Hair Today, Gone Tomorrow: Emerging Treatments for Hair Loss

Good evening, everyone. Welcome. I’m Nora Cain. I’m the director of the
Stanford Health Library. And it’s my pleasure
to welcome you all here tonight for the
first of our community lectures of 2017. So happy new year to all of you. And it seemed like
an auspicious way to start the year with
some discussions about hair loss and possible regeneration. And it’s a great
pleasure tonight to introduce Dr. Anthony
Oro, who is a professor here at Stanford in the
dermatology department. He’s also a member of the
Program in Epithelial Biology and the Institute for Stem
Cell Biology and Regenerative Medicine, part of the Children’s
Health Research Institute and the Bio-X Institute and
the Program in Cancer Biology. His research interests encompass
cancer genomics and tumor evolution, stem cell
biology, and hair skin development and regeneration,
that’s where we come in, and definitive molecular
and cellular therapeutics. His clinical interests include
hair biology, non-melanoma skin cancer, and therapy for
genetic skin diseases. So rather than take
up much more time, I’m just going to introduce
him and welcome him tonight. So just get on with
our first program. Thank you very much. Thank you very much, Nora. Thank you for braving
the rain and cold. We’re pretty excited
to have rain. So what I want to do tonight
is talk to you about hair. It’s something that’s
on our mind a lot. It’s dispensable, but important. What I hope you’ll understand
tonight is that it is an organ. And each hair is an organ
which is like all other organs in the body. And it is a window into how
we can regenerate other organs like the lung and the liver. It’s really a model
for stem cell biology because the things you
talk about for hair growth are the same things
we talk about for trying to regenerate lung
and liver, bone, cartilage, and that sort of thing. And so that’s why I hope
we’ll get to tonight. And so the title, Hair
Today, Gone Tomorrow really will be an
important thing. What I want to point
out is that our clinic, in case you don’t know, is
the Stanford Health clinic. It’s over on Redwood City and
in the Stanford Outpatient Medicine Facility. And it’s part of a brand new
north campus in Redwood City, that Stanford purchased about
35, 36 acres of land right by 101 and Woodside Road. And really it’s a
brand new outpatient medical campus there. They just broke ground. So basically all it is is just
flat except for our outpatient building. And I hope you’ll
visit sometime soon. What I’d like to do today is,
this is sort of the schedule that I’d like to
talk about today. A little bit about hair biology. What is normal hair aging? Soil and seed factors,
hair color and then preventing the immune system
from ruining your hair and give you a bad hair day. This is hopefully interactive. And so if you have questions,
please raise your hand and discuss with me. If not, then we can
wait to the end, and we’ll have a session,
a Q&A session at the end, to get you an answer
to the questions. All right? So what I want to do tonight
is to talk to you about, at first to start,
is about hair growth. And hair growth really is
a matter of seeds and soil. I think that’s really what
we want you to think about. Every hair on your head,
all thousands of them, come out of a group of stem
cells that make a hair. So there’s basically
groups of 10,000 of hairs, of little stem cell
pockets on your scalp, that grow a hair out. And that’s the hair stem cell. But around those stem cells,
these guys right here, these little stem cells
here, this is a stem cell. But around the stem cell are
a whole micro environment called the soil. Its micro-environment,
or stem cell niche, however you what to call it, but
really it informs the stem cell when and where to grow. And there’s blood vessels and
nerves and big fat adipocytes, fat cells, that
secrete factors that cause the hair to
grow in response to metabolic conditions
in your body. And so really these
little buggers, the groups of stem cells
that make the hair grow, are bio-sensors
for the body that sense what’s going
on minute to minute and then read that out in
terms of how the hair grows. Because the hairs are
just a bunch of protein that’s being excreted. And it’s a big energy
drain on the body to put out 10,000 of
these guys at a time. And so if the machine
is not working, it doesn’t want to put it out. And so that’s really the issue. These little bio-sensors, these
stem cells, read out the body and then make the hair grow. So it really is like
little seeds and soil. So this is actually
a picture of the soil here, for example,
here are blood vessels. And the nerve fibers wrap
right around the stem cells. So, for example, we’ll
talk about stress, our emotional state. There’s little peptides
that are coming from the nerves that actually
will affect the stem cells. These are big adipocytes. If you have a crash
diet the factors here that make the hair grow
will go away and then the hair won’t grow. And so these are bio
sensors that make it grow. Hair growth is a matter
of seed and soil. The seeds are the things that
make different types of hair. They code the instructions. On the left there you can see
different kinds of hair color. The seeds are very similar
to, for example, a peacock, feathers. Each one of the
feather stem cells rather than making a
hair makes feather. Those are also
genetically encoded and actually we can
spend a whole evening talking about feather biology. Which is very similar to hair
biology and how birds fly. And they have to fly
in a very perfect way. And different animals have
different length hair. So, for example, a mouse grows
very similar to a human hair but only grows about
an inch and a half because the growth cycle,
the season I’ll talk about, is very short. And the bunny does
the same thing. But there are mutants,
there are rabbit mutants, called Angora where they’re
just a big ball of fur because the hair
doesn’t stop growing. So that’s really what
we’re seeing today is we’re going to talk about
the seeds and the soil. OK? Well, welcome. So the basic bottom line
for tonight is this. There are different
kinds of soil. Here you go. And in different
parts of the body there are different
kinds of soil. And the seeds are
different as well. So these are little green
bean seeds and these are yellow ones. So they’re very similar. They make different
kinds of hair. These would make different
qualities of hair. And so if you put these
seeds, and this is basically how hair development works,
this is developmental biology right here, OK? Basically what they do
is, during development, the stem cells are set apart. And the skin is
actually pulled apart and the stem cells are put into
the cell underneath the skin and they start to grow. But they’re encoded and
make a different kind. So one kind makes
this kind of hair and they’re encoded, the
other kind are encoded, to make this kind of hair. And so if you look
on your scalp there’s terminal hairs, big
thick Redwood trees. On your arm they’re different,
they’re vellus hairs. They’re very tiny ones. So different parts,
different soils. Different parts of the body
have different kinds of hair. It’s genetically encoded. But how they grow and the
quality where they grow and when they grow is
determined by the soil that they’re growing in. And I would suggest
to you tonight that all of the hair biology
that you need to know is right here because most of
the hair diseases that we’re talking about are
either problems with the seeds or problems
with the quality of the soil. And we’ll talk about
more of that tonight, OK? Questions about that? So now you know
about hair biology. And you can go home because
that’s all you need to know. So we know seeds and soil
but what about the seasons? So there’s a, again, genetically
encoded season length of how far the hair grows. So the seeds are encoded
and they grow out the hair. But why, for example, does
a human hair grow down to your waist whereas a
mouse hair is this long? Does it grow faster? No, it grows about the same
rate, but the season of growth is much longer. And so, for example,
a human hair grows about that much
a month, as you know, but the season is
about four years. And that’s why it keeps growing
and growing and growing. And then you go
down to your waist. And then at that point,
there’s a cycle, shown here, where the hair pops out
this hair growth here and then it basically stops. And the real question
that biologists are trying to figure
out is why does it stop? But it actually knows
how to tell time. It stops and then basically
rest and sits there. And the hair stops
growing, it’s this long. And then basically
it ejects the hair and then another one starts
growing for four years. That’s the hair cycle. That happens and
there’s a counter. The seeds have about 40
growth seasons in their DNA. And so if it’s two to four
years and there’s like 40 cycles it’s around 80. And that’s your lifetime. So that’s hair biology. It’s 40 cycles of about
two years, on average. And that’s why your
hair is this long. OK, is that clear? Super important. And this is a picture of the old
hair that’s in a resting phase. And then the new hair production
facility has grown out. And the hair has grown
out here and it’s going to basically
kick that old one out. And this new one is going
to come out this way and then make a new hair
out of the same hole. 40 times in your lifetime
out of the same hole. Now what you have to understand
in terms of understanding hair biology and hair
disease is this, that each hair on your head
is in a different stage of that two year cycle. So it’s kind of
like the freeway. So 100 cars get on the
freeway and 100 cars get off. And so it looks like
there’s the same number of cars on the freeway
at the same time. The flux is the same. So on average if I stood
here and watched you today and counted all the hairs
that came off in the drain, in your comb, as you
roll the window down, you lose about 100. That’s normal. So 100 hairs is normal. They eject them
out and then there are new ones are growing
out there at the same time. The reason why that happens
is because the hair, they can adapt to different
environmental changes, different metabolic changes,
different stress changes. And that allows the body to
adapt to different environments because these little bio sensors
are down there figuring out what’s going on in the
body, metabolically, and stress, and
hormonally, and then that’s how they’re growing. So one of the coolest
organs in the world. I hope you appreciate how this
works because it’s really cool. Yep? Fast question, so if
sometimes your hair gets caught and it pulls out. So would it have to wait for
whenever that new cell was coming to get out? Or would it push it
to go out faster? OK, so that’s a good question. So let’s say this is your
hair and it gets yanked out. It turns out that if
this guy is about ready to go out, start going, it’ll
actually start the process. If it’s not ready its– I’ll take a little longer
but it’ll regenerate. Yeah, so it’s as long as you
don’t pull out the seeds, it’ll regrow. They’re a little deep. Yeah, so depends how you yank. So that’s an important question. But if you just pull the
hair out, so this is the hair but the seeds are actually down
here, and if you pull this out then it will regrow. OK, is that quick? All right, so we
talked about seasons. So there’s around 40 seasons. And each season is about two
years and the flux is variance. And so as a quiz, what
happens if there’s a traffic break on the freeway,
and then you suddenly release the traffic break. What would you see? How many cars come by? Usually you get 10 a minute. Traffic break they all pile
up and then you release it. How many would come at a time? [INAUDIBLE] Exactly, you’d get a lot more. Yeah, so you’d see a lot
more coming by, right? So because of that, if you start
to see a lot of hair coming out there’s two reasons. Either because it’s coming out
abnormally or because it got clogged up for a while
and then released and it’s all coming out at once. So it’s a transient. But if you have a traffic
break and then for a while it piles up but then
it kind of evens out and goes back to where it was. OK, is that clear? That’s a huge
thing because a lot of disease I’ll
talk about later on is an apparent hair loss called
telogen effluvium, that’s the name. But it’s really because
they all piled up at once and they all came out. So that’s one thing you have
to think about, all right? Good answer. If you understand the
seasons, then this is a great cartoon where there’s
a guy with horns on his head. And horns are actually
are like hair, they actually fall off
during the seasons. And the doctor says, well
before trying surgery, I’d like to wait and see if you
just shed them in the spring. So a lot of the things
that actually are abnormal, that thing is
constantly turning over, it will fix itself if
you just wait long enough for the next season. And that’s part of what
we have to think about with hair disorders because
that’s an important thing. Texture. The composition of the
hair, the little protein tube that comes out, which is
the hair, the hair keratins, is genetically encoded. And you know that because
of animals like sheep. These are inbred
lines of sheep that have very specific kinds
of proteins in their wool that give them the quality of
the hair, keratin, the wool keratin, which is just like the
hair keratin, that gives them the properties for the sweaters
and coats that you make. For example, very famous
Merino wool is curly. So what it does is
it really curls up. So when you pack
it together it’s curly so it actually
provides a lot of air. And it’s a lot of breathing. Whereas Dorper hybrid wool
is actually flat and so when you make a sweater of
this, it’s very dense and warm. That was specifically encoded
by these sheep farmers. The types of hair protein
keratins that are made determine the quality of
the hair and the kinkiness. Also the length and the
duration is also encoded. So they actually can
breed these animals for exactly the length of the
season, length of the hair, the quality of the hair,
the color to make products. Now what happens
when we get older? So this is an
important question. And so there’s a
warranty for these seeds. So there’s different seasons. And some of these seeds
can grow for 40 seasons. Some of them can
grow for 20 seasons. Some of them can grow
for five seasons. And so these
warranties, if you will, are genetically encoded
in your hair seeds. So at birth, they’re
given a warranty. So, for example, if your
warranty is for five cycles, and each cycle is about two to
four years, at about 18 or so you’ll start to lose
the growth cycle. And the hair will start to
get smaller and miniaturize and then go away. So on average this is what you
see with age, the 20s, 30s, 40s, 50s, and 60s. Some of the seeds which have
smaller, shorter warranties start to then sort of peter out. And then your hair
starts to thin. And this is normal hair biology. It’s basically
like basic farming, after a while the
seeds give out. And this is a scan of an
electron microscope of a hair shaft at the age 20 and age 60. So it’s thinner. It’s lost this outer covering
called the cuticle which keeps all the moisture in. And actually takes up
a lot of the color. You also can see that
the machinery that’s making the hair, the stem
cells, are having some errors. So there’s breaks and cuts. So it’s more brittle. That’s basically
normal hair biology. So that results in
loss of moisture because the cuticle which
keeps the water in the hair goes away which is more
brittle, loss of hair strength, fraying of the ends, and
a shorter hair length. That’s the normal biology. So the seed warranty
is genetically encoded. So sometimes 18-year-olds can
have male pattern baldness, which really is a shortened
seed warranty, if you will. Also centenarians, even though
they’re both wondering about it, plenty of hair. And so it’s really a
genetically encoded question. And so the real question,
which we’ll talk about, is how do you adjust
that warranty? How do you buy an extended
warranty plan for your seeds? Yeah? Are these related to telomerase? Indirectly they are. The telomerase keep them going. And the rate of
shortening is important. The question is what is
the molecules that actually regulate the telomerase? Yeah, in the back? Is it true that women inherit
their genes from their mother’s side for hair? So the question is, do
you inherit the balding from your mother? Yeah. Yeah, so we’ll talk a little– My father was bald. Yes. But my mother has a lot of hair. Yeah, so I’ll talk a
little bit about that. But it’s complicated genetics. It’s not simple. You have two pairs
that have lots of hair and you don’t have
any and vice versa. So bottom line is you
can’t blame your parents. I mean, you can,
but not for this. I heard that the baldness
skips a generation. Is that a myth or true? So does baldness
skip generations. In some types of
genetics it does. But it’s a complicated,
it’s not a simple. Yeah, yeah. So it can happen the
father has thinning hair, son can also have the same? It can happen? It can happen, yeah. You had a question? I had the same question. OK? Someone whose hair turns
white when they’re twenty, does this tell us anything
about the aging process? Yeah, so save that question
until a little bit later. I have a whole section on that. All right. So let’s talk about how
to slow, basic things, practical thing on how to
slow the normal aging process. OK, so I just showed you
this is what your hair looks like as you get older. So the key really is to
replace this outer covering because that’s the thing
that keeps the moisture in. And it protects the hair from
breaking, this tube of protein from breaking off. And so how do you do that? So really you have to
replace and protect that outer covering. And now the cosmetic companies
and shampoo companies are really becoming
much more sophisticated about the quality of the
conditioners that they use. And they don’t just
straighten or replace, but they have lipids
in most conditioners, higher-ended conditioners,
that actually form a layer around
the hair that actually will replace that covering. But also because that outer
cuticle coat is now gone, sunlight can
actually hit the hair and then cause damage to
it much, much more easily. So sun protection. You don’t think about protecting
your hair from the sun but it becomes more brittle
and more sensitive to sunlight. So sun protection is
even more important now to protect the
hair from breaking Avoiding harsh shampoos
or repeated or high blowing dry on a high
setting, high heat setting, because the high heat because
it’s brittle will break it off. And just a little more
careful with coloring agents. Because when you’re a little
younger, the coloring agents you can just do it once
a month, but the color because the cuticle takes
up most of the color, the color you need
to use may change as you get older because
it doesn’t give you the same color with
the same agents. And harsh chemicals are much
more likely to break the hair. So you have to talk
to your stylist to say, OK, as you
get older, you’ve got to change and
adapt a little bit. [SNEEZE] Bless you. Also stress inflammation can
accelerate this aging process. And we talk a little
bit about the evidence for stress reduction
and diet in terms of reducing the aging process. But it can actually
rapidly age and actually subtract and detract
from the warranty of some of these seeds
a little bit faster. The hair shampoo or conditioner,
if you look at the ingredient, the expensive one
to the cheaper one. There are so many
chemicals in there. One of the thing
you have to avoid, is that true,
sulfur, what is it? Is it something
to do with sulfur? Lauryl sulfur. Yeah. Yeah. Yeah. Is that really bad? I hear that can
cause losing hair. So this so-called
lauryl sulfate, is it? It’s that’s one of
the harsher soaps. But most chemicals– I look at
the expensive and the lower. That is second or
third ingredient. But you’ll see coming out is
now shampoos and conditioners, for the older
population, which have less of those harsh chemicals
and more things to wrap around. So you’ll see those
coming out in the future. [INTERPOSING VOICES] Excuse me? What was the chemical? Sodium lauryl sulfate. Sodium? Yeah, it’s sodium
lauryl sulfate. It’s a very common soap. Is that making you soapy? It’s a soap. And at the end of
the lecture, can you recommend some
better hair product? If you still have a question
at the end, then we’ll talk. OK? Yeah, in the back? What about ladies who color
their hair versus not coloring? Is there a difference? Yeah so the answer is no. I mean the answer is the
protein tube is dead. So it’s not going to affect
this the stem cells itself. So coloring your hair, per se,
does not make a difference. Also it makes you
happier, and so go for it. So there’s a
psychological advantage which actually
helps the stem cells as well, so that’s one thing. But as long as it’s not
a harsh chemical that then will cause an
allergic reaction or breakage of the hair,
it’s perfectly fine. OK. Yeah? Question about you
mentioned earlier on soil. What about maintaining
or encouraging the sort of the
health of the soil. For example, my
dad was saying he likes to use these plastics
scrubbers on his head to really massage in the shower. Would that make a difference? So the question is,
plastic scrubbers or massaging your scalp? So we’ll talk about
that in a second. Maybe I’ll go on for
now and if you have– So let’s talk more specifics
about how your hair grows. And we’re talking more
about seeds and soil, seasons of the growth
and a seed warranty. First soil factors. So if you go to the store, this
stuff is super expensive soil. This is from Home Depot. It’s the top of the line. It has potassium, it’s got
everything a plant and a seed ever need to grow. It’s specific for the
roses, so it’s tuned for it. Similarly, the
hair follicle stem cells have this environment
here around the cells. There’s certain critical things. So common questions we get
in the hair clinic are, do nutritional supplements help? What hormones help or hurt? What about stress? And what about the
medicines I’m taking? Because sometimes I think that
I’m on 20 medicines and my hair stop growing. What do I do? Let’s talk briefly about– This can be an entire
lecture in itself. Actually, every one of
the next four slides can be an entire lecture. But the most important
point I think about it is that there’s a
lot of epi phenomenon that people talk about. And then there’s things that
people that I would feel like I feel confident in saying, and
it’s been well-documented. These four, these three in
particular, iron, biotin and zinc, are really
critical for hair, for normal hair growth,
especially iron. But what you need is enough. And more is not better. So you just need enough that
the factory can actually grow the hairs because
it uses iron, zinc and biotin to actually grow it. And heavy metals from
drinking water particular can inhibit hair growth. These are some of
the things we check, or we can check in the blood. And so we just make sure
that that’s going OK. But I will mention
that you can get a daily requirement
for normal hair growth with a normal daily diet. Well balanced with leafy greens. There are plenty of
supplements out there on the market called
hair supplements that have extraordinary amounts
of biotin and zinc in them. And they don’t hurt
you, just pee them out the stuff you don’t need,
but if you have a normal diet usually you get enough. These are just co-factors for
enzymes that work in the hair. What about sex, stress
and metabolic hormones? These are key because
one of the things we know about a particular
male pattern baldness is that too much male hormone,
in particular this one called DHT, dihydrotestosterone,
accelerates the aging process and reduces the
warranty on the seeds so that they start to
shrink, become miniaturized, much earlier. In contrast, female
hormones slows it down. We know that vitamin D
plays a critical role in allowing hair to grow. And so you need enough
vitamin D for it to work. Thyroid hormone is absolutely
critical for hair growth because it’s the signal
that the hair follicle stem cell sends to get as a
metabolic signal from the body. And stress hormone basically
arrests hair growth and so more stress, less hair growth. The hair says, wow this is
a really stressful place. I don’t want to put the energy
out to make the hair grow. As I mentioned before, the
peripheral nervous system interacts directly
with the hair. It actually wraps
around the seeds, the stem cells, and so
whatever stress is coming through the peripheral
nervous system, the little peptides
from the nerve actually will write on
the hair stem cells. And so we have
people in our clinic that when they stress they start
to shed dramatically and then they stop. A lot of people don’t do that. But many people do that. I can tell how
stressful a person’s job is, with some people, by how
much they’re just dumping hair. And so this is an
individual thing, it doesn’t happen to
everybody, but there is a very strict correlation. And stress will
put the hair into a quiescent or resting phase. What about the
medicines I’m taking? Often, as we age, we
take more medicines. And associated with aging,
we also take more medicines and have more hair loss. And so it’s often confusing,
which is what is causing it. What we know is that
particular medicines do have a role in reducing
the rate of hair growth or putting the little seeds
and slowing them down. And then, in particular,
antidepressants like Zoloft, Prozac, and
Paxil, blood pressure medicines like beta blockers
and ACE inhibitors, anticoagulants like Warfarin
and anti-gout medicine like allopurinol are
also very well known to cause a dramatic
hair slowing and loss. So the hard part is to
try to figure out which one is going to do it or not. And so we often,
in the hair clinic, work together with your
primary care doctor and try to figure out and
swap them out to figure out which one will work. Male and female
pattern baldness. So this is a big question
that people have. What’s the difference
between normal aging, where the season of the hair
miniaturizes and the hair gets smaller versus
patterned alopecia? Because in a sense they’re quite
similar except that patterned alopecia is patterned, whereas
aging is a general process all over your scalp. So why do men, when they bald
in male pattern baldness, look like this? So this is the sort of stages
of male pattern baldness and women do it a different way? Is it a different process or
is it just a different pattern? We have a vote but
I’ll just tell you that it’s pretty much
the same pattern. And it gets back to
this analogy here that every part of the real
estate of your scalp actually there’s a GPS that’s
encoded in the DNA. So every part of the scalp has
a different set of stem cells and is encoded differently. And so in a man who has
susceptibility to male pattern baldness, this
part of the scalp, the warranty of these seeds
is different than the warranty of these seeds. And that’s genetically encoded
because there is really like a GPS that says, OK,
you go two centimeters back and to the left and
those are encoded. And over here, these
are different than this. And so that’s just
developmentally how it works. But both of them are
sensitive to male hormone. More female hormone
makes it last longer. And the difference between male
and female pattern baldness and aging is that
this comes on earlier. The onset for androgenetic
alopecia is earlier and usually AG is after 60. The distribution is patterned
versus more diffuse. They’re both follicular
downsizing, the shorter hairs. They’re smaller
and more brittle. This one is sensitive,
much more sensitive, to male hormone and
actually other things which we’ll talk about. Where this is actually
not hormonally mediated, just the seeds are giving out. Their warranty is done. And we mentioned before,
the male pattern baldness is polygenic, it
doesn’t necessarily come from your mother
or father, there’s a whole set of these
genome-wide association studies with male pattern balding. And it’s clear it’s 20, 30,
40 genes working together. So it’s really a
complicated mix. It’s possible you could
get it passed along. And there are some families
where it’s very strong. You could tell that
that person’s an O’Brian because every single person in
their family is the same way. But that’s just genetics. And the aging process
is really unclear. And this is really what
we’re trying to figure out. We’re using male pattern
baldness as a proxy for aging. So it really giving us a
lot of insight into aging. So factors known, as
I mentioned before, to accelerate
androgenetic hair loss. Male hormone,
dihydrotestosterone, reduced female hormone,
reduced blood flow to the hair follicle,
stress and inflammation. So it’s really clear that
stress and inflammation make the aging process more rapid. And this is a whole
lecture in itself, I can talk more about that. But the mechanism for how
inflammation and stress, which reduces inflammation, ages
the stem cells is very clear. Yes? Minoxidil is usually used to
actually encourage hair growth. So I don’t know how it’s
up to that category. Yeah, so these are
some of the drugs we could use to
actually counteract some of these processes. For example, propecia
is called finasteride. And then there’s another
propecia like medicine called– Oh, I see. OK. I get it. They’re treatments. Other treatments. Right. They’ll [INAUDIBLE] block. For reducing
female, you actually do estrogen replacement. For increasing blood
flow, minoxidil. LaserMax comb, which I don’t
know if you’ve seen those. Basically it’s a red
light laser that you just comb through your hair. And it does increase the hair
a little bit, about as much as minoxidil. But I think what it
does it just increases blood flow to the scalp. But then there’s this thing
called hair helmets which I don’t know if you’ve
seen those are not, but they cost a few thousand
dollars or a few hundred dollars at least and you put
them on your head at night. And it shines a red
light on your scalp. I think the same is it’s
increasing the blood flow. It’s not really
clear how it works. But these are some of the
ideas for male pattern baldness and female
pattern baldness as well. Yeah? Minoxidil doesn’t that cause
facial hair growth for women? So good point. So a lot of these things
if you’re trying to reduce or sometimes when you
block the male hormone in different places you get
more facial hair, for example. And in women that’s the case. So it can if used in a wrong
way, in a wrong concentration, bring out some facial hair
in women, which is an issue. So you have to be really
careful how you use it. Are any of those
other [INAUDIBLE] in anything else [INAUDIBLE]? They wouldn’t, yeah. Right. And finally hair transplantation
is also really the definitive, it’s the original hair stem
cell transplant procedure. Because what you do
is you’re basically taking seeds that have a long
warranty, taking them out, and then transferring the same
seed with its long warranty into a position where the seeds
used to have a short warranty. But the seeds bring their
long warranty with them. The procedure doesn’t
create any new stem cells it just redistributes
the ones you have that have longer warranties
to spread out over a greater area. But it works. And it works because– Now you know how it works
because the seeds that were over here that
had a longer warranty are put into a place where
the short warranty is and they just keep growing. Yeah? Are you going to talk more
in-depth about that procedure? What it takes, in order
to put something in there. Is there any stitches? How painful is this process? Yeah. Maybe the question the answer– [INAUDIBLE] Yeah I will. The question is about
hair transplantation and more specifics about it. Why don’t we talk about
that in the Q and A period. If we would get to that
because the question is– There’s like three different
kinds of hair transplantation techniques that we can
talk about, if you like. There’s a robotic one,
there’s a follicular unit transplantation. That’s more specific topics
but we can talk about in the Q and A if you’d like. OK, getting back to a
previous question then. What about hair pigmentation. Questions like, why
am I going gray? And the big one is, my
friend went gray overnight. And also, I took a drug. I had cancer, I took
this chemotherapy and suddenly every hair
on my body went gray. Why is that? So after this, hopefully
you’ll understand. So what happens
is that hair color comes from a set of cells
that are next to the seed that makes the hair. The melanocytes
and that melanocyte has to basically come
down with the stem cells and then inject hair inject
pigment into the hair. So it’s a separate set of cells
called melanocytes, up here, that basically sit right
in the hair follicle stem cells and inject the
pigment in as the hair grows out. So basically the hair
is growing like this and the melanocyte it’s
putting pigment into the hair as it grows out. The hair color is
determined genetically by how it melanin the melanocyte
makes and the kind of melanin it makes. So basically it concocts
this pigment packet in the melanocyte. And it basically transfers
it from one cell to the other as the hairs growing out. It goes, OK, brown,
brown, brown. And then makes sure
it’s the same color. It’s pretty amazing. Stress hormones, drugs
can alter the pigment to the color of the hair. And also dyes and
bleaches can do the same. But the issue here
is the 50-50-50 rule which is that, in general,
if those little cells, the melanocytes die off,
they have a warranty as well. If they die off, then
your hair goes gray because the hair can be produced
but there is no pigment packets to go into the hair as
the hair’s coming out. So the loss of
melanocytes due to aging or the ability of melanocytes
to make pigment which is called albinism or
albino-ism, albinos, or chemotherapy, results in the
hair being unpigmented or gray. So the 50-50-50 rule is that,
in general, 50% of your hair is gray in 50% of
people by age 50. So that’s in general in the US. So if you line up
50 people who are 50 and then checked their hair in
general then about 50% of them will have gray hair. About 50% of their
hair will be gray. So that is 50% not like every
hair will be half gray 50%, but 50% will be all gray and
50% will still have pigment because 50% all of
their melanocytes are still around
doing their business. [INAUDIBLE] Yeah so the question is how to
keep those little melanocytes around longer so that
they don’t die off and so you don’t get gray. And so sun protection,
again we dermatologist, I’m a dermatologist, it’s
always about sun protection. Well here’s another reason
why to protect yourself. Because sun damage will actually
speed up, and inflammation and stress, speed up the
death of these little cells and make you gray faster. Some people believe harsh
chemicals, peroxides and chemicals, this
is where there’s a lot of debate, getting back
to your question in the back about does if you dye your
hair a lot does that make– Well you dye your hair
because the color is not the right color. Sometimes harsh chemicals can
actually hurt the melanocytes that make the pigment and
so that goes away faster. But it’s a vicious cycle. And we know inflammation is
known to increase gray, just look at President Obama. And stress. And the last thing
I want to touch on is how the immune system can
try to prevent the immunity inflammation from
interfering with your hair because a question
we often get is, when I’m stressed I get
little patches of hair loss that are there for a while
and then they go away. And so what I wanted
to point out again is this slide here where
this is the former hair, from one season. This is the new hair
shaft growing out and it’s going to grow
out the same place, take that hair out, and then
grow out that same hole. But one of the things you
notice this picture it that there’s no immune cells. So this thing is growing
down there like deep into your scalp. The immune system doesn’t care. It’s like, be my guest. So it’s basically like
it’s wearing Harry Potter’s invisibility cloak. The immune system
can’t see it which is why it can keep growing
down and be happy and grow for two years and still grow. However sometimes
there are these hiccups when the system
goes, wow, there’s something growing
down into your scalp. What is that? And it starts to attack it. And you get a disease called
alopecia areata, which is super common, about
2% of the population have these little
circles of hair loss. Or you can get
bigger ones called this is ophiasis distribution
where it’s all around or totalis where every
hair on your scalp is gone or universalis which is every
hair all over your body. And we see this very
commonly in our clinic. So this person has
eyelash eyebrows. Eyelashes, but often
you lose those too. That’s if the immune system is
really going on for every hair. But what it’s doing, and
this is what it looks like. It’s where the immune
system is basically in the middle of a hair
disrupting its growth. But the key is that the
immune cells are influencing the growth but the
seeds are still present because this is
the more mature hair, but the seeds up here
are still protected. So what it’s doing
is putting the hair, the immune system
then is putting a tear into this asleep,
into quiescence. And we’ve discovered this
both through genetics and through hair biology that
the stem cells are there just waiting to grow but the immune
system is preventing it. So you can actually just
block the immune system in the right way it’ll allow
the stem cells to then grow back out. And, in fact, if you
pick the right drug, and there’s a new rheumatologic
drug called tofacitinib, or xeljanz is the trade name,
it blocks the immune system. And people who were completely
bald even after 22 years now have a full head of hair. And so this really
shows if you understand the biology and the power of
how to treat the stem cells and wake them up
you can actually get pretty amazing
results with treatment. And so the idea here is to
try this with male pattern baldness. Is to use stem cell drugs
to wake up the stem cells. They’re starting to age, maybe
re-lengthen their telomerase, and then sort of
recondition them so that they can go on
and have a long growing season and a longer warranty. So that’s where a
lot of the research is going right now is
drugs that do that. So it’s 7:48. So I just wanted to
summarize what I told you. That hair biology really is
a matter of seeds and soil. I talked to you about
normal hair aging and how to prevent the aging. There are soil factors,
nutritional, stress, hormonal, environments. There are seed factors which
are genetically encoded which we try to modify with drugs. We talked about the melanocyte
that injects pigment and why you get gray. And both things that can help
with immune interference. Even a small level might
help the hair to grow better. And that includes, we’ve talked
about diet, stress and also autoimmunity. And then just to remind
you about the Stanford hair clinic in Redwood City if you
have any questions about hair biology. So I’ll stop it to
take any questions. [APPLAUSE] This does have anything
to do with graying, but friends that I’ve
had that had chemo, their hair was straight
before and then when it came back in
it was very curly. Why does that happen? So the question is,
post chemotherapy, the hair quality changes. So if you understood
the lecture, I’ll just tell you that
what chemotherapy does is it damages the
instructions of the seed. And so if that’s the case,
then your hair used to be this and then it got changed to
this because the instructions got damaged by chemotherapy. OK? So that’s kind of how it works. Yeah? When you develop
certain drugs, it’s a pretty dramatic picture
in the other thing. And now you’re causing
something to grow that had been stopped growing. How specific is it? Just for the hair or would
it cause other things to grow in the body? Yeah. So the question is,
correct me if I’m wrong, the drugs that are for this
particular anti-inflammatory drugs that have specific
effects on the hair or does it have effects
on other places as well? It’s a pill. And so it basically affects
this inflammatory signal all over the body. So I’ll just tell you,
every drug has side effects. And the question is what’s
the benefit-risk ratio? And so with this particular
drug we’re using a low dosage. So that ratio is pretty good, . But that’s a personal
decision about how it works. Is there something out there to
use, I can’t remember exactly, something about
something with a plasma that you can inject under
the skin that stimulate– Can you comment on that? Yeah. So question is about
a treatment called platelet rich plasma, or PRP. I guarantee you’ll see this. So some people usually
you take the blood out and you spin down the
cells in your blood, there’s the platelets,
they’re the ones that hold, that form a clot after
you cut yourself. So in the sports literature,
after injury to the baseball players hip, it uses PRP
and inject it into the joint and actually it helps
it heal much faster. And that’s actually
pretty well known. What it does is it
blocks inflammation, allows the healing
process to occur. So there are some
people that believe that doing this for hair
growth, injecting the scalp, will actually
cause hair to grow. When I saw the news
was on advertisement, you pay one fee, seven
injections in your scalp and that’s where
you get hair growth. The latest, I’ll just
tell you that the data is very sketchy about
the benefit of that yet. And I’m not sure how the
mechanism works because there’s not much inflammation as I
showed you in the male pattern baldness. For alopecia areata
it might work, I can see how that would work. But for male pattern baldness
I’m not sure how that’d work. You don’t know how
long that’d last? I don’t even know
how it would work. Yeah? You mentioned one of
the sort of solution for increasing your blood
flow to help follicles. You mentioned
laser, comb in hair. Are these instruments safe? So the question
is about there are devices that you
put on your scalp to increase blood
flow, LaserMax, there’s called hair helmets. Google it, I guarantee
you’ll get a good laugh at the designs. It looks like you’re
orbiting the earth. They’re safe. I mean they’re FDA approved,
so and the FDA approves it because they’re safe. So they’re safe. But the question is,
are they worth the money that they spend? That you spend. The jury is still out there. Sir? I’m confused with
your terminology of using the word stem cell for
the production for the seed. How that is [INAUDIBLE] with
the general usage of the term stem cell. These are not really
stem cells, are they? In the sense of cell that
can become any kind of cell in the body. Yeah. Yeah. So good question. The question is the use
of the term stem cell and how that relates to the
word I was saying it was seeds. So the words stem
cell is a cell that has the capability of
making other cell types. And the ultimate stem cell is
the oocyte, the mother’s egg, when it’s fertilized. And that fertilized
egg has the ability to make every cell in the body. So there’s human
embryonic stem cells, our lab works on some
of those as well, that can make every
tissue in the body. It has the capability
of making it. These hair stem cells will
be called somatic stem cells because they
make other tissues. But they have a
limited repertoire. They’re more limited
than the oocytes, the egg which can make every
cell, every tissue in the body. These hair follicle
stem cells, they can make different types of
hair, different layers of hair. They can contribute to making
this kind of hair, the skin as well under
certain conditions. So they have the capability of
when you actually cut yourself, notice how on your
scalp, it heals much faster because
the hair follicle stem cells can actually contribute
to wound healing as well. So they’re stem cells in
a true sense of the word but they’re somatic
stem cells because they have a limited repertoire
compared to other ones. So the muscle stem
cells can’t make hair and the hair stem cells
can’t make muscle, but they can make many different
tissues within each organ. Yeah, in the back? Yeah can you compare
minoxidil and finasteride as to which is better? Yeah so the question
is comparing drugs which block
dihydrotestosterone and drugs which increase blood
flow like minoxidil. And I would say, one’s
a topical one’s an oral. That’s right now. There’s a move to make a topical
finasteride that’s not ready yet. So I would say, first
of all, generally the oral medicine is stronger
but can have side effects. The topical is
safer, in some ways, but it can cause scalp
irritation from the vehicle that it’s in. And also it’s kind of a
hassle because it’s not exactly a great hair product
because it’s a solution so it mats your hair down, so people
don’t want to use it every day. Whereas a pill is
pretty straightforward. The side effects of finasteride,
for men we usually give it as one milligram tablets. And the five milligram dose is
basically the castration dose. And we give it at one milligram. And so 99% of people, of
men, have no problem with it. So there’s this window where
you can block your hair, you can let your hair grow but
the rest of your body is fine. But there are that 1%
that have side effects. And they’re the
obvious side effects of the maleness side effects. And there’s also evidence
that it effects the brain configuration of maleness too. And so now there’s a
post finasteride syndrome where after you
stop it, it doesn’t reverse in that 1% of people. And so that is a
true side effect. People to be aware of that. You see it in the National
Enquirer but it is a real, but it’s in that 1%, a
small percentage of people, a very small
percentage of people. Most of the people in
a clinic, so what we do is we monitor very carefully
the initial few months to see how you’re doing. And make sure that you’re not
the 1% to have side effects. And then generally it’s very
well tolerated after that. Yep? The stem cell medicines
that you mentioned are currently being
researched now. Any guess on are we talking a
few years, 10 years, 20 years? How far away are we? Because of things like
the California Institute for Regenerative Medicine, that
the California public funded for stem cell research,
there’s a huge amount of research in all sorts of
stem cell, stomatic stem cells. And it turns out that
medicines or drugs that affect stem cells are the heart
and brain and lung, they all have very
similar effects on the hair follicle as well. And so some of those are
being tested right now for their effects. And so not just potentially
but actually really trying at different very
clinically relevant scenarios to see if they work. They work in [INAUDIBLE]
models, but the question is will they work on you I? It’s not in 10 or 20
years, it’s very soon. The testing and the question
is will they work or not? There’s a prostaglandin
like molecule which is one of those other one
of the stem cells molecules. And that one is being
tested now like in a Phase 1, 2 clinical trials. That real read out probably
the end of the year. It’s happening now. Hi, yeah in the back? Do you have any
current local trials going on for hair growth? Good question. So the question is about our
clinical trials at Stanford. So we have a young,
very dynamic hair group at Stanford in our clinic. We have a lot of data and
trials on the autoimmune form of hair alopecia areata. We’re one of the first groups
to really test this new drug. And now we’re testing a
number of different drugs that modulate the immune system
to wake up the stem cells. We’re moving into testing
male pattern baldness drugs. And so we don’t have
any trials right now, but probably early
next year we’ll have that group
set up and going. And so those are
the two major ones that we’re doing trials on. So if you look at our
website, which is up there, or contact me. There’s a bunch of the trials
are listed on our department website so I hope you’ll check
it out or come or just visit our clinic. Well I think that’s probably
the last question we can take. Unless you want to talk
to people afterwards. Great, yep, I can hang around. So thanks very much.

31 thoughts on “Hair Today, Gone Tomorrow: Emerging Treatments for Hair Loss

  1. If you have serious HAIR LOSS and are tired of the OLD and FAILED ideas…I urge you to go to to learn about a totally NEW proven science which for the FIRST time in history explains the truth about the HAIR LOSS syndrome and how to treat it using NO DRUGS, NO LOTIONS and NO SURGERY.

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  2. I wish he would just explain the science in technical terms instead of the bad soil and seeds analogy and trying to dumb it down for laymen's. Makes it more confusing than less and I'm ok with googling a few terms if need be. I otherwise appreciate the talk and presentation.

  3. If you have serious HAIR LOSS and are tired of the OLD and FAILED ideas…I urge you to go to to learn about a totally NEW proven science which for the FIRST time in history explains the truth about the HAIR LOSS syndrome and how to treat it using NO DRUGS, NO LOTIONS and NO SURGERY.

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  5. Someday in the future they might have ahair transplant in the local hospital.someday they put hair transplant for insurance coverage in the near future. Since technology is advancing.

  6. MEN…I was completely BALD and CURED my HAIR LOSS with a totally NEW method. If you are tired of the OLD and FAILED ideas I strongly urge you to go to to learn about a NEW proven ALTERNATIVE science which for the FIRST time in history explains the real cause of HAIR LOSS and how to treat it using NO DRUGS, LOTIONS, transplant SURGERY or ugly WIGS.

    This NEW theory and science explains that all the OLD systems have FAILED because they FOCUS only on DHT . It identifies the true MAIN cause of HAIR LOSS and says DHT is only a « secondary » factor which becomes bad for your hair ONLY when the MAIN cause is not FIRST corrected. It is EASY to understand and very, very simple to use. It is also the most INEXPENSIVE method and it really works

  7. Are the seeds the bulb? I just tried Exosomes and hoping it work. I was c/t off a benzodiazepine and I lost over 50% of my hair. NEVER take a benzo.

  8. 10:30 So we have about 40 seeds. And we go about trying Rogaine and go through a shed. Some other treatment.. go through a shed.. Then we try Finasteride go through a shed.. Each time, we're killing a seed? 🙁 Damn.. I guess by trying to combat hairloss, we are speeding it up.

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  10. Got to know about a lot of think that matters for hair growth. I do think that the information shared by him is very accurate.

  11. DO NOT LOSE HOPE…I was completely BALD and CURED my hair loss with a NEW and proven ALTERNATIVE science. If you have HAIR LOSS and are tired of the OLD and FAILED ideas, I strongly urge you to go to to learn about this science which explains the real cause of HAIR LOSS for the FIRST time and the TRUTH of how to treat it using NO DRUGS, NO LOTIONS and NO SURGERY or paint jobs or ugly WIGS.

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    This NEW theory and science explains that all the OLD systems have FAILED because they FOCUS only on DHT . It identifies the true MAIN cause of HAIR LOSS and says DHT is only a « secondary » factor which becomes bad for your hair ONLY when the MAIN cause is not FIRST corrected. It is EASY to understand and very, very simple to use.

  12. There are so many causes which can affect hair loss so taking precaution is good if you love your hairs. Without consulting any doctor, taking any medicine or hair oil can also harm your hairs.

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