antigen phase of hair
growth have been performed in vitro in a dish although there are some clinical studies exploring this (240)....... are not nearly
as extensive in number or duration as the studies of minoxidil because this approach just hasn't been around quite as long
(241)....... when comparing side effects of minoxidil cost of minoxidil comparing the efficacy of caffeine and minoxidil I
think caffeine as a topical treatment for (242)....... hair loss stands as a pretty good choice if you're going to start exploring
this pathway and there's no reason to think that if (243)....... were to try the caffeine ointment and it didn't work for you or you
didn't like it for some reason or you needed to (244)....... it for some reason that you couldn't stop it safely because it doesn't
carry all the other blood pressure related effects and prolactinemia effects (245)....... minoxidil does so if you look out there
into the hair maintenance and hair replacement literature you look at the treatments that are being (246)....... don't be surprised
to see caffeine there and also don't be surprised when I tell you what I'm about to tell you now which (247)....... no you can't
simply just drink more caffeine in order to accomplish the goal of offsetting hair loss it is true that when you (248).......
caffeine it goes systemically however you have so many adenosine receptors throughout your body those adenosine receptors
and the parking of caffeine in those (249)....... receptors is the main way in which caffeine exerts its stimulatory effects
making you feel less sleepy so it does that because then adenosine (250).......'t have its effects which are to make you sleepy
well those adenosine receptors soak up so much of the caffeine that you would ingest (251)....... that very very little would
make it to the scalp and to the hair follicles at the concentrations that you would want so that's (252)....... you have to rely on
the application of these caffeine ointments about three times a week keep in mind that no one has really (253)....... the
dosages of caffeine in these ointments in a systematic way we are still in the early stages of all this but I do (254)....... it's
important to mention caffeine because of the lower incidence of side effects at least reported side effects and the general
safety margins and (255)....... head-to-head essentially comparable efficacy with Minoxidil because minoxidil has a bunch of
other issues now keep in mind that both minoxidil and caffeine are (256)....... used as a preventative for reducing hair loss
over time they are not expected and they do not as far as we know create (257)....... hair growth to any sufficient degree if any
of you have used caffeine ointments or minoxidil and observe new hair growth that was robust (258)....... put that in the
comments section I'd be curious about those experience says but as far as I know and from the clinical literature (259)....... I
read there's no examples of that one other point about caffeine it does appear that caffeine can not only indirectly stimulate
igf-1 in (260)....... antigen phase of hair cell growth by way of reducing pde and TGF beta but it also seems to reduce
apoptosis which is naturally (261)....... cell death of that stem cell Niche we've been talking a lot about the antigen or growth
phase of hair we also talked about (262)....... catagen or the recession of that hair from the inside out but remember that third
phase the tillogene phase where that whole bulb down (263)....... the bottom the bulges it's called gets pinched off and the
whole thing dies and takes the stem cells off to the Grave with (264)....... it appears that caffeine can offset the death of that
Niche and potentially maintain the stem cell population longer making caffeine a really good (265)....... to think about in
conjunction with the various chemical treatments aimed at directly attacking the DHT pathway that we'll talk about next so
there's (266)....... very direct way to increase hair growth and maintain the hair that you have have on your head and that's to
increase igf-1 that (267)....... be accomplished through prescription drugs such as growth hormone and things that stimulate
the release of growth hormone and igf-1 keep in mind growth (268)....... is released from the anterior pituitary during the first
hours of sleep especially when you haven't eaten anything for the two hours prior to (269)....... and especially when you get
regular bedtimes yes this is a real thing if you are going to sleep at variable bedtimes especially if (270)....... go to sleep much
later than your usual habitual bedtime you will miss that growth hormone pulse that normally occurs in the first two
(271)....... three hours of sleep this does not mean that you need to be neurotic about getting to sleep at the exact same time
every (272)....... there's probably a plus or minus 30 minute window and it doesn't mean that you can't stay out late or have a
bad night's (273)....... every once in a while or get woken up your hair isn't going to fall out my dad's story notwithstanding
your hair isn't going (274)....... all fall out because of that but you do want to try and get that natural growth hormone release
each night and as I (275)....... there are prescription approaches and those are growth hormone itself and things like
sermorelin which is a peptide that increases growth hormone it's actually (276)....... secret agog it causes the secretion of
growth hormone and thereby increases in igf-1 this is well documented both growth hormone and igf-1 as (277).......
mentioned are available but prescription they are not without their side effects so they do cause growth of all tissues they do
increase height (278)....... children they increase bone mass and density they can increase mainly fat loss not so much muscle
size but they can increase leanness and (279)....... increase hair growth they can increase turnover of skin they can make skin
look more youthful all these things sound wonderful and yet they (280)....... have problems because they can increase growth
of small tumors that normally might be eliminated so there is a increased cancer risk with growth (281)....... treatments and
igf-1 or anything that increases igf-1 such as sermoreline hypermeralin any of the peptides that you hear about nowadays that
said a (282)....... of people are using sermorelin as an indirect way to increase igf-1 and thereby to increase hair growth it does
seem to be fairly (283)....... in doing that as especially when done in conjunction with other treatments that we'll talk about
but keep in mind these are prescription drugs (284)....... they do carry their own risks the other thing about stimulating the
natural production of igf-1 is that as its name suggests insulin growth (285)....... one it is insulin dependent in many ways if
not for its secretion then for its action at the hair follicle and stem cell (286)....... one of the things you really want to pay
attention to is to avoid being insulin resistant or rather you want to try to (287)....... insulin sensitive so if you're carrying a lot
of excess body fat if you're obese or if you have type 2 diabetes meaning you're (288)....... resistant you're going to want to
deal with that there are a number of prescription treatments to deal with that nowadays people are very (289)....... about all the
glp-1 agonists but in addition to that regular cardiovascular exercise and resistance exercise making sure that your body fat
percentage is (290)....... in excess of where it needs to be and everyone has a slightly different idea of where it needs to be
both cosmetically and (291)....... health so that's a conversation between you and your doctor and you and you frankly but you
want to avoid being insulin resistant because (292)....... insulin resistant and being obese can indeed lead to hair loss and there
are many people out there who are not obese who nonetheless (293)....... experiencing hair thinning and hair loss because they
are insulin resistant by way of reduced igf-1 activity there are a few supplements so these (294)....... over-the-counter
supplements such as myoinositol taking at dosages of about 900 milligrams before sleep which by the way can also assist in
sleep or (295)....... like berberine or metformin which are known to improve insulin sensitivity each and every one of these
has its own profile of positive and (296)....... effects the lowest number of side effects is associated with 900 milligram
myoinositol taking about 30 minutes before sleep mostly because it can make (297)....... a little bit drowsy and it does Aid
sleep in some really great ways but really exercise and maintaining a healthy nutritional program are (298)....... going to be
key you just can't discard those berberine which is a substance made from tree bark is sometimes called the poor man's
(299)....... metformin being the equally effective prescription version of berberine or put differently berberine is the non-
prescription but equally effective version of Metformin keep in (300)....... that both berberine and Metformin dramatically
reduce blood sugar levels and so if you're not going to take them with carbohydrates it can lead (301)....... some feelings of
discomfort that's why I'm not a fan of them but if your goal is to really improve insulin sensitivity they are (302)....... very
potent tools on the list of things that can do that the other thing that's really important for maintaining proper hair growth this
(303)....... phase is that you need sufficient iron this is because iron and ferritin play a key role in the cell growth Pathways
that go (304)....... the stem cells to the stimulation of keratin within the hair itself I don't have time to go into this pathway in a
lot (305)....... detail but you can have your blood levels of iron measured this turns out to be pretty important because you
don't just want to (306)....... popping iron supplements because too much iron can be toxic too little means you're anemic for
women the levels of iron that you want (307)....... somewhere between 2 25 and 100 and for men somewhere between 30 and
150 fortunately the tests or the blood tests for iron are (308)....... a very inexpensive ad to your current blood panel so if you're
going in for a blood panel for LDL HDL kind of typical (309)....... or if you're doing the more elaborate hormone testing
which I do recommend people do if they can afford it or if their insurance (310)....... it do ask for an iron test as well and if
your iron is low you may need to supplement your iron if your (311)....... is too high that's not good either but iron plays a key
role in the antigen phase of hair growth so you want to (312)....... sure you at least have sufficient iron and if you don't you
want to make sure that you're getting it from nutrition and or (313)....... okay so earlier we were talking about
dihydrotestosterone dihydro testosterone just to jog your memory is a form of testosterone that can bind the (314).......
receptor at five times the Affinity of regular testosterone both men and women have a lot of testosterone relative to estrogen it
just so (315)....... that men tend to have more testosterone than women do overall but both men and women as they age
convert more of the testosterone (316)....... have to dihydrotestosterone and dihydrotestosterone does two things that are bad
for hair maintenance and hair growth first of all it shortens the antigen (317)....... that growth phase so whatever hair is going
to grow is going to occur over a shorter period of time second of all because (318)....... the presence of Androgen receptors on
the stem cell Niche area and around it it actually miniaturizes the follicle and the stem cell niche (319)....... other words it
makes the population of cells that give rise to more hair protein smaller and can eliminate it all together and that (320).......
why anything that reduces 5-alpha reductase is going to reduce DHT is going to maintain or extend the growth phase the
antigen phase of (321)....... growth and is going to offset or prevent some of the tillogene phase the pinching off and the
removal of that stem cell Niche (322)....... one substance that we know can inhibit 5-alpha reductase although it does it pretty
weakly is salt Palmetto which is an extract of the salt Palmetto Berry to be (1)....... I don't know how this was initially
discovered if anyone knows please put it in the show note captions when I looked online I (2)....... a bunch of conflicting
stories about who was the first person to start extracting the extract of the salt Palmetto berries so I have (3)....... idea which
one of those is true maybe somebody can tell me the good thing about salt Palmetto treatment is that it is known (4)....... have
very few if any side effects there might be some side effects in about one percent of people but it's not associated with (5).......
lot of side effects it's also known that when taken at about 300 milligrams per day and here it doesn't have to be that (6).......
most of the studies that I explored involved taking anywhere from 200 to 500 milligrams of salt Palmetto but most of them
focused on (7)....... 300 milligrams of salt Palmetto per day divided into two or three doses why well it has a relatively short
half-life meaning it's going (8)....... get cleared from the bloodstream and more importantly its biological action is going to be
very short-lived so if you can get a hold (9)....... 50 or 100 milligram capsules or tablets of salt Palmetto and divide those up
take them in the morning afternoon and evening or even (10)....... in the morning and evening to achieve a total of about 300
milligrams per day that's going to very likely help you hold on (11)....... some of the hair that you would have otherwise lost
maybe even grow some new hair and I say maybe give you some new (12)....... growth because salt Palmetto is not known to
be a particularly robust treatment for the reversal of hair loss it's known to have some (13)....... but it's generally taken in
conjunction with a bunch of other things and so it's really hard to tease out just what amount of (14)....... growth or prevention
of hair loss is due to Sal Palmetto specifically but I mentioned it here because the mechanism of action is logical (15).......
fairly well known which is this weak effect in reducing 5-alpha reductase and thereby reducing DHT so again because it has
relatively low side (16)....... even though it's not super effective and because it's fairly low cost and it's available over the
counter I felt it was important to (17)....... now as soon as people hear things like Saul Palmetto Berry they're probably also
thinking oh boy here come all the herbals now keep (18)....... mind that there are some herbal compounds that have pretty
robust biological effects and we'll talk before in our optimizing testosterone episodes about things (19)....... Tonga Ali and
fedojia agrestis which taken in correct dosages and in the correct way can be pretty potent for increasing luteinizing hormone
and (20)....... testosterone I'm not going to have huge effects it's not like taking exogenous anabolic steroids but they can have
real effects and so herbal (21)....... can be potent however I do acknowledge that there's a vast Market out there of herbal
compounds and plant-based compounds that people are arguing (22)....... the people who sell them are arguing can increase
hair growth and there are some decent studies of these things the hard part about (23)....... these herbal compounds and these
plant-derived compounds for increasing hair growth is that they are often taken in combination with one another in fact
(24)....... of the hair growth supplements that involve these herbal compounds in plant compounds include five or ten
sometimes even more things altogether so teasing (25)....... which ones are effective and which dosages are effective is nearly
impossible they're just too many variables so you will hear for instance that (26)....... tea extract racy mushroom pumpkin oil
zinc curcumin that all of these things can increase hair growth perhaps the only thing on that list (27)....... makes logical sense
with respect to the biochemistry is that curcumin is known to in some people be a potent inhibitor a 5-falfa or (28)....... and
DHT so much so that I can personally say for me I once took curcumin turmeric it's also called in high dosage this (29).......
about a gram to two gram capsules and I felt absolutely terrible I mean just Dreadful I don't care if it allowed me to (30).......
my hair forever I'd rather lose all my hair three times over well I guess that means it would have grown back I'd rather
(31)....... all my hair let's just put it that way then ever take curcumin or turmeric and high dosages again and in saying that I
(32)....... that many people take turmeric and curcumin and really like its anti-inflammatory properties and don't experience
any side effects I just happen to be (33)....... sensitive to curcumin by way of this DHT pathway and I know this by way of
blood work so I'm never going near that (34)....... again that said a lot of these herbal compounds and Cocktails probably will
have some minor marginal infinissimily small somewhere in that range effect (35)....... maintaining hair growth or in
stimulating new hair growth it's just that there really aren't clinical studies to support any one of them and (36).......'s why I
singled out saw palmetto as one of the few for which the biochemical pathway of inhibiting file for reductase and the low
(37)....... of side effects and the fact that many people have used it with some degree of success makes it a standalone I
wouldn't say (38)....... but a consideration another commonly discussed and used commercial compound for offsetting hair
loss and stimulating hair growth is Ketoconazole sometimes this is known (39)....... Nizoral where Nizoral is the brand name
of a shampoo Ketoconazole is an anti-fungal that was initially developed to treat dandruff and severe psoriasis (40).......
Ketoconazole has been shown to be effective in increasing hair number it's also been shown to be effective in increasing hair
diameter which is (41)....... surprising because one of the common side effects of Ketoconazole is drying thinning and brittle
hair so what's going on there is a little (42)....... we'll return to that in a moment the mech mechanism of action for
Ketoconazole is pretty interesting remember earlier we were talking about the (43)....... gland and the production of sebum
that oily stuff whose very name seems to evoke disgust in certain people well Ketoconazole can disrupt some (44)....... the
fungal growth that frankly we all have on our scalp all the time I know this is a surprise to many of you (45)....... you are
constantly bombarded with viruses bacteria and funguses all the time but we managed to battle those off with our immune
system either (46)....... physical barriers such as an oil barrier like the sebum or through antimicrobial action so chemical
approaches our immune system the sebum Etc Ketoconazole (47)....... as an anti-fungal that in some way seems to reinforce
the properties of sebum at keeping out other fungal infections and the net effect (48)....... least as far as we know is a mild
reduction in DHT now exactly how this happens isn't really clear what is clear is (49)....... the use of Ketoconazole shampoos
two to four times per week with a scalp contact time of about three to five minutes has been (50)....... to give about an 80
response rate of maintaining hair that would otherwise be lost so that's pretty dramatic eighty percent what is less (51)....... is
whether or not Ketoconazole shampoo can actually stimulate new hair growth but as you're probably starting to realize this is
always a bit (52)....... a tough thing to disentangle maintenance of hair that you would have lost versus new hair growth
certainly that's an easy thing to disambiguate (53)....... you have a patch of scalp where there is absolutely no hair these um
so-called dead zones that you can resurrect with certain treatments (54)....... what about areas of your scalp where hair is
thinning so for instance on the top of your head this is where many women (55)....... first experience um pattern hair loss
alopecia is um right at their midline you know if especially if they have a part right there (56).......'ll start to notice that under
very bright light fluorescent lights in particular they'll notice the thinning of their hair there or in the forehead (57)....... they'll
start using Ketoconazole shampoo again the typical recommendation is two to four times per week with a scalp contact time
of three to (58)....... minutes and really rubbing it in and then rinsing it out you don't need to be super vigorous but you want
to make sure (59)....... it gets down into the follicle and around the follicles not just sitting on top of the hair which is going to
be especially (60)....... for people who have long hair to really massage it in well they will experience a growth of hair in that
particular region that (61)....... certainly were due to miniaturization of the hair follicle and reduction of the total population of
stem cells in that follicle as opposed to (62)....... loss of the stem cell population the reason we say this is that there's no
reason to think that Ketoconazole can actually stimulate igf-1 (63)....... activate growth itself it's probably offsetting some of
the reductions in the antigen phase and some of the exacerbation of the telogen phase now (64)....... you decide to use
Ketoconazole as an approach to offsetting hair loss it's very important that you get a hold of a shampoo that's (65)....... least
two percent concentration of Ketoconazole this is important because a lot of the ones that are available out there especially
online are going (66)....... be one percent or lower so you want to try and obtain a Ketoconazole shampoo of two percent or
higher concentration of Ketoconazole because (67)....... has other things in it of course I should mention that there are
occasional side effects with Ketoconazole the rates of side effects from (68)....... meta-analyzes and reviews that I read were
somewhere between one and eight percent of people will experience some side effects but those side effects (69)....... to be
pretty mild things like irritation of the scalp things like thinning and brittleness of the hair that sometimes can be offset by
(70)....... shampoos that contain things like biotin I know many people are probably curious about biotin which is a protein
that can be incorporated into (71)....... Keratin whether or not different Biotin and Rich shampoos can really enhance the total
amount of biotin that gets incorporated into the hair isn't (72)....... but it is clear that having sufficient biotin around is
important so if you get a little bit extra from your shampoo you can (73)....... how that would quote unquote tap off the
amount of biotin in that hair and there are people out there saying that biotinin shampoos (74)....... done wonders for them
who knows I'm not going to dispute their experience so if you're going to use Ketoconazole keep in mind that (75)....... more
typical brand names that are out there you know which ones they are oftentimes don't have two percent or if they do have
(76)....... percent they can be very drying and lead to brittle hair there are newer and now fortunately a greater variety of
Ketoconazole containing shampoos (77)....... as a podcast and I don't have any affiliation to any of these but I will provide a
links to a couple of the (78)....... prominent ones that are known to have two percent concentration of Ketoconazole as well as
some other things in them known to offset some (79)....... that dryness and brittleness that Ketoconazole shampoos can trigger
so by now I think it will be abundantly clear why inhibiting five Alpha reductase (80)....... thereby reducing DHT should
increase hair growth because of the negative impact that DHT has on the hair follicle the major player in this (81)....... story
around inhibiting five Alpha reductase and reducing DHT to maintain or increase hair growth is going to be finasteride and
its close cousin (82)....... finasteride is effective in reducing DHT because of its actions in reducing the type 2 isoenzyme or
isoform of 5-alpha reductase it turns out (83).......'s three different isoforms or what are sometimes called isoenzymes of five
Alpha reductase this is getting pretty far down in the weeds what I (84)....... most of you just need to know is that finasteride
reduces DHT that's the net product of finasteride and in doing so it can (85)....... hair count by as much as 20 percent pretty
remarkable if you think about it in addition finasteride treatment done properly which we'll Define (86)....... a moment can
reduce hair loss in 90 percent of all people that take it so that is I mean near staggering I mean (87)....... aren't many
Pharmaceuticals out there that have that kind of efficacy really dramatic and in addition it's known to increase hair thickness
by about (88)....... to 30 percent overall so not just create new growth of hairs and thicker hairs but whatever hair you do
happen to have on (89)....... head it can further thicken those so the finasteride story is one I think of General success I mean it
really seems to improve (90)....... growth and help you hold on to the hair that you have the issue with finasteride is twofold
first of all it is known (91)....... have some pretty significant side effects if it's not dosed properly and in particular populations
of people and this is because there is a (92)....... variation in the amount of the different ISO enzymes that people make yes
this is why I brought up the iso enzymes earlier some (93)....... make more of isoenzyme one and three some people make
more of isoenzyme two and three and every variation thereof so when people take (94)....... some people are very strong
responders and they achieve really effective hair regrowth and maintenance of hair other people less effective although still
pretty (95)....... but the catalog of side effects that people experience at a given dose varies widely so there's a lot of trial and
error that (96)....... to take place I also should point out that finasteride comes in two major forms there's an oral form and
there's a topical form (97)....... this is not unlike our discussion of minoxidil earlier topical finasteride is typically taken in one
percent solution or ointment and rubbed into the (98)....... sometimes it's now also incorporated into shampoos but typically
it's put into a solution that people rub into their head and it is thought (99)....... the one percent Solutions are equivalent to one
milligram of systemic finasteride now we need to take a step back and ask why was (100)....... developed in the first place
well finasteride as a fairly potent five Alpha reductase inhibitor it's great at lowering DHT it was developed for (101)....... of
prostate enlargement and various issues of the prostate that are associated with Elevate DHT that occurs with age the topical
finasterides were designed (102)....... the hope that the finasteride would make it into the hair follicle and would inhibit DHT
there and allow for more growth of the (103)....... which apparently it does but not make it into the systemic circulation or at
least not at concentration sufficient enough to cause as many (104)....... effects as with the oral dosing now the problem is it
does make it into systemic circulation the issue is also that topical application (105)....... finasteride is harder to dose than oral
finasteride I'm not saying you should be taking oral rather than topical finasteride but keep in mind (106)....... the dosages of
finasteride that have been shown to be effective for inducing hair growth cover an enormous range so as low as 0.01
(107)....... per day and as high as 5 milligrams per day which is a just staggering range now when trying to simplify the
problem of (108)....... much finasteride to take either by way of oral tablet or by way of topical solution we can get a bit of
Leverage on (109)....... by thinking about how much DHT reduction occurs as a function of dose and there finasteride shows
this really interesting what's called logarithmic distribution (110)....... it means is that for a dosage of 0.01 milligrams of
finasteride you're going to achieve approximately 50 reduction in DHT and that's systemic (111)....... so this is a blood draw
measuring your DHT then taking .01 milligrams of finasteride again .01 very low dose of finasteride repeated a (112).......
weeks measure people's DHT in their blood again and you see that it's reduced by 50 percent however at increasing dosages
of 0.2 milligrams (113)....... milligrams five milligrams of oral finasteride per day over the same period of time the increase or
I should say the reduction in dihydrotestosterone (114).......'t increase linearly it's not that you go from 50 to 60 to 75 percent
to a hundred percent with each increasing dose it tapers (115)....... it kind of flattens out it tends to increase a little bit but it's
sort of a gradual slope increasing as you head from (116)........2 milligrams out to five milligrams so what this means is that
given that reducing DHT can cause various side effects sexual side effects reductions (117)....... either sexual function or
sexual drive as well as overall drive and motivation sometimes even some depressive symptoms that everything points to
taking the (118)....... effective dose of finasteride and starting with a very low dose of finasteride because low doses of
finasteride even at that point zero one (119)....... taken orally daily are already leading to a 50 reduction in
dihydrotestosterone and thereby taken for a long enough period of time should offset (120)....... loss and stimulate hair growth
one of the problems however is that people will start taking finasteride at a low dose you know 0.1 (121)....... or 0.2
milligrams maybe even .01 milligrams and there will be a reduction in their DHT but because of the long duration of that
(122)....... phase they don't see a lot of change in hair growth in the first month or even two months and so what they end
(123)....... doing is increasing their dosage and then they start to see hair growth but then they start to experience more side
effects now the (124)....... effects of oral finasteride are serious enough and common enough in people that take finasteride
that the topical Solutions were developed but there too (125)....... needs to exercise caution because if we are going to
translate between topical finasteride and oral finasteride with the understanding that topical finasteride can (126)....... make it
into the systemic circulation we need to look at what's been shown in clinical studies which is that for instance taking one
(127)....... of 0.25 finasteride applied to the scalp this is a very typical recommendation translates to the same thing that would
be achieved with 2.5 (128)....... of oral finasteride and when I say translates to the same thing what I mean is it leads to the
same concentrations in the (129)....... now consider that 0.2 milligrams 0.2 milligrams a finasteride in the blood is known to
be effective in generating new hair growth and maintaining (130)....... that one already has when they start the treatment so if
you think that the topical finasterides are actually creating lower overall systemic concentrations (131)....... finasteride that is
not necessarily the case again one milliliter of topical finasteride at 0.25 leads to a 2.5 milligram concentration in the blood
(132)....... the effective dose within the bloodstream by taking it orally as a pill is 0.2 milligrams that might not seem like a
big deal (133)....... you although it is a big deal right we're talking 2.5 milligrams versus 0.2 but it is a huge deal when you
consider that (134)....... side effects of finasteride increase as you increase the concentration of finasteride in the bloodstream
so where does this leave us should people who (135)....... interested in taking finasteride take the oral form at low dose or take
the topical form and simply try and apply it less often (136)....... guess at what their systemic concentration of finasteride is
well it's going to vary from person to person some people are very sensitive to (137)....... and not in the Good Sense the side
effects just really show up quickly and they tend to be dramatic other people not so (138)....... the dosage recommendations
that I was able to arrive at based on the clinical studies and frankly in discussion with some doctors who prescribe (139).......
were the following 0.5 milligrams to one milligram of finasteride as a tablet per day seems to be an effective and pretty safe
starting (140)....... for most people now some people will find that even that 0.5 milligram dosage is just going to cause side
effects that are not (141)....... to work for them and they're going to either have to reduce their dosage of finasteride or move
to the topical or maybe see (142)....... finasteride altogether but for many people out there that's going to be pretty well
tolerated the key thing here is that one is going (143)....... have to wait some period of time to see whether or not any hair
growth occurs it is a naive and frankly foolish approach (144)....... on what we know about the duration of that antigen phase
of the hair to do one of these treatments wait a week or (145)....... and then decide to up your dose now it is not foolish to
reduce your dose if you're experiencing bad side effects but to (146)....... increase your dose because you're not getting results
quickly enough that's not going to be the best approach I really encourage people who are (147)....... to explore the finasteride
route to think of this as a long-term project and to really ratchet up slowly if at all starting initially (148)....... a low dose taken
for a long period of time maybe even as long as 25 weeks before considering going up any further certainly (149)....... I
mentioned before if you need to go down further that's not going to be a problem at least not in terms of reducing (150).......
effects I mean you're not going to get additional hair growth but you're certainly not going to increase your side effects if you
reduce (151)....... dose however I will talk a little bit later about post finasteride syndrome which is something that's getting
increasing attention nowadays that's something that (152)....... after people have taken finasteride for an extended period of
time now some of you have perhaps heard and I'll just tell you right (153)....... that the topical forms of finasteride are
associated with far less side effects now that might come as surprising given that topical application of (154)....... can lead to
systemic distribution of finasteride but the numbers that are out there right now it's that topical finasteride is associated with
30 (155)....... 50 percent fewer side effects or 30 to 50 percent less severe side effects than oral finasteride now there are
several things probably responsible (156)....... that one is that people tend to ratchet up their dose of oral finasteride pretty
quickly but keep in mind that the effective dose (157)....... finasteride in the blood is 0.2 milligrams now earlier I said the
typical topical finasteride Solutions are 0.25 percent people are taking one mil (158)....... it that equates to 2.5 milligrams and
so it seems like a massive overdosing ah but here's the discrepancy and here's where we can (159)....... at some reasonable
recommendations if you decide that finasteride's right for you you get a prescription I would hope that you're monitoring your
DHT (160)....... and other hormone levels that would be ideal and working with a doctor please 0.5 milligrams to one
milligram per day of oral finasteride (161)....... to be the best starting place for topical finasteride it's going to be that one
milliliter of 0.25 percent that we talked about earlier (162)....... that's taken only one time per week and you can fully expect
that right after the application you will have higher levels of finasteride (163)....... your bloodstream and therefore lower
levels of DHT and that that will alter across the week most people are not going to be able (164)....... measure their DHT on a
day by day or even weekly basis it's just too expensive and labor intensive but I think those dosing (165)....... ought to get
people into more or less the same category of optimizing hair maintenance and hair growth while minimizing finasteride side
effects one (166)....... about finasteride taken either alone or in combination is that in recent years really in the last five or so
years there's been increasing (167)....... about so-called post-phenasteride syndrome now post-finasteride syndrome is indeed
a new phenomenon in the sense that finasteride has been prescribed for a very long (168)....... of time for treatment of the
prostate at dosages of about five milligrams per day right that's a very high dose sometimes lower but (169)....... high as five
milligrams per day and for many years there was no discussion about this post-phenasteride syndrome what is post finasteride
syndrome post (170)....... syndrome is when typically it's males this is where it's been described we'll take finasteride at any
range of dosages from one milligram to (171)....... milligrams per day they're either doing this for prostate or more likely
they're doing it to offset hair loss and increase hair growth and (172)....... they stop taking finasteride for whatever reason
Financial or wasn't working for them or the side effects were not to their liking and they (173)....... to experience some very
severe what can only be called syndrome effects such as very reduced libido very reduced erectile function very reduced
mood (174)....... the point of depression even suicidal depression so this is pretty scary stuff especially since it's occurring at
an age when most of these (175)....... are not typically occurring in males they can't occur but they're not typical of younger
males in their 20s and 30s and early 4 (176)....... so we have to ask ourselves what's going on here after all people have taken
finasteride for the prostate at fairly High dosages without (177)....... post-finasteride syndrome when they've stopped now
these young males are taking finasteride they're coming off an asteroid and they're getting this very severe very (178).......
post-phenasteride syndrome this has become a kind of Hot Topic enough so that medical doctors who've been prescribing
finasteride for a very long time (179)....... been forced to address this I think at first they were sort of perplexed and thought I
don't know this might be psychosomatic whatever (180)....... means I mean as a neuroscientist who works on Mind Body
Connection we know that nothing is truly psychosomatic everything is of the mind (181)....... body but the point is that
enough medical attention has been placed on post finasteride syndrome and trying to unravel exactly what that is (182).......
there are now a few General conclusions about what might be going on first of all it seems that younger males taking
finasteride in (183)....... High dosages to improve hair growth or offset hair loss seems to be one of the key variables we're not
seeing this post finasteride (184)....... as much in older males in fact it seems to occur more in males in their 20s and 30s than
males in their 40s (185)....... older so that's one thing and it may relate to the ways in which dihydrotestosterone we know has
a very key role in early (186)....... development it's actually what's responsible for the male genitalia it's also responsible for
certain things in female development but mainly in utero it's responsible (187)....... male development and development of the
penis in particular and then around the time of puberty dihydrotestosterone acts again in what's called its activating (188).......
to further increase growth of the genitalia increase the musculature bone growth Etc and increase libido and a number of
other things it's probably (189)....... involved in the activation of puberty it's certainly not the only hormone involved in the
activation of male puberty but it's certainly one of (190)....... key players so dihydrotestosterone has these known early roles
in embryonic development and in puberty but what post finasteride syndrome seems to indicate is (191).......
dihydrotestosterone is likely having further effects on male maturation in particular maturation of the hypothalamus and areas
of the brain that continue well into (192).......'s twenties and maybe even one's 30s and here I just want everyone to keep in
mind that we tend to think about development as (193)....... teenage years young adulthood adulthood but really development
never stops development is something that starts at conception and birth of course and then extends (194)....... the way out
until the point when we die so even if we live to be in our late 90s or achieve 100 years (195)....... age development is
occurring during that entire time and these different hormones such as dihydro testosterone are having different impact for
across the lifespan (196)....... in different ways across the lifespan so there isn't a clear conclusion about what post finasteride
syndrome is really all about but it points (197)....... the fact that DHT is likely to be involved in development of the brain and
the Brain to genital axis because I mentioned that (198)....... so many of the side effects that are associated with this post
finasteride syndrome seem to Center on sexual side effects although they're also (199)....... depressive side effects of course
those can be related to one another in either direction so while I do understand that loss of one's (200)....... or potential loss of
one's hair can be particularly troubling and anxiety provoking even cause depression in some cases I am sensitive to that
(201)....... also want to be sensitive to the fact that some of these treatments such as finasteride can carry very serious side
effects even if (202)....... come off them AKA post finasteride syndrome as long as we're talking about finasteride and this
General pathway of five Alpha reductase inhibition in (203)....... by DHC inhibition and on and on topics and themes and
nomenclature you are now very familiar with we have to talk about dutasteride (204)....... testeride is yet another molecule
similar to finasteride but remember those three isoforms of the five Alpha reductase enzyme well it inhibits all three
(205)....... type 1 and type 2 but also type 3 and it does it very potently so as a consequence the typical dosage of oral
(206)....... get this 0.5 milligrams to 2.5 milligrams taken orally Works two to five times faster than typical finasteride at
inducing hair regrowth and reduces (207)....... by get this 95 percent so it's just near flat lines DHT and that can occur at
concentrations as low as 0.5 milligrams although (208)....... will see prescriptions and people taking dutasteride anywhere
from 0.5 milligrams all the way to 2.5 milligrams orally now not surprisingly dutasteride is associated (209)....... a lot of side
effects related to the DHT pathway so things like reduction in sex drive reduction in overall Drive it also tends (210).......
impact other hormone Pathways so increases in estrogen prolactin that's why gynecomastia male growth of male breast tissue
sometimes occurs when people take dutasteride (211)....... so you're probably asking why would anyone take dutasteride why
not just take finasteride and wait for that hair growth well the answer is (212)....... people are often very impatient and it turns
out that dutasteride works about two to five times faster than finasteride so some people don't (213)....... to wait a full 30
weeks or 40 weeks or 50 weeks or more in order to grow their hair back and they're very (214)....... about the hair loss that's
occurring so they will take what I hope would be a very low dose of dutasteride I realize that (215)....... are ways to take
dutasteride that can be safer offset some of these side effects but by my read of the literature if one (216)....... going to try to
mildly inhibit the DHT pathway things like salt Palmetto things like topical caffeine which has some effect on the Androgen
(217)....... but as we talked about earlier tickles other Pathways things like Ketoconazole mild reduction in Androgen receptor
Pathways in the follicle and very direct (218)....... it's applied directly to the scalp things like that are going to be the best
route for mild reductions in DHT as an attempt (219)....... maintain hair or grow hair whereas if one really wants a potent
stimulus for increasing hair growth that's very likely going to be finasteride (220)....... hopefully low enough dosages of
finasteride and hopefully a patient enough patient person that they are willing to wait the duration of time required (221).......
that hair growth to come back because they understand that that antigen phase takes some time now the Holy Grail of all this
hair (222)....... is in understanding that no one specific treatment is Magic and in fact there are now a number of good meta-
analyzes comparing the various (223)....... we've talked about today alone or in combination and we can summarize that pretty
easily by saying that combination treatments that involve a mechanical (224)....... and a chemical stimulus are always going to
be better than either one alone and within the mechanical category the stimulus that seems to (225)....... best is microneedling
so the combination of microneedling and finasteride can lead to some pretty robust and impressive hair regrowth so much so
that (226)....... that were I guess we'd only describe them as pretty bald or bald can regrow significant amounts of hair I've
never seen examples of (227)....... who were completely bald meaning lacking all scalp hair to grow back a full head of hair
but the combination of microneedling and finasteride (228)....... is probably the most effective way to go and if you're going
to do that there's no reason why you couldn't also use Ketoconazole (229)....... you can also use salt Palmetto there's no reason
to think that these things collide with one another although anytime you're inhibiting a DHT (230)....... or whether or not
you're increasing or decreasing any hormone pathway for that matter you want to be careful about layering in too many
(231)....... treatments because you don't want your DHT level to go too low I mean let's keep in mind that even if you take a
(232)....... low dose of finasteride and reduce your DHT and don't have side effects maybe just the mere addition of salt
Palmetto which leads to (233)....... slight reduction in DHT combined with some caffeine ointment would be sufficient
enough to start inducing some of the low DHT Associated side effects (234)....... you really have to see for you and that's one
of the major issues in this whole field of hair growth and regrowth is (235)....... people are highly individual in their response
and in their side effect profile to these various treatments but there's an enormous range there and (236)....... there's no way to
know a priori before doing these treatments what your response is going to be in terms of side effects so (237).......'re simply
going to have to explore and I would hope that you would explore starting with minimal possible effective dosages and to do
that (238)....... coordination with a medical professional so you could really evaluate these things at the level of blood and
cosmetic changes and in fact that's (239)....... pretty good motivator for thinking about the different treatments that we talked
about today everything from mechanical treatments as simple as massage which we've (240)....... heard about but for which
there really aren't a lot of data for supporting hair growth but certainly things like microneedling which is a (241).......
stimulus for which there are pretty good data that it can improve hair growth also things like saw palmetto a weak DHT
antagonist also (242)....... like Ketoconazole shampoo which again is a weak DHT antagonist and operates through some
other Pathways as well to stimulate hair growth my suggestion (243)....... that anyone young old male female who's thinking
about embarking on various treatments for offsetting hair loss and stimulating hair growth consider both mechanical
(244)....... and the approaches that attack the chemical Pathways that can stimulate hair growth and can inhibit the Inhibitors
of hair growth in fact that's (245)....... reason why we spend so much time on the biology of hair growth and what shuts down
hair growth early on in today's episode (246)....... then systematically went through each of the various treatments that relies
on and in some cases hinges entirely on either a mechanical stimulus or (247)....... chemical stimulus in order to exert its
effects my goal today was not to overwhelm you with a ton of biology About Hair although (248)....... did Cover a lot of
biology of hair and stem cells and hair growth my goal in describing all that was really for you (249)....... be able to hear
about various treatments whether or not it's lasers or PRP or finasteride dutasteride or whatever is coming next that we're
(250)....... to hear about soon online and from the medical community and to be able to place those into bins related to their
known or (251)....... mechanisms and then to be able to step back and evaluate which if any of those treatments might be right
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your interest in science [Music]