Although there are many unknowns, the current medical world has accepted androgenetic factors as the main underlying cause of hair loss. However, all the available treatments fail to have encouraging success rates, leading to a delay for baldness rather than a complete stop. The underlying causes of baldness has to be searched somewhere else. Let us see where.
Androgenetic alopecia is a common form of hair loss in both men and women. In men, this condition is also known as male-pattern baldness and hair on side of the head are not interested, leading to the typical male-pattern hair loss depicted in the Norwood Scale of Figure 1 .
Current theories see the hormone dihydrotestosterone (DHT) as the main responsible for hair loss. As the name suggests, two are the supposed causes for androgenetic alopecia: the action of hormones (androgens) and action derived from genetic.
The androgen hormone dihydrotestosterone (DHT) is synthesized from the testosterone by the enzyme 5α-reductase into the hair follicle and it is believed to be the responsible for hair loss. The DHT reacts with the androgen receptor, interfering with the DNA of the cells, inhibiting the follicle from growing healthy hair. Nevertheless, DHT stimulates the production of pigmented terminal hair in many areas after puberty, including pubic and axillary hair in both sexes and beard growth in men. Both beard growth and balding can occur on the same person demonstrating a paradox. How does the same hormone stimulate hair growth on the face while taking it away on the scalp?
The given explanation is that androgen action within individual follicles is specific to the individual follicle i.e. relates to its gene expression. This is also the explanation given to the male baldness pattern: hair follicles in the temple areas and crown are genetically programmed to have receptors that are more sensitive to the DHT action, while hair on side are genetically programmed to be immune to the DHT. Hair transplantation is based on this fact: hair follicles on side and back are considered genetically programmed to be immune to the DHT action, so transplanting them into another region should be a valid solution. But why, once transplanted, these hair start to fall again after some time, leaving patients as in Figure 2?
There are also many other lacks that the androgenetic theory cannot answer, such as:
- Scalp sensitivity (burning, stinging, dry scalp, vague discomfort in the scalp, and sometimes, trichodynia) is associated with hair loss [2,3,4]. Why?
- The last layer of the skin, called stratum corneum, consists of dead cells (corneocytes). Corneocytes are regularly replaced through desquamation and renewal from lower epidermal layers, protecting from pathogenic bacteria, fungi, parasites, viruses, heat, UV radiation and water loss. Replacement of the cells in the outermost layer of the scalp happens regularly, on a monthly base. However, certain conditions trigger a more rapid turnover, leading to a large shedding recognised as dandruff. Excessive dandruff is linked to hair loss . Why?
- Minoxidil is an antihypertensive vasodilator medication, meaning that the main action is the widening of blood vessels, and it has been found to be effective in treating baldness . Also, low level laser therapy has some effectiveness on hair loss . These treatments have no correlation with androgenetic factors, so why are they effective?
- It has been found that in non-bald scalp regions, 1) each region has a uniform skin
thickness and it is thin; 2) the skin is soft; 3) the human head is in flat shape. As for bald scalp regions, 1) each scalp region has a non-uniform skin thickness and it is thick; 2) the skin is hard; 3) the human head is in dome shape . How can be this explained?
So, are androgenetic factors the real main underlying cause of baldness?
To answer this, let us have a look to the scalp layers composition in Figure 3. Just below the scalp skin (epidermis) there is the subcutaneous tissue, where hair follicles, sweat glands, and rich vascular networks lie. Scalp vessels travel within the subcutaneous layer just superficial to the aponeurotic layer called galea. The layer below is the loose areolar connective tissue (subgaleal space) that is so named because its fibers are far enough apart to leave ample open space for interstitial fluid and abundant blood vessels in between. Then there is the periosteum, that in the skull is called pericranium. This is a membrane that covers the outer surface of the bones and it provides nourishment by providing the blood supply to the body. Blood vessels pass through all the scalp layers arriving to the hair follicles.
The galea aponeurotica is attached to the occipitofrontalis muscles, as shown in Figure 4. The temporalis muscles are also connected to the galea aponeurotica via the temporalis fascia. The galea aponeurotica can be stretched by the forces of muscular contraction.
With the rise of civilizations, we are assisting to a down-siding of the entire craniofacial structure, with the maxilla that drops down and back. This reduces the eye support, flattens the cheekbones, narrows the nasal airway, lengthens the mid facial third, and lowers the palate, which narrows and create malocclusion . As shown in Figure 5, a vertical growth of the maxilla forces the mandible to swing back. As compensatory mechanism, a retruded mandible causes the head to tilt forward in a forward head posture [10,11]. Also, vertical growth of the maxilla promotes asymmetrical craniofacial development, referred as cranial distorsions (e.g. sidebending) .
Abnormal posture, like in the case of forward head posture and cranial distortions, affects muscle length/tension relationships . This usually leads to pain and overuse injury where small focal, degenerative changes in the insertion fibers can occur .
The concept of trigger points provides a framework that can be used to help address certain musculoskeletal pain. In particular, they are useful for identifying pain patterns that radiate from these points of local tenderness to broader areas, sometimes distant from the trigger point itself. As Figure 6 suggests, neck muscles’ action propagates through the entire head.
Indeed, whatever else they may be doing individually, muscles also influence functionally integrated body-wide continuities in the fascial webbing . Since muscles throughout the body are connected via myofascial meridians, their action cannot be seen in isolation. This explains why intensity of neck pain, forward head posture, chronic tension-type headache and migraine are strictly correlated [17,18,19,20].
When neck muscles are in continuous tension, their action propagates to the head, stretching and tightening the galea against the underlying layers of the scalp. The underlying structure is rich of blood vessels that are compressed, blocking blood flow towards the hair follicles. The restriction in blood supply to tissues is called ischemia: this leads to insufficiency of oxygen (hypoxia), reduced availability of nutrients and inadequate removal of metabolites. This obviously leads to the death of tissues, thus including the hair follicles (hair loss) and surrounding structures. This is also reflected in the presence of dandruff (excessive shedding of dead cells from the scalp).
When tissues are damaged, an inflammatory response is activated. The function of inflammation is to clear out necrotic cells and damaged tissues. The classical signs of inflammation are heat, pain and redness. These elements describe symptoms of scalp sensitivity and trichodynia.
Since the muscle tension that tight the galea is always present, the inflammation is long-term and chronic, causing fibrosis and calcification. This further decreases the blood flow into the scalp, promoting ulterior cells death, leading to a closed-loop chain of events depicted in Figure 8, reason why hair loss progresses with individuals becoming older.
Furthermore, the role of bones must be taken into account. Indeed, bones remodel under the presence of forces, with sutures acting growth site. The neurocranium may also expand under the compression forces generated by the above layers as a form of protection for the brain. This creates further restriction for the blood vessels, feeding the closed-loop chain of events described before.
The typical pattern of male baldness is characterized by bald frontal and vertex regions that overlie the galea, while temporal and occipital regions that overlie muscles do not lose hair, as shown in Figure 9. Muscles provide a richer network of musculocutaneous blood vessels, with larger arteries, and a softer environment than the galea, thus a compression in these regions do not cause a missing blood flow with consequent hypoxia.
The confirmation of this explanation for hair loss can be found in several studies:
- Bald subjects had a positive response when injected with Botox into the muscles surrounding the scalp, including frontalis, temporalis, periauricular, and occipitalis muscles. Conceptually, Botox “loosens” the scalp, reducing pressure on the perforating vasculature, thereby increasing blood flow and oxygen concentration. This leads to reduced hair loss and new hair growth .
- The subcutaneous blood flow in the scalp of patients with early male pattern baldness is much lower than the values found in the normal individuals .
- Men suffering from androgenic alopecia have significantly lower oxygen partial pressure (meaning microvascular insufficiency and hypoxia) in the areas of their scalp affected by balding (frontal and vertex regions) versus unaffected areas (temporal and occipital regions). Moreover, balding men have significantly lower oxygen partial pressure in the areas of balding scalp than the same areas of non-bald people .
- It has been found that Minoxidil solution stimulates the microcirculation of the bald scalp, effectively promoting hair growth .
- By relieving tension at the vertex in the scalp, cutaneous blood flow rate increases, promoting hair regrowth .
- Minoxidil is less effective in subjects with significant inflammation in the scalp than in subjects with no significant inflammation .
- In women, significant degrees of inflammation and fibrosis is present in cases of androgenetic alopecia. Even if less significant, inflammation and fibrosis is present also in chronic telogen effluvium cases.
- Dr. Frederick Hoelzel of Chicago reported the observations he made in 1916-17 while he served as a technician in gross anatomy at the College of Medicine of the University of Illinois. During that time, he removed the brains of around 80 cadavers and noticed an obvious relation between the blood vessel supply to the scalp and the quantity of hair: “baldness occurred in people where calcification of the skull bones apparently not only firmly knitted the cranial sutures but also closed or narrowed various small foramens through which blood vessels pass“. He thought this would also explain why men suffer baldness more than women, since bone growth or calcification is generally greater in males than females .
Craniofacial development plays an important role in hair loss: indeed it is the real underlying cause that gives predisposition to baldness. Predisposition means that it is possible to see people with a poor craniofacial development and no signs of hair loss, but it is not possible to see bald people with a good craniofacial development. If spotting a bald person, you will be 100% sure that he has jaw problems to some extent. Look around and try yourself! So, do you still believe in the androgenetic theory?
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 Godse, Kiran, and Vijay Zawar. “Sensitive scalp.” International journal of trichology 4.2 (2012): 102.
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 Rossi, Alfredo, et al. “Minoxidil use in dermatology, side effects and recent patents.” Recent patents on inflammation & allergy drug discovery 6.2 (2012): 130-136.
 Avci, Pinar, et al. “Low‐level laser (light) therapy (LLLT) for treatment of hair loss.” Lasers in surgery and medicine 46.2 (2014): 144-151.
 Choy, H. “Detumescence Therapy of Human Scalp for Natural Hair Regrowth.” J Clin Exp Dermatol Res 3.138 (2012): 2.
 Mew, M. “Craniofacial dystrophy. A possible syndrome?.” British dental journal 216.10 (2014): 555-558.
 Gonzalez, Humberto E., and Arturo Manns. “Forward head posture: its structural and functional influence on the stomatognathic system, a conceptual study.” CRANIO® 14.1 (1996): 71-80.
 Solow, Beni, and Antje Tallgren. “Head posture and craniofacial morphology.” American Journal of Physical Anthropology 44.3 (1976): 417-435.
 Strokon, Dennis. “Correction of Dental and Cranial Sidebend with ALF.” IJOM 21 (2010): 3.
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 Simons, David G., Janet G. Travell, and Lois S. Simons. Travell & Simons’ myofascial pain and dysfunction: upper half of body. Vol. 1. Lippincott Williams & Wilkins, 1999.
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 Haughie, Laura J., Ira M. Fiebert, and Kathryn E. Roach. “Relationship of forward head posture and cervical backward bending to neck pain.” Journal of Manual & Manipulative Therapy 3.3 (1995): 91-97.
 Fernández‐de‐las‐Peñas, César, et al. “Trigger Points in the Suboccipital Muscles and Forward Head Posture in Tension‐Type Headache.” Headache: The Journal of Head and Face Pain 46.3 (2006): 454-460.
 Fernández-de-las-Penas, César, et al. “Referred pain areas of active myofascial trigger points in head, neck, and shoulder muscles, in chronic tension type headache.” Journal of bodywork and movement therapies 14.4 (2010): 391-396.
 Fernández‐de‐las‐Peñas, César, Maria L. Cuadrado, and Juan A. Pareja. “Myofascial trigger points, neck mobility, and forward head posture in episodic tension‐type headache.” Headache: The Journal of Head and Face Pain 47.5 (2007): 662-672.
 Freund, Brian J., and Marvin Schwartz. “Treatment of male pattern baldness with botulinum toxin: a pilot study.” Plastic and reconstructive surgery 126.5 (2010): 246e-248e.
 Klemp, Per, Kurt Peters, and Birgitte Hansted. “Subcutaneous blood flow in early male pattern baldness.” Journal of investigative dermatology 92.5 (1989): 725-726.
 Goldman, Boris E., David M. Fisher, and Steven L. Ringler. “Transcutaneous PO2 of the scalp in male pattern baldness: a new piece to the puzzle.” Plastic and reconstructive surgery97.6 (1996): 1109-16.
 Wester, Ronald C., et al. “Minoxidil stimulates cutaneous blood flow in human balding scalps: pharmacodynamics measured by laser Doppler velocimetry and photopulse plethysmography.” Journal of investigative dermatology 82.5 (1984): 515-517.
 Toshitani, Shoji, et al. “A New Apparatus for Hair Regrowth in Male‐pattern Baldness.” The Journal of dermatology 17.4 (1990): 240-246.
 Whiting, David A. “Diagnostic and predictive value of horizontal sections of scalp biopsy specimens in male pattern androgenetic alopecia.” Journal of the American Academy of Dermatology 28.5 (1993): 755-763.
 Whiting, David A. “Chronic telogen effluvium: increased scalp hair shedding in middle-aged women.” Journal of the American Academy of Dermatology 35.6 (1996): 899-906.
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 Repair: Old Plug Removal, SMP Into Hair Transplant Scar, by Balding Blog
 Incisions and Closures, by Clinical Gate
 Muscles Of The Face Diagram, by Anatomy Human
 The Cause and Cure of Malocclusion, by John Mew
 The Mechanics of Male Pattern Baldness, by David M. Hatch
32 thoughts on “Hair Loss: The Real Underlying Causes Are Not Androgenetic”
It is interesting how John Mew doesnt have any hair loss at age 90, contrary Mike has
Indeed, here we talk about predisposition as in many other disorders or diseases linked to jaw problems. As written in https://tmdocclusion.com/home/my-story/tmd-symptoms/, every individual is different, so people with huge jaw problems can have no symptoms, while just a few-millimetre jaw problem can give the worst symptoms. Just notice around you, all bald people have a poor craniofacial development.. also pay attention to them: you will notice reduced neck mobility and really tight neck muscles. However the opposite it’s not true, i.e. people with still their hair in place can also have poor craniofacial development.
I actually recall an instance where Jhon Mew said “My current partner tell me I look better than I did 10 years ago”. From that statement I don’t think Jhon had great body/oral posture around his early 30’s.
Let me start out by saying this entire website is an invaluable source of health related information and I wholeheartedly thank you for the years and dedication you put into this site. I’m in the fitness industry and I’ve advanced my knowledge of very important subjects by years. I’ve always thought of balding to be the cause a poor diet however that was a different type of balding, hair thinning due to a damaged thyroid and poor nutrition. I very much look forward to any future work you may do.
I do have a question I’d like to ask you, there are many different types of posture variations that could cause malocclusions and tight neck muscles that ultimately lead to androgenetic alopecia(male pattern baldness) so based on your knowledge do you know of any exercises that are especially helpful or damaging. I’ve been a fan of Jhon&Mike Mew for a while and I adopted his “Mewing” for fixing my malocclusion which for me was just holding my mouth up with my tongue and sitting up straight. However I didn’t bother properly fixing my kyphosis but rather just shoving my neck back and forcing my neck up right with the inappropriate muscle group and the muscle that I’ve been using happened to be my neck muscles. Now my hair has been slowly receding surprise, and it’s really depressing because I thought I was being very healthy. I’ve had to learn the hard way to fix things the right way rather than compromising.
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Thanks for your appreciation! As you may notice from the different articles, I never mention a solution. The main goal of this website is to make people aware of the causes of their problems, since many concepts of current medicine are controversial. But then, it is the medical world that needs to change due to people awareness and provide solutions.
Although the opposite is also true, it is my personal thought that the majority of postural problems arises from poor craniofacial development. However, every person is different and every situation is different, with different cranial situations. Thus, also in this case, providing a simple general solution is not so straightforward.
Thank you for the response!
You’ve set you goals higher than just helping people, you want the medical/healthcare industry to come up with solutions to a population who are well informed. I do admire that very much. I very much hope to see your hard work as common knowledge some day.
Thanks Mephisto. If one day this hard work will become common knowledge also depends from every single individual. So, if you consider this content valuable, please feel free to share it!
Why is it bad to correct your khyphosis by pushing your head back ? (with neck muscle). What muscle should be used instead ?
Can I say that this is the best article I have ever read, I knew all along that there was more than just genetics involved in hair loss, but I never knew exactly why. Reading this, I have been dumbfounded as everything here seems so logical and scientifically backed, and a plausible explanation for every factor with regard to pattern baldness has been accounted for. However, I find it so strange that the widely accepted cause of baldness, androgenetics, has been accepted by basically everybody despite the glaring inaccuracies with that theory. (Mainly the DHT nonsense) Once again I just really wanted to thank you for showing me this article as it gives me hope that I will not lose my hair, as I previously believed that I was genetically predisposed to do so. My one question is is it possible to change the way your face has developed? I am 20 years old and have had a decent craniofacial development, however I am concerned that because of my mouth breathing in my early teens I may have suffered some forward head posture. Now that I have fixed my breathing and head posture, am I safe from risk of hair loss? Or is there anything I can do now in order to prevent possible future hair loss? Anyways, thanks again for this article and a response to my question would be greatly appreciated.
Best article ever!! straight to the point. This info worth millions and pharmaceuticals and the media always lie to us. So do you think that the combination of Platelet-Rich Plasma (PRP) and Botulinum toxin (Botox) might signify an step forward to counteract the AGA? make sense thought. Is so… Do you recommend PRP + Botox in one session or separate sessions? Do you recommend something else beside healthy food, lots of water, regular exercises?
Thank you!!! This info should be published in a paper!
Very interesting article i have to admit, i have been reading a lot about this lately since i am struggling with hair loss since my yearly 20, being 30 now and almost at the end of the road but even if this theory is strongly based on facts and knowledge and science i really don’t understand why when they took the hair follicle from the top of the balding head and placed it on another part of the body it kept falling ? They actually took it from the balding scalp and transplanted it on the arm and it fell off like it was programmed to fall… And what about the twins study that are balding at the same time, age and pattern, i really don’t understand, what’s your opinion on this… I saw people that had hair transplanted from the back of their heads and it literally lasted almost a lifetime and i saw some that started loosing them after a couple of years after the transplant… I don’t believe the DHT sensitivity also because there are a lot who literally nuked their body DHT and still loosing hair, it’s more than this but this theory also has some flaws that’s why i really think that nobody is able to debunk this issue, there are a lot of missing puzzle pieces that nobody knows about and from what i see they are not struggling to find out either, it looks like the industry is focusing on making only money out of peoples misery… 15 year old balding and by the age of 20 they are NW 6 -7 and nobody gives a damn, they are just in it for the money, nobody is actually trying to really find the real cause !
Wow, the first non bs comment I read here.
I am not a biologist and my comment will well prove, but based what I could gather from this article , baldness is based on an oval face and tight jaw muscles?. I m considered good looking shave my head and a have fairly square jaw . Late 50 s no bp issues 96 percent oxygen rate .
I’m confused as well.
Hello I am studying Human physiology and Myofascial pain and dysfunction I came across your blog. I am very interested as I see there definitely a relationship between hair loss, baldness, and tight overactive surrounding muscles. Is there a way we can connect? i would like to discuss this further. Thank you
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what are thoughts on ‘sitkari prayanama’ and ujjayi prayanama. first one works for jaw and other for neck.they can be affective for hairloss based on this theory.
Hey TMD, great article about hair loss
I have a few quick questions if you don’t mind to answer because I believe that hair loss wasn’t just genetic but had to something with horomones. As Hormones can regulate the body’s functions such Testosterone,Estrogen,etc. Even since I read your article my mind is blown that the real cause of hair loss is due to the Maxilla being down and back and causing postural problems that lead to hair loss. And was never related to genetics or hormones like many us think! Anyways here are my questions
1) If you can correct your head and body posture and restore the blood flow early enough like early to mid 20s can you grow back the hair that you loss?
2) For me I’m 16 years old I use to have a juvenile or child hairline up until I was 14. At that the same time my hormones started to go insane with puberty as my height and started to grow out a beard and I notice my hairline went back a little on the temples. But I do have poor cranialofacial development. So is this either a genetic/horomal thing or that my facial development caused my hairline to go back?
3)How much does nutrition impact your hair as I do wonder like Vitamins A,B,D, and K2 and minerals such zinc and copper impact your hair follicles?
4) If you can’t reach your maximum genetic potential facially as 90% percent of the skull is completed by age 12. How much closer can you reach that potential if you fix your posture,maxilla, and habits? Since I want to improve my health as I don’t want to get braces and have my wisdom teeth removed and facial problems that can cause self-esteem problems later in life. I’m doing mewing and other techniques to fix my face and postural problems at 16. Is it possible to fully reverse the problems that happened to me since I’m still growing?
So how do you explain Mike Mew going bald? His father has been guiding his craniofacial development through oral posture etc since he was a kid
Is a factor in having a large forehead, is having an overworked frontalis muscles?
I’m so glad I came across this article. I’m a woman without any pattern baldness and have been experiencing loss and thinning for a year which has been driving me crazy. The hair loss coincidentally started a couple of months after I got braces in September last year. So stress definitely is playing a big part. Some dermatologists pinpointed my very slightly elevated androgens (PCOS) as a cause but I’m not convinced since I’ve had this condition for 15 years and my hair has always been great. I got two blood tests done, one in February and one in July and July’s results had even lower androgens results (just a tiny bit above the high end for women) and hair loss thinning was worse. It just doesn’t make sense. My iron levels are ok and have been lower in the past and never reflected in my hair. So going back to the point I noticed after getting braces my jaw was very tense, more than usual, but I have bruxism so I didn’t think too much of it, but I suffer from headaches now and again. Today I was doing a stimulating massage into my scalp and noticed my muscles in the lateral and occipital areas of my skull felt sensitive, exactly where my jaw tension tends to go and also where I’ve noticed the most hair thinning. I suspected it had something to do but now I’m sure these two things are related and possibly my muscle soreness is preventing the correct function of my hair follicles, because they’re growing mostly strong and crazy at my middle parting (androgen-related alopecia, I seriously doubt it…) but they don’t seem to really grow at the sides. This is something I’ve noticed in many young women who don’t have any hormonal problems.
So now I’m a little bit closer, I believe, to find the reason to all this madness.