Update (2018): My Research Is Now Published In A Scholarly Journal

Despite decades of research, DHT's role in pattern hair loss is still not fully understood. Why is DHT linked to both scalp hair loss and body hair growth? By which mechanisms does DHT lead to hair follicle miniaturization? Why is there a "pattern" to pattern hair loss? These questions were why I became interested in hair loss research. Now, I've published a paper that attempts to answer them.

Written and reviewed by:
Rob English, Medical Editor

Challenging What We Know About Hair Loss

I’ve spent the last ten years researching hair loss, and the last four years sharing what I’ve learned on Perfect Hair Health — analyzing anything from clinical trials to treatment breakthroughs to my own theories on what causes hair loss (and how to reverse it).

Now, I’m excited to share some big news: I just published a paper in a scholarly journal.

The paper is called, “A hypothetical pathogenesis model for androgenic alopecia: clarifying the dihydrotestosterone paradox and rate-limiting recovery factors“.

I know that’s a mouthful. I also know that reading scientific literature is the last thing on most people’s to-do list. That’s why I wrote this article — to summarize the paper’s biggest takeaways, and more importantly, to give everyone a chance to ask questions about it.

What Is This Paper About?

I wrote this paper to reveal the major paradoxes in hair loss research — and to explain why I think DHT’s role in hair loss is misunderstood. I also wanted to build a better model to illustrate why men and women develop pattern hair loss — since no such model exists.

Essentially, the manuscript achieves four things:

  1. It presents evidence that challenges the commonly held belief that the hormone dihydrotestosterone (DHT) directly causes hair loss
  2. It looks beyond DHT and catalogues all other biological and physiological biomarkers also associated with hair thinning
  3. It builds a better pathogenesis model for what causes hair loss — a model that accounts for (1) these additional biomarkers, (2) DHT’s relationship with hair loss and hair growth, and (3) why DHT-reducing drugs stop hair loss, but rarely lead to full hair recovery
  4. It uncovers three targets to potentially improve treatment outcomes, and maybe lead to full hair regrowth

I’ll get into more details in the coming weeks — and even update this article to break down every part of the paper into lay terms. But for now, I’d rather just explain my motivations behind publishing.

Why I Wanted To Publish My Research

This is my first scientific publication, and it’s important (to me) for two reasons.

Firstly, it’s a major step toward legitimizing these theories behind what drives hair loss — concepts I’ve written about for years; concepts that are finally beginning to gain traction in medical literature.

Secondly, it creates an opportunity to share these theories at an academic level. The reality is this: no drug exists to regrow all our lost hair. This paper explains why. Moreover, it provides insights for research teams to refocus their treatment targets… so that we can improve hair loss outcomes for everyone.

The Paper Is Open-Access

Most scholarly journals protect their publications behind a paywall. That means that if we want to read beyond a study’s abstract — we need to actually buy the paper. This can cost anything from $7 for a paper “rental” to $200 per month for a full-blown journal subscription.

This is how journals financially survive. But there’s a downside: by restricting information behind a paywall, those journals also limit the number of people who see that information, and thereby benefit from it.

Fortunately, not all journals do this. In recent years, there’s been a push to adopt a policy known as Open Access. This is when a journal publishes all parts of a paper — and for free.

My paper is Open Access — meaning you won’t need to pay to read it. My hope is that this will encourage more sharing (and reading) of its content.

The Paper Is Also Peer-Reviewed

Peer review is the gold standard for scientific publishing. It’s the evaluation of any manuscript by professionals working in that field. In other words, investigators or academics familiar with pattern hair loss pathology had to read my paper, critique it, and then recommend whether to reject it or accept it.

Peer review is long and arduous (often several months), but it’s also a crucial step to publishing. Without it, we undermine the scientific process.

Lately, there’s been an explosion of pay-to-publish journals — where authors pay journal editors a fee to publish their manuscript. These journals are not taken seriously — nor are they indexed in most journal databases. This is why I made it a point to publish in a peer-reviewed journal. I want the paper indexed, and I want it to be taken seriously.

Want To Read The Paper?

You can access the entire paper right here. You can also download it… or read it on Science Direct… or read it on several other indexing databases.

If you have any questions about the paper — or my research — please feel free to leave a comment. I get back to everyone!

258 thoughts on “Update (2018): My Research Is Now Published In A Scholarly Journal”

      • Hi Amar,

        Do you mean addiction as in dependency on the supplement for results? While saw palmetto can reduce serum DHT, I’ve yet to see any studies or anecdotes demonstrating that saw palmetto visibly improves hair loss for any pattern hair loss sufferer. So in order for their to be dependency on results, there needs to actually be results — which we’ve yet to see.

        With that said — supplements that combine saw palmetto with other compounds have shown results, and typically, those results are dependent entirely upon the usage of the supplement. This is also true with finasteride (Propecia), and also of pretty much any hair loss topical (including minoxidil (Rogaine)).

        Best,
        Rob

  1. Wow, great job! Peer reviewed and everything, great accomplishment! On a side note, any update on that possible grey hair article you mentioned possibly coming out with ? 🙂

    • Hey Fernando — thank you. That article took a backseat recently, I’m sorry! I still have it on the agenda. So far, what I’ve read seems to suggest that greying hair and miniaturizing hair are from two separate processes, and there may not be much overlap. So it’s a bit like relearning everything! I’ll absolutely email you when it’s ready.

      Best,
      Rob

  2. Hi Rob ,

    Congratulations on your paper.

    Since undertaking scalp excersize to reverse calcification and fibrosis more than a year ago I noticed the following. Which adds further proof your hypothesis.

    My scalp skin has become more pliable and loose, to a point where I can move my whole scalp over my skull, during for example a towel massage.

    This has also coincided with hair regrowth and thickening.

    I’m truly in debt to you , you helped me overcome a very stressful and anxious period.

    I’ve also started essential oiling , and continue with the massage regimen.

    Due to diffused thinning, my hair cycle is out balance, but it’s all there. This will take more time . ( Some hairs longer than other’s)

    But overall it’s amazing to where I was , and now am .

    Thanks.

    Kind regards
    Praz

  3. Really good paper – congrats! I’ve had a few peer-reviewed papers published in a different field and it is not an easy thing to do.

  4. I am currently reading your free book and much impressed – the best books do tend to be free nowadays.

    I notice that you say of your paper that “It challenges the commonly held belief”.
    Ironic in the context of the first quotation in my own book (Experts Catastrophe), at top of page 2 of Chapter 1 at http://www.pseudoexpertise.com, which specifically mentions challenging of existing beliefs as one of the taboo things to be avoided in a scientific career.

    So you might find various quarters being dismissive of your efforts or at least unenthusiastic. Anyway let’s see.

    Cheers, Robin P Clarke

  5. I’m currently shaving my head after I started thinning on my crown and a slow recessing hairline. Can I continue the scalp massage techniques while continuing to shave my head, or do I need the hair to grow while massaging?

  6. Congrats Rob, I remember the first time I spoke to you, I truly thought I was speaking with a Dr- your knowledge and research is astounding!
    You are always bright, positive and happy to help and brain storm…
    This paper is an achievement of life, but much more in the sense that it could help many others in the future cure this.
    Congrats again. Great guy, great paper!

  7. Rob, amazing work as always. A single non-Doctor who is dedicated at heart can always win the race over a whole team of qualified hair loss “professionals.” Believe me when I say this is only one of the “first fruits” of your labor.

    • Thanks Reza! I don’t consider myself a scientist or an authority figure — though I may have an opportunity to contribute to a treatment pilot study for AGA this year (which I’m excited about).

      In general, I think it’s healthy for everyone to discuss and debate science — and in this case, the science behind what causes hair loss. I also think it’s especially important to engage with others who disagree with your position — so long as the debate stays rational and respectful.

      Sadly, this is getting harder and harder to do. The advent of social media has given us the ability to block, unfollow, remove, or publicly (and anonymously) smear any voice with whom we disagree. The ending result is that we all form into small camps of “echo chambers” — where we’re surrounded only by people who reverberate things we want to hear. In my experience — and in every aspect of my life — I’ve learned more from trying to understand the “other side” than I have trying to substantiate my own position.

      So, healthy debates are a wonderful idea — and not just for hair loss!

  8. Medical Hypotheses – I myself have had two papers published in Med Hypoths, accepted by the founding editor Prof David Horrobin. In his journal intro he explained the reason why he did not endorse “peer review”. Numerous others have likewise condemned “peer review” – my own writing includes probably the most extensive presentation on the subject.

    Prof Horrobin died in 2004, and a few years ago the publishers Elsevier took over the journal and thereafter depublished two important papers which had already been accepted by the editorial people. That is the publishers interfered in the editorial process, which is seriously improper. The editor and entire editorial board resigned in protest and the publishers then imposed a “peer review” system in order to prevent “inappropriately” heretical things being published.

    My own epidemics paper was refused by 18 “peer reviewed” journals including Med Hyp, on pathetically pseudic excuses, for the simple reason that it exposes such a gigantic crime of pseudoexpertise, millions devastated. (The whole subject is heavily censored.) I can’t copy in whole chapters or links here but will just add this quote from Prof David Healy:

    “Academic journals and societies show an auto-immune response to information that should be the life-blood of medicine.”– Prof. David Healy, author of Pharmageddon

    None of this reflects on the credibility or otherwise of your or any paper in the journal. Hopefully I will have time to read your paper later today, shortly before my last hair falls out.
    Cheers etc.

  9. This is complete bullsh*t: “The absence of full AGA recoveries from androgen inhibition is puzzling, and highlights the necessity to reevaluate AGA pathology consensus.”
    You do not know anything about the underlying changes from androgenetic hairloss. Cotsarelis has already proven without a doubt that balding scalp creates ever increasing levels of PGD2 and PGJ2 which prevent stem cell renewal and ultimately follicle growth in general. Thus someone with recent loss CAN regrow remarkable amounts of hair on 5AR- or androgen inhibitors while someone who has lost it years ago will mostly only maintain what he currently has.
    You are presenting your lack of knowledge as if others haven’t already figured out things that seem to go way over your head. What a travesty. Whoever “peer reviewed” you should be fired.

    • Hey Enden,

      The data suggests 5-AR inhibitors like finasteride can stop hair loss and lead to a 10% increase in hair count. To me, that’s far from a full hair recovery – especially for those who are NW3+.

      The mechanisms governing stem cell to progenitor cell failure are still speculative, though one pathway might be through PGD2 (like you said). Interestingly, PGD2 precursors also express in chronically contracted ligaments, and PGD2 is associated (in other body tissues) with the tissue remodeling we observe concomitantly in the balding process.

      PGD2 inhibition protocols — at least anecdotally in hair loss forums — have yet to really move the needle in terms of hair regrowth. If stem cell to progenitor cell failure is entirely due to PGD2, it’s puzzling why we’ve yet to see better hair recoveries from PGD2 inhibitors — especially from people trying those in conjunction with finasteride.

      To my knowledge, Cotsarelis and other investigators also have no explanation for the arrival of PGD2 in balding scalp tissues. My paper presents evidence to theorize one way this could happen. PGD2 expression in the scalp may be a symptom of inflammation induced by chronic tissue tension. This leads to slow, persistent tissue remodeling (fibrosis, dermal sheath thickening, calcification) that eventually culminates into hair thinning (a symptom of the remodeling).

      To be clear: I’m not saying Cotsarelis is wrong, or that I’m right. All I’m doing is presenting a case that maybe, we should try to reverse pattern hair loss by targeting to reverse tissue remodeling — rather than mono-targeting PGD2, KROX20, IGF-1, lactate, DHT (to a degree), or anything that makes headlines as a “new hair loss breakthrough” but soon fizzles.

      Evidence in mechanotransduction suggests that mechanically offloading tissue tension while simultaneously creating a wounding-healing environment can significantly revert scar tissue. Why not apply those same principles to the scalp in an attempt to better improve AGA outcomes? I don’t see what’s so controversial about that.

      To summarize — I don’t understand your negativity here — because most of the comments you just presented still fit within the paper’s arguments, and in some ways, reinforce them. This gives me the impression that you didn’t read the full paper, or didn’t understand it. I’m happy to clarify.

      There’s also no need to throw jabs —- we’re all trying to help each other.

      And finally, I’m always open to the idea that I could be 100% wrong about everything. That’s part of the scientific process. Ideas are written, rewritten, and refined as more data is published. The paper re-evaluates many of the mechanisms behind AGA. But the only way we can test its hypotheses is with more studies.

      Best,
      Rob

    • Re. Enden
      I smell a vested interest in “pharmaceutical solutions.” Consider the source, Rob, and keep up the OUTSTANDING work.

      In addition to all the fine qualities expressed in your work and your willingness to share information, I read your reply to this apparent ‘pharma shill’ and I admire your consistently positive, service-oriented attitude.

      Recall the phrase, “You sir, are a gentleman and a scholar.” Well Rob, you are that…literally.

      I scanned your paper and read carefully several sections. As always, I think you’re on the right track – and we all much appreciate your efforts. FWIW, I completely stopped my hair fall months ago after several years.
      After six or eight months I MIGHT be seeing limited regrowth now as a result of these methods:

      1. Galea flexing (for lack of a better term) ala Tom Haggerty
      2. My own version of “massage” that involves two hands pressing the skin toward one another (scrunches/wrinkles/folds the tissue between the hands).
      3. Weekly dermarolling with 1.5mm needle length.
      4. Topical application of Essential Rosemary Oil in a Coconut Oil carrier
      5. Increased protein intake (I eat very little meat)
      6. Increased healthy fats intake (mostly as olive oil)
      7. Learned to make and consume Bone Broth (mostly chicken feet)
      8. Minimum of 320mg Saw Palmetto daily

      I think these methods are in line with your hypothesis, and I’m proof at this point that hair LOSS can be stopped.

      • Thank you Tom. I appreciate the kind words. And congratulations on your success so far! A lot of the book’s first round of best responders also reported success doing the massages in conjunction with Tom Hagerty’s exercises. The biggest benefit to TH’s exercises is likely their ability to retrain those muscles out of chronic contraction — so your scalp can finally relax when you’re not doing them. Please keep us all posted as you continue on, and congrats again!

  10. Hey Rob!

    Congratulations on publishing your research paper. Having read both your book and the article more than once, I can only thank you for your extensive work. Although I do not have any scientific background, I can only imagine that your point of view might be heavily critizised by some fellow researchers, now that you have made it accessible for a broad public, as you have a valid argumentation against the main theories concerning hair loss as well as plausible alternatives on how to treat male pattern baldness.

    I hope that you do not let yourself be discouraged by negative feedback and wish you all the best in your future endeavors.

    I am currently at the 5 month mark of the massage regimen and the lifestyle/diet changes. Although I am still waiting for significant regrowth, my shedding has stabilized over the last few months and the condition of my remaining hair has changed for the better. My hair seems healthier overall, has a darker colour and “feels” thicker. I generally feel healthier and my daily energy levels are more stable throughout the day.

    I want to get bloodwork done in order to rule out possible malnourishments (Vitamin D is a big suspect for me as I clearly do not get enough sunlight on a regular basis due to where I live, as well as possible hypothyroism) and spend blood more often.
    I had discovered your website during a very dark period of my life and your diet/lifestyle/health advices have given me a lot of hope concerning my hair loss and health in general.

    I hope that my results will be similar to some of your best responders and would be incredibly happy to share them with you in a couple of months, possibly even before the 1-year-mark.

    I wish you all the best and please continue your hard work,

    Sincerely, Michael

    • Hey Michael,

      Thank you for your kind words. And congratulations on seeing some early signs of success. Please keep me posted with your vitamin D labs — I’m curious to hear your results. Winter shedding is certainly a reality for many people living far from the equator — which is when a lot of people generally notice a decrease in the quality of their hair. But interestingly, a lot of readers also report more shedding in combination with more thickening in the summer time. Vitamin D is likely one (of the many) substances that regulate this process.

      I look forward to your progress!

      All my best,
      Rob

    • Hey RJ — this is nearly impossible to do in a comment response — since this depends on what kind of hair loss you have (alopecia areata versus androgenic alopecia versus telogen effluvium) and your comfortability with the array of treatment options.

      You can start by first trying to familiarize yourself with hair loss research — either by reading this site’s articles or signing up for the free email course.

  11. Hey Rob,

    This guy from immortalhair saying that you changed your mind about massaging,as you can see at bottom,can you clarify this? I cant seem to understand details of your paper very well.

    Thank you

    • Hey Maya — I cut out the quoted text since it was so large of a copied/pasted segment. But to answer your question — no, that’s not true. That user appears to be misunderstanding (and thereby mischaracterizing) the paper’s presentation of evidence alongside its actual hypothesis.

      If I had to guess why, it seems like they’re under the impression that mechanotransduction is synonymous with mechanical force, and that mechanical force is synonymous with mechanical tension and chronic tension. This is an easy mistake to make — but if made, it leads to a false interpretation of the paper. Those terms are related, but they aren’t interchangeable.

      The paper actually argues that if we can relieve chronic scalp tension while simultaneously promoting a wounding-healing environment in AGA tissues, we may be able to reverse AGA-related fibrosis and thereby achieve better hair recoveries. That’s why the nuance in terminology is so important.

      Best,
      Rob

      EDIT: to be clear, I think there are several ways we can mechanically offload tension in the scalp + create a wound-healing environment. The massages might be one way to do it. They certainly work well for some people — probably because they can improve elasticity and evoke some acute inflammation. But for non-responders, or for those who want better results, there are probably other (potentially more effective) ways to do this.

  12. Hello Rob and fellow regrowers,

    Rob, as I told you, I’m using topical coconut oil for diffuse thinning. You mentioned that shampooing in the morning would not harm the scalp since the oil is absorbed.
    I haven’t been using shampoo and washed my scalp with warm water, however, I scratched my scalp today with my nails and it was clear the it was clogged with some residue from oil.

    Is it wrong to scratch the scalp with my nails? or do you recommend shampooing instead, if so, which brand is the one you think would suffice (sulfate/paraben-free).

    Thanks to you and all the readers for your support.

    Best,
    Julián

    • Hey Julián,

      Let’s hop on a Skype call soon. I can answer these questions in better detail there — and discuss some new updates.

      In general, if you’re using oils nightly, shampooing shouldn’t be too much of a detriment. In addition, the oil residue shouldn’t hurt either — nor should scratching this off with your nails.

      Best,
      Rob

  13. Hey Rob,
    Is your book updated with the full research of this paper?
    I’m thinking about buying the book. Should I wait or it has the same content?

    • Hey Carlos,

      The book isn’t updated with this research yet, but if I do release anything in the future, it will be significantly discounted for anyone who’s already picked up a book package.

      Best,
      Rob

  14. Hello Rob,

    I have a question. If castrated men don’t produce DHT how is their lack of hairloss explained? Is it because their bodies can’t produce inflammation on the scalp with the help of DHT? If they suffer from the same scalp tension how don’t they loose hair?

    Thanks in advance 🙂

    • Hey Riszard,

      It’s a great question, and one that’s answered in detail here:

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

      But the short answer is that pattern hair loss is likely a two-part equation: 1) inflammation mediated by chronic tension, and 2) our body’s response to that inflammation (ie, the arrival of DHT). The evidence seems to suggest that the concomitant presence of both DHT and TGFB-1 leads to scarring and thereby pattern hair loss. But castrated men produce 95% less DHT than non-castrated men. As a result, their “tool kit” for responding to inflammation favors other substances that aren’t DHT. The end-result is that even if these men are carrying a lot of tension in the scalp, they’re likely not responding to that tension-mediated inflammation with DHT — since they no longer have the testes to help produce the testosterone necessary to make it. As a result, they stop losing hair.

      Best,
      Rob

  15. Hi Rob quick question.

    Have you changed any of your opinions on diet ?

    Ie gluten and grains.

    How would the above effect pre and post puberty skull bone growth , in regards to standard mpb.

    The difficult question is. Can one who does lifestyle and mechno therapy still consider a diet free from these foods.

    Thanks.

    • Hey Paz,

      This is a very difficult question to answer (ie, “Does diet influence skull bone growth or muscular tension in relation to AGA?”). To be clear — diet absolutely influences bone growth and muscularity — there’s no question about that. If you don’t eat, you won’t grow. If you stop eating, your muscles will eventually start to waste.

      But in terms of “in relation to AGA” — I’m not sure yet. Here’s my working hypothesis:

      An anti-inflammatory lifestyle / diet / environment changes 1) the severity of an inflammatory response, and 2) the substances our bodies use to respond to inflammation (ie, TGFB-1, DHT, etc.). So if you’re eating foods that you’re allergic to — and as a result, you’re increasing 1) your inflammatory response to other stressors (like scalp tension), and 2) your likelihood of responding with TGFB-1 and DHT (and thereby increasing your likelihood of scar formation) — then yes, diet / lifestyle / environment have a role in pattern hair loss pathology.

      But from what I now understand, I think that if you’re eating generally well and you’re nutrient replete — this should have very little impact. The evidence seems to suggest that pattern hair loss is a localized phenomenon — with genes and androgens at the top of the flowchart in terms of its onset.

      As a result — if you can correct the tension (via mechanical stimulation or other means), then there’s a good chance that, conversely, diet / lifestyle / environment will play an equally small role in its maintenance (provided you’re getting the basics right — generally anti-inflammatory, and generally nutrient replete).

      Best,
      Rob

  16. Hey Rob,

    Congratulations on your paper. I think we’re all one step closer to solving this problem for good.

    I’m a diffuse thinner with hair casts and dandruff. I also suffer from face and shoulder acne. There’s definitely some kind of connection. My acne flares up and gets all red and itchy around the same time my scalp also starts to itch and shed more hair. My derm diagnosed me with Seborrheic Dermatitis and prescribed shampoos, vitamins and Clobetasol Propionate lotion. Can seb. derm really cause hairloss? And is it reversible ?

    Thanks

    • Hey Michael,

      Thanks for reaching out. Have you had a chance to read this article?

      https://perfecthairhealth.com/p-acnes-bacteria-may-cause-hair-loss-heres-what-to-do-about-it/

      In general, seborrheic dermatitis seems to often just be a symptom of scalp inflammation. Whether this is the result of pattern hair loss or just a fungal infection — it’s hard to say.

      I’d recommend reading that acne-hair loss article as a start toward finding an effective treatment. There’s a chance you’re experiencing an overgrowth of pathogenic microorganisms surrounding SD and thinning hair sites — and that these bacteria are contributing to your hair thinning. But without more testing / treatment trialing, we won’t know for sure.

      Best,
      Rob

  17. Hi Rob just to add to my question above regarding diet.

    If the theory hypothesis skull bone growth.

    How does this work on a demographic level ? , Ie nation’s which have more Mpb than other’s ?

    My vague answer would be growth genes ? From parents.

    Thanks
    Praz

    • Hey Paz — it’s most likely determined by genes and possibly even skull suture settlings in early childhood / adulthood. But there’s very little data on this, and so everything in this territory is entirely speculative.

    • Hey Infino90 — I’m absolutely considering creating some sort of community for this site — and most likely a forum. But I’m apprehensive to create a Whatsapp group because that would mean I’m constantly accessible. I like to separate my day-to-day life from my professional life, and my professional life from this site — and with a Whatsapp group, I can’t do that. It’s the same reason why I also don’t have any social media (professionally or personally).

      With that said, one of my goals this year is to create a way for readers to exchange ideas without my presence. So some form of the group is coming.

      Best,
      Rob

      • I’d say start with a discord server Rob. I haven’t used it much personally but I’ve seen all kinds of different communities use it to exchange ideas in real time and I think it would work out well here. You’d be able to have a place with a strong sense of community about this topic without necessarily needing to be online all the time to make it work. It should allow you the separation you need while still allowing people to connect more than they can with a comment section.

        Just a thought.

  18. Hi,

    It is really difficult tu understand your paper as I havent taken a medical training, but still it is really hopeful to read someting academic about hair loss. so so hopeful. Thank you. Readers were mentioning about your book. How can I get it?

      • Hi Rob. Thank you for your answer. I would like to buy the whole package but need to consult about my case first. Doctors told me it is not genetic but it might be as well because I have this condition as far as I know myself, from infancy I mean. When I use medicine or some essential oils, my hair seems to respond. Doctors also told me I have active hair follicles. but still they do not reproduce enough hair it seems. I am 36 years old and live in Turkey btw. Thanks again for your support. It is really hopeful to be able to reach out something solid.

  19. Hi Rob!

    I would like to know your opinion about the research showing that peppermint oil diluted in jojoba oil helps hair loss more than minoxidil?
    I also have another question. Can we say that if a particular oil (jojoba) works great for eyebrew regrowth, it also helps for scalp (for the same person)?

    Thanks!