user27041995

Short: Basic hypothesis: Blood vessels that carry blood away from the upper scalp (veins and venules), which penetrate chronically tense facial muscles and/or masticatory muscles at various points, are squeezed. The result is an accumulation of metabolic products over the years, which leads to degeneration of the hair follicles over the years. In dissection photos (see Fig. 4.14) you can see, for example, how veins (blue) penetrate the temporalis muscle (side of the head).

The existence of the Norwood hair loss pattern and the fact that it has not yet been possible to develop drugs that completely "cure" pattern hair loss or prevent it from occurring in the first place suggest that anatomy may play an important role in the development of hair loss. Looking at the facial and masticatory muscles, it seems obvious at first glance that these (in combination with the galea aponeurotica) are the decisive component. However, just because a connection seems obvious at first glance does not mean that there is a connection – just as there is no connection between wearing a cap and pattern hair loss, even though a connection seems obvious at first glance. Visualisation of the facial and masticatory muscles in the faces of men with pattern hair loss: Figure 1,2: Hair loss pattern and location of the facial and masticatory muscles, the galea aponeurotica and potential tension pattern (markings) Figure 3,4: Norwood hair loss pattern and facial and masticatory muscles Hypothesis on the effects of muscle tension: As can be seen in the Dissection photos (Figure 5,6), blood vessels supplying the scalp penetrate the facial and masticatory muscles. If the facial and masticatory muscles are chronically tense or hardened, this can put pressure on the blood vessels and impair blood flow. This can lead to stagnation or slowing of the blood flow. If the veins and thinner venules that carry blood away from the scalp are in particular continuously squeezed by the facial and masticatory muscles, this would lead to an accumulation of metabolic and waste products in the scalp, which may be the cause of a degeneration process that is said to lead to pattern hair loss. Figure 5,6: Dissection: Blood vessels that penetrate the facial and masticatory muscles (?) This hypothesis would imply the following: Excessive tension of the scalp is not the cause of pattern hair loss. The extent of the accumulation of metabolic and waste products (the alleged cause of pattern hair loss) in a scalp region depends on the length of the supplying blood vessel squeezed by the facial and masticatory muscles and on the intensity of the squeezing of the blood vessels. The lower half of the head (including eyebrows and beard hair) is not affected by hair loss because the atrial and venous network is still too extensive up to these regions of the scalp and the extent of squeezing is not yet sufficient to produce the extent of a metabolic disorder that leads to hair loss. Heavy bleeding of the scalp reported by surgeons after an incision would say nothing about the quality and quantity of blood flow to the scalp if it is assumed that the problem is an obstruction to the outflow of blood from the scalp in the lower part of the head. Disproving the Hypothesis: The following investigations could be carried out to refute the hypothesis: Dissection: Review existing literature and perform targeted Dissection to show that the described mechanism of blood vessel squeezing by facial muscles and masticatory muscles does not exist or that it has no influence on the quality and quantity of blood flow to the scalp. Doppler ultrasound: A doppler ultrasound can be used to monitor blood flow in veins and venules and detect any changes. This non-invasive examination method uses sound waves to detect blood flow and visualise possible abnormalities such as stagnation or slowing of the blood. Laser Doppler flowmetry: This method makes it possible to measure the blood flow in small blood vessels. By using laser light, the speed of blood flow in the veins and venules of the scalp can be measured to detect changes or abnormalities. Hypotheses on the cause of the chronic tension The following 4 hypotheses show possible causes for the described chronic tension of the facial and masticatory muscles, which is assumed to be the cause of pattern hair loss. Hypothesis A – Craniofacial development: Simplified summary: Genetic factors and an unsuitable diet lead to poor craniofacial development. The consequences include chronically tense facial and masticatory muscles. If the skull is not developed symmetrically, for example, this can affect the position and functionality of the facial muscles. Such asymmetry can lead to certain muscles being overactive or overused, while others are underactive or weakened. The overactivated facial muscles must constantly work to compensate for the imbalances. This can lead to chronic tension and tightness. Figure 7: Examples of craniofacial development Figure 8: Effects of asymmetric craniofacial development on the function of the facial and masticatory muscles (?) Related/original hypothesis: https://tmdocclusion.com/home/connection-to-other-diseases-and-syndromes/hair-loss/ https://tmdocclusion.com/2018/07/14/more-on-hair-loss/ Hypothesis B – Stimulus-response pattern (conditioning): Simplified summary: Due to interpersonal mimic and verbal interaction, humans are conditioned since birth to have their facial expressions under control so as not to provoke unwanted/wrong interpretations and associated reactions from their fellow humans. This results in a stimulus-response pattern, which results in chronic tension of the facial and masticatory muscles. Figure 9: Compilation to illustrate the importance of facial features as a tool for interaction and identification Related/original hypothesis: https://open.substack.com/pub/user2...-is?r=288hhe&utm_campaign=post&utm_medium=web Hypothesis C – Malocclusion: Simplified summary: Malocclusion results in a continuous malposition of the lower jaw. This results in chronic tension of the masticatory muscles and parts of the mimic musculature. Figure 10: Chronic tension of the facial and masticatory muscles due to malocclusion (?) Related/original hypothesis: Hypothesis D – Skull shape: Simplified summary: The shape or expansion of the skull leads to chronic tension in the facial and chewing muscles. Figure 11: Skull shape and Expansion Disproving the Hypotheses: It would be helpful to show how the hypotheses mentioned can be disproved and which studies would be necessary/suitable for this. If the proponents of a hypothesis are of the opinion that a disproof is not possible, they should explain why this is not possible.

The consequence of the extraordinary tension (increased muscle tone/chronic contraction) of the muscles mentioned could be an increased regional tension of the scalp and the galea aponeurotica (a) and/or a direct permanent squeezing of blood vessels by the tensed mimic muscles and the masticatory muscles (b) and/or a malposition of the mandible (c). (a) The consequence of the increased regional tension of the scalp and the galea aponeurotica could be inflammatory processes. Chain of effects: Inflammation → DHT at scalp sites → TGF beta 1 → scarring of the hair follicles → hair loss. (b) The consequence of a direct squeezing of blood vessels by the tensed mimic muscles and the masticatory muscles could be a disturbance of blood circulation and thus an obstruction of the removal of metabolic products from the scalp sites. The assumption is that especially the veins (function: blood backflow to the heart) are affected. Chain of effects: Accumulation of metabolic products at scalp sites → Inflammation → DHT at scalp sites → TGF beta 1 → scarring of the hair follicles → hair loss. (c) The consequence of a malposition of the mandible could be a squeezing of blood vessels, whereupon a regional circulatory disturbance occurs, i.e. an obstruction of the removal of metabolic products from the scalp sites. Chain of effects: Accumulation of metabolic products at scalp sites → Inflammation → DHT at scalp sites → TGF beta 1 → scarring of the hair follicles → hair loss. The assumption is that the degeneration process (a/b/c → scarring of the hair follicles) takes place over a period of about 5 to 20 years, until the function of the hair follicles is so severely impaired that there is clearly visible hair loss. The basis for this assumption is the observation of people with transplanted hair, whereby the transplanted hair follicles – contrary to common claims – are apparently also affected by the described degeneration symptoms after a certain time. On 5AR2 deficiency/5AR inhibitors: Men who are castrated before puberty or are born with a congenital 5AR2 deficiency develop a phenotype that is rarely male, gender ambiguous to completely female. This means that these men have, among other things, a female skin structure, thinner skin, lower muscle mass and strength. These two groups thus develop the physiological characteristics that are (according to theory) causal for the absence of pattern hair loss in women – despite an increased tone of the mimic muscles and the masticatory muscles. A possible side effect of 5AR inhibitors is gynecomastia (enlargement of breast tissue in men). 5AR inhibitors can therefore apparently change parts of the physiology. So 5AR inhibitors can possibly also alter the parts of physiology that are hypothesised to be causative for hair loss.

Hypothesis on the cause of male pattern hair loss: Increased muscle tone (chronic contraction) of the facial and masticatory muscles as a result of psychophysiological conditioning (stimulus-response pattern) caused by interpersonal interaction. Article: https://user2704.substack.com/p/cause-of-male-pattern-hair-loss-is figure – Men with hair loss in the forehead and temple area. below: increased muscle tone (chronic contraction) of the corresponding mimic muscles (coloured red) figure – Man with hair loss at the crown of the head. below: increased muscle tone (chronic contraction) of the corresponding mimic and masticatory muscles (coloured red)

The text does not say that the shape of the skull is causative for tension and thus causative for hair loss. The text states that an extraordinary strain/tension of the mimic musculature (facial musculature) and the masticatory musculature – unrelated to the shape of the skull – could be the cause of tension and malposition of the lower jaw. From these tensions and the bad posture of the lower jaw a blood circulation disturbance could result, which is causal for a degeneration of the hair follicles (metabolic disturbance). Moreover, the text does not say that DHT does not play a role in the cause-effect chain. In the text, the special role of the face as a part of the body is taken into account in order to indicate a pychophysiological phenomenon that is possibly causative for male pattern hair loss: In modern, anonymous societies, the face (especially the mouth, eyes, eye structures) is the primary tool for interpersonal communication, interaction, and identification. A wrong or inappropriate facial expression can have serious, life-threatening consequences – depending on the situation: - Example 1 (exaggerated): a wrong facial expression in an area characterized by crime and violence -> physical attack by easily provoked/violent individuals -> injury/death. - Example 2 (exaggerated): a wrong facial expression in a job interview -> no job -> no income -> no money for food -> hunger/death Through interpersonal mimic interaction, humans are conditioned from birth to have their facial expressions under control so as not to provoke unwanted/wrong interpretations and associated reactions from their fellow humans that could have a detrimental effect on their lives in the short or long term, directly or indirectly. The basis for this conditioning is the association of emotion and facial expression anchored in the human mind or predefined by society. Each emotion is assigned a corresponding facial expression. It is a widespread assumption that a person's facial features (facial expressions) basically represent his or her emotional state at all times, since everyone has adjustable facial expressions. This means, for example, that when someone relaxes his/her facial muscles, his/her face, and thus he/she as a person, then also makes a relaxed or neutral impression on other people. "Problem": some people have a facial shape that does not make a relaxed or neutral impression on other people when physically relaxed. These people are consciously or unconsciously conditioned through interpersonal mimic interaction, but also through verbal communication, to keep their facial and masticatory muscles permanently in tension in order to be able to "defuse" their facial features if necessary, since their physically relaxed face triggers undesirable/wrong interpretations and associated reactions in other people. This permanent, subliminal (extraordinary) tension of the facial and masticatory muscles possibly sets off a chain of effects that ultimately causes hair loss.

Theory: Due to a psychophysiological conditioning by interpersonal mimic interaction, a permanent tension of the facial musculature (mimic musculature) and the masticatory musculature occurs, which increases in the course of life and is not perceived by the affected person, whereupon metabolic and/or circulatory disturbances and/or tissue hardenings (fibrosis) occur, which in the final result lead to hair loss. Video visualizing the physiological process: https://youtu.be/QHkjHY_2g0I Description of the process of psychophysiological conditioning: The state of mind (emotion) inferred by outside persons from a person's physically relaxed face does not match that person's actual state of mind. For example, a person in question may be neutral minded, but based on facial features (facial expressions) is perceived by outside persons as, for example, threatening, aggressive, conniving, gloating, or disgusted. The lack of correspondence between the actual state of mind and the state of mind perceived by surrounding persons is registered (subconsciously) by the mind of the affected person. As a result, in the physical areas identified by the mind as causative for the "misinterpretation" of the state of mind (e.g. mouth and jaw area, eye area), persistent, subliminal states of tension occur, which ultimately lead to hair loss. Through the described psychophysiological conditioning, a psychophysiological reflex is formed: Subconsciously, "autonomous" parts of the mind continuously check one's own facial features – even if there are no persons in the vicinity – which results in a permanent, subliminal tension of the mimic muscles and the masticatory muscles. The own face and head shape is permanently a part of the conscious and unconscious perception of the affected persons – different from persons who are not affected by the described form of hair loss. One could say that the face of the affected person – on the psychophysiological level – is treated like an out-of-control body part that needs to be brought under control, with the hair loss being only a side effect. Video visualizing the process of psychophysiological conditioning (simplified): https://youtu.be/dNGLpsQ2kp8 Example 1: In a man with eyes that appear "piercing" to outsiders or an eye area that appears threatening or irritating, a permanent, subliminal tension of the following muscles arise: Musculus frontalis (function: frowning, raising the eyebrows) Musculus occipitalis (function: smoothing the forehead) Musculus corrugator supercilii (function: pulling down the eyebrow, wrinkling the forehead) The final result of the permanent tension of the mentioned muscles is hair loss in the forehead and temple area. The connection of the galea aponeurotica may also cause hair loss on the vertex and tonsure. Simultaneous tension of the above-mentioned mimic muscles is not necessarily visible in a person's facial expression – just as, for example, the biceps and triceps can be tensed at the same time and the arm can still hang down and make a relaxed impression on outsiders. Because the tightness of the aforementioned muscles builds up over time and is in a subliminal range, it is not necessarily noticed by the affected person. Example 2: In a man with a pronounced upper and lower jaw, a slightly open and slanted mouth in a physically relaxed state, and partially visible teeth – which in combination can have a threatening or irritating impression on surrounding people – a permanent, subliminal tension of the following muscles arise: Musculus buccinator (function: pressing the jaws) Musculus orbicularis oris (function: contraction of the mouth opening) Musculus depressor anguli oris (function: lowering the corner of the mouth) Musculus risorius (function: lateral and headward movement of the corner of the mouth, retraction of the dimple of the cheek – laughing muscle) Musculus zygomaticus (function: pulls the corner of the mouth up and back – smile muscle) Musculus levator labii superioris (function: lifting the upper lip) Musculus depressor labii inferioris (function: lowering the lower lip) Musculus levator anguli oris (function: lifting the corner of the mouth) Musculus masseter (function: lifting and lateral movement of the lower jaw) Musculus temporalis (function: jaw closure, retraction of the lower jaw) Musculus pterygoideus medialis (function: lifting of the lower jaw, jaw closure) Musculus pterygoideus lateralis (function: opening of the jaw, advancement of the lower jaw, grinding movements from right to left or vice versa) Musculus mylohyoideus (function: opening the mouth, raising the hyoid bone) Musculus geniohyoideus (function: advancement of the hyoid bone – involved in mouth opening) Musculus digastricus (function: opener of the oral fissure – involved in mouth opening) The final result of the permanent and subliminal tension of the mentioned muscles is hair loss in the tonsure area. The Theory described perhaps answer the following questions: Q: Why does hair loss occur exclusively on the (upper) head? A: The face, the mimic musculature and the masticatory musculature are exclusively located on the head. The assumption is that the tightening of the mentioned muscles primarily impedes blood drainage and thus the removal of metabolic products. On the lower side and back of the head, the tension is less and the distance that blood must travel in the tense area is shorter. Q: How can the Norwood hair loss pattern be explained? A: The Norwood hair loss pattern results from the tension pattern generated by mimic muscles and the masticatory muscles. Q: How is hair loss "inherited"? A: Head and face shape is genetic. The head and face shape of a son resembles the head and face shape of his father and mother (but more like the father's). Due to the similar head and face shape, the son is exposed to the same "misinterpretations" and the corresponding mimic reactions of people around him as his father and is thus subject to the same subconscious psychophysiological conditioning process, which leads to similar states of tension and, as a result, to a similarly pronounced hair loss. The finding that hair loss is supposedly inherited through the mother may indicate that the mimic response of women – for example, to the facial features of their male partners and children – is significant in the expression of the described psychophysiological reflex. Q: Why are significantly more men than women affected by "genetic" hair loss? A: The physiological differences (e.g. lower muscle mass and strength, thinner skin, thinner galea aponeurotica) are probably decisive. For example, the same degree of psychophysiological conditioning described above that results in hair loss in the male does not result in hair loss in the female because of the lower mass and strength of the facial and masseter muscles. Physiological differences aside, men's faces generally appear more "threatening" or "irritating" to viewers than women's. Q: How does hair loss in twins (same genetic makeup) develop differently? A: The twins may have grown up in different environments where people "react" differently to the same face and head shape. Likewise, it could be that the twins are differently "sensitive" to mimic responses to their head and face shape. The result would be different psychophysiologically induced states of tension and different degrees of hair loss. Q: How can the successes be explained by medication use? A: Some of the drugs used so far improve blood flow in areas affected by the described tension states (e.g. minoxidil). The use of estrogen leads to a reduction in muscle mass and strength, which may also affect the mimic and masticatory muscles. Accordingly, this muscle reduction may lead to an improvement of blood flow in the areas affected by the described tension conditions. Q: How can the alleged successes due to the use of muscle relaxants in the face be explained? A: The muscle relaxants used in the face relax parts of the mimic musculature, which partially abolishes the described tension states that lead to hair loss. Q: Why are isolated/uncontacted groups not affected or less affected by "genetic" hair loss? A: They are more often smaller groups of people where everyone knows and interacts with each other from birth. Meeting strangers on a daily basis and interpreting their state of mind based on facial features is not a normal occurrence for these people. Hair loss could therefore also be described as a disease of an anonymous and numerically large society. In the anonymous, technicized societies, in which people are usually clothed up to the head, the focus during interaction is furthermore mainly on the face or the head, which possibly intensifies the described psychophysiological reflex. Q: What are the possible reasons for the failure of research into the cause of "genetic" hair loss? A: Photographs of faces are largely useless as a basis for a pattern recognition because people taking photographs of themselves or being photographed by others usually adjust ("disarm") their faces. It is rare to see physically relaxed faces in photographs. This is equally true when observing the facial features of the people surrounding one, where physically relaxed faces are also rarely seen. The impression that facial features have on an outside person is something very subjective, making pattern recognition difficult. A person's sensitivity to other people's mimic reactions to their own facial features is something very subjective, making pattern recognition difficult. It is a common assumption that a person's facial features (facial expressions) basically represent their state of mind, since everyone has adjustable facial expressions – which is not the case. For example, a relaxed-looking face is not necessarily a physically relaxed face.