Ralf Paus is the Ultimate Hair Geek

Update: Dr. Paus answered some questions in the comments.

Dr. Ralf Paus might be the most interesting and prolific hair loss researcher in world. I have covered his past work (and his Monasterium Lab) many times on this blog. However, it is only in 2021 that I have become a true fan.

Make sure to listen to Dr. Paus’ two latest Dermasphere podcast interviews below:

Dr. Ralf Paus
Dr. Ralf Paus presenting in 2018.

The problem I have with covering Dr. Paus is the fact that his work is way too extensive and wide ranging. This is probably due to the fact that he collaborates with numerous co-author scientists and researchers.

Moreover, besides via his own Monasterium Lab (Germany), Dr. Paus is affiliated with:

Dr. Paus and his team’s most discussed recent work was in relation to the olfactory receptor OR2AT4 and its impact on hair growth. In particular, via the synthetic sandalwood odorant (perfume) Sandalore. Also see this 2020 update on its use for telogen effluvium.

It seems like Dr. Paus and his Monasterium team are especially focused on developing topical cosmeceutical and nutraceutical type hair loss products. They also offer pre-clinical and clinical research facilities, including for pharmaceuticals. Their principal scientist is Dr. Marta Bertolini.

Dr. Ralf Paus Interview

Dr. Paus has offered to answer reader questions in relation to any of his hair loss research. It might take him a while to respond since he is so busy. Please post your suggestions in the comments to this post.

As I noted previously, Dr. Paus’ copious work covers a wide scope (and extends for two decades). Moreover, in 2021, he has already co-authored six new papers per PubMed. All related to hair.

On the Monasterium Laboratory site, they list their clients to include Allergan, Follicum, Giuliani Pharma, L’Oreal and Shiseido. I have covered all these companies many times on this blog.

91 thoughts on “Ralf Paus is the Ultimate Hair Geek”

  1. Is scarring alopecia close to having a solution besides slowing down progression? Specifically regrowth of hair over scarred areas.

    1. Honest answer: No. Once a hair follicle has been replaced by a scar, pharmacotherapy has lost the battle.
      But getting much better at halting progression is the first critical step. Now that we understand some of the key pathomechanisms, we should should soon get there.
      (One likely important future drug class in this battle: topically applied PPARg modulators/agonists.)

      1. I need to update the below post as it is very badly organized, but there are a number of interesting “miracle” examples in there (e.g., burnt scalp regenerating hair photo):

        https://www.hairlosscure2020.com/so-it-seems-like-totally-balding-areas-of-the-scalp-can-regenerate-long-lost-hair/

        Many other unusual one-off type examples in long-bald older men. e.g.,

        https://www.sciencedirect.com/science/article/abs/pii/S0965206X17301328

        https://pubmed.ncbi.nlm.nih.gov/1977262/

        Follica’s premise also seems to be that wounding can create brand new hair follicles (“neogenesis”).

    1. Makes good sense, but is unlikely to be sufficiently effective on its own. Combination with topical minoxidil recommended.
      But even that may not suffice. Optimized combination treatments needed.

    1. Am not so sure about “phenomenal promise”…
      While blocking prolactin receptor-mediated signaling may be useful in male pattern balding, prolactin even appears to be needed for female scalp hair follicle growth. Thus, “blocking prolactin” might backfire in female pattern hair loss.
      More research on the role of prolactin in human scalp hair follicle physiology and in male versus female pattern balding needed before one jumps to premature conclusions.

      1. Plus prolactin levels have been shown to have significant correlation or influence on disease response. I remember, for example, higher prolactin level individuals have a better tolerance and recovery when infected with covid, versus low prolactin. Not sure about the mechanism to explain the connection of prolactin and immunity.

  2. 2) Are their any clinical trials on your research on sandalore, stevioside and other cosmetic you have shown to be effective at growing hair?

    1. Not that I am aware of.
      But you may wish to double-check with Giuliani S.p.a., Milan/Italy, the company that markets Sandalore (“Bioscalin Signal Revolution”) in Italy.

    1. Well, I have been wondering about this, too…
      In principle, this would indeed seem possible – but there are many daunting practical, patenting, and regulatory hurdles to overcome with such a combination approach.
      Also, objectively testing whether this plausible approach really works will require a lot of (very difficult-to-obtain) funding.

    1. Yes, regulating the Wnt pathway is definitely interesting and promising. But one has to be very careful, since chronic overstiulation of this powerful pathway could also promote the some skin tumor growth.
      Therefore, I prefer the approach to rather block/downregulate key inhibitors of Wnt activity (see Hawkshaw et al. PLoS Biol 2018, Bertolini et al. Br J Dermatol 2020) – safer and, perhaps, even more effective.

      1. Sorry but it’s not clear from this research what the (cosmetic) agent to treat this would be? Both cyclosporine and WAY cant be used safely long term.

  3. 6) Is there a problem with good and viable research being done, but the results not being commericalised? What possible avenues have not been explored commerically?

  4. There are several different cosmeceuticals in the research pipeline of Giuliani. When do you expect them to be launched and available? (the Way or Sandalore product and others).

    1. Sandalore is already available on the Italian market and via the internet (“Bioscalin Signal Revolution”).

      See also Bertolini et al. Br J Dermatol 2020

  5. Thanks everyone for sticking to the subject at hand! Most off-topic comments in this post will likely be deleted.

    1. Have seen too few hard, convincing data on the effects of microneedling to be able to comment positively or negatively

      Follicum: I have enjoyed collaborating with this company for a long time (and am thus clearly biased!), but am impressed by their serious, science-driven approach (the studies Follicum publishes speak for themselves).
      If more companies active in the hair arena today rigorously followed this approach, rather than a primarily marketing-driven one, we would already have much better hair products to choose from.

  6. Thanks for reaching out to him and giving us the opportunity to ask questions, admin!

    1. Somebody already mentioned it here but I’d also be interested in his opinion on Prolactin and its effect on hairloss. Has he read the news about Hope Medicine and what does he think of it?

    2. While I don’t expect Dr. Paus to deliver an exact date (as I assume he also has no crystal ball to look into the future), I would like to ask for his opinion on what’s his estimate on when a cure for baldness will be available (bonus question: will there be one in our lifetime in his opinion?)

    3. This goes hand in hand with #2: Which approach does he think is the most promising to provide us with a cure (e.g. hair cloning, etc.)?

    1. 1) see my comments on prolactin above (no, have not seen the news on “Hope medicine”)

      2) whether and when a “cure for baldness” will become available very much depends on how much serious research effort (=funding) is being invested into it; since that has been dismally insufficient, we are in for a long wait – until this situation changes (thereafter, 1-2 decades sound like a reasonable guesstimate)

      3) I place my main hopes in the “cure for baldness” challenge on good old, well-targeted pharmacology, rather than on cell-based therapy, and certainly not on “hair cloning”. However, well-characterized exosomes (generated from a patient’s own hair cells or blood) could attain therapeutic importance as well – if their effect on human hair growth in general and balding specifically is studied more systematically and in-depth in the right models, at long last.

      1. Why has this reply not received more comment? A cure is “1-2 decade” away?? That is crushing for anyone who was thinking more like 1-2 years. And his 1-2 decades is only after the “situation changes” around funding. It looks like there will be a cure for aging before there is a cure for baldness.

  7. Hi Dr. Paus,

    Stemson Therapeutics, Shiseido and Dr. Takashi Tsuji/Riken all seem to be less than 5 years away. Any thoughts on their work?

  8. Hi Doctor Paus. You have already been asked about prolactin. But

    1) do you have any idea why Bayer would choose a prolactin receptor antibody over a small molecule inhibitor? A small molecule inhibitor would be way cheaper and topically deliverable.

    2) Prolactin has been implicated in keeping adult stem cells in a quisescent state. Could this be the reason why hair regrowth is so hard, that we would first need to inhibit the extrapituitary prolactin?

    3) Do you have any opinions on PAI-1 inhibition for androgenetic alopecia?

    4) Monasterium laboratories, when do you/your company plan to release the taste receptor cosmetic to market?

  9. Hello Dr. Paus,

    First of all, thank you for taking the time to come on here and answer our questions.

    I’m curious what you think the limit is for pharmacological restoration of dormant/vellus follicles to full thickness terminal hairs in terms of the amount of hair that could be restored with the right treatments, and the timeframe after which restoration becomes impossible. Is there potential to regrow slick bald areas, and what would be the limiting factors that would make it impossible, such as enough fibrosis to destroy the follicle?

    Regarding the question of prolactin, have you seen the macaque study showing substantial regrowth of terminal hairs from a PRLR antibody? If so what are your thoughts on how this could translate to human males?

    There was a recent paper(Harshuk-Shabso, S., Dressler, H., Niehrs, C. et al) showing that FGFR signaling induces catagen through suppression of R-spondins. What do you think of the potential of R-spondin agonists?

  10. I place my main hopes in the “cure for baldness” challenge on good old, well-targeted pharmacology, rather than on cell-based therapy, and certainly not on “hair cloning”. A “well targeted pharmacology” is not a cure and it’s a way for big pharma and scientists like yourself to profit from us not once but unlimited until we stop treatment. I find it interesting that you are not hoping for hair cloning when that would be the one and done cure for most, several scientists are working on it right now as you probably know. And exsomes have already been tested on humans for AGA and it’s not wonderful I doubt years of more testing will make a difference.

    1. woofy97, bioengineered hair follicles are the true future of treatment and cosmetical enhancement. This is without question. Imagine being able to synthetically control: Hair curliness, hair diameter, hair growth rate at the dermal level by manipulating parameters like DP cell count. This is still new in development, but the dream becomes clearer every year. In general, the world is moving away from traditional pharmaceuticals into bacterial therapies (injections for autoimmune diseases), viral therapies, cell therapies and genetic elements (miRNA)

  11. What are your thoughts on WAY-136606 and its potential for topical application in treating hair loss?

    In the past there were companies working on this but then shifted to something “derived” or “similar” to WAY-136606 and it is unclear to me exactly why.

    I understand of course there is a long way to go between published studies and phase1-3 trials but to my knowledge I could never find a concrete reason why it didn’t get further.

    Thanks.

  12. Not to be too greedy but if you have time for one last question from me:

    What are your thoughts on KY19382 and do you think its a “silver bullet” of sorts?

    If not that then at the very least do you think it has promise in that it could provide a new pathway (blocker or growth promoter) than what we already have at our disposal these days (dut/fin/minxo)?

    Thanks!

  13. Dear Community, dear Dr. Paus,

    I would be interested in how Bioscalin Signal Revolution works. Personally i can not find any Reviews/ articles in english, only in italiano.
    I also would be interested in when it will be available worldwide?

    1. I am also interested in Sandalore. I remember it looked very promising when studies were published about it. Did anyone get the chance to try it? I remember that results were supposed to come in a very short period of time and with a pretty good amount of hair regen.

  14. Is micro-needling in conjunction with minoxidil superior because it inhibits TGF beta and mitigates the production of collagen?

    *TGF beta is a pro-inflammatory cytokine responsible for increased collagen product. Over time leading to fibrosis and ultimately hair follicle miniaturization. Micro-needling tends to enhance the product of collagen, which *could* have an extremely detrimental effect on hair growth.

    **It is for that reason that I wouldn’t be surprised in case the adjunctive topical product in Follica’s micro-needling device will turn out to be a drug which reduces inflammation.

  15. Hello Dr. Paus, I would also like your opinion on SM04554, as Kamal stated previously. Correct me if I’m wrong, but SM04554 may be the only possible pharmaceutical candidate available in the next 2 years.
    Thanks, have a wonderful day and keep fighting the fight!!

  16. Hi, just one on dermal papillae transplanting and attempted regrowth with non androgen sensitive cell populations in the scalp from the occipital scalp. Are these therapies likely to yield permenant results ? Im 100% keen on the idea on the basis of reactivation of follicle from the androgen sensitive areas that initiate miniaturisation. However, is it
    plausibly going to be unsuccessful because hair loss is possibly a more wide spread mechanism… the galeal aponeurosis changes in terms of tension is the one I can reference off the top of my head (and obviously mirrors the receding hairline). On top of that I’ve seen that occipital follicles aren’t androgen insensitive they are just not regressing in the same way possibly because of mechanisms like thjs

  17. I think the doctor might’ve left the house…?!
    I’ll take all questions from here…
    Is there a cure? No.
    Is there a ‘definite’ timeline for better treatments in the future? No.
    Will my partner still love me if I’m bald? *No.
    (*unless you don’t give a sh*t).
    Is there any hope left at all? Possibly?
    Is SummyKim a little bored today? Refer to above answer.

    1. Lol so true Kim , unless hair cloning happens there’s no hope but I seriously doubt it’ll happen within this decade.

  18. Just a general comment, not for anyone in particular…

    I’m sorry, but I don’t believe the pharm industry can cure this. Not a true cure. And by a true cure I mean a full head of hair. What they’ll do is come come out with minoxidil part 2, then part 3 etc. or more products that you have to study super close to see the .03% density increase. Maybe it’ll happen but it won’t be for a very long time, if ever. Instead it’ll be more of the same and and they’ll continue to try to bleed everyone dry. Jaded? Yes, but it’s their fault for pushing snake oil and after pics that look exactly like before pics year after year (after year).

    In my opinion, hair cloning is what is going to cure hair loss. And yeah, it’s not going to happen soon, but it would happen sooner if more money was put towards it (and less towards “cures” with .03% density increase – what a joke).

    I’ve lost all faith in the pharm industry to cure hair loss. They dispute hair cloning as the cure because they see the potential loss of billions every year in revenue. But I refuse to purchase any wannabe cures. I’m done with that. Unless I see true results, meaning big time density and hair growth, I’m no longer interested. I’d rather just save my money and wait for the real cure.

    1. I agree with that and BAYERS idea to use an injection is living proof of that. They have an endless stream of r and d money but chose a non conventional therapy for a reason

  19. Let’s be honest here the likely hood of hair cloning happening within this decade is SLIM TO NONE!.. DONALD TRUMP has a better chance of winning another term in 2024, which he probably will win if he runs again, then hair cloning coming out mark my words….

    1. Trump was the only president that would have helped bring attention to hair cloning if he knew about it. He talked about his hair a lot in his speeches and spent $70,000 on his hair. He’s also on fin

      1. I know I was hoping he would fast track stem cell research but I believe the pharmaceutical industry came to him and lobbied against any stem cell research,just my opinion but I’m pretty sure I’m correct!…

    2. Do you think a real cure from pharm is coming within the next decade? No way (depending on your definition of cure). I have yet to see ANY evidence (photos, etc) or anything being worked from pharm that has REAL growth (significant growth). Zero. In fact, some pharm products take decades to make it to phase 2 or 3 trials – THEN they wow us with their pitiful results (or else never put the product to market). Anyone that’s been following the hair loss industry long enough knows now to get their hopes up from pharm. Their ideas/definitions of a cure are weak (less than 1% growth but they still tout how great it is and that we should all buy it for $100 a month for the rest of our lives). We’ve all been burned too many times. I hope I’m wrong but I very highly doubt it. And they have a lot to gain (billions annually) from trying to downplay or discredit cloning – which I agree isn’t likely anytime soon either.

      Personally, even though I’m not super young, I’m good waiting 10+ years for cloning. And it may be expensive but I’ll be saving all the money I won’t be spending on snake oil cures for the procedures.

      I’ll still follow the pharm work, and like I said hopefully I’m wrong. I just won’t be buying anything unless it shows real growth. I’m no longer wowed by 5 new hairs. It’s significant growth or nothing for me. Time for the pharm industry to…….or get off the pot, so to speak.

      1. FYI — The pharmaceuticals that MTF transexuals take often bring back some scalp hair that was lost years ago. Same with Dutasteride (Avodart) in the best responders.

        1. I follow it all. And I’d love to be wrong. How much is some? I need pics for proof. And good ones not shadowy pics where I need a magnifying glass to see anything. We’ve been down this rows and I’m skeptical. I think most of us are. Obviously, breakthroughs do happen and they could really produce a great product (and I truly hope they do). But if all of this funding was thrown at hair cloning I think we’d see a real cure much sooner. Instead, funding is going to 200 different “solutions.” We’re not coming together to combat this, it’s like a one for all and all for one. Which makes it much more difficult and time consuming to actually cure. But yes, I know, it’s the nature of the beast. Everyone has different tech and ideas and beliefs on how it could and should be done. That will never change.

          I won’t beat a dead horse. We’ll see in time. We could all be wrong. Who knows?

          Cheers.

          1. As far as MTF before and after pics go, I have seen dozens over the years that totally blew me away. e.g.,

            https://www.reddit.com/r/transtimelines/comments/dd85fp/i_didnt_think_this_was_going_to_work_but_i_think/

            https://imgur.com/gallery/FOL39

            https://imgur.com/gallery/3DNJp

            https://imgur.com/a/XL74b

            Was planning to write a post on such transformations, but postponed indefinitely. We will not take so many pharmaceuticals daily as almost none of us trying to become female :-(

      2. James1 may I ask you how old you are ? Since your willing to wait 10+ years. I’m 35 and I said this in1997 when dolly the sheep was cloned, I thought for sure by the time I’m 35 hair cloning should be out I mean there cloning all sorts of mammals with eyes and fur and organs I thought for. Sure they’ll be able to clone a single hair, pffffff much to my dismay were not even close to being able to clone one human hair, so I just don’t know how much longer I can wait I’m only a Norwood 2 but it destroys my confidence. Its nice that were hearing from Dr tsuji, but honestly I’m starting not to trust him especially after coming out with a shampoo c’mon give me a break

        1. Same age as you. Very good point though. We could be having this same conversation in 10 years. Things move super slow, unfortunately.

  20. Senolytics (Dasatinib + Quercetin) appear to regenerate new hair in mice by getting rid of senescent cells. So far the human studies seem to me complying with animal studies.

    I would think that the robust autophagy from an extended fast repeated monthly, like maybe Dr. Valter Longo’s 5 day fasting mimicking diet, or a 5 day water fast, would be helpful in sloughing off damaged cells and regenerating new tissue would also be beneficial. New stem cells are generated somewhere between 3 and 5 days.

    Advanced Glycation End Products (AGEs) also play a huge role in the aging process. So eating a diet low in AGEs could only be a good thing. In addition, the are also some supplements that interfere with the formation of AGEs and/or protect against the damage that they cause: Benfotiamine, pyridoxal-5-phosphate, alpha-lipoic-acid, and Carnosine.

    I use an alpha reductase inhibitor, dutasteride, and Dr Proctor’s shampoo. I would never part with either. And I also use Nizoral occasionally.

    1. Dude Stemsons therauputics are not going to come out until the next decade if propecia took 20 years to come to the market after its discovery , i can only imagine how long ClONING Will take ! Not only that its a business so its probably not going to be permanent to make people keep on coming back.

      1. Idk Marc I mean Finasteride is a oral drug so I’d expect the FDA would take 20 years for a oral drug. they need a quicker way though, But we’re talking about your own hair follicles basically a hair transplant the only bad thing that could happen is cancer but Alexey says it’s very hard to cause a cancerous mutation from this, he said the worst that could happen is rejection of grafts. If the FDA slow walks this American groundbreaking some would say life changing innovation while the Japanese have it then it’s a big missed opportunity.

        1. I didn’t say that. I said its a possibility and if you can wait 20 years what are you doing here checking in ? Come back in 20 years Jan

          1. marc i am interested in hair cloning that is why i read this forum, 20 years is a long road, personaly i think it will takes 10 years for full commercialization

            1. I agree hair cloning isnt coming out until the next decade or when Dr dre drops a new album he drops one every 20 years or so. Either way 10 years is à long long time to wait for something that should have already been here by now. And i dont know if i can waste my life waiting to see if this comes out

                1. I see what your saying but 10 years is à very very long time and its not promised. But either way everyone is wasting there time and energy becuase hair cloning Will not happen until the next decade it doesnt matter what woofy97 says this is not coming out until 2035. And im right sorry to say that but its true

  21. What do you think about mechanical stress and hair loss?

    https://www.sciencedirect.com/science/article/pii/S0306987717310411

    One thing is nobody seems to be able to explain why hair on the top of the head is genetically different from the hair on the sides (which doesn’t fall out).

    It seems the mechanical stress theory has some explanatory value as to why baldness happens in a pattern.

    The stress models line up exactly with pattern hair loss.

    Seems to close a correlation to be coincidental.

    Any thoughts on this?

  22. @Omg
    I believe that the issue is in the soil (the scalp environment) not the seed (the actual hair follicle)…
    As the balding scalp has a significant higher inflammatory markers profile in comparison to the non balding scalp in the same person
    1- ​higher fibrosis (4 times higher)
    2-Higher Prostaglandin D2
    3-Higher Calficofication of the small artieries
    4-lower blood /oxygen supply (hypoxic environment) (where T is converted into DHT )

  23. Might be a dumb question but what the hell. Castration stops hair loss but does removing the prostate stop hair loss as well? Because Finasteride shrinks the prostate so

  24. I have been using finasteride and 5% minoxidil for almost 20 years, in all these years I have been able to maintain a fair amount of hair but lately I am losing ground on the hairline, can someone tell me if there is anything I can add to what I’m already doing, in order to stop further recession?

      1. @cowlick – can you elaborate? Which Dr. Pen do you use and how often do you use it? Which size needles? Thx.

        1. •Dr. Pen A6 Ultima
          •12 pin cartridges
          •1.5mm depth
          •Once per week
          •Small circles on scalp at the highest speed usually 5-10 circles (only until skin is red not bleeding)
          •I soak the cartridge in 70% alcohol before using it
          • I use 5% minoxidil daily, but I wait 24 hours after the dermapen usage
          • I tend to get minoxidil sides so sometimes I go down to half dosage

            1. Sure thing. Some people reuse the cartridges a few times and keep rinsing them in alcohol but you risk an infection so it’s your call. Others do one time use on the cartridges. After I put the cartridges in alcohol I let them dry for a while so I’m not putting alcohol into my scalp.

  25. Admin,

    What do you think about the mangrova trees extract?
    There is some news online from this january and seems it will be on the market in some months.
    I do not have hope but maybe it can help slowing the baldness.

  26. You & me both, brother! I am suddenly thinning pretty dramatically in the frontal hairline after being on these puke drugs for so many years. They may lose their effectiveness as one gets to be a certain age or after taking them for so many years. I cannot wait for better treatment options!

  27. As always, Thank you for the elaborately detailed review for MSM.
    one thing I would like to add is that MSM when added to DMSO is effective in treating baldness and promote hair growth.
    and there was a patent for this application (WO1994005250A1) that’s showed almost 100 % success rates hope this helps someone.

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