Why The Galea Is The Fundamental Cause Of Male Pattern Balding (& Androgens Are Secondary)

[infinitepain]

Tension is naturally induced onto the galea by the scalp muscles it attaches to. That is the purpose of the galea - to be a point of reference for scalp muscles to constantly pull on.

I did not get into skull shape changes with age as I was primarily trying to explain how the Norwood pattern gets created during development. I'm also unsure of the veracity or evidence for the claim that skulls shape changes significantly enough to alter this process over time.

But yes, that is one extra proposed feedback loop by which androgenic hair loss worsens:

- Androgens cause skull hypertrophy which increases galeal tension leading to further upregulation of androgen sensitivity genes in the follicles.

I doubt pillows make any significant effect. I don't think they could signficantly alter blood flow. I think the Norwood problem is likely mostly already coded into our heads from birth.

So you are claiming that the amount of tension delivered by these vector forces described in the graphics are set in pre-natal stages?

And where do you do draw the conclusion that these forces mean higher androgen sensitivity?

I like this model because it describes the pattern, but there are connections lacking between the dots in my book.

And I would like to point again to the study in which they used some sort of device to counteract the tension vector forces, it's quoted in this video:

Anyone knows where one would buy that device? im willing to try it out.

 

[Cue Bald]

What is this "galeal tension" - are muscles in the galea pulling on something?
I do think the galea has something to do with it, otherwise it would be a massive co-incidence that it just happens to have the exact shape of the male pattern baldness pattern.

the question is why do androgens make the hair on the galea fall out; yet everywhere else on the body, androgens cause it to grow in thick? (such as androgens causing chest hair, back hair etc to grow)

here's a picture of the galea, it's classic male pattern baldness

 

[infinitepain]

What is this "galeal tension" - are muscles in the galea pulling on something?
I do think the galea has something to do with it, otherwise it would be a massive co-incidence that it just happens to have the exact shape of the male pattern baldness pattern.

the question is why do androgens make the hair on the galea fall out; yet everywhere else on the body, androgens cause it to grow in thick? (such as androgens causing chest hair, back hair etc to grow)

here's a picture of the galea, it's classic male pattern baldnessView attachment 85408

The galea is clearly involved in my book, but there are big gaps in the theory.

Also still waiting for someone to tell me where the f*** to buy the device to stretch the scalp upwards against the supposed galea forces. Where do we buy it and why is no one talking about that?

 

[Georgie]

People have claimed massage helps scalp hair for years, and in the context of this theory, perhaps it can. I think it would be unreasonable to expect scalp massage alone to resolve anyone's hair problems, but it certainly couldn't hurt by at least temporarily relaxing the galea and improving blood flow, which might in turn reduce inflammation.

The Botox study was summarized as:

Fifty males with Norwood/Hamilton alopecia classes II to IV had injections to the scalp muscles (divided equally to the frontalis, temporalis, periauricular, and occipitalis) of a total of 150 units of BTX A, followed by a second session 24 weeks later. Assessment included change in hair counts in a 2-cm scalp area, changes in hair loss counts collected by lint roller from the subject's pillow, and patient responses to a questionnaire. The 60-week study period consisted of a 12-week baseline lead-in period and two 24-week treatment periods following each BTX A treatment session.

In the 40 patients who completed the study, mean hair counts increased 18% from baseline to 48 weeks after the initial injection, a statistically significant change. Hair loss was also significantly reduced, by a mean of 39%. The reduction in hair loss and increase in hair counts were not correlated. The treatment response rate was 75%. The subjects noted statistically significant increased hair growth. No adverse events were noted.

https://www.jwatch.org/jd201111100000001/2011/11/10/growing-hair-with-botox
​

My mom actually gets scalp Botox for migraine headache prevention. I think what you would be looking for is a Botox practitioner who is familiar with using Botox for migraines, since the same principle of relaxing the scalp muscles would apply for both. You could show them the summary article listed above, and instruct them that you want "150 units of Botox to the scalp muscles (divided equally to the frontalis, temporalis, periauricular, and occipitalis) now and again in 24 weeks."

As for the question of why more people don't try this, I'm not sure. The results are quite impressive from that study. It was a small study admittedly so perhaps not as impressive a result as studies that include thousands of men. Beyond that, Botox is expensive and a bit painful to get. We have no long term studies on how well it works beyond a year. But it might be worth a shot if you're not interested in the usual chemical measures.

Hmmm i would love to see the before and after photos

 

[Xander94]

Hmmm i would love to see the before and after photos

Hey

 

[Georgie]

1. @IdealForehead oh dear god...

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5096242/#!po=27.5000

I’ve also seen quite a lot of similar stories on “realself”.

 

[Georgie]

Hey

Hi

 

[alebaba]

This theory is horseshit.

 

[sunchyme1]

Hey

thats more like it mate

 

[IdealForehead]

1. @IdealForehead oh dear god...

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5096242/#!po=27.5000

I’ve also seen quite a lot of similar stories on “realself”.

That's freaky. I tried to look into the phenomenon. I could find one published article discussing the possibility of Botox triggering hairline recession and here's what they said:

The aim of this paper is to report a new type of alopecia, which we have seen in women undergoing periodic injections of botulinum toxin type A for forehead wrinkles, and to differentiate it from other types of hair loss. Dermatologists should be aware of the possible occurrence of frontal alopecia after repeated injections of botulinum toxin type A for forehead wrinkles.

Alopecia is never mentioned as a possible side effect of BTXA injections, and its occurrence is difficult to explain. Possible explanations include changes in the levels of molecules that may be involved in regulating the hair cycle, i.e. substance P and calcitonin gene-related peptide and other signaling molecules and receptors [11], and/or decreased neurological stimulation of hair follicle function due to blockage of the function of autosomic fibers [12].

Collection of more cases and histopathological/immunohistochemical studies will be necessary to understand the real prevalence and etiopathogenesis of this entity.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5096242/​

My theory in the context of everything in this thread is that this may be due to either (1) A direct Botox toxicity to the hair follicles (botox is a poison after all), or more likely (2) A result of greater mechanical traction applied to the frontal hairline when botox is applied selectively to the front of the forehead but nowhere else.

It is known that isolated forehead wrinkle treatments can cause shifts in the muscle activity of the face and skull as described here. For our interests, if you paralyze the frontalis (forehead) muscle, but the other galeal muscles are still pulling on it to a similar extent, the frontal aspect will "stretch" more from the fact that the forehead can no longer resist the other muscles. This would cause greater mechanical shear/stress to the hair follicles at the forehead where the muscle has been paralyzed and can no longer maintain positional stability.

All the cases they report were people who had forehead wrinkle treatments which would fit with this.

If this is the case, then patients who have proper migraine Botox treatments should have less problem with this, as migraine treatments provide a more balanced relaxation similar to what's desirable for hair, like this migraine protocol:

If there is truly significant hair loss risk from this type of migraine Botox protocol, it must be very rare. For example, here's what one popular and highly rated surgeon said about migraine for Botox and hair:

Botox injections are likely not linked to hair loss. Our office performs Botox for migraines and we have not seen any similar reports by patients who have undergone treatment.

https://www.realself.com/question/hair-loss4
​

I asked my mom who gets Botox for migraines and she says her neurologist has never mentioned it as a potential issue either. So obviously I couldn't say for sure but I think hair loss from a balanced Botox would be likely safe for hair. Unbalanced Botox for wrinkles would likely be riskier for the frontal hairline from a mechanical standpoint, and the mechanical stress theory of hair loss described in this thread could explain frontal loss in isolated forehead Botox injections.

If on the other hand the Botox is directly toxic to the hair, then no Botox anywhere would be safe. But I doubt this as millions of people have had Botox by now and if it was rampantly toxic to hair, someone would have figured it out by now.

I still think this would be a useful therapy for you to consider, and if I was you, I would feel comfortable trying it based on everything I've read. You do have risk factors for increased mechanical hair stress (tendency toward high muscularity, low body fat). While anti-androgens can seem to disrupt this cascade for most men, for some men and women, perhaps the mechanical stress may be more directly damaging to the follicles irrespective of androgenic signalling. Perhaps in those cases where anti-androgens don't disrupt the process significantly enough, relaxing the underlying stress directly may be the only effective approach.

 

[sktboiboi]

Hey Idealforehead:

if u can tell me what the associated genes for these IncRNAs are, it's a major step towards figuring out what is primarily causing Androgenetic Alopecia- molecularly.


ASHGV40018997 239.8588454 Up T131417 G030772 RNA-seq 16 ND ND ND
ASHGV40008202 74.2665386 Up T056221 G012997 RNA-seq 11 ND ND ND
ASHGV40005196 71.7819478 Up T008148 G001747 RNA-seq 1 ND ND ND


Also, u listed u r using niacinamide- i wouldnt use that- it exponentially upregulates pgd2- that's how we get the red flush and itch

 

[sktboiboi]

these are the top 3 known mRNAs most upregulated in alopecic scalp(so yes, Prostate cancer is indeed related to Androgenetic Alopecia by the same mechanisms, but i cant figure out what the 2nd and 3rd does:

ASHGV40021887 69.7530454 Up NM_001282275 PRAC2 17 Hs.236557 Prostate cancer susceptibility candidate 2
ASHGV40032572 66.2385552 Up NM_181615 KRTAP20-1 21 Hs.553697 Keratin-associated protein 20-1
ASHGV40017687 30.3940994 Up NM_015161 ARL6IP1 16 Hs.634882 ADP ribosylation factor-like GTPase 6 interacting protein 1

 

[Georgie]

That's freaky. I tried to look into the phenomenon. I could find one published article discussing the possibility of Botox triggering hairline recession and here's what they said:

The aim of this paper is to report a new type of alopecia, which we have seen in women undergoing periodic injections of botulinum toxin type A for forehead wrinkles, and to differentiate it from other types of hair loss. Dermatologists should be aware of the possible occurrence of frontal alopecia after repeated injections of botulinum toxin type A for forehead wrinkles.

Alopecia is never mentioned as a possible side effect of BTXA injections, and its occurrence is difficult to explain. Possible explanations include changes in the levels of molecules that may be involved in regulating the hair cycle, i.e. substance P and calcitonin gene-related peptide and other signaling molecules and receptors [11], and/or decreased neurological stimulation of hair follicle function due to blockage of the function of autosomic fibers [12].

Collection of more cases and histopathological/immunohistochemical studies will be necessary to understand the real prevalence and etiopathogenesis of this entity.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5096242/​

My theory in the context of everything in this thread is that this may be due to either (1) A direct Botox toxicity to the hair follicles (botox is a poison after all), or more likely (2) A result of greater mechanical traction applied to the frontal hairline when botox is applied selectively to the front of the forehead but nowhere else.

It is known that isolated forehead wrinkle treatments can cause shifts in the muscle activity of the face and skull as described here. For our interests, if you paralyze the frontalis (forehead) muscle, but the other galeal muscles are still pulling on it to a similar extent, the frontal aspect will "stretch" more from the fact that the forehead can no longer resist the other muscles. This would cause greater mechanical shear/stress to the hair follicles at the forehead where the muscle has been paralyzed and can no longer maintain positional stability.

All the cases they report were people who had forehead wrinkle treatments which would fit with this.

If this is the case, then patients who have proper migraine Botox treatments should have less problem with this, as migraine treatments provide a more balanced relaxation similar to what's desirable for hair, like this migraine protocol:

View attachment 86270

If there is truly significant hair loss risk from this type of migraine Botox protocol, it must be very rare. For example, here's what one popular and highly rated surgeon said about migraine for Botox and hair:

Botox injections are likely not linked to hair loss. Our office performs Botox for migraines and we have not seen any similar reports by patients who have undergone treatment.

https://www.realself.com/question/hair-loss4
​

I asked my mom who gets Botox for migraines and she says her neurologist has never mentioned it as a potential issue either. So obviously I couldn't say for sure but I think hair loss from a balanced Botox would be likely safe for hair. Unbalanced Botox for wrinkles would likely be riskier for the frontal hairline from a mechanical standpoint, and the mechanical stress theory of hair loss described in this thread could explain frontal loss in isolated forehead Botox injections.

If on the other hand the Botox is directly toxic to the hair, then no Botox anywhere would be safe. But I doubt this as millions of people have had Botox by now and if it was rampantly toxic to hair, someone would have figured it out by now.

I still think this would be a useful therapy for you to consider, and if I was you, I would feel comfortable trying it based on everything I've read. You do have risk factors for increased mechanical hair stress (tendency toward high muscularity, low body fat). While anti-androgens can seem to disrupt this cascade for most men, for some men and women, perhaps the mechanical stress may be more directly damaging to the follicles irrespective of androgenic signalling. Perhaps in those cases where anti-androgens don't disrupt the process significantly enough, relaxing the underlying stress directly may be the only effective approach.

It certainly seems freakish but I would agree that it must have something to do with the toxin interacting badly with the hair follicle where localised loss is seen. Others have reported mass shedding which could obviously just be a Telogen Effluvium reaction.

There are some things about your galea theory that do not fit for me. I have diffuse loss all over my scalp, but my hairline recession is the most rapidly progressive area of loss each time I am in the “loss” phase of my minoxidil cycle. My hairline is the most densely miniturised area, and I tend to lose all the way up my nape, in a deep m shape at my temples, then again an inward arc below my temple point, and general hairline recession everywhere else. Both those are the worst areas. Right now, my nape is in really bad shape and only has scraggly, wispy hair up to about my occipital scalp. Those are areas not overlying the gea.
I mean, I could always go into a clinic and say “I need Botox for migraines” just to avoid being knocked back, especially given that I see almost nowhere that does this procedure for hair in he greater Brisbane area.

 

[sktboiboi]

Discussion of the study:

We used qRT-PCR to validate the findings of the microarray analysis with regard for the expression patterns of two upregulated and three downregulated lncRNAs in seven Androgenetic Alopecia patients. The validation study genes were randomly selected and included two lncRNAs (RP11-818024.3 and RP11-76908.2) that were closely associated with the process of protein synthesis (the adapter molecule crk isoform b and the tyrosine-protein kinase Yes). The microarray data and qRT-PCR results matched well. The differentially expressed genes were then organized into hierarchical categories using heat maps and hierarchical clustering. Moreover, the pathway analysis identified 64 pathways (53 upregulated and 11 downregulated) that may play key roles in the mechanisms underlying Androgenetic Alopecia. Of these, T-cell receptor signalling was the most upregulated pathway, and Hedgehog signalling pathway was the most downregulated pathway. The Hedgehog pathway has been a focus of research in recent years. The Hedgehog pathway has been shown to be closely related to hair cycle control, and the inhibition of this pathway can lead to hair loss, in alignment with our results.17,18 The T-cell receptor signalling pathway plays important roles in human immune functions.19 It has been reported that this pathway is associated with the generation of alopecia areata, which is an autoimmune disease.19 However, a relationship between Androgenetic Alopecia and this pathway had not previously been reported. Our results reveal that Androgenetic Alopecia might be significantly and importantly involved with the immune system, but this requires further investigation. Among the most differentially expressed lncRNAs, some are closely related to coding genes, such as CTD-2636A23.2, which is associated with the coding gene HMGCS1. This gene was shown to be associated with cellular responses to follicle
stimulating hormone stimuli, cellular responses to cholesterol, cholesterol biosynthetic processes and male gonad development, all of which are tightly associated with Androgenetic Alopecia mechanisms.20–23 The lncRNAs RP4-742J24.2 and AC137932.5 are related to the coding genes BTBD3 and ANKRD11, respectively. ANKRD11 has been found to be associated with tissue homoeostasis,24 and BTBD3 is related to cerebral cortex development.25 Other lncRNAs, such as RP11-818024.3 and RP11-76908.2, are associated with the genes CRK and YES1, respectively, which are involved in ion channel binding, the vascular endothelial growth factor receptor signalling pathway, cellular responses to transforming growth factor-beta and platelet-derived factor.26–29 It is interesting to note that the functions of these genes are associated with the processes underlying and the development of Androgenetic Alopecia. In conclusion, Androgenetic Alopecia has a characteristic lncRNA profile, and lncRNAs that are altered in Androgenetic Alopecia may be potential novel candidates for preventing and treating this condition. Further investigations of larger cohorts are currently underway in our laboratory, and we hope to confirm the findings in this study. As a next step, we will explore the relationships between the target genes downstream of differentially expressed lncRNAs and Androgenetic Alopecia to increase our understanding of the pathogenesis of Androgenetic Alopecia.

 

[Georgie]

Discussion of the study:

We used qRT-PCR to validate the findings of the microarray analysis with regard for the expression patterns of two upregulated and three downregulated lncRNAs in seven Androgenetic Alopecia patients. The validation study genes were randomly selected and included two lncRNAs (RP11-818024.3 and RP11-76908.2) that were closely associated with the process of protein synthesis (the adapter molecule crk isoform b and the tyrosine-protein kinase Yes). The microarray data and qRT-PCR results matched well. The differentially expressed genes were then organized into hierarchical categories using heat maps and hierarchical clustering. Moreover, the pathway analysis identified 64 pathways (53 upregulated and 11 downregulated) that may play key roles in the mechanisms underlying Androgenetic Alopecia. Of these, T-cell receptor signalling was the most upregulated pathway, and Hedgehog signalling pathway was the most downregulated pathway. The Hedgehog pathway has been a focus of research in recent years. The Hedgehog pathway has been shown to be closely related to hair cycle control, and the inhibition of this pathway can lead to hair loss, in alignment with our results.17,18 The T-cell receptor signalling pathway plays important roles in human immune functions.19 It has been reported that this pathway is associated with the generation of alopecia areata, which is an autoimmune disease.19 However, a relationship between Androgenetic Alopecia and this pathway had not previously been reported. Our results reveal that Androgenetic Alopecia might be significantly and importantly involved with the immune system, but this requires further investigation. Among the most differentially expressed lncRNAs, some are closely related to coding genes, such as CTD-2636A23.2, which is associated with the coding gene HMGCS1. This gene was shown to be associated with cellular responses to follicle
stimulating hormone stimuli, cellular responses to cholesterol, cholesterol biosynthetic processes and male gonad development, all of which are tightly associated with Androgenetic Alopecia mechanisms.20–23 The lncRNAs RP4-742J24.2 and AC137932.5 are related to the coding genes BTBD3 and ANKRD11, respectively. ANKRD11 has been found to be associated with tissue homoeostasis,24 and BTBD3 is related to cerebral cortex development.25 Other lncRNAs, such as RP11-818024.3 and RP11-76908.2, are associated with the genes CRK and YES1, respectively, which are involved in ion channel binding, the vascular endothelial growth factor receptor signalling pathway, cellular responses to transforming growth factor-beta and platelet-derived factor.26–29 It is interesting to note that the functions of these genes are associated with the processes underlying and the development of Androgenetic Alopecia. In conclusion, Androgenetic Alopecia has a characteristic lncRNA profile, and lncRNAs that are altered in Androgenetic Alopecia may be potential novel candidates for preventing and treating this condition. Further investigations of larger cohorts are currently underway in our laboratory, and we hope to confirm the findings in this study. As a next step, we will explore the relationships between the target genes downstream of differentially expressed lncRNAs and Androgenetic Alopecia to increase our understanding of the pathogenesis of Androgenetic Alopecia.

Odd, given that it’s been found that T cells are essential for hair growth signalling, and when inhibited hair stops growing.

 

[sktboiboi]

if anything, this gene is what we lack in alopecic scalp:

ASHGV40041683 33.8073415 Down ENST0000 0565748 CTD2636A23.2 GENCODE 5 Natural antisense HMGCS1 Hydroxy methylglutarylCoA synthase

https://en.wikipedia.org/wiki/Hydroxymethylglutaryl-CoA_synthase

 

[IdealForehead]

It certainly seems freakish but I would agree that it must have something to do with the toxin interacting badly with the hair follicle where localised loss is seen. Others have reported mass shedding which could obviously just be a Telogen Effluvium reaction.

There are some things about your galea theory that do not fit for me. I have diffuse loss all over my scalp, but my hairline recession is the most rapidly progressive area of loss each time I am in the “loss” phase of my minoxidil cycle. My hairline is the most densely miniturised area, and I tend to lose all the way up my nape, in a deep m shape at my temples, then again an inward arc below my temple point, and general hairline recession everywhere else. Both those are the worst areas. Right now, my nape is in really bad shape and only has scraggly, wispy hair up to about my occipital scalp. Those are areas not overlying the gea.
I mean, I could always go into a clinic and say “I need Botox for migraines” just to avoid being knocked back, especially given that I see almost nowhere that does this procedure for hair in he greater Brisbane area.

Temple points and retrograde stresses were addressed here:
https://www.hairlosstalk.com/intera...gens-are-secondary.113256/page-2#post-1647067

It is hard for me to know exactly how temple points work, as everyone seems to draw the anatomy differently in this area. But here is yet another diagram that would support why temple points would be potentially vulnerable, as these areas appear to be a transition point for fascia and muscle:

We all have different skull and muscular structures of our heads which would be expected to lead to slightly different tension patterns and degrees of nape/temple sensitivity.

You can see how different variations of Norwood balding were predicted by this thread with just subtle differences in tension on a simple 2D mesh, showing how much slight tension pattern variation can change the outcome:

https://www.hairlosstalk.com/intera...alopecia-von-mises-2d-analysis-models.113276/

We don't have good maps of how aromatase distributions vary from one woman to another. Women might be expected to have even greater pattern variation due to added variations in aromatase expression.

It would be reasonable to tell them you're interested in Botox for migraines. Once you get your foot in the door, during the consult you could mention that you also have hair loss, and saw this article summary linked in this post with the protocol here for hair:

https://www.hairlosstalk.com/intera...-androgens-are-secondary.113256/#post-1646795

And ask them if that's the same as what they'd do for migraine. I just looked and I can confirm the migraine protocol uses essentially the same number of total units, so they are probably very similar:

The protocol for use of Botox-A injection therapy for treating chronic migraine is based upon the clinical research studies that earned the treatment its FDA approval and subsequent guidelines provided by the FDA. Each treatment involves 31 injections (5 Botox-A units per injection, for a total of 155 units).​

In fact I would bet the hair study just used a standard migraine protocol with 150 units given that the principle behind relaxing scalp muscles for headaches and hair should be identical.

 

[Ollie]

@IdealForehead could there not be a surgical procedure where by the Galea / attachment muscle is sliced in varying position to allow it to stretch out before essentially healing in its new more elongated position ?

 

[IdealForehead]

@IdealForehead could there not be a surgical procedure where by the Galea / attachment muscle is sliced in varying position to allow it to stretch out before essentially healing in its new more elongated position ?

We reviewed this multiple times in the thread and the answer is "no" for multiple reasons. Sorry I don't know where that was in the thread but it was in the first 4-5 pages, and I don't want to rewrite everything all over again, so perhaps read the thread in full if you want the full answer.

 

[Ollie]

We reviewed this multiple times in the thread and the answer is "no" for multiple reasons. Sorry I don't know where that was in the thread but it was in the first 4-5 pages, and I don't want to rewrite everything all over again, so perhaps read the thread in full if you want the full answer.

Thanks i'll have a dig.