Hi, long time lurker on this thread, very interesting.
TLDR: I think the key, from a practical perspective to reverse Androgenetic Alopecia is getting ahead of the rate at which fibrosis is accumulating
Here is my perspective, based on what I have learned thus far from various posts and my own experience/research. I believe the current most popular theory regarding Androgenetic Alopecia is correct: androgen receptors in the follicles are sensitive to DHT, which leads to inflammation, which leads to fibrosis, and thus continuous miniaturization of the of the hair follicles. After reading up more on the effects of needling, i feel it provides more evidence for this popular theory of Androgenetic Alopecia.
So in medicine, there is treating the disease, and treating the symptoms. Applying this analogy to Androgenetic Alopecia, I believe treating the "disease" would be either 1) finding a way to make your androgen receptors less sensitive to DHT (which I don't think exists), or replacing the hair follicles all together with a hair transplant.
As I mentioned above, I am more convinced now based on what I have learned about microneedling that the combination of minoxidil, finasteride, and microneedling is an effective treatment to handle the symptoms of the disease, depending on how far you have progressed. They all work in 3 different ways to reduce or halt fibrosis accumulation. Ultimately, if fibrosis accumulation can be decreased, I believe hair loss can be reversed. The key here, I think is the extent to which fibrosis has accumulated. This is why, treatments of minoxdile and finasteride are more effective in early on hairloss, rather than late hair loss. Both minoxidil and finasteride impact the rate at which fibrosis accumulates. Minixodil does this by increasing blood flow (a lack of blood flow results in fibrosis), finasteride does this by decreasing dht, thereby decreasing rate of fibrosis accumulation as well. However, keep in mind, your androgen receptors are still sensitive to dht, and since dht isnt completely halted, you are still accumulated fibrosis
I think my own example demonstrates this fairly well, which I believe many others have experienced. Like many others, I got on finasteride and minoxidil at my second shed of of noticeable hair loss. my hair regrew fully within a few months, and this was because my fibrosis had not accumulated as much. As time went on, however, my hairloss came back again, but its very slow. Ive been losing hair for the last 7 years, diffuse, but i still have quite a bit left. I have no doubt that it would have been much quicker hair loss, had i not been on minoxidil and finasteride.
Often times, it is thought that hairloss progresses because the treatment is just less effective over time. I do not think this is the case. Rather, its simply because fibrosis as accumualted to such an extent, making it less effective. So if there is a mechanism to break down the fibrosis (e.g., microneedling), minoxidil and finasteride will remain just as "effective".
So where does microneedling come into play. Well i think, microneedling not only physically breaks down the fibrosis, it also increases the blood flow, which also breaks down the fibrosis. This is why i think these studies that have groups with minoxidil and microneedling see a synergistc effect. This is also why i think we see hair growth in reverse and for the areas that have tons of fibrosis accumulation, why it will take quite some time to see improvement, for three reasons : 1) you are still following the 3 -6 month shedding cycle, 2) every shedding cycle will result in a hair that is slightly thicker, just as it took multipel shedding cycles for it to miniaturized.3) most importantly, two repairs need to take place. The first is the fibrosis, the second is the recreation of your arterial network that feeds the follicles. I dont think the latter can happen until some degree of the skin is re ecoveree from the fibrosis
However, I also think that halting microneedling will result in the accumulation of fibrosis again, so this is why i still think this is still treating the symptom rather the disease, but still a good treatment nonetheless.
As for me, I started needling a month ago, and I am experiencing everything as others have posted. My scalp feels great, my hair looks soo much healthier and i think these are the effects of the increased blood flow. My scalp also was in a constant inflammatory state (burning sensation), especially around the times when my shedding increased, this has also decreased. So i will certainly post updated pics at the 3 month mark.
) but reversing fibrosis and calcification and stopping the dht requires a lot of time to get that lost hair back..
