Exosomes, ExoFlo, Mesenchymal Stem Cells, Vesicles, XoFlo

Exosomes for Hair Growth. Miracle or Not?

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The 2019 word of the year in the hair loss world has got to be “Exosomes”. Another name for exosomes is extracellular vesicles (EVs).

Update: September 2024 — Another popular option is topical exosomes for hair loss.

Update: August 2024 — A reader and his father both saw great hair regrowth from intravenous exosomes.

Update: November 2023 — Check out my comprehensive list of exosome suppliers for the hair loss market.

Update: December 2020 — I wrote an update on exosomes and hair growth, including a summary of new published studies.

Update: July 2020 — US FDA Consumer Alert on Regenerative Medicine Products. Including Stem Cells and Exosomes.

Update: December 2019 — US FDA warning on unapproved exosome products.

While exosomes can be harvested from most human stem cells, the most powerful ones are derived from mesenchymal stem cells. Exosomes contain no DNA or nucleus, and are around 1000 times smaller in size compared to regular cells.

More specifically, exosomes are tiny nanoparticles (30-100 nanometers) that are involved in cell-to-cell communication and intercellular signaling. They are secreted by most cell types in the body, and contain both messenger RNA (mRNA) and microRNA (miRNA).

Exosomes were first discovered around 35 years ago. They have only been studied extensively for the past decade. Especially in the regenerative medicine field for therapeutic applications. Exosomes are known to activate several signaling pathways that are important in wound healing, tissue regeneration and bone fracture repair. This phenomenon is called paracrine signaling.

I have had a few readers email me about exosome treatment for hair loss throughout this year. There are almost no reviews on this procedure on the internet. Initially, after minimal research, I assumed that this was just yet another platelet-rich plasma (PRP) type of treatment. See my post on whether PRP works for hair loss.

Exosomes to Grow Hair Breakthrough

However, I started paying more attention to exosomes (sometimes called micro-vesicles) a few months ago. Besides some new studies on the subject, a few renowned hair transplant surgeons emailed me to praise this fledgling technology.

Towards the end of this post, I cover some recent studies in support of using exosome injections to promote hair growth. Moreover, there is even a patent filed all the way back in 2010 and approved in 2019 from Singapore related to using exosomes for hair growth. Another patent was filed by a Turkish university in 2015, but is not yet approved.

Dr. Ron Shapiro from Minnesota told me that he is especially excited about early reports. I do not think that he is offering this treatment at his clinic as yet. However, he is very positive about its potential based on feedback from colleagues. He told me that Dr. Jerry Cooley from North Carolina is extremely knowledgeable about this subject.

Some of the early adopters are using exosomes on donor hair before and after a hair transplant and seeing thicker hair. Some are microneedling the scalp beforehand for greater absorption and effectiveness.

It has been postulated that exosome therapy promotes hair growth via providing the signals necessary to reinstate mesenchymal-epithelial communication.

Dr. Jerry Cooley

I contacted Dr. Cooley, and he told me that he is currently writing a paper on exosomes and hair growth with Dr. Daniel McGrath. Dr. Cooley thinks that Dr. McGrath has the most experience with this technology. He also thinks that “exosomes might represent a real breakthrough in hair loss treatment.”

Dr. Daniel McGrath

Dr. McGrath of McGrath Medical has injected ExoFlo into the back of his own scalp with with very good results. He also got a hair transplant for his frontal hairline five months ago. In the below video, the doctor ends with the following statement: “Stay tuned guys, because I am telling you that this is going to be something big.”

The ExoFlo exosomes are isolated from donated human bone marrow-derived mesenchymal stem cells (MSCs). Direct Biologics only launched this treatment in July 2019. The company seems very professional. It has put strict sterility and quality controls in place, including cGMP and cGTP.

ExoFloTM Exosomes and Direct Biologics

Lo an behold, yesterday, one of this blog’s readers e-mailed me a new video (embedded further below) interview with the same Dr. Daniel McGrath. This doctor is based in Austin, Texas and is using an exosome hair loss treatment called ExoFloTM.

The ExoFlo technology is manufactured by a company named Direct Biologics. The company can make over 100 million exosomes per cc in terms of concentration per one source. On Direct Biologic’s site, they describe their product as: “naturally occurring allograft extracellular vesicles.” The company purifies and processes donated human mesenchymal stem cells using a proprietary technique.

XoFloTM

Note that there is another similarly named XoFloTM treatment that utilizes mesenchymal stem cell-derived exosomes. Dr. Ken Williams is conducting a clinical trial on this technology. The exosomes in this case are derived from placental mesenchymal stem cells rather than bone marrow.

According to Bioinformant and CEO Cade Hildreth, the 4 most richly funded exosome startups through 2018 were:

  1. Codiak Biosciences.
  2. Exosome Diagnostics.
  3. Evox Therapeutics.
  4. ExCoBio.

Feedback from other Hair Loss Surgeons

Dr. John Cole

Dr. John Cole has a detailed write-up about exosomes on his website. He told me last week that he would send me some more information in the near future. I decided to publish this post rather than wait longer. Dr. Cole and exosomes were covered in a video by Hairsite in August 2019.

And just last week, Dr. Cole was interviewed on The Bald Truth Show and I have embedded the video below. He makes some very interesting points about fetal exosomes derived from amniotic fluid; the various companies involved and their wide ranging claims (he praises Direct Biologics); comparisons versus PRP, ADSC and SVF; and much more.

Despite some cautious words and warnings, Dr. Cole says that this new treatment is “about as good as it gets.” Exosomes represent the purest form of cellular therapy that is currently available. Also see past blog posts of mine where I discussed Dr. Cole’s work. In a more recent video from 2020, Dr. Cole mentioned 500 billion exosomes per 5 cc vial or injection as the latest achievement. The product is dilated with another 5 cc saline solution.

Dr. Joseph Greco

Exosomes Cell Counting
Cell counting by Dr. Greco using a Luna machine (though exosomes are too small to be counted by this machine).

Dr. Joseph Greco is one of the pioneers in PRP and CRP technology for hair growth. I have covered him a few times on this blog in the past. He seems to always be involved in any new injection based treatments involving stem cells, cytokines, growth factors and so forth. He has an informative page on exosomes on his website. In an email to me last week, Dr. Greco said the following:

“I’m quite optimistic with the addition of exosomes for hair and with other pain and ortho treatments. Because no one really know’s proper dosing yet and how often treatments are needed, we are doing an outcome study prior to an IRB comparing exosomes verses Wharton’s Jelly UCT. I am injecting exosomes and my colleague Dr Edwin Griffin in the other arm of the study is doing the Wharton’s Jelly. Protocols include blood test before and after, global and digital photos with tattoo, patient observation forms and attached is a video of how we doing a cellular assay as part of the study. (the video can be shared). Results will be in 6 to 9 months.”

Note: Dr. Greco sent me the 3 month before and after patient photo, but he does not want it shared on this blog as yet. There is clear hair growth in that photo. The patient had a depleted donor supply from FUT and FUE done somewhere else. If Dr. Greco shares the photo in future, I will paste it here.

Dr. Chiara Insalaco

Dr. Chiara Insalaco is based in Italy and has in the past worked closely with Dr. Cole. She has been involved in some truly ground breaking work in hair loss. However, in the case of exosomes, Dr. Insalaco was cautious and told me the following:

“Actually the research is still in progress. We don’t have yet any scientific evidence about it. I will come back to you when we will have more information.”

Others

  • A California-based company named Novus has been promoting exosomes for hair loss prevention very heavily recently. Their website even claims that:

Hair loss will soon be an affliction of the past. Exosomal therapy is the hair restoration treatment of the future.

I hope that this is not just marketing, and that they have seen strong proof with their own eyes.

  • Also getting into the action is Avalon GloboCare, whose CEO Dr. David Jin seems very optimistic.
  • Update: ExoCoBio (South Korea) is yet another new company involved in using exosomes for hair loss. Their main focus seems to skin regeneration, and they are targeting both cosmetic and medical applications. In April 2020, company CEO Byong Cho made an interesting webinar presentation. He discusses exosomes and hair loss in the second half of the video. On Facebook, the company announced in January 2020 the pending release of a 10 billion exosomes per cc hair loss product.

Recent Studies on Exosomes and Hair Growth

Note that there already exist a few studies that have concluded positive effects on hair growth after exosome treatment.

Also of interest, several years ago, I covered a new hair loss drug candidate called UK 5099. Earlier this year, scientists successfully tested a combination treatment involving this UK 5099 drug and exosomes in growing hair. The delivered both products via a unique microneedle patch.

Further reading: A 2011 article titled “Exosome Explosion” suggests that this field only started getting significant traction around that year. And when it comes to hair loss, it seems like we are only starting to get traction in 2019. One amazing thing of note — in 2005, there were less than 50 results on PubMed for a search on “exosomes”. Today, there are over 10,000 results.

Growth Factors in Extracellular Vesicles

There are 100s of proteins, cytokines and growth factors in exosomes. Far more than found in platelet-rich plasma. Among the ones that are proven to aid hair growth and have been covered on this blog in the past include FGF, HGF, IGF and VEGF.

Make sure to read my post on PRP and growth factors for more information on how growth factors benefit scalp hair.

Premature Balding, Early Onset Hair Loss

Are Men Losing Hair Earlier than in Past Generations?

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This post was originally written in January 2018. Every few years, I add some new updates on top.

Update — September 2025: From Reddit, did people from older generations have better hair?

Update — February 2021: Our hormones are out of whack. Sperm counts and egg quality have drastically worsened. Women reach puberty much earlier. Endocrine disruptors (in plastics and much more) may be to blame. Average sperm count levels in western countries have dropped 60 percent since the 1970s.

Update — November 2020: Hair loss epidemic in China fueling hair transplant boom. Especially among those born in the 1990s.

Update — July 2020: Increasing rates of hair loss at younger ages in South Korea.

Update — April 2020: A new CNN article analyzes the increasing rates of hair loss and balding in Asian men.

Update — October 2019: Millennial Chinese men are going bald at younger ages. A number of such reports have come out of China in recent years, some of which I cover further below in this post.

A new study from from South Korea suggests that overworked men are balding younger and faster. People in their twenties or thirties who worked at least 52 hours per week were twice as likely to develop alopecia in comparison to their lazier counterparts. It should be noted that stress has been blamed for hair loss many times in the past, so this is not an entirely new finding.

Apparently, worsening air pollution levels are causing higher rates of hair loss. I am not entirely sure if air quality is worse today than in the past. Factory emissions and car emission are certainly much cleaner compared to 50 years ago. However, at the same time, both human and car population levels are drastically higher in comparison to 50 years ago.

Fewer Balding Young Men in Old Photos

For many years, I have observed and felt that men are losing their scalp hair earlier than in past generations. Males 25 years and younger rarely seemed to go bald in the past, at least based on what one can see from older photos.

I have also noticed this increased hair loss phenomenon in younger women in more recent years. However, the generalized thinning type of hair loss in females is sometimes harder to notice from a distance.

My original observation regarding increased rates of hair loss in younger men was based upon three key factors:

  1. Seeing at least half the older men in my father’s and grandfather’s generations still having excellent hair in old age.
  2. Fewer young bald men in the past.
    No bald young men among college graduates in 1900.

    Seeing old group photos of people from 100 or more years ago from around the world having very few balding people. Sometimes none. There are also rarely any obese young men in such older group photos.

  3. Noticing NBA basketball players going bald at much more rapid rates than in the past. Because fully shaved heads in the NBA have become very popular over the past three decades, this point is hard to prove and I could be wrong. Afro hairstyles have almost gone extinct, but is that purely due to fashion? Or also due to the fact that very few men can grow Afros when most have some degree of hair loss? A number of basketball players have discussed their hair loss openly in recent years. Some after shaving it, and others while trying to hide their hair loss like Lebron James. NBA players are also more muscular than in the past.

The second point above is all the more impressive when considering the fact that no-one in those old photos would have had a hair transplant at that time. Moreover, hairpieces would have been far more obvious in that era and easily noticeable.

In modern group photos, it is quite likely that at least one person in the group has a had a hair transplant; or is using a hairpiece; or is using a hair loss concealer.

For example, in recent US politics, Donald Trump and Joe Biden come to mind as men in the upper echelons of power having had some type of surgery to give them new hair. Both of them when appearing in group photos are deceiving us.

More Evidence that Men are Balding Earlier

My above three original observations were further solidified by several further developments during the past decade.

Around 10 years ago, my older female hairdresser told me that she was seeing many male high school children going bald. She said it was quite shocking, and in the past she rarely saw men younger than 21 with any significant hair loss. My hairdresser did not mention younger females having thinner hair at a greater rate than in the past. I think that premature hair thinning is also happening to females more frequently.

In more recent years, I have read a number of articles discussing how Japanese men were going bald at much greater rates than in the past. In fact, it seems like balding in your 20s and early youth was an exceedingly rare phenomenon in Japan prior to World War II.

Are Bad Diets Causing Increased Early Onset Alopecia?

A famous scientist by the name of Dr. Masumi Inaba published a famous book in 1985 in which he concluded that after World War II, Japanese men were going bald at a much more rapid pace. He postulated that this was largely due to a westernized high animal fat diet. This was adversely impacting hormones and sebaceous gland activity. It should be noted that average height in Japan as well as the rest of Asia has gone up with dietary changes over the past century.

Other studies have shown that Japanese men who move to the western world start balding more rapidly. Some people think that bad diets are causing excess inflammation in human bodies along with insulin resistance. Both of these can adversely impact scalp hair.

While researching this post, I also found a 1990 paper from the Netherlands that immigrant communities were experiencing higher rates of hair loss than in their home countries.

Other Theories on Premature Balding

There are many other theories besides dietary ones as to why premature balding and androgenetic alopecia rates are increasing at younger ages. You will find at least a few studies on the below highlighted factors correlating to higher rates of hair loss. However, none of these theories are set in stone or conclusively proven. In many cases, the hair loss due to any of the below factors is temporary.

Low Vitamin D Levels, Hormone Alterations, Chemicals and Stress

Some scientists think that low vitamin D levels can cause hair loss. This is especially true in northern hemisphere western countries with limited sunshine for months on end.

Historically, Caucasians have had much higher rates of male pattern hair loss in comparison to other races. In the modern day, lack of vitamin D has been further exacerbated by heavily indoor-based lifestyles worldwide. Direct sunlight is the ultimate and most natural source of vitamin D.

Yet other hypotheses have focused on changing hormone levels in humans due to various chemicals in our environment, food and water. This includes effects of birth control medications, pesticides, herbicides and more in the water that we drink.

Increasing stress levels in modern societies have also been used to explain higher rates of hair loss. Steroid, growth hormone and testosterone supplementation have all also been blamed for increased rates of hair loss. Especially among athletes and body builders.

Online pornography addiction has frequently been blamed for hormonal changes and hair loss. Although I doubt there are any studies on this sort of thing, it would not surprise me if porn addicts had altered hormonal makeups.

None of these theories are set in stone of course. Moreover, it has not even been proven that hair loss rates are definitely higher in the current generation than in past generations.

Will Evolution Make all Men Bald in Future?

Evolution to balding alien look.
Evolution of male hairlines into an alien-like appearance?

Genetic theories on hair loss have focused on the fact that balding can be passed on from either side of the family. And it does not require both male grandparents to be bald for a male grandchild to also be bald. i.e., balding is a dominant trait and therefore likely to increase in each generation.

However, the genetics of male pattern hair loss are not so clear cut. On many online hair loss forums, people have joked in the past that the final step in human evolution is when everyone (or at least all men) look like in the above photo. So from an evolutionary perspective, it makes sense that each generation is balder than the prior one.

More Younger Chinese and Indians Loosing Hair

The reason for my writing this article is due to yesterday’s news from the South China Morning Post that a shocking 60 percent of university students in China were losing their hair according to one survey with 4,000 participants. Per Dr. Fu Lanqin:

“My feeling is that this generation is losing its hair sooner than previous generations.”

China is the world’s most populous nation, and historically, Asians lose hair at much lower rates than Caucasians. However, a 60 percent hair loss figure for young university students in China seems even higher than what we would see today in the western world’s colleges.

India is the world’s second most populous country. In recent years, a number of articles from that nation’s newspapers have mentioned increasing hair loss in younger people. One of the more interesting ones found that young Indian men from the IT sector were especially prone to balding.

Koreans Too

An article published in 2018 suggests that Korean men are also losing their hair at an earlier age than in the past. The usual reasons of bad diets, stress and sedentary habits are given for this increase in premature early onset balding.

It seems like whoever finally comes out with a hair loss cure will have an unlimited supply of young clients.