Hair Loss And SIBO: How To Treat Gut Dysbiosis

Rob Misc. Research, Treatments 28 Comments

Is Small Intestinal Bacterial Overgrowth (SIBO) Connected To Hair Loss?

Not long ago, I wrote an article about the connection between acne and hair loss (androgenic alopecia), and highlighted research suggesting that a primary driver of acne (specifically, acne rosacea) may be a condition known as small intestinal bacterial overgrowth (SIBO).

This got a lot of readers asking: is SIBO also related to hair loss? And if so — how do I test for small intestinal bacterial overgrowth… and how do I resolve it?

The answers aren’t straightforward. For one, I haven’t found a single paper demonstrating a clear connection between hair loss and SIBO. However, several papers suggest a connection between SIBO and intestinal inflammation, nutrient malabsorption, and the over-colonization of gram-negative bacteria… all of which are involved in the pathology of fibrosis (ie: scar tissue development) and certain fibrotic disease states (ie: cystic fibrosis). And as we know, fibrosis is directly implicated in the pathology of pattern hair thinning.

But we’re stretching the evidence here. We can’t conclude that just because SIBO is linked to cystic fibrosis — then it must also be linked to all forms of fibrosis — like the kind implicated in pattern hair loss (perifollicular fibrosis)…

But anecdotally, the SIBO-hair loss connection gets more interesting.

Of the female hair loss sufferers with whom I’ve worked — nearly every woman who tested for SIBO, tested positive. And of the women who sought SIBO treatment and later retested as SIBO-negative, those women reported a reduction in hair shedding, and that their hair (which in some cases, had stopped growing) started to lengthen again.

Those are huge wins — especially for any female hair loss sufferer who feels she’s exhausted her hair loss treatment routes and doesn’t know where to turn next. And while SIBO doesn’t seem as prevalent in male hair loss sufferers — at least the ones with whom I’ve worked — the reality is this: anything that contributes to chronic inflammation in the small intestine (ie: SIBO) has the potential to hurt our hair.

Why? Because the small intestine is roughly 20 feet long. And of the foods we eat, it’s responsible for nearly all nutrient absorption. That includes iron, vitamin B-12, and vitamin D — of which many female hair loss sufferers are deficient. Dozens of studies show that prolonged protein malabsorption and nutrient deficiencies can lead to diffuse hair thinning, excessive hair shedding (telogen effluvium), and even autoimmune-related hair loss like alopecia areata.

And encouragingly, studies also show that resolving these deficiencies — either with better nutrition, or fixing the underlying causes of malabsorption (like SIBO) — might sometimes lead to hair recovery (see these articles on vitamin D and zinc).

So… If I Have SIBO And Treat It, Will I Regrow My Hair?

Now, this doesn’t suggest that for the majority of those with hair loss — treating SIBO will regrow hair. But it does suggest — for men and women who fit the bill of SIBO symptoms — that resolving SIBO might also help resolve some of the underlying factors associated with their hair loss… and in doing so, maybe slow or stop hair loss (or encourage healthier hair growth).

So how do we test for small intestinal bacterial overgrowth? And if we test positive, how do we resolve it?

SIBO Treatment Recommendations Vary Wildly

There are many kinds of SIBO, and each kind requires a different treatment. Depending on the doctor — everyone seems to have differing opinions on how to best treat each SIBO type.

Resolving SIBO is also complicated, and it’s something of which I lack first-hand experience (I tested SIBO-negative in a breath test two months ago). Moreover, there’s limited research on SIBO pathology and treatment efficacy. As a result, SIBO sufferers often must rely on the experience and advice of medical professionals who work with SIBO patients regularly.

The bottom line: I’m a hair loss researcher, not an SIBO expert. And that means you shouldn’t read about SIBO treatments from me; you should read about them from someone more qualified. So I decided to forgo writing the rest of this article — and instead reach out to an authority in digestive health.

I’d like to introduce John Brisson — an author, researcher, educator, and expert in digestive disorders, hormone dysregulation, autoimmunity, and most importantly: small intestinal bacterial overgrowth.

John is the cofounder of fixyourgut.com. His deep-dive into health research began from a personal tragedy. His experience working with SIBO and digestive disorder sufferers spans years and thousands of hours. And today, he’s even referred to as a contributor and expert in published medical literature.

Note: I am not financially affiliated with John Brisson or his website. But I’ve spoken with him over Skype, and I value his work. There are few others qualified to write the same SIBO treatment guidelines, and my hope is that this content will help anyone who might be experiencing SIBO, hair loss, or both.

So let’s get started. John’s content covers what is SIBO, why SIBO negatively impacts our health, how to test for SIBO (and minimize false results), and most importantly: how to treat SIBO based on its type (methane-dominant, hydrogen-dominant, or both).

Note: the following is written by John Brisson of fixyourgut.com

SIBO, Gut Health, And Bacterial Overgrowths

Bacterial dysbiosis (a microbial imbalance of bacteria inside the body) can wreak havoc on many different aspects of our overall health. I have coached many people with SIBO, and I have seen those with the condition struggle trying to manage their illness and the stress of modern life. Imagine reacting negatively to almost everything you consume, causing severe abdominal distension to the point where you look like you are pregnant, for weeks and months at a time.

SIBO (small intestinal bacterial overgrowth) is a medical condition where many people have an opportunistic bacterial infection in the small intestine. And unfortunately, SIBO can take a serious toll on one’s physical, social, spiritual, and mental health because it directly compromises the functionality of the small intestine.

Why Is The Small Intestine So Important?

The small intestine helps to break down proteins, lipids, and simple carbohydrates and is very important for the assimilation of nutrients. The MMC (migrating motor complex) maintains peristalsis in the small intestine and helps move our food along for proper digestion.

With a bacterial overgrowth in the small intestine, our ability to process and absorb nutrients is significantly impaired, and will remain so until the condition is addressed.

What Causes SIBO?

The development of SIBO is usually caused by the poor standard American diet, food poisoning, viral gastroenteritis, antibiotic overuse, motility issues (mainly chronic constipation), or long-term use of stomach acid reducing medications (proton pump inhibitors or antacids).

The long-term use of acid-reducing medications causes opportunistic bacteria that would typically be eliminated by stomach acid, to survive and flourish in the small intestine. A lack of stomach acid causes food proteins to become partially undigested. Allergies develop from the undigested proteins.

Undigested proteins also cause excessive flatulence and increase inflammation. The standard American diet of FODMAP carbohydrates allows opportunistic bacteria to thrive, strongly colonize the small intestine, and produce excess gas.

How Does SIBO Develop?

These contributing factors create a window of opportunity for microorganisms to enter and colonize the small intestine, an organ with relatively fewer microorganisms than the rest of our intestinal tract. This leads to something known as opportunistic dysbiosis (a microbial imbalance), which depending on the severity, begins to inhibit the small intestine’s ability to perform its tasks.

The more opportunistic bacteria in our small gut, the more food that bacteria ferments, and the more gas byproducts and toxins they produce.

The opportunistic microorganisms (and their toxic byproducts) then begin to decrease fat absorption in the intestines. This leads to stool problems with color/fat content. And unfortunately, the cycle reinforces itself. Increased fermentation in the small intestine also increases the chances of further small intestinal dysbiosis, and as a result, the intestinal lining further degrades and eventually cannot digest larger nutrients correctly.

These improperly digested start to cause food allergies and sensitivities.

The opportunistic microorganisms produce toxins that then enter the bloodstream from the loss of integrity in the intestinal wall. Excessive toxins in the bloodstream lead to an immune overreaction that causes fatigue, systemic joint pain, and elevated liver enzymes.

Finally, these byproducts or toxins that cause neurological and cognitive problems including cognitive impairment and forgetfulness. The vicious cycle continues as the body’s immune system tries to eliminate the opportunistic microorganisms, which react to the body’s defenses by releasing more acids, toxins, and creating more opportunities for these inflammatory microorganisms to continue to flourish. The cycle then repeats itself, and the end result is chronic illness.

What Are The Symptoms Of SIBO?

The main symptoms of a SIBO infection are indigestion, an increase in flatulence, and horrible-smelling deification, burps, and flatulence. Other symptoms of SIBO include abdominal pain, severe bloating, abdominal distention, chronic constipation, acid reflux (GERD), fatigue, headaches, chronic diarrhea, fat malabsorption, food allergies, and occasional low-grade fever. There is also a strong correlation between rosacea and SIBO.

In my coaching experience. I’ve found that most people with IBS (irritable bowel syndrome) are actually suffering from SIBO, and that SIBO is their main cause of their digestive problems.

Diagnosing SIBO: The Hydrogen/Methane Breath Tests

A hydrogen/methane breath test is often the standard used to diagnose SIBO.

The hydrogen/methane breath test is a non-invasive fasting test in which your doctor has you breathe into a machine that monitors excess hydrogen or methane that is released by the opportunistic bacteria in your small intestine.

You are given glucose, dextrose, or lactulose, during the test to consume, and the test input is collected at twenty-minute intervals for at least three-five hours.

SIBO-Positive Thressholds

If you produce at least twenty ppm of hydrogen or three ppm of methane during the test, you test positive for an active SIBO infection (but even a result of twelve ppm hydrogen should be treated at the very minimum).

If your hydrogen and methane are flat-lined or do not rise during the test, you may have the third type of SIBO: hydrogen sulfide producing bacterial overgrowth.

SIBO Tests Aren’t Perfect! Sugars & False Results

It’s debatable which sugar is best to ingest for diagnosing SIBO (lactulose or glucose). For instance, bacteria have to ferment lactulose in the intestines for it to be absorbed by the body. Glucose is easily broken down by the microbiome or directly absorbed by the gastrointestinal system.

Moreover, the use of glucose as a test marker may give a false negative reading because at least seventeen feet of the small intestine may not be tested. And in people with irritable bowel syndrome with diarrhea (IBS-D), the glucose might reach the cecum and begin fermentation sooner, creating a false positive SIBO result in people with strictly colonic overgrowth.

There are also issues with the use of lactulose that might produce false negatives. Not all organisms that cause an overgrowth ferment lactulose, and if you have an overgrowth of bacteria that doesn’t ferment lactulose, you might receive a false negative test result. In addition, lactulose increases bowel transit time, which can further skew test results. So if you’re going to test for SIBO, you need to be aware of these issues so that you can maximize your chances for an accurate diagnosis.

Want To Get Tested For SIBO?

I recommend using these guidelines of hydrogen/methane breath interpretation by the leading SIBO expert, Dr. Allison Siebecker. I also recommend getting a GI Effects performed by Genova Diagnostics through your gastroenterologist.

You can find out how to order the SIBO tests (based on your location) right here.

It might be best to get both tests done (glucose and lactulose) to determine bacterial overgrowth, alongside that bowel transit test as well, to determine one’s motility and how long it would take the test substances to reach the colon. That way, you’ll have a better idea of what’s going on (and help minimize your chances of an incorrect diagnosis).

And remember, some people can have SIBO symptoms and still receive a negative diagnosis. This is because not every overgrowth of bacteria in the gut will contain bacteria that produce hydrogen.

There is also no unified medical interpretation of SIBO breath tests. Therefore, a doctor might perceive your results to be normal, and they aren’t. If your values do not rise during the test, you may have hydrogen sulfide producing bacterial overgrowth in the small intestine.

How Do You Treat SIBO? It All Depends…

So, what do you do if you have SIBO? In general, it’s better try an SIBO treatment if you have many of its symptoms, instead of relying on an unpredictable diagnosis from breath testing.

Depending on the type of SIBO you have, some doctors might prescribe antibiotics including Xifixan, Cipro, Flagyl, or Neomycin. Some more integrative doctors may prescribe more natural approaches like Allison Seibacker’s natural protocol for tackling SIBO.

Many people follow a low FODMAP diet to try to reduce overgrowth and control symptoms with moderate success (if you’re interested, here are specific guidelines).

If you are not any better within a month of following a low FODMAP diet or doing any SIBO protocols, then SIBO was either not your problem in the first place (it could be small intestinal yeast overgrowth (SIYO)), or the protocol was not strong enough to eliminate some of the hardier bacteria like MAP (Mycobacterium avium paratuberculosis, a cause of Ulcerative Colitis and Crohn’s disease) or Klebsiella (a cause of Rheumatoid Arthritis and Ankylosing Spondylitis).

If you find yourself in the latter position, you should know there’s currently no public test for MAP (outside of specific testing at a university or hospital pathology laboratory), but Klebsiella can be tested for by using Genova’s GI Effects Stool Profile test (you’ll need a gastroenterologist to order the test, though some functional medicine practitioners can order these too).

SIBO Treatment Guidelines

Treating Hydrogen-Producing SIBO

If you are suffering from hydrogen producing SIBO, taking the antibiotic Xifixan for ten to fourteen days, or following my hydrogen SIBO protocol for two to four weeks, may help reduce your overgrowth and improve your digestion.

In addition, many of my clients with dominant hydrogen overgrowth have seen success with using berberine and oil of oregano as antimicrobial agents, and activated charcoal to help with loose stools. Moreover, following a low FODMAP diet for a few weeks may help reduce bloating.

Treating Methane-Producing SIBO

If you are suffering from methane-producing SIBO, following my methane dominant SIBO protocol for two to four weeks may help reduce your overgrowth and improve your digestion.

Many of my clients with dominant methane overgrowth have seen success with using allicin, neem, or Atrantil as antimicrobial agents and magnesium and 5-HTP to help increase motility. Multiple protocols and rotation of herbs may be needed for proper recovery, as most your gut issues didn’t start overnight, and it might take some time for your digestion to improve.

Above all, don’t become discouraged. Most people improve their quality of life or conquer their SIBO in time.

Note: the above segment is written by John Brisson of fixyourgut.com

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Comments 28

  1. Hi Rob! Thank you very much for your info. Im female 33, I wrote you several years ago and tried your massage for 10 months but didnt see results, so I quit it. Reading this article I found all the symptoms. I suspect i have this SIBO. At the moment Im in Sweden and im a bot frustrated now what to do. im foreign here. Who could help me online to start some treatment without testing? And also in this case do i need to perform your scalp massage? How is your experience with female hair loss? Thank you

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      Hey Anna,

      Thanks for reaching out, and I’m sorry you’ve yet to find a successful treatment regimen for your hair loss. In my experience working with women, SIBO appears to absolutely be associated with female pattern hair loss. The question still remains: is SIBO associative, or causative?

      At least at a theoretical level, it seems that SIBO might negatively impact our hair via hair shedding and the hair cycle by inhibiting nutrient assimilation and transportation. With that said, these forms of hair loss are a bit different from the typical “scarring” alopecias characterized in men and women with pattern hair loss. But at the end of the day, hair loss is hair loss — and those suffering from any form (whether it’s telogen effluvium, alopecia areata, or androgenic alopecia) want their hair back.

      The good news is that clearing up SIBO might help to significantly improve your digestive symptoms and your hair. But the only way to know is to do some testing, and work with someone with experience successfully treating SIBO. John Brisson (in the article) is my go-to resource for digestive health, and booking a consultation with him might be a good first step. Conversely, you can always just assume you have a moderate SIBO infection and attempt to treat yourself with the guidelines within this article (and the links to John’s site). In the case that you do have a SIBO infection, I would first focus on resolving that rather than massaging — so that when you do resolve your SIBO, the massages will likely be much more effective and therapeutic.

      Best,
      Rob

      1. thank you so much for your reply, Rob! i will try to reach out for John. i hope he could clear up my situation

  2. Rob what’s your opinion on Yakult ? A Japanese probiotic drink which is now being advertised on TV.

    As I think biotic bacteria can possibly help gut and digestive health.

    Thanks

    1. Yakult is a ferment dairy product that is popular in Japan. The primary strain that is used in the production of the probiotic drink is Lactobacillus casei shota. Lactobacillus casei is known to produce histamine (it is unknown if Shota does), so for some people with histamine intolerance (allergies, asthma, eczema), it may cause their symptoms to worsen. There are some newer versions of Yakult that contain Bifidobacteria breve, which may be better for some people with histamine intolerance. That being said most fermented beverages and foods are going to provide some histamine, and maybe more difficult for anyone to tolerate it. The drink also includes some added amounts of sugar which can cause some issues with SIBO and carbohydrate fermentation. Overall, some people with basic gut issues might find benefit from Yakult, but for most people with SIBO, they may not be able to tolerate fermented foods and beverages until their gut is better.

  3. Hey Rob,

    I bought your ebook and have started the regimen for scalp massage. I havent shampooed since then. Could you send me couple of before and after pictures? Of a couple of your previous readers who tried the regimen

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      Thank you Manuel! John Brisson did most of the heavy lifting. Even since posting this article, two more women with hair loss have emailed to let me know they just tested positive for SIBO. Evidence suggests it could be a bigger driver to female-related hair thinning.

    1. L. acidophilus should be fine for people with histamine issues but it can produce D-lactate so if you take it and it gives you strong brain fog, then you might have issues with D-lactate. L. acidophilus is good for people with stomach issues and H. pylori. B. lactis should be perfectly fine for most people, it colonizes the colon and may improve IBS. Remember, if you are having motility issues (primarily constipation) and are dealing with SIBO you might not want to supplement with probiotics because they might colonize the small intestine where some strains do not belong.

  4. Hi Rob, rather long post sorry but would like to contribute to helping any other members in the same situation or that had similar questions 🙂

    I purchased the standard package and was just wondering if you could answer a few questions for my situation. I’m 25 and first noticed mpb at 20 got on finasteride which maintained for 5 years until I developed truly severe side effects (Major depression, Many food intolerance’s, Major exercise intolerance, Mood swings, Low Energy/fatigue, Complete Apathy, Non existent libido or interest in females what so ever) I’m not over exaggerating at all there’s many people on hair loss forums saying the sides are all in your head and very unlikely but I’m someone who can honestly say finasteride destroyed my mental and physical health to the point of being suicidal. I’m doing better now after 6 month off but still have lingering side effects which I’m afraid could be permanent. I’m now a norwood 2.5 with diffuse thinning all over from once thick dark brown to now light brown thin weak hair. I am so desperate to stop my hair thinning its on my mind 24/7 and will be extremely uncomfortable with a bald head which will look terrible on me 🙁 I’m following your program now and would greatly appreciate if you could please answer a few questions..
    1. Nearly everybody recommends ketoconazole shampoo Regenpure which I’ve used for a year but every time I do my hair seems thinner lighter and drier after use would you say I’m a non responder and just drop it?
    2. I’ve just bought super zix 2 kit which is a topical of zinc, vit b6, liquid saw palmetto/beta sitosterol in polysorbate 80 water & alcohol many say its great at stopping the itch reducing dht and shedding/thinning could the anti inflammatory zinc decrease massage effectiveness buy stopping the acute inflammation response as I’ll be doing both together everyday ?
    3. Lastly I don’t consume wheat but like to eat gluten free alternatives occasionally cereals, spaghetti & meat in breadcrumbs containing either maize flour, corn flour, Rice flour, tapiocha starch I live in the UK so dont think our corn is GMO but what would you advise with these minimum to no consumption again and is rice flour the least problematic?

    I eat very well and supplement Vit D/K2, magnesium but still suffer depression, intolerance to heat/cold, low libido but mainly after eating most foods as a full meal I don’t get bloated indigestion or gas but feel fatigued, heavy overall discomfort and bad palpitations could you possibly advise on tests to get or what direction to look? From all the hair loss sites I’ve spent huge amounts of my time on yours is my favorite I love reading your articles and appreciate everything you do to help others its clear your a genuinely decent human being
    Thanks for everything Ryan

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      Hey Ryan,

      Thanks for your support to keep the site running. And I’m sorry to hear about your situation. I completely understand your desire to stop finasteride — and the side effects associated with its use. The challenge here is that transitioning away from finasteride after long-term use (many years) — and still maintaining hair — is incredibly difficult. The reason why is because long-term finasteride use upregulates androgen receptors in certain tissues — namely, the prostate (which uses the same enzyme as balding scalp tissues (type II 5-alpha reductase) to convert free testosterone into DHT). Unfortunately, this androgen receptor upregulation appears to persist after someone stops finasteride, so when their production of type II 5-alpha reductase returns to normal, there’s likely a DHT flooding effect in the scalp. This leads to rapid hair loss — a symptom commonly described in men quitting hair loss — to the point where all progress / maintenance during its use is absolved within 3-12 months, and the rate of hair loss (in many cases) thereafter likely increases.

      A potential way to combat this situation is to first recognize that your scalp tissues are now likely DHT hyper-sensitive, and that as a result, it’s in your best interest to downregulate DHT expression in these scalp tissues as much as possible. Studies in mechanotransduction and wound healing suggest that DHT is actually anti-inflammatory in prostate tissues, and arrives in scalp tissues as a result of a chronic inflammation. A major driver of this chronic inflammation is likely chronic mechanical tension — either through chronic involuntary contraction / overdevelopment of the muscles surrounding the galea aponeurotica, skull bone growth, or both.

      Dermarolling, mechanical stimulation (massaging), botox injections into these muscles, or acupuncture into these muscles will likely all help reduce tension within the galea aponeurotica, and thereby the inflammation associated with that tension, and thereby the inflammatory cascade that leads to more DHT arriving to the scalp. You can read a little more about the science behind this hypothesis here:

      https://perfecthairhealth.com/trans-hormone-replacement-therapy-hair-regrowth/

      Otherwise, I’d recommend hormone testing (for example, a DUTCH hormone panel) to see if your low libido might be the result of low testosterone. Not surprisingly, SIBO infections can also influence our hormone production. And once we have more data, we can begin to formulate treatment recommendations catered to your specific case (as always, I am not a doctor — so can only give you advice for what I would do in your situation).

      — To answer your other questions–

      1. Ketoconazole shampoos often help reduce hair loss because of their anti-fungal, antibacterial properties (which help decrease inflammation and thereby DHT levels). They also may act directly to reduce 5-alpha reductase. But if you’re experiencing further hair thinning with each use, then it’s worth trying to stop to see if the thinning continues, or improves. I’d recommend at least a couple months (unless you notice aggressive and worsening thinning immediately within a couple weeks — in which case, feel free to end the experiment).

      2. It’s likely this topical is fine and won’t produce any negative effects. In general, the studies on Zix’s compounds were done in vitro (out of body) and likely don’t produce as drastic of an effect in vivo (within the body / in human models). Moreover, topical finasteride has been shown to reduce DHT levels in the scalp, but not move the needle as much in terms of hair regrowth as oral finasteride — so topicals are generally more limited versus oral drugs in their ability to improve our hair. With that said, finasteride injections under the scalp have been shown — in case studies — to lead to potentially even better hair loss improvement than oral finasteride. The takeaway: delivery methods matter, and for DHT reducing drugs, supplements, and topicals —
      the order of effectiveness for hair health might be injections, oral intake, then topicals.

      3. It all depends on the individual. Some people have inflammatory reactions to nearly all grains. While cutting out gluten is a great first step, for many people, it’s just not enough. Similar to your shampoo experiment, I’d recommend cutting out all grains for a month or two and tracking the quality of your skin, hair (shedding rate changes), and bowel movements daily — then reintroducing grains into your diet and seeing if you notice / don’t notice changes. Make sure to keep your calorie count the same (so that you don’t slip into a calorie deficit or ketosis — which will probably further your symptoms of feeling cold and/or having low sex drive). You might find you feel way better.

      Best,
      Rob

  5. The ideas are intriguing. In my case the scalp is seriously tight. At some regions it’s like rock solid. Other regions it is softer. Hair is thinner throughout. But it is thinner in the softer regions as compared to the harder regions. I could feel bone expansion about different regions. Bone growth region and hair loss region doesn’t match. Does it fit the pattern. Also how soft will be the healthy region will be? What do you think?

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      Hey Arne — I’d recommend reading through this article for more scientific support behind the tension-inflammation-androgen-mediated hypotheses of pattern hair loss:

      https://perfecthairhealth.com/trans-hormone-replacement-therapy-hair-regrowth/

      The hardest thing about explaining the hypothesis is that tension from the galea doesn’t always transmute to physical tightness at the epidermis in balding scalp regions — even though the tension could still be present. We need more research in this area, but so far, this hypothesis is the only thing that checks all the boxes for me in terms of explaining all of paradoxes in hair loss (for instance, why DHT exerts pro- and anti-hair effects, depending on tissue location). I’m currently in the process of submitting a paper about these ideas — which will hopefully push future AGA research down this path and to better treatment options.

      Best,
      Rob

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        The evidence suggests that the release of chronic scalp tension is likely incredibly important for hair recovery. If chronic tension begins the inflammatory cascade that results in hair thinning, then resolving this tension should be step one to any protocol — and make any other efforts (DHT reduction, etc.) that much more effective.

  6. Hi Rob, before i used to know DHT is one of the reason for hair fall now hearing a new term call PGD2. How true is that?

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  7. Same case with me. Thin hair and tight skin doesn’t perfectly overlap. Does this fall in MPB. If it fits, how soft or loose should the scalp become for regrowth.

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  8. Keep doing the massages until it hurts a little, everyday. You’ll lose a lot of hair in the beginning, but after 4-5 months you’ll start getting new hair.

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      Hey Scotty,

      For a lot of people — this is a great approach (massaging until slight pain). But for some, this can be too overwhelming (and even discourage the continuance of the regimen). Rather than use pain as a benchmark, I like to use hair shedding. For instance, tapering the intensity of each massage session so that you shed no more than 15 hairs per session. As someone continues the massages, they often notice in a few months that they can evoke way more pressure / intensity and shed the same amount of hairs as the months go by.

      Congratulations on your regrowth so far! If you have any photos, I’m sure the readers here (and myself) would love to see your progress.

      Best,
      Rob

      1. Hello, Rob

        The problem that I face (and I imagine many others suffer from this too) is that I can shed up to that amound just from the warm-up alone, still after 4 months of massaging. Overall, I’m shedding more hairs after all this time than when I started.

        All the best

  9. Thanks for the quick reply Rob, I’m thinking of getting 3 prp sessions but just cant decide from the mixed reviews theres an american doctor Jason Emer who claims combining prp with progesterone every 2 month with great results on himself and patients would you have an opinion on this to help make my decision? Also if I got the doctor whos doing my prp to inject botox into my scalp muscles could you tell me where exactly to get the injectons or a link that I could show him as I do remember reading some promising info on scalp botox reducing mpb, my scalp on the back & sides is loose and pinchable with two fingers but as I hit the ridge across the whole top and where my hairline is its clearly tighter and very hard to pinch.
    Im grateful for any help cheers

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      Hey Ryan,

      I don’t have any opinions on that doctor (positive or negative). I’ve found that in general, the readers here have been more disappointed by PRP due to the cost not matching up to the degree of their expected regrowth outcome. But if you’re going to do it, I’d recommend combining it with dermarolling as it’s shown to have synergistic effects and better results than PRP alone.

      https://www.ncbi.nlm.nih.gov/pubmed/28761259

      https://www.ncbi.nlm.nih.gov/pubmed/28771982

      Otherwise, the other issue with PRP is someone’s predisposition to respond with DHT to inflammation. PRP is, in itself, an inflammatory-driven hair loss treatment (which can be incredibly beneficial when administered under the right settings). But if you have high serum DHT — and/or a predisposition to respond to inflammation with DHT — and undergo PRP (which involves injecting components of your own blood into your scalp), then PRP is actually going to just increase DHT in your balding scalp tissues, and as a result, likely increase hair loss. So if you’re going to do PRP, you should also consider taking a DHT reducer before, during, and for a month after treatment (depending on your comfortability with those) — at least if you want to maximize results.

      RE: botox injections–

      Please see these comments for explicit directions:

      https://perfecthairhealth.com/trans-hormone-replacement-therapy-hair-regrowth/#comment-12019

      Best,
      Rob

  10. Hi Rob,
    Thanks for addressing this issue. I feel like the source of hair loss is very different for women and there just isn’t much out there addressing the real cause.
    I also found that massage didn’t help with my hair.
    I’ve been taking a high quality multivitamin (smarty pants) and I think that’s really helped, along with extra d3 and iron, turmeric and probiotics.
    Thanks for doing this important research, Sierra

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      Hey Sierra,

      I think that’s a great approach. It seems nearly every woman with whom I’ve worked so far experiences at least one of the following in conjunction with hair loss:

      -Nutrient deficiencies (typically D3, iron, zinc, and/or B-12)
      -SIBO (a symptom of which is often nutrient deficiencies)
      -Hypothyroidism
      -Hyperparathyroidism (generally indicated by high blood calcium, low D3)
      -PCOS (polycystic ovarian syndrome)

      When it comes to treating hair loss for women, it’s likely that resolving any and all of the above takes priority over the massages. And you’re right — the pathology for female hair thinning is likely different vs. male pattern hair loss. I plan on writing more about each of these things in the near future — with action plans on steps to (hopefully) resolve them.

      Best,
      Rob

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