Earlier today, a reader named Chris posted a very interesting video about a new hair loss treatment from Australia that entails putting some kind of dissolvable listerine-style strip underneath the tongue. Chris asked me for my opinion about this treatment. At first, I thought that this seemed like an obvious scam since the title of the video includes the word “breakthrough” in it. Moreover, the video does not even mention what ingredients are in the sublingual strip or patch itself.
However, since the famous Dr. Rodney Sinclair appears in the video, I decided to conduct further research. Dr. Sinclair is an extremely well respected researcher in the hair loss world. In the above video, he is honest and clearly says that this treatment will not bring back hair in totally bald scalps. Having said that, so far it seems that the results from this treatment on people who have moderate levels of balding have been very positive. And this got me curious about what magic concoction was in the strip itself?
Clinical Trial for Minoxidil Tablets (or strip underneath tongue)
I did not have to conduct much further research to figure out what this new potential breakthrough hair loss cure entailed. On Dr. Sinclair’s blog, the latest post from today discusses a new clinical trial they are conducting that is recruiting both men and women. Volunteers will be treated with low-dose oral Minoxidil that will be given as a sublingual tablet (which will dissolve under the tongue).
I would not be surprised if the tablet is actually the strip/patch that was shown in the video I posted earlier. It would be very uncomfortable to put an actual tablet underneath the tongue and wait for it to dissolve, unless the dissolution happened very rapidly. On the other hand, a strip would be much easier to keep in place underneath the tongue for a longer period of time.
I discussed oral Minoxidil for hair loss in detail last year. While I often use topical Minoxidil foam, I would not take the oral version as I do not want more body hair as a potential side effect. However, oral Minoxidil clearly seems to be a superior option to topical Minoxidil when it comes to hair growth benefits.
If you live in Australia or in the nearby vicinity, perhaps it is worth volunteering for these trials. Today I finally learnt the definition of “sublingual”.
Arrector pili muscles are small muscles attached to individual human hair follicles on both the scalp as well as body (so we have millions of these muscles throughout our bodies). Contraction of these muscles causes hairs to stand up, a phenomenon that is known as goosebumps. Therefore, the arrector pili muscle is often referred to as the goosebump muscle.
The Arrector Pili Muscle Degeneration and Hair Loss
In recent years, a few studies have come out that suggest a possible connection between the arrector pili muscle degenerating (where it gets replaced by fat) and hair loss due to the subsequent disconnection between various hair follicle stem cell populations. It is possible that an intact arrector pili muscle plays a crucial role in the maintenance of follicular integrity and stability.
However, there are many uncertainties about this theory that I discuss in the next section. It seems that while in alopecia areata (AA) patients the arrector pili muscle remains intact, this is not true in androgenetic alopecia (AGA) patients (and unfortunately over 95 percent of balding men suffer from AGA). So this could be why it is much easier to grow back hair for people with AA compared to people with AGA. However, the rate at which the arrector pili muscle degenerates and gets replaced by fat varies substantially between patients and between individual hairs on the same scalp. Some miniaturized vellus hairs in balding regions might even never lose most of their arrector pili muscle connection.
Points of Contention
According to Dr. Sinclair’s own quote from a past paper, “It remains unclear whether arrector pili muscle regression is a cause or effect of permanent follicle miniaturization“. I think this is the crux of the issue surrounding this theory/hypothesis.
It seems like hair that is transplanted from the back of a person’s scalp to the front of that same person’s scalp regenerates the arrector pili muscle. A very important related study from 2012 comes to us from Japan. So it might be very possible to regenerate this muscle.
There are 100s of anecdotal reports on the internet of people regrowing long-lost hair. On the internet, you can find many reports of old men who recently started taking Dutasteride for enlarged prostate issues and have subsequently noticed hair regrowth on areas of their scalps that have been totally devoid of any visible hair for decades. Maybe they regenerated their arrector pili muscles; or maybe their arrector pili muscles always remained intact in spite of severe AGA; or maybe one can regenerate hair without the need for having any intact arrector pili muscles?
It is unclear when exactly we have a point of no return where the arrector pili muscle is largely or entirely replaced by fat and hair stops growing (either as a cause or effect — see first bullet point above). It seems like there is significant variation depending on person and hair follicle. In many cases, the arrector pili might not be entirely degenerated and replaced by adipose tissue even in areas of the scalp where one has been bald for several decades. In such cases, subsequent hair and muscle regeneration could perhaps even be possible via something like Dutasteride or Finasteride?
It would seems that just as with out bodies, muscle beats fat yet again. However, as is always the case in the world of hair, nothing is ever straightforward! Even fat has significant hair growth benefits in the correct circumstances.