Hair Loss: The Ultimate Guide

According to the stats and facts, you’re not alone

Unfortunately, some things don't get better with age

Significant balding affects about 20% of men in their 20s, about 30% of men in their 30s and nearly 50% of men in their 40s.[1]

It basically happens to everyone

As many as 85% of men will have some sort of hair loss in their lifetime, and it can happen for different reasons.[2]

The usual suspect

Male pattern baldness (MPB), also known as androgenetic alopecia or androgenic alopecia, is the most common cause of hair loss in men.[3] Up to 95% of guys with thinning hair can blame MPB.

MPB most often begins when a guy is in his 30s or 40s, but it can start earlier in some cases.[4]

Hair loss cuts deep and it’s hard to talk about

Some men view losing hair as a sign of wisdom and maturity, but for many, it can feel like they’ve lost their mojo entirely. Hair is, after all, more than just a beauty asset. It’s very much tied to physical and emotional wellbeing. As a culture, we link hair with youthfulness, health, strength, sexual power and desirability.

According to a 2009 survey by the International Society of Hair Restoration Surgery, almost 60% of men said they would rather have more hair than more money or friends.5 So priority-wise, having hair on your head is right up there! And despite being a widespread issue, balding is still a surprisingly taboo topic of conversation, which means many men suffer in silence.

In the early stages of suffering you might have irrational thought processes and start desperately seeking solutions online. That’s not necessarily a bad thing, but you should also be mindful that it’s the time when you’re most vulnerable to being drawn into the vicious lies of the hair loss treatment industry. Ultimately, choosing to treat or not treat your hair loss is entirely up to you.

The hair care factor

How you choose to view your hair loss is your decision and a mindset shift might be all that’s needed to get comfortable with your new look.

When your inner critic tells you that most people (especially women) have a negative view of bald men, you might like to challenge that thought. The truth is, balding men often find they do better on the dating scene and at work once they shave it all off. Listen to this:

• A study [6] out of the University of Pennsylvania found that when participants were shown pictures of different hair-blessed and hair-challenged men, they repeatedly ranked the bald men (those who had shaved their heads entirely) higher for masculinity, strength, dominance and leadership potential. In addition, baldness was found to make the men appear taller.
• Some balding men took to Reddit [7] and gave this feedback about how shaving their head has affected their dating habits:

*Names have been changed to protect anonymity

So yeah, embrace your baldness, but if you decide to take action to prevent or even reverse your hair loss, there is absolutely no shame in doing that either. For many guys, feeling good requires looking good too. You may need a hairy head to feel confident and take steps to build the life you want, and that’s totally okay. No matter what your hair care factor is, we just want to empower you to live the life you want.

Growth Phase (Anagen)

This is the active phase of hair growth, where 85-90% of hairs are growing at any given time, lasting up to seven years.

Transitional Phase (Catagen)

Hair growth slows as follicles shrink over a few weeks. Approximately 3% of hairs are in this phase.

Resting Phase (Telogen)

The hair follicle is at rest and not growing. Around 6%-8% of hair is in this phase, lasting a few months.

Shedding Phase (Exogen)

At the end of the resting phase, hair gradually detaches from the follicle and falls out. The average person sheds between 50-100 hairs daily. After exogen, old hair is replaced with new hair in the anagen phase, restarting the cycle. Disruptions in this cycle can lead to hair loss.[4]

The causes of hair loss and balding

When you first start to notice that your hair is thinning you might be quick to blame yourself. Is it the shampoo you’re using? Is that new hair fudge to blame? Have you been wearing a hat too often?

Whilst hair loss can be the result of a number of causes, the most common cause is male pattern baldness (MPB), also known as androgenetic alopecia or androgenic alopecia. That means it’s nothing to do with your shampoo, fudge, or your hat. It's actually to do with the genes you’ve inherited.

“Thanks Mum!” we hear you say. But actually, it’s not just her fault.

Contrary to popular belief, the genes from your father play a role too. What researchers are still unclear about, however, is the exact mode of inheritance and the relative importance of each parent.[10] It’s these genes combined with your hormones and environmental factors that set the stage for potential MPB.

Testosterone and DHT - The Major Culprits of MPB

Without testosterone and DHT, you wouldn’t have any of your manly features, but in a cruel twist, they’re also the hormones that play a big part in MPB. Sucks, right?

In the body, testosterone is converted to its more ‘active’ form, dihydrotestosterone (DHT), with the help of an enzyme called 5-alpha reductase.[11] DHT acts on different organs in the body including the hair follicles.

It’s not the DHT production itself that causes hair loss, but the inherited sensitivity to DHT that causes it.[12] Men with a genetically high sensitivity to DHT will be the first to experience a weakening in their hair follicles.

Essentially, the DHT shrinks the hair follicles as well as shortens the hair growth cycle we talked about above.[13] This causes hair to grow out looking thinner and more brittle, as well as fall out faster. DHT can also make it take longer for the follicles to grow new hairs once the old hairs fall out.

Certain behaviours can increase DHT levels

Sometimes the desire to get pumped up at the gym works against blokes that are susceptible to MPB.

Engaging in behaviours that increase DHT production, such as using creatine supplements,[14] resistance and weight training exercise,[15] or taking anabolic steroids,[16] all have the potential to increase hair loss.

Age will get you…eventually

Whether you have MPB or not, hair thinning and loss is actually a normal part of ageing for everyone.[17] It’s called involutional alopecia. That’s not to say you’ll lose all your hair as a result of ageing, but as hormones in the body change with age, and the rate of hair growth naturally slows, the number of hair strands on your head will decrease.

Women experience it too, and it’s one reason you’ll notice many older women with thinning hair, particularly after going through menopause.

Emotional stress or shock can temporarily kill your hair

We all experience some level of stress most days, such as sitting in traffic or dealing with an office worker who chews loudly, but that’s not the kind of stress that will cause your hair to fall out.

It’s periods of chronic or traumatic stress such as dramatic weight loss, illness, or death of a loved one, that can cause hair loss.

Unlike MPB, this is usually a form of temporary hair loss called telogen effluvium.[18] In this instance, follicles are pushed into the shedding and resting phases. Once the stress is under control, however, the hair is likely to grow back over time.

Stress has also been implicated in a condition called alopecia areata – where the body's immune system attacks the hair follicles causing hair loss.[19] But again, once stress levels decrease, hair can grow back.

Finally, trichotillomania is a disorder in which people feel compelled to pull out their own hair as a way of dealing with negative emotions such as stress and frustration.[19]

All these conditions are much rarer than MPB.

Regardless of the effect on your hair, too much stress is not a good thing. It’s important to look after your mental health by eating healthily, exercising, and getting enough sleep. If you’re feeling stressed or overwhelmed, there’s no shame in asking for help from your doctor.

A Poor Diet Can Mean a Lacklustre Mop

You may be one of those blokes who can get away with eating anything, but if you’re starting to thin on top, it pays to look at your diet.

In the developed world, nutritional deficiencies leading to hair loss are quite rare, but if anything, it’s worth talking about protein and iron.

If you’re deficient in either of these, you could experience hair loss.[20, 21] Vegans and vegetarians may be especially vulnerable.

And if you’re aiming for weight loss, don’t try to get ripped too fast. Crash diets and sudden weight loss can cause telogen effluvium – the temporary form of hair loss.

The good news is that once nutritional deficiencies are corrected and you resume a normal, healthy diet, your hair can grow back.

Your Waistline Could Affect Your Hairline

When you’re carrying a spare tyre – and we don’t mean the one in the boot of your car – it puts all kinds of added strains on your body. Your heart, your joints and your hormones to name a few.

If that’s not enough reason to lose the extra flab, this might be:

Research has shown that a higher Body Mass Index (BMI) may be associated with more severe hair loss in men who already have MPB, especially those who started to bald at a young age.[22]

Ready to forgo that second Big Mac now?

Smoking Can Choke More Than Just Your Lungs

We all know the cancer sticks are bad for you, but aside from them being a major risk to your health, they may also be contributing to balding and early greying.

According to epidemiological studies, the toxins in smoke can harm hair follicles and damage hormones. A report in the journal BMJ found a “significant” and “consistent” link between smoking and early greying.[23]

Further research showed that in a group of 740 men aged 40-91 years, smoking at least 20 cigarettes a day was linked to an increased risk of baldness, even after other risk factors were taken into account.[24]

Whilst the results of this research are in conflict with some other studies and more research is needed, giving up the durries will benefit so much more than your hair.

Certain Medications and Illnesses Can Be To Blame

Popping pills for some common health conditions such as acne, high cholesterol, depression and high blood pressure can (although very rarely) come with side effects like hair loss. And then there’s anabolic steroids. What’s pumping up your guns might be causing you to shed more hair.

The severity of hair loss depends on the type of drug and dosage, as well as your sensitivity to that drug.[25]

The good news is that in most cases, hair loss is reversible once you stop taking the drug.

If you are currently taking any of these medications and hair loss is a concern for you, it’s best to speak to your doctor. Remember, never stop taking a medication before discussing it with your doctor.

Some illnesses can also bring on hair loss[26], such as an underactive or overactive thyroid; eating disorders; iron deficiency anaemia; diabetes; autoimmune diseases such as lupus and alopecia areata; and skin conditions such as psoriasis and dermatitis.

If you’re experiencing hair loss, speak to your doctor to rule out such illnesses.

If it’s any comfort, MPB doesn’t happen overnight. Going bald is usually a long and slow process that can take anywhere from a few short years to several decades.

Don’t want to suffer through the process? Then noticing the signs and taking action early is the way to go. The earlier you act, the more hair you’ll be able to save.

What stage are you at?

MPB gets its name because the hair falls out from the scalp in similar pattern in most guys. It’s one of those things in life that you wish wasn’t so predictable.

As a rule, it starts at the temples and crown of the head, and over time, the two areas eventually meet leaving a U-shaped rim of hair at the back. Think Prince William, Larry David and Dr Phil.

Most men never lose the U-shaped section of hair as this hair is typically less sensitive to DHT,[31] although there are rare cases of men losing all of their hair to MPB.

The Norwood scale is the leading classification system used by clinicians to measure the extent of male pattern baldness. It provides a reference point to diagnose the extent of baldness, discuss treatment options, and measure the effectiveness of treatment. [32]

The take home message is that as soon as you discover that you’re losing your hair, the best approach is a proactive one.

A healthy diet and lifestyle = healthy hair

Dadbods might be the new six-pack, but your hair might not agree.

Hair needs adequate protein, vitamins and minerals to keep its strength and shine. Make sure you get enough of the following as part of a healthy, balanced diet:[33,34,35,36]

• Protein
• Iron
• Zinc
• Vitamins C, D, E and A (but not too much A, as it can contribute to hair loss when taken in excess)
• The B-complex vitamins
• Omega-3 and omega-6 fatty acids

And then there’s lifestyle habits…

Research done with balding male twins[37] says that while genetics accounts for most of it, the twin who leads an unhealthy lifestyle increases his risk of more hair loss compared to his brother.

So, get regular exercise, sleep 7-9 hours each night, staying hydrated, quit smoking (if you smoke), reduce your alcohol intake, and manage your stress levels.

Yoga and meditation are great ways to help reduce stress and calm your mind.

Natural treatments or just snake oil and lies?

We know you’re desperate to hold onto your strands, but be careful where you invest your hard-earned cash.

There are a host of natural treatments on the market claiming to increase scalp circulation and prevent hair loss, but only a few have been evidence-based. Here are some popular ones.

Scalp massage

Some small studies[38,39], claim it can help increase hair thickness, but robust research is lacking.[33] The benefits most likely have to do with reduced stress levels as a result of having a massage!

Biotin (vitamin B7)

You may have also recognised biotin (vitamin B7) as an ingredient in many hair thickening shampoos and hair loss supplements. There is, however, no clinical trials that have demonstrated that biotin supplementation can help hair loss when there’s no existing deficiency – and biotin deficiencies in the developed world are rare.[20]

Saw Palmetto

Of all the natural treatments on the market, saw palmetto is the most promising, although it still has limited effectiveness compared to medical treatments.[40,41]

An extract of saw palmetto berries may block the enzyme that converts testosterone to DHT, thereby reducing DHT levels (the hair loss culprit).[40]

It can be taken orally, as topical drops, or in a shampoo, but the doses used in shampoos may be less effective.

Shampoos

You can scrub, shave, brush your teeth and may be do a few other things in the shower (which we won’t mention here), so how about managing your hair loss?

While shampoos may offer a slight benefit (depending on what is causing your hair loss) they’re unlikely to be a game changer for your hairline if you have MPB. Combining them with medical hair loss treatments may improve their effectiveness, though.[42]

These are two common ingredients you’ll see in hair loss shampoos.

Caffeine

It’s a great way to wake you up in the morning, but unfortunately it doesn’t work to wake up your hair follicles. Currently, there is no clinically viable evidence that it improves hair growth in MPB.[43]

Ketoconazole

A small study[44] back in the 90s found that this antifungal drug increases hair density almost as well as minoxidil, but larger more robust research is lacking. It does, however, treat dandruff quite effectively,[45] which some men experience as part of hair loss.

Cosmetic treatments

The Prince Charles kind of combover or a wig are probably not what you consider attractive options for your hair loss. But fear not. There are other hairstyles, products and procedures that can help you disguise your hair loss in a more discreet way…at least for a while.

Hair-Thickening Products

The last thing your thinning hair needs are products that weigh it down, so get rid of any thick pastes, heavy conditioners or gels, and invest in lighter alternatives or hair thickening products.

Thickening shampoos, conditioners, sprays and powders contain special polymers which plump up the hair shafts to make them look fuller. The effects are only temporary so you'll need to use them regularly, but they can increase hair thickness noticeably. Speak to your hairdresser about your options.

Modified Hairstyles

Just because you're losing your hair doesn't mean you don't want to look good. There are plenty of ways to create a trendy, clean, and professional look with thin hair or bald sections of the scalp. There are plenty of haircut for a balding crown to choose from.

The Pompadour
If you’re starting to develop that island of hair at the front of your hair or a thin crown, opt for the swept-back look. Just grow it longer on top, trim it short on the sides, and brush the whole thing back. If you still have some volume, feel free to give it a small part.

The Short Mohawk
This is great if you’re struggling with thinness over the top of their head. Keep the sides nice and tight to make the top look thicker. Use a bit of paste to give it volume and stand up a bit.

The Combover
There is a right and a wrong way to do a combover and it only works if you still have a decent amount of hair.

Grow the hair on the top of your head about ten centimetres and sweep it to the side. Once your hair loss reaches a point where you can see the scalp through your combover, switch to a new style.

The Buzzcut
This style looks good on guys with various degrees of hair loss or recession, and it’s easy to maintain. It's a great way to get used to seeing the shape of your head in the mirror. You can still take steps to recover your hair, but this style will help you become more comfortable with yourself.

The Brushed Forward
If you’re dealing with thinning at the front, you can create the illusion of density by growing it long on top and pushing it forward. This will remove some of the density from the crown of your head, though, so it's not the best hairstyle if you are thinning at the back. Keep the sides short to make the top seem thicker.

The Finger Length
For this style, you cut all of your hair as long as two or three fingers are wide. This gives you enough length to style your hair a little bit, but not so much that you can use it to disguise your hair loss. It’s a great style to ‘connect’ sections of hair that have become separated by gaps.

The Shave
If your hair loss is quite advanced or you’ve just decided to embrace your baldness, go for the shave. It can be liberating!

Get yourself a sturdy straight razor and plenty of razor blades. Stubble becomes visible quickly, so you’ll end up shaving every third day or so.

Remember to invest in sunblock or a hat for sunny days. Sunburn on your head is no joke!

Medical treatments

If you’re serious about saving your hair in a cost-effective way, this is a path you’ll want to consider.

Minoxidil (topical spray)

Of all the medical treatments, this one appears to be the most effective for the least side effects.[46]

It’s most commonly used as a topical foam or spray and works by widening the blood vessels, allowing more blood, oxygen, and nutrients to the hair follicle to slow hair loss and promote hair growth. It won’t stop the onset of MPB, but it can be very effective in the early stages of MPB, and even more effective when used in combination with other medical treatments[47,48,49]

But here’s the thing…

When you first start using minoxidil, you’ll actually have an increase in hair shedding for some weeks before you see any benefit from the treatment. This will likely freak you out, but the hair will grow back again if you can push past that phase. Some scalp irritation is also possible.

A treatment we can't mention

Australian law prevents us from mentioning certain treatments until you’ve spoken to a doctor, so it’s in the vault for now.

What we can say, though, is there is a evidence-based way to halt (and in some cases reverse) hair loss in the majority of men with MPB.[50] When used in combination with other products such as minoxidil, it can be even more effective.[47,48,49,51]

Curious? Arrange a discreet online consultation with a medical practitioner to determine if this treatment is an option for you.

Low Level Laser Therapy (LLLT)

If there was a hair loss therapy for intergalactic superheroes, this would be it.

It’s a non-surgical treatment that works by exposing the scalp to a low level of red or near infrared light.

Researchers think it works by stimulating stem cells in the hair follicle and shifting them back into the growth phase of the hair cycle. The possible result is an overall improvement in the length and thickness of the hair.[52]

Some studies have shown that it’s effective in the short term (when used consistently over several months), but more research is needed to determine its effectiveness compared to other more established treatments, and in the long term.[53,54]

The best thing about LLLT is that it can be done at home using a purchased LaserComb or wearing a laser helmet for a certain amount of time, every second day. It’s painless and has not been shown to have adverse effects.

Cost-wise, a laser comb or cap can set you back several hundreds, if not thousands, of dollars. So, while it might be an alternative to medical treatments, it’ll create a significant hole in your back pocket and it requires commitment and patience to see results.

Minimally invasive treatments

These one’s aren’t quite surgery, but they do involve blood (which we only really like in movies), and they aren’t cheap.

Scalp Micropigmentation (hair tattoo)

Tatts are in fashion, but hair tatts? You might need some time to digest that idea.

This procedure uses microneedles to tattoo pigment into the scalp. It creates the appearance of tiny hair follicles to restore the look of a fuller head of hair. A skilled practitioner works to ensure the dots look like a natural hair follicle and blend in with your complexion.

But having this procedure is not a decision you’ll want to make lightly. Treatments can cost in the thousands of dollars, and depending on the amount of hair loss you have, can take several sessions.

It’s a permanent procedure that requires you keep your hair very short to take full advantage of the look, and the pigment can also fade over time with sun exposure.

Microneedling

This one makes us squirm a little bit.

It’s a procedure that involves the use of a skin roller with small needles that cause minor skin injuries to the scalp. The process of creating tiny skin wounds is thought to regenerate the health of the hair follicles and result in new hair growth, or perhaps thicken thinning hair.[55]

While it’s shown some promise for improving hair growth in some small studies, more research is needed.[56] If it’s combined with other therapies such as topically applied minoxidil, it may help the treatment be absorbed better into to the scalp.[57]

Microneedling can cost in the hundreds of dollars per session, and several sessions may be needed.

It can make the scalp red and inflamed for a few days following the procedure, and there is a risk of infection and scarring.

Platelet Rich Plasma (PRP) Injections

Also known as Vampire PRP Hair Growth this is one of the hottest new treatments to become available, partly made famous by Kim Kardashian (don’t ask). It uses your own blood to help restore hair growth in thinning areas.

Essentially, a sample of your blood is collected (just like a normal blood test) and it is put in a centrifuge machine to separate your blood components. The platelet rich plasma part of the blood is then injected into your scalp with the hope of reviving dying hair follicles.

Although PRP has a good scientific basis to support its use in hair restoration, it’s a treatment that is in its early days and the clinical (in practice) evidence is still weak.[58]

You’ll typically need three treatments in a 4–6-week period, with maintenance treatments every 4–6 months.

Whilst the procedure itself is fairly quick with no downtime, it’s pricey (in the thousands of dollars) and there are risks such as infection, scarring and damage to blood vessels or nerves. [58]

Surgical hair transplants

We’re not going to delve too deep into this option for three reasons:

1) it’s too expensive for many men to consider,

2) it carries significant risks, and 3) it’s a major and personal decision that should be made only after consulting a good doctor.

Various hair transplant techniques are available, but they all involve taking areas of the scalp that have active hair (usually from the back and sides of the head) and grafting these pieces of skin onto bald or thinning areas of the scalp.

It’s the most invasive and expensive treatment for hair loss, and can cost in the tens of thousands of dollars. Multiple treatments are often necessary, and the procedure carries the risk of scarring and infection. The upside is that the result looks quite natural, if it’s done well.

Don’t be fooled though. Hair transplantation doesn’t necessarily provide a one-off definitive treatment for MPB. Even after a successful treatment, maintenance medical treatments are often recommended in the long term to prevent thinning of the hairs that are not yet affected by MPB.

You’ll need to consult with a doctor (or a few) to determine if you’re a suitable candidate for this surgery. In general, the best candidate is someone who has had hair loss for a number of years but it has stabilised and they are not losing more hair quickly.

Stem cell for hair transplant

Stem cell hair transplants offer hope for people who aren’t candidates for the hair loss treatments currently available, but research and application of the procedure is still in its early days.

Can stem cells regrow hair?

Cells in the body have specific purposes, but stem cells are cells that do not yet have a specific role and can become almost any cell that is required[59]. They can also divide to produce more of the same type of stem cell.

Because of their unique abilities, stem cells have the potential to help repair and replace damaged tissues in people who need, for example, organ transplants, skin grafts after severe burns, and in this case, new hair.

The ultimate goal amongst scientists is to create “hair farms”, where hair is grown after extracting stem cells from a person’s skin or blood and those are then implanted into the area where a person’s hair follicles are dormant[60].

Following lab studies done using human tissues, some hair loss clinics in the US and the UK have started performing these procedures investigationally, despite not being approved by their medical regulatory bodies – the FDA and MHRA, respectively.

What is the procedure for a stem cell hair transplant?

It’s similar to a traditional hair transplant, but rather than removing large areas of the scalp with active hairs, it only requires removal of a small skin sample[61]. These small samples of skin contain hairs and fat that are rich in stem cells, from which whole hair follicles can be grown.

The skin samples are placed into a centrifuge and spun at high speeds for a minute to extract hundreds of thousands of stem cells. They’re then mixed with saline to produce a clear liquid that is injected into the scalp[61].

According to Dr Ioannis Liakas in the UK who has performed this procedure, the injected stem cells not only grow new hair, they may also trigger a new growth phase in dormant follicles, taking them back to the beginning of their growth cycle[62].

What are the side effects of a stem cell hair transplant?

Given the infancy of the procedure, there's very little information about the side effects, but similar to the traditional hair transplant, there is a likely risk of scarring and infection at the site of the samples and the injections [61].

What is the success rate of a stem cell hair transplant?

Again, it's hard to know the success rate of the treatment so early on, but one small Italian study conducted in 2017 showed a 29% increase in hair density 23 weeks after the final treatment [63]. More studies need to be done to determine long-term success of the treatment.

What is the price of a stem cell hair transplant?

No standard price has been established yet, but some of the clinics involved in the investigational therapies are charging anywhere from US$3,000 to US$10,000 [61]. So, it might be a promising treatment, but only for those who can afford it!

3-D printing for hair growth

This innovative method was developed by a team of researchers from the Columbia University Medical Centre in New York.

It’s another procedure that involves a hair transplant, but the way the hair is harvested is a little different. Instead of relying on human skin, it uses 3D printing methods, which, unlike traditional hair transplants, means success is not limited by the number of donor hairs a person has.

How do you grow 3-D hair?

Despite what it sounds like, hair is not actually printed with a 3D printer (although there is one company in the US who makes hair prostheses using a 3-D printer).

In this instance, researchers used the 3D printer to make a special mould with projecting extensions half a millimetre wide, which mimic the exact shape of hair follicles64. Such thin projections – made possible because of the printer – were critical to the success of the procedure.

Using the mould, the researchers created a microenvironment exactly like the natural environment that human hair follicles grow in. Human skin was grown around the mould, hair follicle cells collected from human volunteers were placed inside, along with keratin-producing cells, and finally, various growth factors were added. This combination stimulated hair to grow within three weeks[65].

When will hair cloning be available?

According to Medical News Today[65], the researchers say the process is far from perfect, so more work needs to be done in the lab before clinical applications start.

An article in the Guardian[66] pointed out that there are still some aesthetic challenges to be overcome, such as how to pigment the hair and how to create the right texture – straight or curly. Hair follicles grown on the scalp get signalled naturally with which colour and texture to have, but hairs grown in a dish lack that signalling.

Such problems need to be solved before hair is injected into a patient’s scalp and then time will tell whether the treatment is safe and cosmetically pleasing.

So, whilst the timeframe is unknown and there are still problems to solve, the research has the potential to establish a sustainable source of natural hair for transplants in the future. The engineered follicles could also be used by the pharmaceutical industry to screen for new hair growth drugs.

JAK inhibitors and targeting trichophages

The same team of researchers who developed the 3-D printing hair growth model also discovered a new potential therapeutic pathway, called JAK-STAT signalling, for treating hair loss disorders[67].

JAK-STAT is active inside the stem cells of resting hair follicles and keeps them in a dormant state. By applying a topical JAK inhibitor to mice skin, the Columbia researchers demonstrated a way to reawaken resting hair follicles in mice[67]. Since then, a biotech company have successfully completed a phase 2 trail in humans[68].

The discovery of 'trichophages'

The Columbia researchers’ latest studies have looked in further detail at factors that control the JAK pathway activity in the hair follicle. They revealed a previously unknown immune-related cell type that produces a substance known as Oncostatin M that keeps the follicles in a state of dormancy. They named these new cell types, trichophages.

It’s possible that by using small molecule inhibitors and antibodies to block a specific receptor on the trichophages, the researchers could block the flow of Oncostatin M and restart the hair cycle.

What does this mean for people experiencing hair loss?

Discovery of the JAK-STAT pathway and tricophages may lead to new hair loss treatments. Both these pathways act independently of the male hormone pathways, which existing drug treatments target, meaning they could be effective for both men and women.

Drugs inspired by cyclosporine A

In the 1980s, cyclosporine A was approved for medical use as an immunosuppressant in patients receiving organ transplants.

As with all drugs, it comes with possible side effects, one of which was enhanced hair growth. This led researchers to investigate the mechanism behind this specific side effect as a potential for treating hair loss.

WAY-316606

As reported in New Atlas[69], a 2018 study[70] conducted at the University of Manchester’s Centre for Dermatology Research found that Cyclosporine A reduced the expression of SFRP1, a protein that negatively regulates a key pathway crucial for the growth of hair follicles. So, suppressing this protein seemed to explain how Cyclosporine A enhanced hair growth.

The next step was to find a way to specifically antagonise SFRP1 and the research uncovered a compound called WAY-316606.

Originally developed to treat osteoporosis, it was discovered that WAY-316606 targets similar mechanisms to Cyclosporine A but without the broader immunosuppressive actions of that drug.

Tests using human scalp samples revealed WAY-316606 enhanced hair growth, suggesting external application of it, or a similar compound, could be an effective hair loss treatment.

When will WAY-316606 translate into a treatment for hair loss?

According to New Atlas, it’s still early days in the research process. The next step will be a clinical trial (in humans) to determine whether the drug or similar compounds are both safe and effective in hair loss patients.

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