Giorgos Tsetis: I am an entrepreneur and have an engineering background that allows me to think in strategic ways to solve complex problems. Of course, I did have this very personal experience. But, to be honest with you, getting into this category wasn't directly a choice, it felt more like destiny. I say that, because their are literally millions who suffer from what I was suffering from. Aside from being a model, I owned an engineering company in New York, and business was steadily growing. The tipping point came when I found out the University of Washington published research that said my issue could cause permanent sexual dysfunction without the specific drug I was taking. That's when I panicked, reached out to my business partner and dear friend, and we begun to dig deeper into the issue. As we started diving deep, we recognized there was a tremendous white space.
Prostaglandins are modified forms of unsaturated fatty acids–those unsaturated or “essential” fatty acids (EFAs) that are also called Omega fatty acids. These EFAs cannot be produced by your body, but must be absorbed from our food. EFAs are naturally found in nut and seed oils in different compositions. EFAs have been shown to increase prostaglandin production in those with a deficiency (source, again).
Hair loss is a condition that can affect any area of the body, including the eyebrows. Approximately three million Americans experience brow hair thinning and loss. Trauma, grooming habits, disease, and genetic predisposition all can contribute to this concern. Our experienced hair restoration surgeons at Leonard Hair Transplant Associates, Dr. Robert Leonard and Dr. Matthew Lopresti, often see individuals with eyebrow hair loss for which they offer a comprehensive selection of restorative options that can help you address this problem.

Giorgos Tsetis: Hair loss completely shattered my confidence, and losing your confidence in modeling isn't a good thing. It was a very high price to pay. For eight years I was struggling, trying different solutions, searching for answers, not knowing what was going on. It was exhausting to say the least. So, when I made the decision to close down my company and started working on Nutrafol, people really thought I was crazy. They wondered why I was taking the chance of getting into this industry. To me, it wasn't really a choice, because there was nothing on the market that was healthy, accessible and helping the other 80 million people who are effected in the United States. We wanted to help ourselves, but really help others by making a valuable product that addressed an unsolved issue.
Madarosis is a terminology that refers to loss of eyebrows or eyelashes. This clinical sign occurs in various diseases ranging from local dermatological disorders to complex systemic diseases. Madarosis can be scarring or non-scarring depending upon the etiology. Appropriate diagnosis is essential for management. Follicular unit transplantation has been found to be a useful method of treating scarring madarosis and the procedure relevant to eyebrow and eyelash reconstruction has been discussed. A useful clinical approach to madarosis has also been included for bedside diagnosis. The literature search was conducted with Pubmed, Medline, and Google scholar using the keywords madarosis, eyebrow loss, and eyelash loss for articles from 1960 to September 2011. Relevant material was also searched in textbooks and used wherever appropriate.
Alopecia areata: Researchers believe that this is an autoimmune disease. Autoimmune means the body attacks itself. In this case, the body attacks its own hair. This causes smooth, round patches of hair loss on the scalp and other areas of the body. People with alopecia areata are often in excellent health. Most people see their hair re-grow. Dermatologists treat people with this disorder to help the hair re-grow more quickly.
Giorgos Tsetis: In the beginning, we left three factories because we didn't feel confident that they could do the job at our standard. These type of factories are sourcing the ingredients for you, but you have no clue where these ingredients are coming from. You don't know the efficacy, if they're clinically tested, and what about absorption? As a company, we decided to identify these root triggers that play a role in disrupting the hair growth cycle, then rigorously tested how we can target them and what specific ingredients solve for each trigger. Then, we developed individual partnerships with top suppliers all over the world that specialized in single ingredients that actually have that efficacy. We decided to source our own ingredients because we wanted to control the entire process. At least nine of the ten companies we consulted with said we couldn't do that, because the ingredients we chose to use were incredibly expensive. That's one main reason others can't do the work we do. For example, we purchase our primary ingredient for $600 per kilo, and you can buy the standard version of that ingredient in China for $30 per kilo. Same ingredients, but ours is clinically tested and proven to be effective. We only use patented ingredients, which made others think we're crazy, but creating the absolute best product is our top priority.
Both benign and malignant tumors such as seborrhoeic keratosis, molluscum contagiosum, basal cell carcinoma, squamous-cell carcinoma, sebaceous cell carcinoma, and sclerosing sweat duct carcinoma have been shown to be associated with loss of eyelashes.[1,111–113,119,120] A sebaceous cell carcinoma very often presents as a recurrent chalazion. An associated madarosis (due to lid infiltration and follicle destruction) would help to differentiate the two.[121,122] Tsuji et al. reported a rare case of primary epithelioid hemangioendothelioma of the eyelid associated with madarosis.[123] Primary leiomyoma of the eyelid has been reported with madarosis.[124] Kuan[125] described a case of lacrimal gland tumor masquerading as blepharitis with madarosis.
Madarosis is the hallmark of lepromatous leprosy. It was reported in 76% of patients with multibacillary leprosy.[76] Bilateral symmetric cicatricial madarosis occurs in lepromatous leprosy due to histiocytic infiltration of hair follicles[77,78] [Figure 4]. It occurs in multibacillary leprosy after at least 5 to 10 years of untreated disease.[79] Loss or atrophy of the eyelashes may follow. Madarosis adds to the cosmetic disfigurement caused by leprosy. Absence of madarosis is a good prognostic sign in long-standing cases.[80] Unilateral madarosis may occur in tuberculoid leprosy due to the facial patch in the eyebrow region. In tuberculoid leprosy, madarosis occurs due to granulomatous infiltration of hair follicles leading to their destruction.
Anagen effluvium occurs after any insult to the hair follicle that impairs its mitotic or metabolic activity. This hair loss is commonly associated with chemotherapy. Since chemotherapy targets your body’s rapidly dividing cancer cells, your body’s other rapidly dividing cells such as hair follicles in the growing (anagen) phase, are also greatly affected. Soon after chemotherapy begins approximately 90 percent or more of the hairs can fall out while still in the anagen phase.
When compared with no treatment, patients who received ethinyl estradiol 50 μg and cyproterone acetate 2 mg with cyproterone acetate 20 mg on days 5 to 20 of the menstrual cycle for 1 year had a significant increase in their percentage of anagen hairs with trends toward a larger shaft diameter of full anagen hairs and a decreased number of hairs that were less than 40 microns (Peereboom-Wynia et al., 1989). A 12-month randomized control trial of 66 women compared treatment with topical minoxidil 2% plus an oral contraceptive (ethinyl estradiol 30 μg + gestodene 75 μg) with treatment with cyproterone acetate 50 mg plus an oral contraceptive (ethinyl estradiol 35 μg + cyproterone acetate 2 mg) and demonstrated that treatment with cyproterone was more effective in hyderandrogenic patients but otherwise less effective (Vexiau et al., 2002). Side effects of cyproterone acetate include weight gain, breast tenderness, and a decreased libido (Kelly et al., 2016). Hepatotoxicity and development of multiple meningiomas may occur when doses exceed 25 mg daily (Medicines and Healthcare products Regulatory Agency, 2009). Cyproterone acetate is used widely in Europe and Canada, either in an isolated form or in combination with ethinyl estradiol, but it is only available in the United States as an orphan drug for the treatment of hirsutism (Carmina and Lobo, 2003, Jurzyk et al., 1992, Kelly et al., 2016). Cyproterone acetate is classified as pregnancy category X.
Many unpleasant things can happen to your body as you age. Losing eyebrow hairs is one of them. When you get older, your eyebrows may naturally become thinner as you experience hair loss. Though aging is inevitable, there are some ways you can help to prevent hair loss as you get older. Managing your stress, maintaining good nutrition, hydrating your skin and not exposing your eyebrows to excessive trauma, such as waxing, plucking, or threading, should help prevent eyebrow loss.
The WHI was a very large, very prominent long-term study which looked at the health effects of HRT. While the study did find a few benefits (women who used HRT had fewer hip or bone fractures and were less likely to develop colorectal cancer), it found a number of risks, including an increased chance of heart attack, stroke, cancer, and blood clots.
Trichotillomania is a hair pulling disorder associated with anxiety, stress, depression, boredom and frustration. It is where a person manually removes hairs with their finger, either a few strands throughout the day or sometimes many strands at one time during an emotional outburst. This behavior is usually a means of coping with stress or emotional turmoil. However, it can sometimes become a habit that is difficult to break. The eyebrows is a commonly targeted area as is the scalp.
Both benign and malignant tumors such as seborrhoeic keratosis, molluscum contagiosum, basal cell carcinoma, squamous-cell carcinoma, sebaceous cell carcinoma, and sclerosing sweat duct carcinoma have been shown to be associated with loss of eyelashes.[1,111–113,119,120] A sebaceous cell carcinoma very often presents as a recurrent chalazion. An associated madarosis (due to lid infiltration and follicle destruction) would help to differentiate the two.[121,122] Tsuji et al. reported a rare case of primary epithelioid hemangioendothelioma of the eyelid associated with madarosis.[123] Primary leiomyoma of the eyelid has been reported with madarosis.[124] Kuan[125] described a case of lacrimal gland tumor masquerading as blepharitis with madarosis.
Additionally, two other considerations are important for a patient who receives treatment for FPHL. First, there is a set of reasonable expectations in patients. Maintaining the current hair density can be considered a successful treatment because women tend to have further thinning as they age (Harfmann and Bechtel, 2015). Second, it is important to ensure that patients understand that progress is slow, and months or years can be required to see a significant improvement (Boersma et al., 2014, Yeon et al., 2011). In our practice, we wait at least 6 months to assess treatment efficacy.
Reproductive hormone changes can also play a part, and dermatologists believe the same factors that cause hair loss from the scalp, a common problem for women as they age, may contribute to thinning brows. Nanette Santoro, M.D., ob/gyn and professor of reproductive endocrinology at the University of Colorado at Denver, says, “Abrupt hormone changes can cause sudden hair loss (telogen effluvium) that recovers over about six months' time. It happens postpartum to many women and can happen at menopause.”
Certainly when those testosterone levels rise, DHT is even more of a problem. DHT levels can be elevated and be within what doctors consider "normal range" on a blood test, but they may be high enough to cause a problem. The levels may not rise at all and still be a problem if you have the kind of body chemistry that is overly sensitive to even regular levels of chemicals, including hormones.

Finasteride is a 5-alpha-reductase type II inhibitor, and although it is approved by the U.S. Food and Drug Administration (FDA) for the treatment of male androgenetic alopecia, it is not approved for FPHL. Finasteride is significantly teratogenic and has been shown to cause feminization of male fetuses (Bowman et al., 2003) as well as sexual side effects, depression, headache, nausea, and hot flashes (Varothai and Bergfeld, 2014). The decreased conversion of testosterone to DHT causes a build-up of testosterone, which subsequently converts to estradiol and creates a relative estrogen excess, and this could theoretically increase the risk of breast cancer (Kelly et al., 2016). Studies that use low doses (1 mg daily) showed no significant benefit (Kim et al., 2012, Price et al., 2000). However, one study of 37 premenopausal women who were taking a 2.5-mg dose of finasteride daily with an oral contraceptive pill showed improvement of hair loss in 62% of patients (Iorizzo et al., 2006). Another study of 87 pre- and postmenopausal normoandrogenic patients who were taking a 5-mg dose of finasteride per day for 12 months showed a significant increase in both hair density and thickness (Yeon et al., 2011). The effectiveness of finasteride does not seem to differ between pre- and postmenopausal patients (Yeon et al., 2011). Finasteride is classified as pregnancy category X.
 Because too much insulin (which is released by the pancreas in large amounts when we consume foods high in sugar or refined flour) signals the ovaries to produce more testosterone, and because an overload of testosterone increases the likelihood that our bodies may make more of the hair-thinning hormone DHT, work to keep blood sugar steady by eating fiber-rich whole foods.  In addition, the Saw Palmetto herb has shown promise for its ability to block the conversion of testosterone into DHT, so it may help androgen-related hair loss. To date, research on saw palmetto for hair loss is limited, but the research that has been done is promising.
 Estrogen dominance is an extremely common imbalance and it can fuel thinning hair as well as an arms-length list of annoying symptoms, from bloating and PMS to irregular periods and infertility. Your first, best step in clearing excess estrogen from the body is doing a liver supportive detox. My 4-Day Hormone Detox has you eating fresh, nourishing foods for three meals a day, plus snacks. You won’t feel hungry or deprived and, most importantly, you will help kickstart hormonal healing. A hormone detox is one of the best first steps you can take to reverse thinning hair. 
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