people formulate theories all the time, and then other come in and empirically test it. Without the theorists (in several fields like psychics, economics, so on and so forth) there would be nothing to empirically test. So, step one is a theory with enough random citations to merit delving into it further with empirical testing.
I see your point, again, I don’t think the doctor said it was the empirical, or gospel, truth. He’s just positing.
By your logic (that we should never theorize ever because layman will misinterpret it), nobody should ever publish any ideas ever, as it could be misinterpreted by a retard or two (or three)
[quote][postedby]Originally Posted by needhairasap[/postedby]
By your logic (that we should never theorize ever because layman will misinterpret it), nobody should ever publish any ideas ever, as it could be misinterpreted by a retard or two (or three)[/quote]
Theorising is absolutely fine, but doing so without solid backing evidence is not always without consequence. One more example of this is the Andrew Wakefield MMR case: Andrew Wakefield - Wikipedia
““There is not another theory that reasonably and satisfactorily explains hair loss in AGA without ascribing a function to DHT that is opposite to its known function,” Dr. Ustuner writes.”
[quote][postedby]Originally Posted by needhairasap[/postedby]
By your logic (that we should never theorize ever because layman will misinterpret it), nobody should ever publish any ideas ever, as it could be misinterpreted by a retard or two (or three)
[postedby]Originally Posted by walrus[/postedby]
Theorising is absolutely fine, but doing so without solid backing evidence is not always without consequence. One more example of this is the Andrew Wakefield MMR case: Andrew Wakefield - Wikipedia
““There is not another theory that reasonably and satisfactorily explains hair loss in AGA without ascribing a function to DHT that is opposite to its known function,” Dr. Ustuner writes.”
This is ignoring the PDG2 work by Dr Cotsarelis.[/quote]
The basis for Dr Ustuner’s statement about DHT above is also completely wrong.
He is basically saying (although not in so many words) that the “known function” of DHT is to increase male secondary sex characteristics – for instance, to promote beard hair and body hair growth. From that, he extrapolates that it would be a contradiction for DHT to cause decreased hair growth on the scalp. To attempt to reconcile this “contradiction”, he somehow then he jumps to DHT decreasing adipose tissue in the scalp (while not offering any studies to prove that). So, to him, it would NOT be a contradiction if DHT is just doing what we expect it to do – increasing male secondary sex characteristics. He’s implying (although again, not clearly and not in so many words) that this happens everywhere in the body through the same mechanism – decreasing fat deposition – and that therefore the mechanism in the scalp must be based on this. However, don’t forget that he hasn’t proven this idea for any tissue or organ in the body.
But his theory doesn’t stop there. Even if you accept the above herky-jerky story about fat (I don’t), you still have to deal with the gravity thing, which is even more ridiculous, and adds fuel to the fire of an already unnecessarily bizarre set of ideas. Has he not heard of Occam’s Razor?
What he forgets with respect to the DHT part, is that (surprise, surprise!) the body is more complex than he imagines, and DHT can have opposite phenotypic effects in different parts of the body – baldness on the scalp, but perhaps increased hair growth on other parts of the body. This has to do with the genetic programming of cells in different parts of the skin, not with fat or gravity. He’s saying that hair growth on the skin is ultimately modulated by two things: (1) presence of subcutaneous fat; and (2) the effects of gravity mechanically stressing the follicles. But if fat-padding were the main requirement for healthy “hydration” of the follicles and terminal hair growth, why do women, who tend to have more subcutaneous fat-padding, have much less visible hair on their bodies than men?
He also doesn’t mention Female Pattern Baldness, which is generalized over the entire scalp. Or how the 1/3 of our lives spent horizontal while sleeping affects his so-called gravity theory.
Furthermore he hasn’t even begun to describe why he thinks a downward gravitational vector along the longitudinal axis of the follicle (almost, as scalp hair follicles are somewhat angled) is worse for the follicle than the effect of gravity along a transverse vector, as on the sides of the scalp, or how the ears mitigate the supposed effects of gravity on the sides of the head.
And I’ve only just skimmed the surface of this simplistic “theory”.
If your theory is correct, wouldn’t hair transplants (from sides and back to the top) necessarily thin out and fail just like original hair on the top does?
Anyway, Doc, I was merely curious in how you could empirically test this theory yourself, as I was fairly certain it could be done without astronauts.[/quote]
The theory can be tested with a well designed clinical experiment. A good protocol could involve increasing the cushion in a test area in the scalps of volunteers and comparing the results with the control areas in the same individuals. I have been trying to conduct one.
Theorising is absolutely fine, but doing so without solid backing evidence is not always without consequence. One more example of this is the Andrew Wakefield MMR case: Andrew Wakefield - Wikipedia
Andrew Wakefield wrote a deceitful research paper. He did not present a theory for scrutiny of the others. There is nothing similar between the two cases and I believe a person with normal intelligence should be able to grasp the irrelevancy and avoid insulting people making this kind of comparisons.
""There is not another theory that reasonably and satisfactorily explains hair loss in AGA without ascribing a function to DHT that is opposite to its known function," Dr. Ustuner writes."
This is ignoring the PDG2 work by Dr Cotsarelis.[/quote]
It is not ignoring the Cotsarelis and colleagues’ work. Showing high PDG2 levels in balding scalp and showing that PDG2 inhibits hair growth do not satisfactorily explain hair loss in AGA. Because, PDG2 normally increases in the beginning of the regression phase of the hair cycle. In AGA, hair follicle turnover is increased and more hair follicles enter into regression phase at any time compared with non balding scalp. Therefore, it is normal to see high PDG2 levels in balding scalp. And, since it is required for the regression of the follicle in the normal hair cycle, it is expected to inhibit hair growth.
By this logic people today could also formulate a theory that the Earth is flat. The danger is, when a doctor does so, in the eyes of a layman it can automatically gain credibility. Similar to how some doctors suck their patients into believing alternative therapies like homoeopathy are legitimate - just because someone in a white coat prescribed it to them.[/quote]
I do understand your concerns. Please, do not worry. I am not making money out of this theory in any way and not treating patients currently. In addition, the articles are peer reviewed before they are published. However, the people, who write offensive comments, may be selling one of the remedies for hair loss which will be worthless when my theory is proven to be true.
[quote]
It is not ignoring the Cotsarelis and colleagues’ work. Showing high PDG2 levels in balding scalp and showing that PDG2 inhibits hair growth do not satisfactorily explain hair loss in AGA. Because, PDG2 normally increases in the beginning of the regression phase of the hair cycle. In AGA, hair follicle turnover is increased and more hair follicles enter into regression phase at any time compared with non balding scalp. Therefore, it is normal to see high PDG2 levels in balding scalp. And, since it is required for the regression of the follicle in the normal hair cycle, it is expected to inhibit hair growth.[/quote]
Your reasoning sounds quite muddled here. While you admit that PGD2 was found to inhibit the growth of hair - a causal effect. On the other hand you seem to be suggesting PGD2 is only present because the scalp was balding in the first place - a mere correlation.
Given that the synthesis of PGD2 may be androgen dependant, please, tell us why this explanation is not satisfactorily?
[quote]
It is not ignoring the Cotsarelis and colleagues’ work. Showing high PDG2 levels in balding scalp and showing that PDG2 inhibits hair growth do not satisfactorily explain hair loss in AGA. Because, PDG2 normally increases in the beginning of the regression phase of the hair cycle. In AGA, hair follicle turnover is increased and more hair follicles enter into regression phase at any time compared with non balding scalp. Therefore, it is normal to see high PDG2 levels in balding scalp. And, since it is required for the regression of the follicle in the normal hair cycle, it is expected to inhibit hair growth.
[postedby]Originally Posted by walrus[/postedby]
Your reasoning sounds quite muddled here. While you admit that PDG2 was found to inhibit the growth of hair - a causal effect. On the other hand you seem to be suggesting PDG2 is only present because the scalp was balding in the first place - a mere correlation.
Given that the synthesis of PGD2 may be androgen dependent, please, tell us why this explanation is not satisfactorily?[/quote]
can’t you argue without the “your reasoning sounds quite muddled” garbage. You’re hiding behind a psuedoname and the doc is on here as is. I’m not saying don’t quiz him, just do it inquisitively, and not like a boner.
Doc, interesting to hear about your intentions for a case study. Good luck.
Please dont hesitate to expand on your thoughts here. We’re all interested, some ruder than others.
Excellent point. I’m curious as to why the good doctor has posted 3 times since my last inquiry, but has completely ignored my post, which is a very straight-forward and simple to understand question.
[quote]
can’t you argue without the “your reasoning sounds quite muddled” garbage. You’re hiding behind a psuedoname and the doc is on here as is. I’m not saying don’t quiz him, just do it inquisitively, and not like a boner.
Doc, interesting to hear about your intentions for a case study. Good luck.
Please dont hesitate to expand on your thoughts here. We’re all interested, some ruder than others.[/quote]
Needhairasap, you’re a good member of this forum, but unfortunately I think you’re giving this doctor too much leeway.
You criticize walrus for using a pseudonym for saying Dr. Ustuner’s reasoning is muddled, while Dr. Ustuner is using his real name, while you call walrus a “boner”, under your own pseudonym. If walrus’ using a pseudonym to attack Dr. Ustuner’s reasoning is wrong, then your using a pseudonym to make an ad hominem attack against walrus is wrong.
We shouldn’t be overly impressed by people simply because they’re wearing white lab coats. There are millions of people with medical degrees in this world. Not all of them are paragons of rationalism and brilliance.
I respect Dr. Ustuner as a plastic surgeon. I’m sure he’s a good plastic surgeon. He’s not a geneticist, a cell biologist, a biochemist, an endocrinologist, or a dermatologist. But he’s created a “theory” which ignores all of the above disciplines, just sweeps them under the carpet as if they don’t matter, in favor of a concept based solely on physics and mechanics, gravity and vectors. Yet he hasn’t even sufficiently explained how his theory works.
Look at the questions I asked to Dr. Ustuner in my above post, which he’s totally ignored.
Why exactly does gravity hurt follicles on the top of the head, but not on the sides? Remember, gravity is pulling the follicles on the sides down just as much as the ones on the top. Is Dr. Ustuner suggesting there’s a specific “escape velocity” for hair to emerge from a follicle, and the force of gravity is holding it back?
Why is hair lost on the sides and back in Female Pattern Baldness?
I think the above questions illustrate why Dr. Ustuner’s “gravity” theory is illusory.
The doctor’s idea of a clinical study involving “cushioning” the scalp – how exactly would that work?
The only way that test would work, as far as I could see, is to inject fat cells into the scalp of a patient who’s just starting to bald, to see if the balding process stops.
The doctor hasn’t described the biomechanics of how he thinks the pull of gravity hurts the hair follicle.
Again, he needs to explain why exactly does it hurt the hair follicles only on the vertex and crown, but not follicles on the sides?
Also, Dr. Ustuner mentions how he thinks the “shape of the calvarium” affects balding (this one of the many things he mentions in passing). Exactly what “shapes” of the calvarium does he find correlate with balding, and what exactly is his hypothesis as to why? How does this notion of head shape play into his gravity theory?
I suspect that he is seeing a lot of patients with specifically “shaped” calvariums (skulls) in his practice more due to ethnic factors than anything else.
A theory like this has to have a lot more supportive evidence, and much more detailed reasoning. It can’t just rely on vague references to “gravity” without explaining in detail the forces, vectors, etc. and how they act on specific parts of the follicle.
That is the true standard expected in the scientific community.
Dr. Ustuner’s paper was published in an “open access” journal that was was specifically set up to publish all articles submitted by members, without applying the normal rigorous academic standards found in most scientific journals.
It was “peer-reviewed”, but only according to the lesser standards in place for this “open access” publication. Here’s link to the ASPS “Global Open” journal, where Dr. Ustuner’s paper was published:
Here’s a link to their normal journal, which has much stricter academic and peer-review standards:
[quote]Anyway, Doc, I was merely curious in how you could empirically test this theory yourself, as I was fairly certain it could be done without astronauts.
[postedby]Originally Posted by Emin Tuncay Ustuner[/postedby]
The theory can be tested with a well designed clinical experiment. A good protocol could involve increasing the cushion in a test area in the scalps of volunteers and comparing the results with the control areas in the same individuals. I have been trying to conduct one.[/quote]
I think your theory should be tested.
You should inject fat cells into test areas on a balding patient’s scalp, and compare those areas with uninjected control areas.
I’m really unclear as to what you mean by “cushioning”, though. How exactly are follicles being cushioned? Are you saying that subcutaneous fat surrounding the follicles mitigates the stress load caused by gravity, and that the fat “cushion” is somewhat akin to the safety air-bag in a car, protecting the driver’s body from blunt force injury or pressure?
If gravity acts in a downward manner, and follicles at the vertex are slightly angled, what exactly are the vector forces acting, and where on the follicle are they acting to damage it? How does the “cushioning” protect the follicles?
Have you done a hypothetical vector analysis, and have you identified the specific injury to the follicle?
Note that all of the above rests on the assumption that there is less subcutaneous fat in the scalps of balding people in the first place, something that still needs to be proven.
In my estimation, “thinning out” of subcutaneous fat may be a secondary, long-term effect of MPB’s miniaturization of follicles. But for your theory to work, to establish a useful correlation, it would have to be fully present from the very onset of MPB.
He is basically saying (although not in so many words) that the “known function” of DHT is to increase male secondary sex characteristics – for instance, to promote beard hair and body hair growth. From that, he extrapolates that it would be a contradiction for DHT to cause decreased hair growth on the scalp. To attempt to reconcile this “contradiction”, he somehow then he jumps to DHT decreasing adipose tissue in the scalp (while not offering any studies to prove that). So, to him, it would NOT be a contradiction if DHT is just doing what we expect it to do – increasing male secondary sex characteristics. He’s implying (although again, not clearly and not in so many words) that this happens everywhere in the body through the same mechanism – decreasing fat deposition – and that therefore the mechanism in the scalp must be based on this. However, don’t forget that he hasn’t proven this idea for any tissue or organ in the body.
The paradoxical effect of testosterone on hair follicles at different body sites is not something that I extrapolated. There are concepts that have been used to explain this paradox. They can all be found in my article. A number of studies that show the effects of DHT, testosterone and estrogen on adipose tissue at different body sites are cited too.
What he forgets with respect to the DHT part, is that (surprise, surprise!) the body is more complex than he imagines, and DHT can have opposite phenotypic effects in different parts of the body – baldness on the scalp, but perhaps increased hair growth on other parts of the body. This has to do with the genetic programming of cells in different parts of the skin, not with fat or gravity. He’s saying that hair growth on the skin is ultimately modulated by two things: (1) presence of subcutaneous fat; and (2) the effects of gravity mechanically stressing the follicles. But if fat-padding were the main requirement for healthy “hydration” of the follicles and terminal hair growth, why do women, who tend to have more subcutaneous fat-padding, have much less visible hair on their bodies than men?
In one paragraph of the comment, it is claimed that I basically say DHT is responsible from hair growth, while in another paragraph the claim changes, so that I say two things modulate hair growth: presence of subcutaneous fat and the effects of gravity. The comment is incoherent in itself. By the way, I do not say anywhere in my articles that the fat tissue hydrates the hair follicles.
Today, many people think that AGA is a polygenically inherited condition. This theory has not been proved yet like my theory, and it is solely based on some observations and some findings all of which support my theory too. Any specific gene causing AGA has not been shown yet. One should also think about the odds of a polygenically inherited condition affecting the majority of the population.
Why is hair lost on the sides and back in Female Pattern Baldness?
He also doesn’t mention Female Pattern Baldness, which is generalized over the entire scalp. Or how the 1/3 of our lives spent horizontal while sleepingaffects his so-called gravity theory.
Writing and googling “Ludwig classification” would have been enough to see where hair loss takes place in Female Pattern Baldness.
I do mention Female Pattern Baldness in a previous article on the same theory. There is not a requirement to mention everything in every article. One can also find my thoughts on the effects of sleeping time and positions on the hair loss pattern in the same article. Briefly, it is only the very top of the head where the pressure is completely relieved during sleep regardless of the sleeping position. That area usually keeps its hair for a longer time. This may be the reason for the receding hair line while the hair at the very top stays longer.
Why exactly does gravity hurt follicles on the top of the head, but not on the sides? Remember, gravity is pulling the follicles on the sides down just as much as the ones on the top. Is Dr. Ustuner suggesting there’s a specific “escape velocity” for hair to emerge from a follicle, and the force of gravity is holding it back?
The theory does not say that gravity pulls the hairs out of scalp. This thought is very funny. I would suggest that you read more and think more to understand better before writing whatever comes to your mind.
Given that the synthesis of PGD2 may be androgen dependant, please, tell us why this explanation is not satisfactorily?[/quote]
It should also explain why DHT increases in balding scalp. If you cite the study showing that the synthesis of PGD2 is androgen depended I can comment further on it.
Excellent point. I’m curious as to why the good doctor has posted 3 times since my last inquiry, but has completely ignored my post, which is a very straight-forward and simple to understand question.[/quote]
Dr. Ustuner,
If your theory is correct, wouldn’t hair transplants (from sides and back to the top) necessarily thin out and fail just like original hair on the top does?
I did not ignore your inquiry. I am sorry if you think that I am responding late. In fact, you could find the answer of your question in my previous article on the same theory.
Transplanted hair follicles survive for a long time. This is something that should be expected. A number of factors may be effective. First of all, terminal hair follicles are transplanted with surrounding soft tissues along the full length of the follicles. One should also keep in mind that these follicles are not overstrained follicles by high DHT levels. Transplant follicles are placed in the recipient holes opened in the scalp skin and left there freely. The hair follicle with its own surrounding soft tissue is added on the available soft tissue at the recipient site. Transplant follicles are not sutured to the skin. Healing process takes places without a force on the follicles. The skin can not apply the same pressure that it applies on the hair follicles in an intact skin, on the transplanted follicles. A scar tissue that forms around the transplant follicle during the healing process envelops it and provides extra strength.
Briefly transplanted hair follicles are not permanent. However, hair loss process in AGA is a very long process. Roughly 30% of the men are affected at age 30, 50% at age 50, and 80% at age 80. And this is the case for normal hairs, not transplant hairs. Transplant hairs are expected to live longer than normal hairs that they replace.
In one paragraph of the comment, it is claimed that I basically say DHT is responsible from hair growth, while in another paragraph the claim changes, so that I say two things modulate hair growth: presence of subcutaneous fat and the effects of gravity. The comment is incoherent in itself. By the way, I do not say anywhere in my articles that the fat tissue hydrates the hair follicles.
Doctor, I’m sorry for the misunderstanding of my comment above. What I meant was, although you have clearly acnowledged that DHT plays a central role in AGA, the only role you see for it is decreasing subcutaneous fat. But, in your view, it is the effects of diminished subcutaneous fat and gravity that ultimately and proximately modulate hair growth.
The theory does not say that gravity pulls the hairs out of scalp. This thought is very funny. I would suggest that you read more and think more to understand better before writing whatever comes to your mind.
Again, I’m sorry for your misunderstanding of my comments here. I was not reading your theory in that way – that the force of gravity is pulling hairs out of the scalp, down to the floor.
Rather, my interpretation of your theory is that, in general, hair shafts have to fight against the force of gravity to emerge from the scalp during normal hair growth. The growth of the hair shafts on the top of the head is from inferior to superior (in a generally upward direction, albeit with some angling), which means that, to grow normally, they are fighting directly against the force of gravity, which pulls in a downward direction.
My interpretation of your view is that the scalp follicles which are most “disadvantaged” here are precisely the ones on the top of the head, and perhaps those at the vertex and hairline, because they are the ones which have to fight against the vector force of gravity most directly. In other words, the hairs on the crown and vertex are trying to grow directly upwards (albeit with some angling), while the force of gravity is acting directly downwards.
As I interpret your view, follicles on the sides and back of the head don’t have this same problem, because the direction of their hair growth is not exactly in the opposite direction to the force of gravity.
Therefore (in my reading of your theory), when the subcutaneous fat cushioning is removed generally from the scalp in a balding person, the basic physical disadvantage of the crown and vertex follicles is exacerbated and completly exposed to the deleterious downward force of gravity. The follicles on the sides and back of the scalp are not similarly disadvantaged, because of their fortunate positioning, and if subcutaneous fat is removed from those areas, it doesn’t have the same damaging effect.
Am I at least correct in my interpretation of your theory, and if not, could you please correct me?
I agree. I was referring to walrus’ behavior and not trying to demean him in a debate, either way you get my point.
All I’m thinking is, the doc is here talking, so why not quiz him politely? If he is wrong, he’ll talk his way out of it, but if we scare him away, we’re in no better a place than if we hadn’t.
I am no scientifically inclined enough to really comment. All I know is that his theory is at least worth hearing out.
[quote]All I’m thinking is, the doc is here talking, so why not quiz him politely? If he is wrong, he’ll talk his way out of it, but if we scare him away, we’re in no better a place than if we hadn’t.
I am no scientifically inclined enough to really comment. All I know is that his theory is at least worth hearing out.[/quote]
OK, needhairasap, you are right.
Actually, the last thing I suspected was that the doctor would appear here himself, and my comments questioning his mental competency were stupid.
I still strongly disagree with his theory, as I see all kinds of problems that a biomechanics expert, for instance, could have with it, not to mention an endocrinologist.
I think he is seeing this purely from the standpoint of a plastic surgeon, a profession that tends to see “the force of gravity” as the culprit in any anomaly that needs to be fixed.
[quote]Given that the synthesis of PGD2 may be androgen dependant, please, tell us why this explanation is not satisfactorily?
[postedby]Originally Posted by Emin Tuncay Ustuner[/postedby]
It should also explain why DHT increases in balding scalp. If you cite the study showing that the synthesis of PGD2 is androgen depended I can comment further on it. [/quote]
From Garza et al., 2012 (Prostaglandin D 2 Inhibits Hair Growth and Is Elevated in Bald Scalp of Men with Androgenetic Alopecia)
Quote: “Intriguingly, Ptgds is a highly testosterone-responsive transcript
(30, 31), which further suggests its importance in AGA.”
The relevant references are:
30. H. Zhu, H. Ma, H. Ni, X. H. Ma, N. Mills, Z. M. Yang, Expression and regulation of lipocalin-
type prostaglandin D synthase in rat testis and epididymis. Biol. Reprod. 70, 1088–1095
(2004).
31. N. S. Treister, S. M. Richards, T. Suzuki, R. V. Jensen, D. A. Sullivan, Influence of androgens on
gene expression in the BALB/c mouse submandibular gland. J. Dent. Res. 84, 1187–1192 (2005).
[quote]Given that the synthesis of PGD2 may be androgen dependant, please, tell us why this explanation is not satisfactorily?
[postedby]Originally Posted by Emin Tuncay Ustuner[/postedby]
It should also explain why DHT increases in balding scalp. If you cite the study showing that the synthesis of PGD2 is androgen depended I can comment further on it. [/quote]
Dr. Ustuner,
The PGD2 Synthase gene’s Induction: By IL1B/interleukin-1 beta and thyroid hormone. Probably induced by dexamethasone, dihydrotestosterone (DHT), progesterone, retinoic acid and retinal. Repressed by the Notch-Hes signaling pathway
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