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2
Contents
Introduction
4
Chapter 1: What Really Causes Hair Loss?
7
Chapter 2: The 3 Layer System
46
Chapter 3: Hair That Keeps Getting Better
59
Chapter 4: My Journey
65
Got Questions?
73
Bonus Section
92
Appendix
105
Acknowledgments
110
References
111
3
Introduction
History is full of accidental discoveries that ended up
changing the world.
But the story of University Professor, Dr Brian Freund, who
was trying to treat headaches, and ended up regrowing his
patients’ hair, is probably one of the more unusual and
underrated discoveries out there.
Not only was this accident groundbreaking, because the
amount of average hair regrowth was about 2x what would
be expected from finasteride (the gold standard of hair loss
treatments), but because it reveals a fundamental truth
about the real cause of hair loss which had been hidden up
until that point.
With this new finding about the real cause of baldness,
there was once again the possibility for innovative new
solutions for hair loss treatments that worked at the root
cause.
4
This is what this book is about.
To start with, we’ll go into detail about the anatomy of the
scalp. Since the scalp is made up of different layers, it’s
important to understand what each layer does and the role
it plays in hair loss. After learning about the layers of the
scalp, you’ll see how a doctor trying to treat recurring
headaches could accidentally regrow his patients’ hair.
Next, in Chapter 2, you’ll learn about the 3 Layer System
which fixes hair loss at the root cause, and how this all
makes perfect sense given what you’ve just learnt about the
anatomy of the scalp.
Keep in mind, if you’re currently using, or plan to use,
minoxidil or finasteride then you’ll want to pay special
attention to this chapter because this 3 Layer System can
more than 2X the effectiveness of these well-known hair
loss treatments (I’ll show you how later, with proof from
new clinical studies.)
5
In Chapter 3 you’ll see why fixing hair loss at the root cause,
using the 3 Layer System, can give you hair that will
continue to grow thicker and healthier with time and how
this is different from “band-aid solutions” where results
quickly plateau after 6 - 18 months as the traditional
treatments gradually become less effective at regrowing
more hair.
So if you’ve tried hair loss treatments like minoxidil,
finasteride, laser caps or PRP before and were frustrated
with the lack of results you’ll want to make sure you read
this chapter. Or if you’re interested in a non-pharmaceutical
approach to fixing hair loss this is for you as well.
Let's get started by looking at the different layers of the
scalp.
6
Chapter 1: What Really Causes Hair
Loss?
The scalp is made up of 3 main layers:
● Layer 1: The Epidermis
● Layer 2: The Dermis (and adipose layer)
● Layer 3: The Galea
These 3 layers are connected together to form the main
portion of the scalp, which looks like this:
7
The Scalp Layers
Layer 1, the epidermis is the thin top layer of the scalp
which acts as a protective barrier against the outside world.
Layer 2, the dermis, is below the epidermis and is the
substrate which contains the hair follicle bulb.
Layer 3, the galea, is a sheet of connective tissues which
overlays the skull bone, and is below the dermis, as shown in
Figure 1.
I’ll explain these layers in more detail later on.
The Hair Follicle
The hair follicle bulb, also known as the dermal papilla, is
where the hair shaft grows from, and it sits in the dermis
(Layer 2).
8
Blood supply feeds the dermal papilla, via a vascular
network which travels through and above the galea, and
into the root of the follicle.
The hair follicle shaft grows from the bulb and pushes out
through the dermis and epidermis, to become the hair on
our head we know and love.
That’s the quick overview of the scalp and hair follicle,
which leads us to the next point.
What actually causes hair loss?
Hair loss (specifically I mean androgenetic alopecia, or
male/female pattern baldness) at the most fundamental
level is caused by reduction of the hair follicle blood supply
and growth space.
As blood supply and growth space decreases, the hair
follicle
gets
smaller
and
eventually stops growing
altogether.
9
All living cells require nutrients and oxygen to survive and
grow. Nutrients and oxygen are delivered to the cells from
the blood supply. If the blood supply is low, those living cells
and the structures they make up start to atrophy (shrink)
and won’t be replaced by new ones.
When it comes to hair loss, we see this kind of atrophy all
the time; we just call it something different. It’s called “hair
follicle
miniaturization”.
It
means the hair follicles
progressively get smaller and smaller over time, until they
eventually disappear altogether.
The balding process due to constricted
blood supply and growth space
10
This hair follicle miniaturization process is caused by
constriction of the hair follicle blood supply and growth
space, and it takes place within the 3 layers of the scalp.
You are going to learn how each layer of the scalp
contributes to this process. In doing so, you’ll see why
traditional hair loss treatments have never been very
effective; because they only treat hair loss in 1 layer of the
scalp.
For now, let’s look at each layer of the scalp individually.
Layer 1: The Epidermis
The epidermis is the outermost layer of the scalp. It is less
than 0.5mm thick and serves as a protective barrier
between the scalp and the outside world.
Many people with hair loss report an itchy scalp, dandruff
and overproduction of scalp sebum (which is the oil that is
naturally secreted by the skin to condition the hair.) This is a
result of what’s going on in deeper layers of the scalp. But
11
the consequence is that the epidermis is coated in a layer of
‘plaque’ which blocks the hair follicle pores, and contributes
to inflammation.
I took the photographs below using a microscope. Notice
how the epidermis surrounding the unequally sized hairs is
white and flaky and almost blocking the hair follicle pore.
The hairs are thinner or thicker depending on how far down
the hair follicle miniaturization process they are.
12
In the second image the hairs are uniformly thicker and
show no signs of miniaturization. But notice also how the
scalp is free from dandruff and sebum.
This layer of plaque on the epidermis blocks the scalp pores
and causes microinflammation. It also stops topical
(meaning ‘applied to the scalp’) active ingredients, such as
minoxidil, from penetrating into the dermis where they can
be effective (more on this later).
In fact, studies have shown that less than 5% of topically
applied minoxidil is actually absorbed past the epidermis.
(1)
13
Layer 2: The Dermis
The dermis is a connective tissue layer sandwiched between
the epidermis and galea. There’s also a layer of adipose
tissue below the dermis, however it’s not so important for
our understanding of hair loss.
The dermis is composed of collagen, elastic tissue, and other
extracellular components including vasculature (blood
vessels), nerve endings, hair follicles, and glands.
The dermis makes up the tissue in which the hair follicle
bulb grows. As such, its health is incredibly important for
the proper functioning of the follicle.
Think of it like a plant growing in soil. If the soil is a dry,
tough, constricting layer of rock, there’s no way a healthy
plant can grow.
Thick, healthy hairs grow from a healthy dermis, and as we’ll
see, if the structure of the dermis deteriorates, hair loss
soon follows.
14
What happens in the dermis that reduces blood
supply and growth space?
Take your hand and pinch an area of your scalp where you
are experiencing hair loss. No doubt you will notice the
scalp is tougher and less flexible than the scalp at the back
or sides of your head where your hair is thick.
In advanced cases of hair loss, the scalp goes shiny. We’ve all
seen this kind of shiny bald scalp as in the photo below:
What is happening is that the structure of the dermis is
actually changing. In other words, the structure and
anatomy of the dermis are changing from what is normally a
15
soft, flexible and thick layer to the tough, rigid, thin and
shiny layer.
So what exactly is this process, and how is it related to hair
loss?
The alteration of the structure of the dermis is a process
called ‘dermal fibrosis’. The best analogy I can give is that
dermal fibrosis is similar in many ways to tissue scarring.
If you’ve ever suffered an injury serious enough to form a
permanent scar then you have first-hand experience of
fibrosis. To fill in the gap from the wound, the body deposits
irregular collagen, which replaces the normal structure of
the skin, leaving a scar.
Have you ever noticed how hair can’t regrow in scar tissue?
This is because the irregular collagen deposits are so tightly
packed that the follicles don’t even have any space to grow.
Predictably, the blood supply also gets constricted, and the
dermis and adipose thickness gets reduced.
16
The balding process is the process of the dermis changing
structure and becoming more fibrotic due to the
overproduction of irregular collagen which restricts hair
follicle growth space and blood supply. The process is so
slow and gradual that we don’t notice much of a change
from day to day.
The
hair
follicles
literally
become
surrounded
by
constrictive layers of collagen, and eventually the normal
follicle structure is completely destroyed, replaced by
fibrotic collagen. This results in a tougher, more rigid scalp
with lower microvasculature (micro blood supply), and less
hair.
17
To quickly summarise; the dermis is the bed of the hair
follicle, as such, when the structure of the dermis changes it
reduces hair follicle growth space and blood supply leading
to follicle miniaturization.
Think of it like a microscopic tightening around each hair
follicle, literally strangling the blood supply and growth
space and consequently leading to smaller and smaller hair
follicles (aka ‘hair follicle miniaturization’.)
Before we go into why this process happens, let's double
check the clinical studies to see if blood supply is actually
lower in balding scalp tissues.
Does blood supply really go down in balding scalps?
Researchers sought to find out if balding scalps had lower
blood supply than non-balding scalps, and a number of
studies were conducted.
18
One study found that men who suffer from pattern hair loss
have significantly reduced scalp blood flow compared to
men without hair loss. (2)
Furthermore, balding men have significantly more blood
flow in the non-balding parts of their scalp compared to the
balding frontal areas. But men who don’t suffer from hair
loss show no such variation. (3)
That’s two confirmations that blood supply goes down in
balding scalps.
In another study, researchers estimated that subcutaneous
blood flow in the balding scalp is approximately 3x lower
than that of men without hair loss. (4)
19
When you think about the fibrosis findings we discussed
earlier, this makes sense. As irregular collagen fibers expand
into space previously occupied by healthy tissue, the ability
of blood vessels to supply the hair follicles decreases.
The blood vessels literally cannot find a way to pass through
the fibrotic collagen, and the scalp cannot receive an
adequate blood supply. The result is reduced amounts of
oxygen and other nutrients necessary for normal hair
follicle growth.
20
The author of one study on hair loss and blood supply, Dr
Klemp MD from the University of Copenhagen, writes:
“Growth and regrowth of the hair in the scalp depends upon a
sufficient nutritive blood supply to the hair follicles. The
significantly reduced SBF in the scalp of patients with early male
pattern baldness, as found in this study, might explain the loss of
hair and the inability to regrow hair.” (4)
The author of one particular study on dermal fibrosis and
hair loss, Dr Won from Seoul National University of
Medicine in Korea writes:
“It was found that collagen bundles were significantly increased
in balding vertexes than in non-balding occiput scalp skin. A
near 4-fold increase in elastic fibers was observed in both vertex
and occiput scalp skins with male-pattern-hair-loss versus
controls.” (5)
But what actually causes fibrosis in the first place?
Enter DHT.
21
We’ve seen how fibrosis in the dermis starts to restrict the
growth space, and cut off the blood supply to the hair
follicle. We also saw how multiple scientific studies confirm
that a balding scalp has reduced blood and oxygen levels
compared to men without hair loss.
But what actually causes dermal fibrosis in the first place?
This is where DHT comes into play.
If you have spent any time at all researching pattern hair
loss, you have surely come across DHT. It is the very first
thing you will find mentioned in any mainstream hair loss
article, and with good reason.
DHT is short for ‘dihydrotestosterone’, and is a male
hormone made from testosterone. During early life, DHT is
critical for the development of the male genitalia and
secondary sexual characteristics like a deep voice and
bodily hair.
22
We know from case studies that men who can’t produce
DHT never go bald. This led pharmaceutical companies to
look for a way to block DHT to try and cure baldness.
Enter finasteride.
Oral finasteride is the most commonly used hair loss
medication, and it works by blocking DHT throughout the
body. After 3 to 12 months, about 80-90% of finasteride
users will stop losing further hair, and about two thirds will
also see some small amount of hair regrowth. (6)
So, even though DHT is undoubtedly involved in the hair
loss process, the way it actually causes hair loss is not so
clear.
In other words, scientists knew that blocking DHT stops
hair loss, but they didn’t know exactly why DHT causes hair
loss in the first place.
23
They also couldn't explain why blocking DHT is sufficient to
stop hair loss, but never results in full recoveries of bald
areas.
Up until now, the mainstream understanding of the role of
DHT was that some hair follicles are ‘sensitive’ to DHT, and
others aren’t. This sensitivity was put down to ‘genetics’ and
that was the end of the discussion.
The scientific consensus was that hairs fall out in the front
and crown of the scalp but not the sides and back because
the front and crown follicles are “genetically sensitive to
DHT”, whereas the ones on the side and back are not.
But this was not really a satisfying explanation. Saying
something is ‘genetically sensitive’ is basically saying we
don’t really understand what is going on.
Clearly genetics are involved in hair loss, but that’s not
nearly specific enough to be very useful in treating it.
24
In recent years the scientific consensus has started shifting
to an understanding that DHT plays a role in dermal
fibrosis. That’s why blocking DHT stops further hair loss,
but typically only regrows a small amount of hair.
Dermal fibrosis has changed the structure of the scalp,
reducing hair follicle blood supply and growth space, but
blocking DHT doesn’t reverse the fibrosis.
So why does DHT cause dermal fibrosis which then leads to
hair loss?
It turns out, DHT only causes dermal fibrosis under certain
conditions, and that certain condition is when the scalp has
on-going (chronic) inflammation.
But why is there chronic inflammation in the scalp in the
first place?
Well the most likely source of chronic inflammation is scalp
tension.
25
Put it like this: DHT + inflammation (from scalp tension) +
genetic predisposition = dermal fibrosis.
At this point the science of why “DHT + inflammation via
scalp tension = dermal fibrosis” gets more complicated, so I’ve
added a section to the Appendix where you can read more
about it if you want.
For now, the main question is: What is scalp tension and
what causes it?
To answer this question, we move to the next layer of the
scalp, the galea, where we learn that reducing scalp tension
can stop hair loss altogether, without even blocking DHT.
Layer 3: The Galea
Layer 3 is arguably the most important layer of the scalp,
because the galea is connected with all the layers above.
Blood supply flows through and above the galea and
branches into the top layers of the scalp.
26
The galea is a tough, fibrous sheet of connective tissue,
which covers the entire top of the head and is held in place
by muscles connected at the front, back and sides.
Since the layers of scalp tissue are all connected, when the
galea is pulled tight, all the other layers (adipose, dermis and
epidermis) are pulled tight as well.
Blood vessels travel through and across the galea, up to the
dermis and epidermis tissues, supplying them with the
nutrients and oxygen needed for growth and repair.
If you want a better visual understanding of the size and
position of the galea, look at someone with advanced-stage
male pattern baldness. The area where he is bald, that is
where the galea is positioned, underlying the dermis.
27
The parts of the scalp where hair continues to grow even in
advanced stages of male pattern baldness, there is muscle,
rather than galea, underlying the dermis.
Knowing that hair loss takes place only in the scalp area
that’s directly above the galea, researchers suspected that
tension in the galea might be involved in hair loss.
Fortunately, researchers conducted two experiments to see
if tension in the galea affects hair loss and hair growth.
28
Let’s look at those studies now.
What if you relax the muscles attached to the galea?
Dr Brian Freund was trying to help patients with tension
headaches and wanted to see if injecting the scalp muscles
with Botox would help resolve the headaches.
Botox is a substance which causes the muscle to relax by
blocking the nerve ending.
With the nerve endings of the muscles blocked, the signal to
contract the muscle can’t get through, leaving the muscle in
a state of ‘flaccid paralysis’.
Botox is most commonly used to reduce facial wrinkles by
relaxing the facial muscles.
What Dr. Freund found when he injected the scalp muscles
with Botox was absolutely fascinating.
29
Not only did the Botox injections help reduce the tension
headaches, but some of the patients who were losing hair
noticed their hair loss had stopped.
Intrigued by the findings, Dr Freund and his team conducted
another study, this time focusing on patients with male
pattern baldness.
They took 50 male patients and injected the muscles
attached to the galea with Botox.
Those muscles became completely relaxed for as long as the
Botox lasted (4 - 6 months).
In the diagram below you can see where the researchers
injected the Botox:
30
With the muscles now relaxed and not pulling down so
forcefully on the galea, would the tension decrease and
would the hair loss stop?
Yes. In fact after 48 weeks and 2 rounds of Botox, male
patients with hair loss noticed an improvement in hair
growth of 18%. (7)
31
The author of the study writes:
“Mean hair counts for the entire group showed a statistically
significant (p < 0.0001) increase of 18 percent between baseline
and week 48”.
Hair counts are measured by using a fixed 2cm2 area of the
scalp and photographically counting the number of hairs in
the same area at the beginning and end of the experiment.
Just to put the results in perspective, an 18% hair growth
increase easily beats the average 11% increase that follows
from a year of daily 1mg oral finasteride. (6)
Except unlike oral finasteride, the only side-effects from the
Botox injections were fewer wrinkles and less headaches.
On the next page are two before and after photos from
male patients who had their scalps relaxed via Botox
injections:
32
The patients above received 100 units of Botox every 3 months
for 12 months. Photos show the baseline to 12 month period.
33
Simply by relaxing the muscles connected to the galea using
Botox, hair loss not only stopped, but actually reversed in
many of the male patients.
And even more effectively than the typical results expected
from using oral finasteride (although more studies would be
useful to compare the two treatments directly.)
Multiple studies, totaling over 100 patients, have confirmed
the same hair regrowth results from Botox injections. (8)(9)
The evidence is now overwhelming that the scalp muscles
play a role in genetic hair loss, either through causing
tension on the galea or constricting blood flow to the upper
parts of the scalp. Most likely a combination of both.
In the first paper published on using botox for hair
regrowth, Dr Freund states:
"Mechanistically, the scalp behaves like a drum skin with
tensioning muscles around the periphery. These muscle groups...
can create a “tight” scalp when chronically active.”
34
“Because the blood supply to the scalp enters through the
periphery, a reduction in blood flow would be most apparent at
the distal ends of the vessels, specifically, the vertex and frontal
peaks." - (those places men lose hair first.)
He continues:
"Botox “loosens” the scalp, reducing pressure on the perforating
vasculature, thereby increasing blood flow and oxygen
concentration.”
“Blood flow may therefore be a primary determinant in follicular
health. Strategically placed Botox injections appear able to
indirectly modify this variable, resulting in reduced hair loss and
new hair growth."
Dr. Zhou, the author of another botox hair regrowth study,
notes:
“BTA may relax the muscles around the head, increase blood
flow and oxygen concentration in the alopecia area, and further
35
inhibit the activation of DHT, ultimately leading to a reduced
occurrence of hair loss.”
“Moreover, a high concentration of oxygen can stimulate the
hair follicle into the growth phase, resulting in hair regeneration"
I know it’s a bit of a strange concept, since most people are
never even aware of these muscles, let alone that they are
constantly pulling down on our galea, but stay with me for a
little longer because this is an important point to keep in
mind if you want to fix your own hair loss.
Another way to relax the galea
A similar study was created by leading hair loss researcher
Robert English, but instead of using Botox, scalp massages
were used to reduce tension throughout the galea by
massaging the muscles attached to the scalp perimeter, as
well as to help reduce the fibrosis in balding areas.
36
The results were very promising. Just 20-40 minutes of
daily scalp massages were enough to halt or even reverse
hair loss in nearly 70% of participants. The details differed
from one person to the next, but on average, 36 hours of
scalp massage were required for the effect to become
visible. (10)
The conclusion of the scalp massage study was that:
"AGA is the result of chronic GA-transmitted scalp tension"
(AGA stands for ‘androgenetic alopecia’, another term for
pattern baldness. GA stands for ‘galea aponeurotica’)
Further, this tension in the galea results in conditions that:
"restrict follicle growth space and decrease oxygen and nutrient
supply to AGA-prone tissues – leading to tissue degradation, hair
follicle miniaturization, and eventually pattern baldness."
What is interesting about the results from the massage
study is that they were time-dependent. This means the
37
more time spent massaging, the better the regrowth. Once
the 36-hour threshold was reached, results kept on getting
better and better. This is an important point that we’ll come
back to later on.
In fact, the case gets even stronger when we see how
tension patterns in the scalp correlate with the pattern
found in ‘male pattern baldness’.
Highest scalp tension areas = first place to lose hair
An interesting pattern emerges when we look at
mathematical models of tension in the male scalp as
described in the following study.
Researchers applied their models to estimate the tensile
force across the scalp of men. By knowing the shape of the
skull, along with the forces pulling the scalp down at the
perimeter of the scalp. (11)
38
Here’s the result of those mathematical models of tension in
the scalp:
What is interesting is that where the models predicted low
tension (dark blue areas in this diagram), those are the
places where we don’t lose any hair (the sides and back of
the head.)
39
The tensile force was highest at the temples and vertex.
These are the first places men start losing hair (the lighter
blue areas in the diagram above.)
Remember that:
Scalp tension + DHT + Genetic Predisposition
↓
Dermal Fibrosis
↓
Reduced Blood Supply & Growth Space
↓
Hair Follicle Miniaturization
Therefore we can clearly see that high tension in the scalp
causes hair loss because the patterns match closely.
Everybody has a slightly different skull shape, which is why
men often have slightly different patterns. But in general
the pattern of hair loss stays approximately the same and is
known as the ‘Hamilton-Norwood Scale’.
40
It starts at the front with the temples, and progresses
backwards. The crown area is also a high tension area and
can start to develop hair loss soon after the temples.
The Hamilton-Norwood Scale of Male Pattern Baldness
What are the chances that the tensile forces in the scalp
just happen to match exactly the pattern of male pattern
baldness? It was proven statistically that the chances of this
being down to coincidence were less than 1 in 1,000! (11)
41
The authors of the study conclude that:
“stress distribution in the scalp determines AGA patterning”
Without understanding the role of scalp tension, there was
simply no explanation for the pattern found in male pattern
baldness.
Summary:
We’ve seen how reduction of blood supply and growth
space of the hair follicle throughout the 3 layers of the scalp
causes hair loss.
42
You’ve seen how the galea which overlays the skull is
connected to all the other layers. Subsequently, when the
galea gets pulled tight it causes tension throughout all the
layers of the scalp, restricting blood supply and growth
space through layers 3, 2 and 1.
In summary, this tension has a ripple-on effect, causing:
● Restriction of blood supply to the upper layers of the
scalp
● Fibrosis in the dermis (when DHT is present)
because of chronic inflammation
● Inflammation and blocked scalp pores in the
epidermis
To confirm that scalp tension leads to hair loss we looked at
mathematical models of tension in the scalp. The highest
tension areas coincided with those areas that lose hair first.
The pattern of tension matches the pattern found in ‘male
pattern baldness’.
43
The chance of this being a coincidence is statistically 1 in
1,000.
The scientific consensus is that genetics plays a role in
androgenetic alopecia (male pattern baldness). However, up
until recently that statement provided little practical help
to balding men.
Now we can see that genetics plays a role in the process of
dermal fibrosis that takes place via scalp-tension-caused
inflammation and DHT, rather than the direct sensitivity of
the hair follicle to DHT.
This insight gives us more practical ways to stop and
reverse hair loss.
With a firm grasp of the science behind the root cause of
hair loss, we can take a look at the revolutionary 3 Layer
System which reverses these processes.
44
In doing so, you’ll discover the most effective way to stop
and reverse hair loss, in a way that actually helps fix the
cause of the problem like no other treatment does.
Since constriction takes place across the 3 scalp layers, we
use 3 steps, which correspond to each of the 3 layers of the
scalp
Each step works well individually, but the power comes
when we combine these steps into the 3 Layer System and
they begin to work synergistically.
45
Chapter 2: The 3 Layer System
In the previous chapter we’ve seen how constriction of hair
follicle blood supply and growth space is the real cause of
hair loss.
Now let's take a look at how to treat this constriction across
each layer of the scalp, in order to achieve better hair
regrowth.
Step 1: The Epidermis
For step 1 we use a scalp brush and topical solution that work
on Layer 1 of the scalp.
The scalp brush helps remove dandruff, sebum, dead skin,
and dirt from the hair follicle pore and invigorates the
surface of the scalp.
46
Brushing the scalp helps expose the epidermis, so the
topical solution can penetrate more deeply (and not just sit
on top of the dandruff and sebum where it doesn’t do any
good).
The correct topical will help to:
a) block DHT and prevent fibrosis
b) stimulate blood flow through vasodilation (increase in
the size) of the capillaries
c) reduce inflammation
d) trigger the anagen (growth) phase of the hair follicle.
47
I will explain more about the right topical solution to use
later on in this chapter.
Step 2: The Dermis
In this step we need to go deeper than the epidermis,
remember the dermis is 0.5mm - 2mm thick.
For this layer we use a device called a ‘dermaroller’. This is a
simple handheld tool consisting of a rolling drum with
48
dozens of microscopic 1mm needles that is rolled along the
balding areas of the scalp.
The microscopic needles penetrate into the dermis and
activate wound healing to help break down the fibrotic
tissue and increase blood capillary networks. This helps
increase blood supply and growth space around the hair
follicle. It also helps improve the absorption of hair growth
topicals.
A study from 2017 showed that microneedling was more
effective at regrowing hair than using 5% minoxidil. (12)
However, the group of participants who used both
microneedling and minoxidil together had by far the best
results.
Although
it might sound uncomfortable to use a
dermaroller, because the needle size is so small it’s
relatively quick, easy and painless. Dermatologists have
used dermarollers for decades to reduce the appearance of
wrinkles and scars and they are perfectly safe and easy to
use.
49
The exact process of how using a dermaroller reduces
fibrosis and increases blood supply requires a longer
explanation, so a section has been added to the Appendix
explaining this process in detail if you are interested.
50
Step 3: The Galea
We need to reduce the tension on the galea which is
constantly pulling downwards on the entire top of the scalp
causing the ‘pattern’ in pattern baldness. Just imagine a
swimming cap being pulled down by muscles attached at
the forehead, back and sides of the head.
As we’ve seen, Botox injections and scalp massages reduce
tension in the galea and result in impressive hair growth
outcomes. However, Botox injections are very expensive,
51
and can cost anywhere from $500-$1500 per session and
require a trip to a clinic.
That could add up to $1000-$3000 per year, never mind
finding a Botox specialist who will perform this off-label
procedure.
Scalp massages, on the other hand, although very effective
and cheap, are hard work, tiring on your hands and arms
and time-consuming.
Fortunately there is a much easier option, which involves
using a device called a ‘growband’ which is designed to
directly reduce muscle contraction and galea tension, whilst
activating pressure-induced vasodilation.
A growband grips the scalp perimeter and pushes the galea
upwards, causing the entire top of the scalp to pinch
upwards together, whilst also stretching out the muscles
attached to the galea.
52
The growband targets the muscles connected to the galea
at the front, back and sides, stretching and massaging them
out of contraction and into relaxation.
Step 3 reduces galea tension, stimulates blood flow through
massage, and reduces constriction of the blood vessels
going into the upper layers (dermis, adipose tissue, and
epidermis).
53
The 3 Layer System in Practice
Hairguard created the 3 Layer System and has perfected a
hair care routine that uses this system. Now let’s break
down each layer into simple, practical steps.
Step 1:
Use the Hairguard Scalp Brush to unblock the scalp pores
and clean the epidermis plaque, so the topical can penetrate
more effectively into the dermis.
Brush for 5 minutes in the evening and immediately
afterwards apply the Biogaine topical to any thinning or
receding areas of hair.
Biogaine is our ultimate all-natural hair growth topical. It
contains the most potent and effective drug-free hair loss
stimulants and DHT blockers available including:
● Caffeine
● Adenosine
54
● Larch Tree Extract
● Pea Sprout Extract
● Red Clover Extract
● Zinc
All of these ingredients have been shown through scientific
studies to help with hair growth one way or another. Please
visit pro.hairguard.com to learn more about the full list of
ingredients and their research.
Step 2:
Use the Hairguard 1mm Dermaroller to microneedle any
areas of the scalp where you want thicker hair. Remember,
microneedling helps reverse the process of fibrosis and
revascularises the tissue through a process known as
angiogenesis.
Microneedling is perfectly safe and causes a temporary
redness of the scalp for 30 minutes or so after using it.
Although dermarolling is mildly uncomfortable, your scalp
55
will quickly adjust and the procedure becomes quick, easy
and relatively painless.
We recommend doing this 1X per week. (Please note, you
should suitably disinfect the dermaroller before using it.)
Step 3:
Use the Hairguard Growband for 15 minutes per day, to
release tension on the galea and lift the entire top scalp
upwards. The Growband is designed specifically for
releasing tension throughout the galea and helping massage
(via scalp pinching) the top of the scalp.
Our studies show that after 10 minutes using it, the scalp
skin temperature increases, showing an increase in blood
flow throughout the dermis. Your scalp will also feel
noticeably more relaxed and invigorated after 10 minutes
of using the Growband.
We recommend using it for 15 minutes per day, but if you
want to use it more often that’s also fine. As we’ve seen
56
from the scalp massage study, the longer you massage the
scalp the better results you get.
This is a really powerful point, because unlike traditional
treatments like minoxidil and finasteride which don’t
become any more effective the more you use them, the
massaging effect from the Growband works in a
time-dependent manner. You could happily use it for an
hour a day to get even better results.
Summary:
We know that reduced microvascular blood supply and
growth space of the hair follicle, caused by processes taking
place across the 3 layers of the scalp, is the true root cause
of hair loss.
As such, using a 3 Layer System is by far the most effective
way to treat hair loss.
One step for each of the 3 scalp layers has been described
above. By addressing each layer, step by step, we can
57
reverse hair loss by treating it at the root cause rather than
using “bandaid-solutions”.
In the next chapter I want to explain why this 3 Layer
approach turns out to be not just more effective, but a much
better long term plan for beating hair loss as well.
58
Chapter 3: Hair That Keeps Getting
Better
Following the Hairguard 3 Layer System, based on the 3
main layers of the scalp, means you’ll have hair that keeps
getting better.
By that I mean, thicker, stronger, healthier, and more protected
against future hair loss, month after month, year after year.
The healthy hair you love and deserve.
So why does a 3 Layer treatment mean your hair continues
to get better and better over time?
Because you’re fixing the problem at the real root cause!
This is the big difference between just using a Layer 1
treatment like minoxidil, or a Layer 2 treatment like
finasteride.
59
Minoxidil and finasteride don’t fix the root cause. Which is
why results typically plateau after a year of use. They work
only on Layers 1 and 2 respectively.
The 3 Layer System fixes the root cause by reducing scalp
tension starting in the galea. As such, the results become
“time dependent.”
This is an important point, because it means the more time
you spend using the Growband, the better the results you
will get.
Read that again: the longer you use it, the better results you
get.
Not so with treatments that just target layers 1 or 2 of the
scalp.
Minoxidil often becomes less effective over time when used
by itself.
60
Finasteride users report plateaus in hair growth after 1 or 2
years. That means a small amount of regrowth in year 1 and
year 2, followed by maintenance, or even a slow decline.
This is still good, because it means you can easily stop
further hair loss, but for people looking to grow back more
hair, blocking DHT is only 1 part of the equation.
And if you ever tried to use more minoxidil or apply it more
times per day, or take a bigger finasteride dose, it wouldn’t
yield any better results because neither treatments are
time or dose dependent.
This is because the issue hasn’t been fixed at the root cause.
The bottleneck to getting better results is microvascular
blood supply, which is still limited across the different layers
of the scalp, starting with tension in the galea.
So by using the 3-Layer System your hair can keep getting
better and better with time.
61
If you want your hair to keep getting better over time,
choose a 3 Layer System.
In addition, by working on all 3 of the layers, your newly
regrown hair will be more protected against future hair loss.
It’s well known that if you ever stopped finasteride or
minoxidil then you’ll probably lose a lot of the hair you’ve
gained fairly quickly.
The 3 Layer System stops the cause of hair loss from the
ground up by:
62
-
Reducing chronic tension in the galea using a
Growband (or Botox/scalp massages)
-
Reversing fibrosis in the dermis using a dermaroller
and blocking DHT in the scalp topically
-
Stopping inflammation and unblocking the hair
follicle pores in the epidermis with the scalp brush
and topical solution
Results you get from the 3 Layer System are more
protected against future hair loss, and can lead to fuller
recoveries over time.
Summary:
By addressing the real cause of hair loss across the 3 layers,
your hair can continue to improve in a time-dependent
manner over the long term.
This is in contrast to Layer 1 or 2 treatments where results
typically plateau or even diminish within 6 - 24 months after
starting them.
63
Therefore, the longer you utilise the 3 Layer System of:
-
Brush scalp for 5 minutes, then apply the Biogaine
hair growth topical
-
Use 1mm Dermaroller (1x per week)
-
Use a Growband (15 minutes per day)
...the more regrowth you will experience. This could never
be achieved with treatments that only work on layer 1 or 2
because they don’t fix the real cause of hair loss in the first
place.
64
Chapter 4: My Journey
In 2012 I graduated from the University of Birmingham in
the UK with a Master’s degree in Chemical Engineering. I
was also rapidly losing my hair at just 22 years old.
I knew that losing hair at such a young age is a sign of more
aggressive male pattern baldness and things were not
looking good for me if I did nothing.
My father is bald, my uncle is bald, and both of my
grandfathers were bald as well, so it was pretty much
inevitable that by age 30 I would be well on my way to
advanced stage hair loss.
But I wasn’t ready to give up just yet.
I started researching male pattern baldness and writing
about what I had discovered on my blog.
65
I was reading and writing a lot, but honestly, I was more
confused than ever. During that time I tried oral finasteride
(1mg) and for a while it seemed to slow down my hair loss.
However, after I experienced sexual side-effects, I decided
not to use oral finasteride again, and to try and find a better
way to treat my hair loss.
Some people have said my side-effects were due to a
‘nocebo’ effect where the patient believes they are
experiencing something because they’ve already been told
that side-effects can be common. However, for my situation
this wasn’t the case because I didn’t connect my side-effects
with finasteride until I later made the connection after the
side-effect had taken place.
I am not saying that oral finasteride is a bad idea for
everyone. Clearly it can work well and without side-effects
for many men and is still considered the ‘gold standard’ hair
loss treatment after 20 years and is a powerful and
incredibly useful drug. But for my situation, it wasn’t the
right option. I had bad side-effects and it wasn’t even very
effective for me.
66
(Men taking oral finasteride can combine this treatment
with the 3 Layer System to achieve even better results.)
Still, my curiosity spurred me on to try and find the deeper
cause of hair loss.
From 2013 - 2015 my hair continued to get worse. At one
point I was ready to give in. I shaved my head, stopped
researching and writing about hair loss, and tried to stop
worrying about my hair and accept that I’d just have to try
and look good bald. I don’t have many photos from that time
because my self-confidence was so low, but I managed to
find a couple from friends’ old albums.
67
This is a bit of a strange photo, because it’s a double exposure
photo, however I think it’s worth sharing here as it is the best
angle and haircut to show the extent of my hair loss. Remember
this was a time in my life when I was very shy of having photos
taken. Hence my somewhat surprised expression in this photo.
You can see the advanced hairline recession and thinning on top.
68
Although I had basically given up and tried to stop thinking
about hair loss and worrying about my own hair, I still had
nagging questions about the root causes of hair loss.
During that time from 2015-2017 I focused on improving
my health, removing chemical-laden shampoos from my
bathroom, using shower filters (there was very hard water
where I lived) and reducing my stress levels.
It seemed to help slow down the rate of thinning and
recession, but I was still just barely holding on to what I had.
Then I became fascinated by the anatomy of the scalp, and
combined this knowledge with all the latest hair loss studies
and the pioneering work of hair loss researchers like Robert
English, whose research on scalp tension and dermal
fibrosis has been referenced throughout this book.
Follow-up Botox studies showed definitively that scalp
tension and microvascular blood supply played a role in hair
loss.
69
With this insight, and a clear understanding of the anatomy
of the scalp, this led me down the path to create the 3 Layer
System.
I also wanted to be able to share this information with as
many people as possible so that I could help them fix their
own hair loss problems, which is why I decided to launch the
Hairguard business.
Doing so meant that I could build a team to help develop
products designed to treat each of the 3 layers specifically,
with
the aim of creating the most effective yet
straightforward system out there.
As soon as I started using the 3 Layer System and the new
Hairguard products, I knew we’d found the most effective
way I’d ever seen to regrow hair.
I’d gone from rapidly losing my hair at age 24, to finally
stabilizing the hair loss but barely holding on to it.
70
Then, with the 3 Layer System, finally I was seeing visible
improvements in my hair thickness and coverage. I could
grow my hair longer and it still held its shape and looked
thick, even when wet. My scalp which was visible before
under harsh lighting became less and less obvious as it
became covered in thicker and thicker hairs taking up space.
One friend who hadn’t seen me in a year asked if I’d had a
hair transplant. Friends and family started commenting that
my hair looked great and that I looked younger, healthier
and happier.
Look, my hair is far from perfect, but if you look at how
rapidly I was losing hair at age 24, and how far back my
hairline was at that young age, I’m so grateful I’ve managed
to stop further hair loss whilst improving the health,
thickness and strength just by using the 3 Layer System.
And the best thing is, things are getting better every 6
months because of the power of reducing the tension with
the Growband.
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The Botox study referenced earlier showed how relaxing
the scalp can almost double the performance of finasteride,
and microneedling studies have shown you can 3X the
performance of minoxidil. That’s why if you want to use
minoxidil and/or finasteride it’s best to use them as part of
the 3 Layer System.
I’ve finally found something that’s worked so well for me,
when nothing else did, even after years of trying. I’m so
excited and honoured to share it with you.
Please feel free to reach out and shoot me an email to
will@hairguard.com if you have any questions. Thank you.
72
Got Questions?
If microvascular blood supply to the dermis is so
important, why do some men with good
cardiovascular health still go bald?
Actually, numerous studies report a link between male
pattern baldness and metabolic syndrome, heart disease,
hypertension and obesity. In other words, men with pattern
hair loss are disproportionately likely to also have one of
these serious health conditions, all of which are linked to
poor circulation. Depending on the study, the risk can be as
much as double, compared to non-balding men.
Does that mean that all men with hair loss have these
problems, and that men with perfect cardiovascular health
cannot go bald? Of course not. Though there is a link
between general blood flow and hair loss, what is really
important is the quality of blood supply to the dermis. And
blood flow at the scalp is primarily determined by the
degree of microvasculature supply, scalp tension and
fibrosis.
73
The local microvasculature supply to the top of the scalp is
determined far more by local factors such as the galea,
muscles attached to the galea and the skull, rather than
non-local factors such as general cardiovascular health. This
has been demonstrated time again by Botox and massage
studies showing that reducing tension and increasing blood
supply improves hair growth outcomes.
Think of it like a garden hose pipe. If there’s a kink in the
hose, it doesn’t matter if you increase the water pressure by
10% (peak cardiovascular fitness) the amount of water
dripping out of the end will still be very small because of the
kink.
If I were to cut my bald scalp it would still bleed,
doesn’t this show it still has adequate blood flow?
Your scalp will always bleed, even if you are completely
bald. Blood flow is never impaired to the degree that blood
stops flowing completely. This would quickly lead to
74
gangrene and if left untreated would cause death of the
individual.
The reduction in blood flow is mild, and in its wisdom the
body prioritizes the limited blood to maintain essential
structures. The hair follicles are not essential to survival,
but it will still take years for them to miniaturize and die.
Studies have shown balding scalps have lower blood flow
and more fibrosis, but this doesn’t mean there’s no blood in
the scalp at all.
Shouldn’t blood pressure medications help fix hair
loss, since they improve blood flow?
Actually, they do. Minoxidil - the most widely used hair loss
topical treatment in the world - is an FDA-approved
anti-hypertensive (in other words, a medication that
reduces high blood pressure). It achieves this by widening
the blood vessels, which then allows more blood to flow
through them. When taken orally, minoxidil leads to hair
regrowth not just on the scalp, but all over the body.
75
Again, keep in mind that local factors which affect blood
flow to the top of the scalp have a much larger impact on
hair growth outcomes than factors such as blood pressure
and cardiovascular health which are systemic factors.
How sure are we that scalp tension causes hair loss,
and isn’t just correlated to it?
The scalp tension pattern found in a computer model was
highly correlated with the Norwood-Hamilton Scale. The
author of the study calculates the statistical probability
being down to chance is 1 in 1,000. (11)
Given what we know about scalp tension leading to
inflammation and then dermal fibrosis in the presence of
DHT, the scalp tension models make perfect sense. We also
see that male pattern baldness takes place only over the
galea.
76
Why do men lose hair in slightly different patterns?
The Norwood-Hamilton Scale is universally accepted as the
way in which male pattern baldness progresses. Yet some
men will vary in the exact pattern that their hair loss
progresses. For example, some men have more crown
thinning than others.
There could be a number of reasons for this variation,
however this is an area where more research is needed to
more accurately determine the causes of the variation.
Some men who suffer from pattern baldness also have a
hair shedding disorder at the same time. This can cause a
more diffuse hair loss pattern. If you find you have a lot of
thin hair and a less obvious pattern, it is worth
remembering that treatments for male pattern baldness do
not necessarily work for hair thinning disorders such as
telogen effluvium.
77
There can be a number of causes of hair thinning disorders
such as stress, nutrient deficiencies, heavy metal toxicity,
hyperthyroidism and more.
The other possible reasons that cause subtly different hair
loss patterns could be skull shape and differences in blood
supply, although more research is needed in this area.
To put it simply, variations in hair loss patterns are caused
by the addition of hair thinning disorders and/or individual
variations in tension patterns and microvascular blood
supply throughout the scalp.
Isn’t low blood flow and low oxygen levels a
consequence of hair loss, rather than a cause?
In this book we’ve referenced studies showing that balding
areas of the scalp have lower blood flow, lower oxygen
concentration
and
higher
collagen
deposits
than
non-balding areas.
78
In principle, one could argue that these differences are the
consequence, not the cause of pattern hair loss. However,
the conventional, widely-accepted model of androgenetic
alopecia (AGA) cannot account for this reduced blood flow.
According to this conventional model, DHT attaches to
receptors inside the hair follicle, and then triggers
genetically predetermined pathways inside the follicle that
lead to its miniaturization and eventual death. There is
nothing in this process that could lead to the observed
reduction in blood flow, not to mention the extensive
perifollicular fibrosis.
What if I stop using the Hairguard System?
The beauty of the 3 Layer System is that it helps fix hair loss
at the root cause, and therefore your hair is more protected
against future hair loss.
It is also easier to maintain your healthy hair once it has
regrown than it is to regrow it in the first place. So once
79
you’ve achieved a level of regrowth you are happy with you
may be able to continue with just scalp brushing or using
the Growband infrequently to maintain what you have.
Just like brushing your teeth keeps your mouth healthy,
brushing your scalp and using the Growband helps keep
your hair healthy, though what you need to maintain your
hair varies for everyone depending on the severity of the
hair loss.
The main point is that you will need to deal with either the
scalp tension, or the DHT in your scalp, to maintain your
hair. If not, you’ll steadily lose what you’ve regrown over
time.
Although the Growband does help reduce scalp tension,
this isn’t necessarily a perfect long term solution as the
muscles can begin to tighten up again.
However it’s probably true that less use of the Growband is
needed over time. Once the muscles have been stretched
80
out they are unlikely to return all the way to their
previously contracted state.
Does the 3 Layer System work for women?
Although the 3 Layer System has been designed for male
pattern baldness, it actually works incredibly well for
women too.
Although DHT plays less of a role because it’s found in much
lower levels in women, female pattern baldness is also
caused by reduced growth space and blood supply to the
hair follicles, so the 3 Layer System will still be effective at
reversing hair loss in women.
Can I use the Hairguard System without the
Growband?
Yes, you can use the Hairguard 3 Layer System without the
Growband and still achieve excellent hair regrowth.
81
If you don’t want to use the Growband at this time, instead
we recommend using the Scalp Brush to massage the scalp.
You can also do manual scalp massages with your hands.
Your hair care routine must deal with the scalp tension
(Layer 3) to some extent to be successful in the long term.
As an example, let’s say Ben uses the full 3 Layer System
with the Growband. Or he uses manual scalp massages, or
receives a Botox treatment.
Essentially, Ben makes sure he reduces the scalp tension in
some way.
Jerry decides to go for only steps 1 and 2 (layers 1 and 2 of
the scalp.)
After 6 months, Ben and Jerry may have achieved similar
results in terms of hair regrowth. However, after the first 6
month period, Ben would most likely start to pull away from
Jerry and achieve better results from there onwards.
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For Jerry, the chronic scalp tension and reduced blood
supply remains and therefore limits his recovery going
forward from the 6 month period.
If both Ben and Jerry stopped all hair loss treatments, it is
more likely that Ben would keep his new hair for longer as
well.
Some people choose to go for steps 1 and 2 initially and
then come back and order the Growband at a later date.
The Growband comes with our 12 month money-back
guarantee so there’s absolutely no risk to you if you decide
to try it. It makes most sense to go for the full 3 Layer
System knowing your Growband purchase is completely
risk free.
Is using a dermaroller painful?
Using
a
dermaroller
dermatologists
have
is
mildly
used
uncomfortable,
cosmetic
yet
microneedling
treatments for over a decade with great success. Your scalp
83
will adjust over time to the sensitivity, so just keep in mind
the first time you try dermarolling will be the most
uncomfortable time.
Microneedling is an important part of the system because it
actively helps reverse fibrosis and also helps with the
absorption of the topical into the dermis.
Personally, I just spend 10 - 15 minutes per week in the
evening when going over my entire scalp. It doesn’t take
long and any irritation quickly subsides.
Once you’ve reached your hair goals, and if you’ve removed
the chronic scalp tension by using the Growband, and
blocked DHT using our topical products, you may not even
need to use a dermaroller anymore as the fibrosis will have
been dealt with.
84
When should I expect to see results?
Hair regrowth takes time so it’s important to stay patient.
Most of our clients see visible results within 3 months,
however sometimes it can take longer.
Hair goes through phases so at the initial stage of the 3
Layer System the hairs will be transitioning to the growth
phase which takes some time before the hair itself actually
starts growing.
Remember, your hair can be thickening and improving
without it being necessarily visible to start with. The 3-6
month period is when many of our clients see their biggest
improvements as the scalp tension and fibrosis reduces and
microvascular blood supply increases throughout the entire
scalp.
When using the 3 Layer System your hair will be getting
thicker before it’s noticeable. It may take a hair cut to reveal
the new thickness of your hair.
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Although the 3 Layer System can work faster than
traditional treatments, the power of the system comes at
the 6-12 month mark as tension decreases and blood supply
increases from the 3rd layer up.
Which topical should I use?
When implementing the 3 Layer System it is key to use the
correct topical since it should perform many functions, such
as helping to block DHT and triggering the anagen (growth)
phase of the hair follicle.
We designed Biogaine to do exactly that, plus more. In fact,
Biogaine is by far our most advanced and sophisticated
formulation, containing a wide range of ingredients that you
won’t find anywhere else. We strongly believe Biogaine is
the best all-natural hair growth topical on the market,
making it the perfect choice for use in the 3 Layer System.
Biogaine is suitable for men and women, and because it
does not contain any drugs, the chances of even mild
side-effects are very rare.
86
How often should I apply Biogaine?
We recommend applying Biogaine once per day. The ideal
time is to apply it in the evening around 1 hour before
bedtime, straight after using the Scalp Brush. Biogaine
needs around 30 minutes to properly dry and therefore it is
better not to apply it right before going to bed.
The longer the solution is in contact with the scalp the more
effective it is. Ideally leave Biogaine in for 24 hours before
washing out.
Will the 3 Layer System cause hair shedding?
Hair shedding may occur in some cases, however this is
nothing to worry about and is actually a good sign in most
cases, as it shows the hair follicles in the resting phase are
being replaced by hair follicles in the growth phase which
can grow back thicker and stronger than the follicle before
it.
87
In a lot of cases, those with an obvious amount of hair
shedding at the start of the treatment are also the ones who
achieve quicker results.
Shedding periods can last from a few days up to a few
weeks. In the very unlikely event you have severe shedding
then please contact our support team where we will provide
help and feedback.
Can I use the Growband by itself?
The Growband is effective by itself but works much better
when combined with steps 1 and 2.
Clients who use only the Growband typically have much
slower regrowth rates than clients who use the full 3 Layer
System because the topical actively stimulates new growth,
whereas the Growband works by removing the root cause
of the hair loss.
88
Therefore it is highly recommended to use Growband as an
adjunct treatment alongside steps 1 and 2.
If you’re already happy with hair and simply want to protect
against future hair loss then the Growband alone may be a
suitable option.
Are there any side effects?
Since Biogiane does not contain any drugs the chance of
even mild side effects is very rare.
What size is the dermaroller?
The Hairguard System uses a 1mm dermaroller. The needle
size is based on a number of studies that used this length
and achieved excellent results.
There are yet to be any studies comparing the dermaroller
needle size and their respective effectiveness and therefore
1mm is considered the most effective size when used in
combination with a hair growth topical.
89
I have long hair, can I still use the scalp brush and
dermaroller?
If you have long hair it may take you slightly longer to use
the scalp brush and dermaroller. You’ll simply need to be
more careful not to pull out any hairs whilst doing so.
However, it’s still totally possible and important to use both
the scalp brush and dermaroller even with long hair.
Does the Hairguard System work for all types of hair
loss?
No, the Hairguard System is designed only for male and
female pattern baldness (androgenetic alopecia). The
system is not suitable for telogen effluvium, alopecia areata
or other less common forms of hair loss.
Where do you ship?
We ship to the US, Canada, Europe, Australia and New
Zealand.
How does Biogaine compare to other topicals?
90
Biogaine is probably the best all-natural hair growth topical
on the market. The reason we can say that so confidently is
that for the last four years Hairguard has been researching,
developing and refining the formulation, with the result
being that Biogaine is by far the most effective natural
product available.
In fact, when we began developing Biogaine, we first started
by asking ourselves a simple question: “If cost wasn’t an
issue, what would the best non-medicinal hair growth
product look like?”
The result is Biogaine, and it has exceeded our expectations.
Far from being a weak hair growth topical as you might
expect, Biogaine rivals and even exceeds regular minoxidil
thanks to its exhaustive list of superior (and in some cases
patented) ingredients that target hair regrowth from
multiple angles to make it as effective as possible. No
expense has been spared in the Biogaine formulation.
91
Bonus Section
Do hair transplants prove that scalp tension does not
cause hair loss?
We’ve seen how reduced hair follicle growth space and
blood supply (in the 3 main layers of the scalp) causes hair
loss.
However,
hair
transplants
represent
the
main
counterargument to this theory.
If hairs can be transplanted from the back of the head to the
front (into balding areas) and continue to survive, this
would prove that the hair follicle itself is genetically
sensitive to DHT, and this sensitivity is the deciding factor
of whether the follicle lives or dies, rather than the scalp
environment surrounding the follicle.
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Let’s call these two sides of the argument:
●
“Scalp environment dominant”- Reduced hair follicle
blood supply and growth space causes hair loss. (This
is the argument we present in this book.)
●
“Hair follicle dominant” - Hair follicle’s genetic
sensitivity to DHT causes hair loss.
To put it another way, here are the two sides of the
argument:
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The Hair Follicle Dominant Argument
vs.
The Scalp Environment Dominant Argument
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I want to address the ‘hair follicle dominant’ side of the
argument, and then show how it falls apart under closer
inspection.
In doing so, you’ll realise why the hair follicle dominant
argument has stifled progress of new hair loss treatments
since the theory came around: because it places emphasis
on the hair follicle itself, rather than taking a deeper look at
the scalp environment surrounding the follicle.
Hair transplants and the Hair Follicle Dominant
argument
The hair follicle dominant theory suggests the hair follicle
itself determines whether it lives or dies due to genetic
sensitivity to DHT and the scalp environment is practically
irrelevant to hair health.
Scientists took healthy hair follicles from the back of the
head (donor area), and transplanted them into balding areas
at the front of the head (recipient area).
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This is known as a hair transplantation procedure.
If the scalp environment really did affect the hair follicles,
then those hairs transplanted from non-balding areas to
balding areas would surely start miniaturizing as well.
If the hair-follicle-dominant argument was correct, those
transplanted hairs would continue to live on (because they
aren’t genetically sensitive to DHT, the argument goes).
In a study from 1959, researchers did exactly that and the
transplanted hairs continued to grow as normal. (13)
They didn’t miniaturize and they didn’t fall out for the
entirety of the study.
This allegedly proved that the scalp tissue environment
(across the 3 layers of the scalp) was completely
unimportant when it came to the hair loss. All that mattered
(the researchers concluded), is the local hair follicle
sensitivity to DHT which was genetically predetermined.
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This gave birth to the hair follicle dominant argument,
which forms the basis of modern hair transplants.
In fact, thousands of people each year get hair transplants,
taking healthy hairs from the back, and transplanting into
balding regions where they continue growing healthily.
This clearly shows the hair follicle dominant argument must
be correct, and disprove that blood supply and growth
space plays a role in hair loss, right?
This goes against exactly what we’ve been talking about in
this book.
So how can this be?
Well there are some crucial parts of the hair transplant
studies that didn’t receive the proper attention.
Firstly, during the initial studies on hair transplantations,
the researchers didn’t take single hairs from the back and
transplant them into the front. In fact, what they took were
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6-12mm punch biopsies with a large amount of surrounding
tissue.
Here’s an example of a punch biopsy from the scalp. It
contains the the hair follicles and all the surrounding tissue
and blood supply from the dermis:
These grafts were moved together from the back to the
front and continued to grow healthily for the remainder of
the 2.5 year study.
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The problem here is, the study looked at a chunk of the
scalp environment, rather than a singular hair follicle. Each
6-12mm punch biopsy contained a large number of hair
follicles (more than 10).
This is a really important distinction because the healthy
scalp tissue environment is also being transplanted, not
just the follicle by itself.
Subsequent hair transplant studies actually show that graft
survival rate is dependent on the number of hair follicles,
and the amount of surrounding tissue taken with each graft.
Bigger grafts with more tissue have a higher survival rate.
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Clearly the tissue surrounding the hair follicle is important
to whether the hair follicle lives or dies.
So how about all the hair transplants that are taking place
each year and still look great years later?
Firstly, almost all hair transplant patients are required to
take finasteride.
As we now know, finasteride blocks DHT, which then stops
the process of dermal fibrosis from taking place which
would restrict blood supply and growth space.
This means we can’t include those patients in the
hair-follicle-dominant argument, because DHT has been
removed from the equation, thereby rendering the ‘DHT
sensitivity’ argument obsolete.
However, in the few cases when hair transplant patients
don’t take finasteride, those transplanted hairs do
eventually start thinning. It just takes 5, 10 or even 15 years
before the scalp environment surrounding the transplanted
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hair follicle changes enough due to fibrosis to start
constricting hair growth space and blood supply and
causing miniaturization.
Remember, fibrosis is a slow process and takes place over
many years, even decades.
It took many years for these patients to start losing their
hairs in the first place. Similarly, it takes many years for
them to begin losing their newly transplanted hair. Think of
it like resetting a countdown timer in the hair follicle.
Some researchers have called this the hair follicle’s “balding
clock.” Think of it as a clock that starts when the hair gets
transplanted into a scalp environment under tension, in a
patient who isn’t blocking DHT.
Summary
Hair transplants present the strongest counter-argument to
the idea that reduced blood supply and growth space
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causes hair loss, by showing that hair follicles are
genetically predestined to live or die due to genetic
sensitivity to DHT.
But a closer look reveals that even transplanted hairs are
(eventually) affected by the scalp environment and start to
miniaturize (if the patient doesn’t block DHT or reduce
scalp tension).
It just takes time for the surrounding tissue of the
transplanted hair to feel the effects of scalp tension and for
constriction to take place around the hair follicle due to
dermal fibrosis.
Consequently, hair transplants show all hair follicles do
eventually miniaturize from fibrosis caused by scalp
tension; it just takes time. This proves that the scalp
environment plays the defining role in causing male pattern
baldness.
To put it another way, in a patient who doesn’t block their
DHT, the transplanted hairs which do eventually start
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miniaturizing would still be growing perfectly healthily, had
they remained at the back of the head where tension is low.
Just look at celebrities like Joe Rogan who didn't take
finasteride after having a hair transplant. That transplanted
hair is now essentially gone, yet the hair on the back of his
head still persists long after his transplanted hair has fallen
out.
I know in this chapter we’ve gone deep into the science
surrounding the causes of hair loss.
It is important to clarify why the reduction of the
microvascular blood supply and growth space is the real
root cause of hair loss, so that we can understand how best
to treat it. We’ve looked at the strongest counter-argument,
and then seen how it doesn't hold up upon closer inspection.
A treatment that works across the 3 layers of the scalp is
the best solution for blood flow and growth space
constriction, because it fixes hair loss at the real root cause.
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Consequently, as explained in the previous chapter, your
hair can continue to improve in a time-dependent manner,
rather than reaching a plateau after a year or so, as happens
with traditional 1-Layer treatments.
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Appendix
Why DHT + scalp tension causes dermal fibrosis
DHT is an anti-inflammatory molecule. For example, when
you suffer a wound, DHT modulates your body’s
inflammatory response. DHT has also been found to act as
an anti-inflammatory in the prostate, as well as in other
instances of inflammation like gingivitis.
When the scalp is pulled tight, it creates the chronic
low-grade inflammation we discussed earlier. In response
to this inflammation, DHT is then activated in the tissues.
In tissues under tension, and in the presence of DHT, a
signalling protein called transforming growth factor beta-1
(TGFβ-1) is induced. This protein plays countless different
roles in our bodies and has unsurprisingly been the subject
of literally thousands of scientific articles.
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But what researchers have generally overlooked is its
connection to hair loss. And in particular its potential to
induce fibrosis in the scalp. You see, whenever TGFβ-1 is
overexpressed in a tissue, it leads to progressive and
eventually irreversible fibrosis. The scalps of balding men
are just another example of this fibrosis process.
Fibrosis is the reason why men with advanced stage male
pattern baldness get shiny scalps, and why hair loss is so
hard to reverse. Not only do you need to reduce the cause
(the scalp tension) but you also need to reverse the fibrosis
for the hairs to be able to regrow.
To recap, chronic tension in the scalp causes inflammation.
In response to this inflammation DHT is then activated,
inducing in turn the overexpression of TGFβ-1. The result is
progressive remodelling of the scalp tissue in the form of
fibrosis.
The more advanced the fibrosis, the more microvascular
blood supply in the scalp is restricted, and the less space
there is for the hair follicles to grow. The results from men
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who take finasteride show that blocking DHT can stop
further hair loss and regrow a small amount of hair.
But blocking DHT cannot lead back to a full head of hair for
a simple reason: even if you removed every last molecule of
DHT from the body, the fibrosis that already exists would
not be corrected one bit. This explains why blocking DHT
stops hair loss, but doesn’t completely reverse it.
How microneedling with a dermaroller helps reverse
fibrosis and increase blood supply
The practice of microneedling was discovered by plastic
surgeons fairly recently, in the 1990s. An important
complication of plastic surgery are the scar tissues after the
operation. These are instances of large-scale fibrosis that
are visible to the naked eye and often irreversible.
A hallmark of these post-surgical scars is the absence of
hairs and pigment. Back in the 90s, plastic surgeons used
tattoo guns to inject artificial pigment into the scars but
noticed that after some time the mechanical punctures
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caused by the tattoo guns led the body to a) re-pigment the
scars naturally and b) grow back hair!
This observation led to the field of microneedling as we
know it today. Its most common application is the treatment
of scars, be they acne scars, burn scars or stretch marks.
Microneedling mechanically breaks down the fibrotic scar
tissue and at the same time prompts a healing wound
response through the release of growth factors and
cytokines. The end result is healthy tissue regeneration,
including new hairs.
Though it is useful in its own right, microneedling becomes
even more effective when combined with a topical product.
The tiny holes created by the dermaroller allow the
enhanced penetration of the topical, leading to far better
results. In the case of hair loss, the most commonly used
topical is minoxidil or minoxidil-containing formulations.
Minoxidil is a potent vasodilator, meaning it enlarges the
blood vessels, which allows more blood to flow to the
follicles. And it is almost certain that microneedling
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dramatically enhances minoxidil’s vasodilatory effects:
clinical studies show that adding weekly microneedling
sessions to daily minoxidil results in a 4x increase in hair
regrowth! In other words balding men who combine
microneedling with minoxidil get four times the results they
would get through applying minoxidil on its own.
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Acknowledgments
Robert English from Perfect Hair Health is a leading hair
loss researcher and medical editor, and much of the
information presented in this book is based on his work. Not
only has Robert pieced together study after study into a
coherent model and theory of the constriction of blood flow
and growth space related to hair loss, but his work on scalp
massages as a treatment for hair loss resulted in the study
that was referenced in Chapter 2. It is highly recommended
to follow along with his work.
We have the hard work of researchers and scientists
worldwide to thank for their studies which contributed to
the ideas we explain here. The 3 Layer System is born out of
the results from these studies.
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References
1. TJ Franz, 1985, “Percutaneous absorption of minoxidil in
man”
2. H. Kato et al., 2020, “The Effects of Ischemia and
Hyperoxygenation on Hair Growth and Cycle”
3. BE Goldman et al., 1996, “Transcutaneous PO2 of the
scalp in male pattern baldness: a new piece to the puzzle”
4. P. Klemp et al., 1989, “Subcutaneous Blood Flow in Early
Male Pattern Baldness “
5. CH Won, 2008, “Dermal fibrosis in male pattern hair loss:
a suggestive implication of mast cells”
6. KD Kaufman et al., 1998, “Finasteride in the treatment of
men with androgenetic alopecia”
7. BJ Freund, 2010, “Treatment of male pattern baldness
with botulinum toxin: a pilot study”
8. Y Zhou et al., 2020, “Effectiveness and Safety of
Botulinum Toxin Type A in the Treatment of Androgenetic
Alopecia”
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9. S. Singh et al., 2017, “A Pilot Study to Evaluate
Effectiveness of Botulinum Toxin in Treatment of
Androgenetic Alopecia in Males”
10. RS English, 2019, “Self-Assessments of Standardized Scalp
Massages for Androgenic Alopecia: Survey Results”
11. R. Tellez-Segura, 2015, “Involvement of Mechanical Stress
in Androgenetic Alopecia”
12. L. Bao et al., 2017, “Randomized trial of electrodynamic
microneedle combined with 5% minoxidil topical solution
for the treatment of Chinese male Androgenetic alopecia”
13. N Orentreich, 1959, “Autographs in alopecias and other
selected dermatological conditions”
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