Fibrosis, Atrophic Scalp, Insulin

Dr. Rassman,

I don’t believe there is anyone in the field of hair research/restoration today as qualified, knoweldegable, and practical as you – and it is for these reasons that I have come to your blog to ask my questions.

It is my understanding that as a person loses his or her hair, the skin of the scalp undergoes a number of changes, namely there is a loss of fat, an increase in ceullar atrophy, and of course the dreaded perrfollicular fibrosis (now that’s a mouthful). It seems to me that these changes, in particular the fibrotic scarring, are the main obstacles in the way of regrowth, and THE reason propecia does not work for extensivly bald men.

1.)What can be done about this demon we call fibrosis? Can it be slowed, stopped, prevented, reversed? If we could somehow counteract collagen formation, wouldn’t our baldness problems be solved for good?

2.) If bald scalp is atrophic, how does it have the capacity to hold a whole new head of transplanted hair? Is there a limitation to the number of hairs we can transplant (outside of donor limitations) simply because the new scalp can’t accomodate it?

Finally, this last qustion may be of particular intesrest to you, becuase it tackles the baldness issue from a whole new perspective: Recent studies have suggested that insulin resistance, heart disease, and AGA are all part of one big happy family. My father is a research cardiologist and is CONVINCED that if we treated prematurely balding men with insulin drugs as if they were diabetic, that we’d indirecty be adressing the baldness problem as well. Is there any merit to this? If so, we’d love to get in touch with you and discuss things further.

I would be VERY interested to hear your response, and I thank you for giving this invaluable service to us. God bless.

In your first paragraph, you mostly defined the way the balding process impacts the scalp. The loss of blood vessels and the development of atrophic changes along with the fibrosis is the result of the disappearance of hair. Without the rapidly growing hair ‘organ’ there is no need for the infrastructure supplied by (for example) the blood vessels. So the blood vessels just disappear, because there is no end organ to feed. I believe that the fibrosis is more a reflection that something was there before (hair and support infrastructure) and not there now.

When the transplant is done, it brings with it stem cells that command the body to bring in the infrastructure to feed the new hair cells to grow into a normal hair. The stem cells induce infrastructure building. You can look at it as if the hair transplant (in addition to bringing in hair) is really a stem cell transplant with fatty and glandular tissue. For the hair to grow, it needs lots of blood vessels and therefore it commands blood vessel growth and the building the complete new hair organ infrastructure.

As your father is a research cardiologist and is convinced that some relationship exists between balding men and insulin deficiency, then he knows far more than I do on this matter. I would love to learn more about his thesis. I would like to know what he thinks should or could be done that is safe to address the balding problem. Please have him send me more information here.

Thank you for your kind words.