Category Archives: Androgenetic Alopecia

Diet, Lifestyle and Androgenetic Alopecia

Diet Hair Loss
Diet, lifestyle and the pathogenesis of pattern hair loss (androgenetic alopecia).

For a second week in a row, a reader e-mailed me something that impressed. Moreover, in ten years of writing this blog, I have never received original content of this length in terms of effort.

The reader (“RF”) has shared his 60-page version 1 document about androgenetic alopecia (AGA) causes on GitHub. (Note: keep checking in there for updated versions). It covers in detail the connection between AGA and diet and lifestyle

Mr. “RF” also gave me permission to let people download it from here: AGA Diet Lifestyle Connection. Even if you disagree with some of its content, it contains great advice on diet and health.

The reader would like to be known as “RF” and is not in this for publicity or to sell any product or subscription plan. The following statement from him reminds me of myself when I used to “work” full-time in several pointless office jobs:

“Due to my professional position in an office, spending enormous amounts of free time researching cosmetic issues would not be perceived well. I prefer to stay anonymous.”

Note that “RF” also sent me his before-strict-diet and after-strict-diet scalp hair photos and there is some clear regrowth after one year. His blood glucose levels declined from 110 to 85 over the course of two years (in the first year, he had not yet perfected his theory and diet regimen). One anecdotal report is obviously not too meaningful, but everything about this person seems legitimate and sincere to me.

We have communicated back and forth a number of times by now. He is interested in getting reader feedback, suggestions for improvements and corrections. This 60-page document will be revised with further improvements in the near future.

The Connection Between Diet, Lifestyle and Androgenic Alopecia

Almost two weeks after receiving this document, I have only had time to read through one-half of it thoroughly. I did not want to delay this post any further. For now, I will just summarize some of the key points below and will add more details later:

  • While the connection between AGA and genetics is obviously strong, the early onset of and speed of progression of baldness are both significantly impacted by diet and lifestyle choices. This is proven from twin studies as well as diet related studies. Make sure to browse through all the new links on the top in my post titled: “Are men losing hair earlier than in past generations.” The increase in the rate of balding throughout Asia seems especially pronounced. Interestingly, the decline in global fertility rates and sperm counts is no longer even considered debatable. However, the increase in global hair loss rates is still not discussed much.

There are four key disease clusters that correlate highly with AGA:

  1. Metabolic Syndrome and Type II Diabetes.
  2. Cardiovascular disease.
  3. Polycystic Ovary Syndrome (PCOS) in women.
  4. Benign Prostatic Hyperplasia (BPH). i.e., enlarged prostates in men.
  • Consumption of excess carbohydrates and sugar raises dihydrotestosterone (DHT) levels. This is exacerbated by: lack of magnesium (a cause of scalp tension); sedentary lifestyles; lack of sleep; stress; consumption of inflammatory foods; drinking alcohol; and smoking. Make sure to go through the chart on Page 18 and the later discussion of the body’s adipose storage process and fatty liver problem.
  • Downstream effects of scalp vasculature damage and fibrosis.
  • The section on halting hair loss is very detailed. The best diet is proposed as a whole-food plant-based (WFPB) diet. While a free-range meat based diet might be superior to a processed food diet, it still has problems. Meat consumption will raise your levels of purines and IGF-1, both detrimental to scalp hair.

I have not tried to check the evidence for the above, but the dietary advice given does not seem extreme. I am a bit skeptical about any hard-core diet regimens. My grandmother died last year at the age of 103 with almost all of her scalp hair still intact. She never ate meat in her life, and also had a very carbohydrate and sugar heavy diet. Including drinking Coke in old age like Warren Buffett. Sometimes, genes just make all the difference in the world.

Cholesterol, Insulin and Androgenetic Alopecia Severity

A number of people have in the past conducted studies and research on the impact of diet and health upon male and female pattern hair loss. Some of the below studies that analyze this connection are also cited by “RF” in his paper.

  • One famous study that I have discussed a few times in the past pertains to the finding that Japanese men started balding at higher rates since adopting a western diet after World War II.
  • A June 2021 paper from the UK concluded that treatment options for AGA should include: “A low cholesterol and low glycemic index diet, improved glucose control, and fortification with magnesium.”
  • A very detailed 2016 system review on skin manifestations of insulin resistance is quite interesting. It discusses some recent findings on the significant relationship between androgenetic alopecia and insulin resistance. Moreover, some have argued that early onset androgenetic alopecia can indicate insulin resistance.

Note that male pattern baldness (MPB) is also known as androgenetic alopecia (AGA). Around 95 percent of men with hair loss are suffering from AGA. For women, that percent is a bit lower. Other less common types of hair loss that I have discussed in the past include alopecia areata and telogen effluvium.

Past Theories from Foote, English, Hagerty, Roddy and More

Over the past two decades, a number of online personalities have postulated unique theories behind the pathogenesis of androgenetic alopecia. And, more importantly, written detailed articles on methods to stop further hair loss. And possibly even regrow some hair. Healthy skepticism is the default emotion for all these interesting ideas of course.

  • In 2019, I covered hair loss researcher Stephen Foote’s Hydraulic Theory of Hair Loss. He even responded to readers in the comments section of that post. He is currently in his mid-60s and published his last paper in 2015.
  • Another unique hair loss personality is Robert English of Perfect Hair Health. I covered him in my 2019 post on scalp massage and mechanotransduction. His methodology is comprised of both scalp massage and dietary changes.
  • In that same post (as well as here), I covered Tom Hagerty, renowned for his self-taught scalp exercises for hair growth. On his unique site, Tom covers nutrition and insulin resistance in detail.
  • Another hair loss researcher that is widely cited in online forums is Danny Roddy. He has published a book called “Hair Like a Fox: A Bioenergetic View of Pattern Hair Loss.
  • On a slightly related note, there is Dr. Will Powers. He seems to have quite a following when it comes to his topical hair loss customized medications. He does not really belong in this post, but his Reddit page is quite something. I did not want to write an entire post about him so added him here.
  • And while I am at it, who can ever forget crazy Ernie Primeau and his comprehensive (entire) body hair plucking for scalp hair growth theory? He even posted some comments in my above linked post covering him, and made some sense. I appreciated Ernie solely due to the fact that several hair transplant surgeons refused to believe me when I said that men with excessive body hair tend to bald at much higher rates. Only those who have been involved in the hair loss world for 20 years or more will remember Ernie. He ruined the renowned alt.baldspot newsgroup with incessant spam and bickering.

Hair Loss and Heart Disease

In the past, a number of studies and articles have covered the fact that men with male pattern hair loss (especially in the crown region) tend to have higher rates of heart disease. There also seems to be an inflammatory component to both hair loss and heart disease.

When doing research for this post, I even found a post I wrote in 2018 that covered new findings on Minoxidil possibly having heart and brain health benefits. Not surprising considering that it was originally used as a high blood pressure medication.


More Good News on JAK Inhibitors for AA. Mixed News for AGA

I was 50/50 about writing an entire post on JAK inhibitors, but in the end gave in due to the fact that I usually neglect the 1-2 percent of balding people who suffer from alopecia areata (AA) or the related conditions alopecia totalis and alopecia universalis.  For a majority of these people, JAK inhibitors clearly seem to be a cure assuming there are no long-term side effects.

There are also some new developments in the more controversial JAK inhibitors for androgenetic alopecia (AGA) patients discussion that are worth elaborating.  As is the norm when JAK related news comes out, the discussion in the prior post was taken over by this subject, in no small part due to “nasa_rs”.   I have let him run rampant in the comments section only because he came back after a lengthy break from this blog.  He will be allowed to continue posting the same stuff in the comments to this post, but thereafter I will become stricter.  It should be noted that despite his often repetitive comments, over the years “nasa_rs” has sent me some highly interesting and unique scientific information.  And recently, he was the first one out there to find the good news about Alcaris Therapeutics adding JAK inhibitor trials for AGA patients to their website’s pipeline page.  As a side note, if I recall, “nasa_rs” really did or does work for NASA…a bit of a scary thought.

Two New Studies Show JAK Inhibitors Work for Alopecia Areata

In 2014, two groundbreaking papers discussed complete reversal of hair loss in alopecia areata patients.  While this was justifiably by far the biggest news of the year in the hair loss world (and widely covered by the global media due to the spectacular before and after patient scalp photos), there was one problem: the first of these two studies only involved one patient of Dr. Brett King (on arthritis drug tofacitinib), and the second only involved three patients of Dr. Angela Christiano (all three on bone marrow cancer drug ruxolitinib).

Two weeks ago, two new larger studies were released that solidified the above findings:

  1. Dr. Angela Christiano’s team from Columbia University in New York found that 75 percent of 12 patients with alopecia areata had successful hair regrowth while on ruxolitinib for between 3-6 months followed by a 3-month follow-up period.  By the end of treatment, average hair regrowth was 92 percent.  Perhaps the best part of the news: “The drug was well-tolerated in all participants, with no serious adverse events.”
  2. Even more significant, a much larger joint study from Stanford University (led by Dr. Anthony Oro) and Yale University (led by Dr. Brett King) found that of 66 alopecia areata patients treated with tofacitinib, 64 percent of patients had a positive response to treatment (and 32 percent achieved an improvement of over 50 percent after only 3 months of therapy). Side effects were generally mild.

From the above studies, it seems like ruxolitinib is better than tofacitinib when it comes to treating alopecia areata.  It remains to be see if results are even better when treatment is continued for a longer duration when it comes to either of the above two drugs. Note that a number of other newer JAK inhibitors will get approved and come onto the market in the US in the coming years.

Finally, for those who do suffer from alopecia areata, this is by far the best place in the internet to connect with others such as yourself.

JAK Inhibitors for Androgenetic Alopecia (AGA)

Some good news, some bad news and some in-between news here.

The Good:

  • First, from the 12 patient study article link I posted in the above section, Dr. Christiano still seems optimistic about JAK inhibitors working for AGA per the following quote:

“The CUMC research team plans to expand their studies to include testing these drugs in other conditions such as vitiligo, scarring alopecias, and androgenetic alopecia (pattern baldness) where they may also show efficacy. “We expect JAK inhibitors to have widespread utility across many forms of hair loss based on their mechanism of action in both the hair follicle and immune cells,” said Dr. Christiano.

The Bad:

  • However, Dr. King who in the past thought that it was worth testing JAK inhibitors (especially topical ones) for AGA now seems pessimistic according to this article:

“King said it is doubtful that Xeljanz (=tofacitinib) will work for the most common types of hair loss (such as male pattern baldness), which are not the result of an autoimmune disease.”

Note that both Dr. Christiano and Dr. King are listed as advisers to Alcaris Therapeutics in the conflict of interest section of the earlier linked 66 patient study summary page.

The In-Between:

  • One important bit of information on JAKs and AGA that never received the attention it should have (partly because I did not cover this subject much in recent months) happened a few months ago when Solomon interviewed Dr. Eddie Wang (who previously worked with Dr. Angela Christiano).  According to Solomon, Dr. Wang “rated JAKs success chance for AGA 5 out of 10“.  Dr. Wang seemed to think that JAKs could be reducing microinflammation in AGA patients and that could help hair growth.  I contacted him about how he came up with this 5/10 estimate, but he never responded.  I would put this development under “good news” if Dr. Wang had responded with a detailed answer.

Two (or More) Variants of AGA?

I have mentioned in the past that it seems like a majority of balding people have significant itching and dandruff in their balding regions, while some balding people have none of those annoyances whatsoever.  I always wonder if the people who have this itching and dandruff associated with their balding also have a significant inflammation (and maybe even autoimmune) component to their hair loss?  If topical JAK inhibitors do end up helping people with AGA, will those with significant itching benefit more?  I would not at all be surprised if researchers some day find that AGA patients can be broadly split into two main camps.

Pharmacologic Inhibition of JAK-STAT Signaling Promotes Hair Growth

Finally, while I discussed this October 2015 study on this blog before as part of a lengthy post, I keep finding new items of interest in there.  I therefore thought it was worth pointing out the study again here in the hopes that some of the readers with a scientific background can give us more feedback on the contents.  Dr. Angela Christiano and Dr. Claire Higgins are both co-authors of this study. Some of the more interesting quotes:

“Hair growth after JAK-STAT inhibition mimics normal anagen initiation by activating the Wnt (Note: this is what Samumed is focusing on) and Shh signaling pathways.”

“JAK-STAT inhibition causes activation of hair follicle (HF) progenitor cells.”  (Note: also see this important patent filed in 2013: “Jak inhibitors for activation of epidermal stem cell populations”).

“Inhibition of JAK-STAT signaling improves skeletal muscle regeneration in aged mice.”

“Tofacitinib treatment promotes inductivity of dermal papilla (DP).”

“In human hair follicle assays, we show that JAK inhibition via tofacitinib treatment increases the growth rate of anagen hair shafts (skin grafts and organotypic culture assays) and enhances the inductivity of human DP spheres (neogenesis assays).  It is surprising that ruxolitinib treatment did not improve the inductivity of human DP spheres, despite the fact that it increased the rate of growth in the organ culture model. We postulate that down-regulation of proapoptotic signals in tofacitinib-treated spheres, which did not occur in ruxolitinib-treated spheres, may promote survival of DP cells, leading to enhanced hair growth in this assay.”