The real cause of hair loss...
In this article I'm going to show you why the real cause of male pattern hair loss is DHT + Scalp Tension.
This is a long article, but I recommend you read it thoroughly, because by the end you'll know exactly what really causes hair loss, and therefore how to stop it.
Ask any doctor and they'll say that DHT is the hormone that causes male pattern baldness.
But in this article you'll learn why that's only half the story. DHT by itself doesn't cause hair loss, and you're about to learn why.
With the understanding that DHT + scalp tension is the true cause of male pattern hair loss, you'll be able to make an informed decision and decide for your self on the the best treatment for you.
Let's get started...
The curious case of the Guevedoces.
In a small community in the Dominican Republic there are a group of men, known as the Guevedoces.
The Guevedoces are special because they are born without the ability to produce the enzyme 5-alpha reductase.
Because the Guevedoces can't produce 5-alpha reductase, they therefore also can't produce DHT.
(5-alpha reductase converts testosterone into DHT.)
And because they can't produce DHT, they also never suffer from male pattern baldness (or enlarged prostates.)
Back in the 1970's, when the Guevedoces first came to mainstream attention, researchers became interested in the curious of the Guevedoces.
Because they never went bald, scientists wondered if these men held the key to curing male pattern baldness.
Summary: The Guevedoces of the Dominican Republic lack the enzyme 5-alpha reductase, and therefore their body cannot produce DHT. The Guevedoces have never shown any signs of male pattern baldness, even into old age.
Finasteride was invented, and it works (kinda).
At the time when the Guevedoces where gaining mainstream attention, a man called Roy Vagelos was head of research at the multinational drug company Merck.
Roy saw how the Guevedoces never went bald and realised the opportunity it presented to help invent a cure for hair loss.
As the Merck scientists learnt more about the Guevedoces they realised if they could stop 5-alpha reductase they might be able to stop hair loss (and treat enlarged prostates too.)
Finally, in 1994 Merck released and got approval from the FDA for a new drug, finasteride, to help treat enlarged prostates and later in 1997 to treat baldness.
Finasteride blocks almost all type-2, 5-alpha reductase (type 2 is the important enzyme for hair loss because it's the one present in the scalp.)
The problem however, is that despite almost all the DHT being blocked very little hair regrew. Finasteride could help stop further hair loss and thicken existing hairs, but it didn't really regrow hair that was already lost.
There must have been something more going on at the root cause of hair loss than just stopping DHT.
And also, why was it that some hair follicles fell out (at the front) but other hair follicles (at the back) were absolutely fine and continued to grow healthily forever?
(There is DHT circulating throughout the entire scalp.)
Researchers suggested that the follicles at the front were different from the ones at the back. That they were more sensitive to DHT. And those at the back weren't affected by DHT. But as we'll see from hair transplant studies further down in this article, this isn't the case.
This begs the question, since DHT is present throughout the scalp, why does the hair fall out in a predictable pattern starting at the front?
What causes the 'pattern', in male 'pattern' baldness?
Summary: The inventors of finasteride studied the Guevedoces and realised if they could block DHT with the drug they could prevent hair loss. Finasteride blocks about 70% of circulating DHT, but it doesn't regrow much hair.
Scalp tension causes hair follicle sensitivity to DHT.
DHT is present throughout the scalp. So why do the hairs at the front fall out first and why are the hairs at the back not sensitive to DHT and stay healthy forever?
To answer this question, we need to look for another factor that's causing the hair follicles to become sensitive to DHT in the first place.
Have you ever wondered why there's a pattern in male pattern baldness? This predictable pattern in known as the Hamilton Norwood scale (shown above). I'm sure by now you've seen this scale before.
But researchers could never explain this pattern before, that was, until they took a closer look how the tensile force varied across the scalp.
In the digram below, on the left hand side is the tensile force of the scalp. Dark blue shows less tension. Lighter blue/green shows more tension.
On the right hand side of the diagram shows the progression of male pattern baldness as shown in the Hamilton Norwood scale.
What scientists noticed was that the exact same places where the tension was highest (due to the curvature of the top of the scalp) was where hair loss happened first.
And at the back and sides of the scalp where the scalp was not tense at all, the hair was growing thick and healthy.
Below is the same image but with a real image of a man with the typical male pattern baldness pattern. Now you can clearly see how high tension areas correspond with the first areas to lose hair.
The scalp is being pulled down from the back and sides creating tension on the top. This tension makes the hair follicles sensitive to DHT causing hair follicle miniaturization (if DHT is present).
Here's another image where you can clearly see: side and back = low tension. Top = high tension.
Try it yourself now. Take your hand and feel your scalp.
At the front temple area take two fingers and try to pinch together the skin. If you're losing hair there you'll notice the scalp is tough, tense and hard to pinch.
Now try at the back of your head where there's plenty of hair. The skin pinches much more easily. There is almost no tension. You can probably pinch together a big chunk of skin because it's loose.
Scalp tension varies throughout of the scalp, due to where the muscles connect with the scalp and the curvature of the top of the head. This tension makes the hair follicles sensitive to DHT and therefore start to miniaturize when DHT is present.
In the next section of this article I'll show you what happens when you transplant a hair follicle from the back of the scalp (low tension) to the front (high tension), and then I'll show you what happens when the tension is reduced.
Summary: Scalp tension makes the hair follicles sensitive to DHT. Both scalp tension and DHT must be present for the hair follicles to start balding. The 'pattern' in male pattern baldness is caused by the varying amount of scalp tension throughout the scalp. Highest tension areas start losing hair first. To reverse the pattern, the tension must be reversed.
Why hair transplants prove that DHT+ scalp tension = hair loss.
By taking a closer look at hair transplants we can see the truth about DHT + scalp tension causing male pattern baldness.
What happens when hairs are transplanted from the back (low tension) to the front (high tension)?
Firstly, almost all hair transplant surgeons require their patients to take finasteride. As we know already, finasteride blocks DHT, stopping the hair follicle from miniaturizing.
But what if a hair transplant patient doesn't take finasteride?
Do those transplanted hairs start falling out because there's DHT and now there's also scalp tension?
Yes, they do!
It just takes longer for the hair follicles to become affected by the scalp tension.
When a hair follicle gets transplanted, it's not just the shaft of hair, there's also a fairly large chunk of the surrounding tissue, dermis and vascular network that comes with it.
This is a typical hair transplant graft when looked at up-close:
Also, hair follicles are rarely transplanted 1 by 1. Usually a graft containing more than 1 hair follicle is taken, which means there's even more surrounding tissue taken with it.
The tissue surrounding the graft is very important because this is what allows the hair follicle to survive in the scalp, even when the surrounding scalp is under high tension.
Eventually though, the area of tension surrounding the transplanted hair follicle starts to affect it.
Imagine it like this...
You try growing a plant in some poor soil, unfortunately, because the soil is so poor, the plant dies.
Now imagine you transplant a tree, with all its roots and nutrient rich soil surrounding the roots into the poor soil. The tree will survive, it may even survive for years, but eventually the environment where the tree has been moved to will affect the tree and cause it to eventually die.
Below is an image of a tree being transplanted. The more roots and soil taken with the tree, the better the survival rate.
The same goes for hair follicles. The more surrounding tissue gets transplanted with the hair shaft, the longer the hair will survive in the new (high tension) scalp environment.
Remember though, this is only the case when the HT patient doesn't take finasteride (which is rare because almost all surgeons require it).
This is also why studies show that micrograft 'clumps' had much higher survival rates than singular hair follicles.
Decreasing survival rate
The time taken for the newly transplanted hair to succumb to the higher scalp tension is known as the 'balding clock'.
So when a healthy hair follicle from the back of the head gets transplanted to the front the 'balding clock' gets reset as the tension surrounding the hair follicle starts to increase. The more surrounding tissue that comes with the hair follicle, the longer the patient has before the hair follicle starts to miniaturise.
Summary: Hairs transplanted into high tension areas will eventually fall out unless the patient takes finasteride. The balding clock gets reset (typically 5-8 years) and the time depends on the amount of surrounding tissue around the hair follicle graft.
The 3 ways to reduce scalp tension
Given what we now know about scalp tension + DHT causing hair loss, what happens when we reduce the tension in the scalp?
Scientists thought of 3 clever ways to test their theory and see if new hair would grow. Let's take a closer look at the 3 ways.
The first method to reduce scalp tension is the most obvious technique. The idea is to massage the scalp (rubbing, kneading, pinching, stretching) throughout the perimeter and top, with the goal of manually reducing the tension.
There have been a number of studies that show scalp massages reverse hair loss, the latest study was done in 2019 and involved 327 participants who self administered standardized scalp massages. (Source)
Of the 327 participants, 70% reported hair loss stabalization or hair regrowth after 7 months of 10-20 minute daily scalp massages.
Reducing scalp tension via standardized self-administered scalp massages helped stablize and even regrow hair for the majority of participants who can stick with it for 6+ months, and multiple other studies have confirmed that scalp massages help regrow hair. You can look at those studies here and here.
Now let's look at the 2nd way to reduce scalp tension that scientists looked at.
The 2nd way that researchers looked at to reduce scalp tension wasn't such an obvious method, but it was ingenious: they would inject the muscles surrounding the scalp with a muscle relaxant which would stop the top of the scalp being pulled so tight.
Researchers injected a liquid (botox) which caused flaccid paralysis, into the muscles. This meant the muscles went completely relaxed for 6 months, until the botox wore off. Botox was injected into the temporalis and occipitalis muscles as shown in the diagram below.
As a result, participants in the study noticed their hair loss start to stablize and then regrow. After 6 months noticeable amounts of new hair had grown back for the majority of participants, due to the muscles being relaxed.
A 6 month before/after photo is shown below. See how the balding area (crown) has regrown hair. For this patient, the crown was the high tension area. Simply by relaxing the muscles in the perimeter to reduce the tension hair started to grow back in the high tension area.
Clearly, relaxing the scalp, either through massages or via relaxing the muscles via injections helps to stop hair loss and even regrow hair. After looking at these studies it becomes obvious that scalp tension does play a role in male pattern baldness.
The problem with scalp massages and injecting the muscles is that both methods are tiring (10-20 minutes daily massage), difficult or expensive.
Luckily there is now a third way which is starting to gain massive attention in the hair loss communities.
It's a quick, easy and effective way to reduce the scalp tension directly and user case studies are showing that it's getting great results and people are stopping their hair loss and showing very impressive amounts of hair regrowth as well.
Let's take a look at the 3rd way to reduce scalp tension, and the best way to stimulate new hair growth.
Summary: By reducing scalp tension, either through scalp massages or via relaxing the muscles in the scalp, hair loss can be stopped and some hair regrown (even without blocking any DHT).
Why growbands work so well.
Growbands are the third and most effective way to reduce the scalp tension. Let's take a look at how they work, and why they work so well.
A growband helps to reduce the scalp tension directly, by pushing the perimeter of the scalp upwards and squeezing the top of the head together.
If we imagine the top of the scalp pulled tight from the sides and the back like the photo of Jude Law below, the growband does the opposite, by pushing the back and sides upwards, relaxing the whole of the top of the scalp.
This upwards pushing movement essentially massages the whole top of the scalp and relaxes the muscles around the perimeter. Tests were performed on the top of the scalp to measure the temperature.
After 10 minutes there was a significant increase in temperature showing an increase in blood flow (something that's vital for hair growth).
Growband users report feelings of less tension and more relaxation and better sensation all over the top of the scalp. The whole top of the scalp feels massaged and relaxed. You won't even know you've been feeling tension in your scalp until you try it for yourself.
You'll after 6 months of use that your scalp is becoming more and more flexible and more loose. This often coincides with the period when your hair will start getting thicker and stronger.
But what actually happens when someone uses a growband consistently? Does their hair loss stop? Does their hair get thicker, healthier and start to regrow? Let's take a look at this 8 month case study.
Growband case study - 8 months later:
After 4 months of daily use, all hair loss had stopped and there was visible (but subtle) thickening along the hairline. At month 6 the hair appeared to be growing through thicker and stronger with the upper and lower temple are starting to improve in terms of coverage.
After month 8, the lower and upper temple showed substantial new hair growth and the hairline density continued to improve, along with the overall quality of the hair. No other treatments were used, only 10 minutes daily growband usage.
Not only did the upper and lower temple area fill in, but the hairline thickened and hair quality on the top improved, becoming less thin/wispy/wirey, and getting thicker, stronger and with a more healthy sheen indicating clear improvement in hair follicle strength.
What stage of hair loss can a growband help recover?
Early stage NW 1-3 are the best responders because the scalp is still supple enough to regrow hair if the tension is removed. There's also more incentive for users at these early stages to keep the hair they have, and not let things get any worse.
In the later stages of hair loss (4+) when the scalp has been under tension for many years then the scalp becomes calcified so it makes regrowth much harder. The best option at this stage may be a hair transplant and then using a growband to help keep those new hairs healthy.
How often and for how long is it recommended to use a growband?
10 minutes daily, and sticking with that regime for 6 months.
Does it hurt to have your scalp squeezed upwards?
No, on the contrary, much like a good massage, the feeling of using a growband is actually enjoyable and fairly relaxing. There's also quite a nice sensation after using it for 10 minutes when the scalp feels more tingly and less numb.
How tightly does the growband squeeze the scalp?
It's recommended to inflate the inner tube only to the point where the scalp stops rising upwards, since we're looking for maximum upward movement. When it gets to the point where the scalp isn't moving upwards anymore that's where you hold and then release.
Will a growband help with all types of hair loss?
Growbands are only for men with male pattern baldness. For other types of hair loss (hair shedding disorders) the causes will be different therefore a growband won't be effective. The best way to tell if a growband is suitable for you is to see if there's a pattern to your hair loss or if it's all-over generalised thinning. If there's a pattern (following the Hamilton-Norwood scale) then it's the right tool for you.
Summary: A growband is an effective tool for reducing scalp tension and growband users have shown complete stoppage of hair loss and significant amounts of hair regrowth after 6 months+ of daily use. You can get hold of a growband with a 365 day refund guarantee here.
This has been a long in-depth article on the real cause of hair loss.
But the evidence is now clear that blocking DHT with finasteride is not the only way to stop hair loss.
Reducing the scalp tension, either through daily massage, botox injections or simply by using a growband is an absolute must do.
Whether you are already taking finasteride or not. Whether you are considering a hair transplant or have already had one, reducing the scalp tension is paramount to keeping the hairs healthy.
A growband is a new, simple and straightforward way to stop hair loss and as user reports show, a good amount of hair regrowth can take place in a reasonable time frame.
Right now Hairguard is offering the Hairguard Growband for only $297 along with a spectacular 365 day refund guarantee.That means you can take a whole year to try the growband, and see the results for yourself before committing to your purchase.
At any time within 365 days of the purchase date you can ask for a full refund simply by emailing our support team at email@example.com. No questions asked and no slow replies.
Hairguard has been in business for over 5 years and we plan on keeping our customer happy for another 5 years and beyond with products you love and a refund policy we stand behind.
If you have any questions for me or the Hairguard team feel free to email us on firstname.lastname@example.org
Author: Will Slator, founder of Hairguard.
Published in January 2020.