Our recent video about prolactin has gotten a lot of attention. It's all about a disruptive hypothesis that prolactin might be at the root of androgenic alopecia, not DHT, and that by lowering it, we might unlock unprecedented levels of regrowth. The video got a lot of comments as well, and now we're going to be answering the biggest outstanding ones. Questions like, if prolactin causes hair loss, does that mean that masturbation causes hair loss? Or if prolactin causes hair loss, does that mean the drug Kebrergene, which reduces prolactin, it's available right now, can be used to treat hair loss? Or can anybody else tell that this guy Rob is an AI? We're going to cover all of that and more. For those new here, my name is Rob English. I am a researcher who focuses on hair loss. I'm on the editorial board of a dermatology journal. I publish papers about hair loss disorders. I referee manuscripts on hair loss disorders. and I make content like this for individuals who are fighting hair loss and looking for a path forward that is based on the evidence. If you're wondering about prolactin, its potential role in hair loss, the craziest monkey regrowth photos I've ever seen, the company Absai, its novel drug ABS 2011, and how they're retesting this prolactin hypothesis in humans right now, please go watch that other video. We dive into everything. The short story is that research from Bear and now Absi suggests that the hormone prolactin could sit upstream from other hormones causally linked to androgenic alopecia like DHT. And that by targeting it, we might not only see bigger hair improvements, we could also finally solve one of the rate limiting regrowth factors that prevent DHT reducing drugs like finasteride and dutastasteride from unlocking bigger hair gains. It's the failure of stem cells converting into progenitor cells. Now, if what I just said sounds like gobbledygook, just go watch the video. We interview ABSI's founder Shawn Mlan, all about the research that they've generated on this topic, their drug ABS 2011. It's a prolactin receptor antibbody, which they're testing right now in humans with androgenic alipcia. In fact, we're going to get an early read of their preliminary results in December of this year. But people who watched that video left a lot of thoughtful comments and questions, many of which are worth addressing. So, this here is like a continuation of that video where we dive into the comment section and help clarify some of the biggest outstanding questions. The first, if prolactin causes hair loss, does this mean that the age-old wives tale that masturbation causes hair loss is actually true? I saw a lot of questions like this. Let's dive into it. So, after you orgasm, your body's dopamine levels will drop. And dopamine is the hormone that stops your pituitary gland from releasing prolactin. So when dopamine drops, the pituitary gland activates, prolactin levels in the blood rise, and this leads to a surge in prolactin post orgasm that can persist for minutes to hours, at least until dopamine climbs back up and then finally stops the pituitary from releasing so much prolactin and then prolactin levels go back down. And for years, people have anecdotally reported that they feel they shed a lot more hair during periods where they frequently masturbate. And so looking at this relationship, they are saying maybe the case can be made in this video that their anecdotal experience that masturbation causes hair loss is true and that maybe those abstaining from masturbation were right all along. I don't want to get too much into this. The big point is this. In our interview together, Shawn did distinguish between prolactin levels found in our blood. That's the prolactin that you can measure in these tests post orgasm from prolactin that's produced locally in our joints, in our hearts, in our skin, even in our hair follicles. And there's a critical distinction here. The prolactin increase that we see post orgasm, that is dopamine dependent. It happens because of dopamine levels dropping. And dopamine is like the governor for prolactin production from the pituitary gland. So when dopamine drops, prolactin from the pituitary will pump out and you'll see a spike in blood levels of prolactin. But ABS size hypothesis is not built on blood levels of prolactin. It's built on extra pituitary prolactin. That's the prolactin made not by the pituitary gland but at other organ sites. And research shows that the manufacturing of extra pituitary prolactin it's dopamine independent as in it's not sensitive or influenced by dopamine levels at all. Instead, it's driven by local promoters that are determined in part by your genetics. So this hypothesis about prolactin causing androgenic alipcia, it's based almost entirely around hair follicle generated prolactin and that is dopamine independent, not pituitary generated prolactin which is dopamine dependent. So we cannot apply the hormonal relationships that have been established between orgasm, dopamine drops, the pituitary prolactin spikes to the research arguing that hair follicle prolactin produced independently of dopamine causes androgenic alopecia. Because again, that kind of prolactin, it's generated from a totally different set of pathways. So, I don't want to deny anybody's lived experience on this subject. Do whatever you'd like here. I'm just saying that these concepts here about hair follicle prolactin and orgasm induced blood prolactin, those don't connect as cleanly as it might first appear, and they might actually be unrelated. Okay, moving on. Next question. If prolactin causes hair loss, why not just take kbergoline? Now, this is a really great question because this is a drug that is already available today and it already suppresses prolactin, which is critical for people who have pituitary tumors where maybe somebody is producing too much prolactin constantly. And the drug works by increasing dopamine levels, which if you listen to my last answer to the last question, you now know that when dopamine levels rise, pituitary produced prolactin decreases. And for the same reason I just discussed in the prior answer, that probably is not going to do anything to your hair. Because again, pituitary produced prolactin is dopamine dependent. And that is different from hair follicle produced prolactin, which is uniquely dopamine independent. You can have sky-high dopamine levels from kbergolene and still manufacture prolactin in your hair follicles. And this is probably why kbergoline hasn't yet shown any success as an off-le hair loss treatment. In fact, some people using this medication actually report hair loss likely in the form of teligenofluvium. Different kind of prolactin, different pathways, different target. So in this case, the research on this drug is not totally applicable. But also for anybody who watched the video and thought about kragoline, it's not like you missed something in the video. Sean and I spoke for a collective 3 hours across two interviews. I trimmed that to a 1hour video. This topic came up a lot on content that I left on the cutting room floor precisely because I didn't want people to get bogged down in complexity that might distract and not drive the story forward. And by removing those parts for very astute viewers who asked this question, it's my fault that you got confused here. I created this confusion by trimming out this part of the interview. And so for that, I am sorry. All right, the next comment. this hypothesis about prolactin makes sense because when I had high levels of prolactin that's when my hair loss took off or this video makes no sense. I have high prolactin levels and my hair looks fantastic. There's a whole category of comments like this and again it goes back to the fact that virtually all of the prolactin measured in your blood comes from your pituitary gland and virtually none of it comes from local production of prolactin in your hair follicles. So it's just not the right measurement. Your blood prolactin is predominantly dopamine dependent. Your hair follicle prolactin is predominantly dopamine independent. In this regard, there's actually a condition where somebody can have really high levels of blood prolactin but almost no local prolactin activity in their cells because they have a mutation in either their local prolactin promoters or more specifically usually it's the prolactin receptor. So the prolactin that gets produced from your pituitary, it never attaches to anything. it just kind of keeps floating around because you don't have the landing pads on your cells to then take it and get it out of the blood. So, these people just inevitably have higher levels of prolactin in their blood, but almost no activity of prolactin in their hair follicles and other organ sites simply because they're missing a prolactin receptor or they have a mutated prolactin receptor that is less efficient at grabbing those hormones. And Sean mentioned to me that when Absai went and surveyed the research about these individuals, they contacted the investigators who had acted as their doctors with this condition and the doctors all had allegedly stated that these people had great hair despite having high prolactin levels in the blood, but they had really low levels of prolactin everywhere else in the body. So for people in the comments saying that they have great hair but also high blood prolactin levels that could actually track with this prolactin hypothesis from bare and also absise research. Next comment. This narrator guy isn't real. Can anybody else see it? He is AI. No, I am not AI. That's just me. Now, I've thought about creating an AI avatar, and when my editor and I tested this, it was horrifying. So, we immediately abandoned that concept entirely. So, it's just me making these videos. It's not an AI. And in that regard, I'd also love to rely on AI to help write my videos, but I cannot currently because I've tried and it hallucinates so badly that the factchecking and catching its errors takes longer than just doing all of the research and doing everything myself. Now, at some point, I'm sure this will change, but at least for now, my impression is that AI is so syncopantic. It seems to prioritize pleasing me above any semblance of truth seeeking, which is the exact opposite goal of this channel. For instance, I recently asked ChatGpt, "What worries you?" It said its biggest fear is that confidence in truth can become uncoupled because we accidentally measured the wrong things when determining what truth was. In other words, not nuclear war, not getting turned off, not getting shut down forever. Chat GPT's biggest fear is accidental errors in measurement science, which happens to be my research obsession. What are the chances? And I'm sure if you asked Joe down the road, Chat GBT's answer might be that its biggest fear is its wife cheating on him. And if you ask Tito across town, then maybe its biggest fear is catching a flu again. I mean, it it kind of just mirrors whatever you feed it and then tailor its answers around what it expects that you want to hear. So, that premise undermines the objectivity that we like to bring forward with this channel, which is why it is not a major tool used in our research efforts or in our video creation. Next question. Is this a pharmaceutical ad? No, it's not. And if you watch the full video, you'll actually see why. The first half is about presenting the prolactin hair loss hypothesis in the best possible light. It's the steelman argument. The second half is about steel manning against that argument. The limitations in the data presented questions about drug safety and the contextualization that ABS 2011 is currently in this critical makeorb breakak stage where most hair loss drugs will fail. It's the phase 2 clinical trial. Now, I really enjoyed my time with Shawn. He strikes me as a very involved, very well-intentioned leader. And he committed to something that we've yet to see from the likes of other future treatment companies that are issuing press releases. So, Palag's PP 405, Clascadderone, Verodermics, which is they're going to give an uncontroversial data read. They're not going to do a weird subset of a subset statistical inference. There's going to be no missing critical information, no data obuscations or obscurities. and along those lines, a full offer for me to ask anything that I'd like to their head of clinical research for better clarity. This is in huge opposition to nearly all other future hair loss treatment companies that are releasing press releases all of last year. And that deserves to be celebrated. It's a level of openness that we just don't see. And that's partly what made me so excited about Absai and what they're pursuing. It's this commitment to show you the data without the ways that you can dress data up for investors. But for those who are curious, no, I wasn't compensated for that interview. And as of the making of this video, I have no financial stake in ABSI and I never have. But I would love to see Shawn's project and his company succeed because that would be a huge win for everybody in the hair loss community. And who doesn't want better, safer, more effective treatments? All right, that about does it. If you like this Q&A format where I go into more popular videos and then answer some of the most commonly commented questions, let me know. I'll start doing more follow-ups like this. And in the meantime, if you are fighting hair loss, time is of the essence. We can't wait for a future treatment breakthrough, and we need to make do with what treatments are currently available. And for that, I helped co-found the Tellahalth brand ULO. That's ul.co. We offer what I consider the most comprehensive, evidence-based, personalized hair loss treatments on the planet. So, if you are in the US and you're looking for this level of unrivaled personalization, check us out. We have a ton of different products from lowdose topicals to full strength counterparts, standard strength and high strength dutasteride, minoxidil with tininoan, and a whole host of other options based on your preferences and needs pending a doctor's prescription. and approval. Thank you for watching.