Andrew Huberman: Professor of neurobiology and ophthalmology at Stanford School of Medicine and host of the Huberman Lab podcast. This is a solo episode.
What this episode covers
In this solo episode, Huberman explains how each hair has its own stem cell niche cycling through three phases (anagen growth, catagen recession, telogen rest), and how blood flow, oxygen, hormones and mechanical cues regulate them. He shows why dihydrotestosterone (DHT), made from testosterone by 5-alpha reductase, drives androgen-related pattern hair loss in both men and women. He then walks through mechanical treatments (microneedling, scalp massage, PRP, Botox) and chemical treatments (minoxidil, tadalafil, caffeine, saw palmetto, ketoconazole, finasteride, dutasteride, IGF-1/growth hormone peptides), covering dosages, mechanisms and side effects. He concludes that combining a mechanical stimulus (microneedling) with a chemical one (finasteride) is the most effective approach, while urging low starting doses and medical supervision.
Also referenced (named, not recommended)
Rogaine (minoxidil)
Johnson & Johnson
“Minoxidil, sometimes also referred to by the brand name ROGAINE, was actually a drug that was developed to treat hypertension.”— Andrew Huberman
Cialis (tadalafil)
Eli Lilly
“Higher doses of tadalafil sometimes also referred to by its brand name, which is Cialis, are used to treat erectile dysfunction.”— Andrew Huberman
Botox (botulinum neurotoxin)
AbbVie/Allergan
“an increasingly common treatment for hair loss is Botox. Botox is the brand name for what is otherwise known as botulinum neurotoxin.”— Andrew Huberman
Nizoral (ketoconazole shampoo)
Johnson & Johnson
“Another commonly discussed and use commercial compound for offsetting hair loss is ketoconazole. Sometimes this is known as Nizoral where Nizoral is the brand name of a shampoo.”— Andrew Huberman
Microneedling and its Use in Hair Loss Disorders: A Systematic Review
unstated authors
“the title of the review is Microneedling and its Use in Hair Loss Disorders: A Systematic Review. We will provide a link to this in the show note captions.”— Andrew Huberman
Big reveals from this episode
- Dispels the myth that you inherit your exact balding pattern from your mother's father; you inherit androgen receptor density, better predicted by your mother's mother.
- Huberman admits he is losing hair in patches up front at age 47 but has never fretted about keeping his hair.
- States the combination of microneedling and minoxidil can recover 'dead zones' of scalp that neither treatment recovers alone.
- Reveals topical caffeine can be as effective as minoxidil for slowing hair loss, without minoxidil's blood pressure and prolactin side effects.
- Recounts personally taking high-dose curcumin/turmeric, feeling 'absolutely terrible,' and confirming via blood work he is sensitive through the DHT pathway.
- Finasteride can reduce hair loss in 90% of people and increase hair count by ~20%, but carries serious sexual and mood side effects.
- Highlights post-finasteride syndrome: younger males stopping finasteride report severe drops in libido, erectile function and mood, even suicidal depression.
- Concludes microneedling plus finasteride is probably the single most effective hair-regrowth combination.
Worth remembering
- Scalp hairs can keep growing for 4-6 or even 8 years, while eyebrow hairs grow only for months, which is why eyebrows never reach your waist.
- By age 50 about 50% of all men and women experience noticeable hair loss, with up to 85% of them feeling anxiety about it.
- Hair loss is actually ongoing from about age 30 to 50; people only notice it around 50 under bright bathroom lighting.
- Sebum from sebaceous glands waterproofs skin and acts as a strong antibacterial/antimicrobial barrier.
- Minoxidil (Rogaine) was originally a hypertension drug; it grows hair by causing vasodilation and extending the anagen phase.
- Healthy women actually have higher levels of testosterone than estrogen, though far less testosterone than most men.
- DHT binds the androgen receptor at five times the affinity of testosterone, making it the most powerful androgen in humans.
- Ketoconazole (Nizoral) shampoo used 2-4x/week with 3-5 minute contact gives roughly an 80% rate of maintaining hair.
- Dutasteride inhibits all three 5-alpha reductase isoforms and can reduce DHT by ~95%, working 2-5x faster than finasteride.
- Caffeine works by inhibiting PDE to indirectly raise IGF-1 and may also reduce apoptosis of the hair stem cell niche.