When hair starts to thin at the crown or temples, it is natural to assume the follicles underneath have simply died. For many people with pattern hair loss, that is not quite what the science shows. Many of those follicles are still there, shrunken and resting, with their stem cells intact. This October (2026), a new clinical trial began testing whether they can be switched back on. Here is what that research means, what it does not mean yet, and what you can do today.

Myth: "Once Hair Thins, the Follicle Is Dead"

In androgenetic alopecia (male and female pattern hair loss), follicles go through a process called miniaturisation. With each hair cycle, the growth (anagen) phase gets shorter and the resting phase gets longer. The follicle shrinks and produces finer, shorter, lighter hairs, until some barely break the surface. On the scalp it looks like hair has gone. Under the skin, the story is often different. If you want a refresher on the cycle itself, see our guide to the Normal Hair Growth Cycle.

Science: Many Follicles Are Dormant, Not Gone

Every hair follicle has a reservoir of stem cells in a region called the bulge, just below the oil gland. At the start of each new cycle, these stem cells are activated and produce "progenitor" cells, which build the new hair.

• Stem cells survive: a 2011 study in the Journal of Clinical Investigation compared bald and haired scalp from the same men with pattern hair loss. The bald scalp still had hair follicle stem cells in similar numbers.
• The switch is the problem: what bald scalp lacked were the progenitor cells that stem cells normally turn into. In other words, the hold-up seems to be activation, not the loss of the cells themselves.
• Not always reversible: in scarring forms of hair loss, and in some areas that have been bald for many years, follicles can be permanently lost. "Dormant" applies to many thinning follicles, not all.

The Metabolic Switch: How Stem Cells Decide to Wake Up

Why would a healthy stem cell stay asleep? One answer comes from cell energy. In 2017, researchers at UCLA published a study in Nature Cell Biology showing that hair follicle stem cells in mice switch on when they shift their metabolism towards producing more lactate.

• The key enzyme: stem cells with higher lactate dehydrogenase activity entered the growth phase; when the enzyme was blocked, they stayed dormant.
• The lever: blocking a gatekeeper called the mitochondrial pyruvate carrier (which moves fuel into the mitochondria) pushed cells towards lactate production and woke resting follicles in mice.

This connects to a theme we explored in Biohacking Hair & Energy: NAD+ and Mitochondrial Health Explained: follicles are among the most energy-hungry structures in the body, and how they use fuel helps decide when they grow.

What Happened This Month: The AWAKEN Trial

On 14 October 2026, Pelage Pharmaceuticals announced that the first patient had been dosed in AWAKEN, a Phase 2/3 trial of PP405. PP405 is a topical gel designed to act on that metabolic switch in follicle stem cells, rather than on hormones like DHT.

• Design: randomised, double-blind and placebo-controlled, lasting 12 months, in about 600 men aged 18 to 55 with moderate to advanced pattern hair loss (Norwood IV–V), in the US and Canada.
• What it measures: change in hair count, how participants rate their hair, and signs of follicles reactivating.
• Earlier results: in a small, 8-week Phase 2a study, the company reports PP405 was well tolerated, with no drug detected in the blood, early signs of increased hair density versus placebo, and new hairs growing from follicles where none had been visible. These results are company-reported and have not yet been published in a peer-reviewed journal.
• Timing: the trial's primary completion is listed for December 2027. PP405 is not approved anywhere, including by Singapore's HSA, and is not available to buy.

How This Differs from Today's Options

• Finasteride: lowers DHT, the hormone that drives miniaturisation in genetically sensitive follicles.
• Minoxidil: helps prolong the growth phase and enlarge follicles; it was first developed as a blood pressure medicine.
• Low-level laser therapy: red light is absorbed by an enzyme in the follicle's mitochondria, supporting energy production. Devices such as the FDA-cleared Theradome bring this home.
• PP405 (experimental): aims to activate the stem cells directly. If it works in large trials, it would be a new approach that could sit alongside, not replace, the options above.

Already Had a Hair Transplant?

A common question: if dormant follicles might one day be reactivated, did a transplant remove them? Mostly, no.

• Grafts come from the donor zone: surgeons take follicles from the back and sides of the scalp, which can be more DHT-resistant and are actively growing. Each graft moves with its own stem cells and keeps behaving like donor hair.
• Your own thinning follicles stay: grafts are placed between the native follicles in the thinning area. Those native follicles are exactly what reactivation research targets, so a transplant does not close that door.
• Two real trade-offs: follicles harvested from the donor zone are gone from there for good, and creating graft sites can disturb nearby native hairs ("shock loss", usually temporary).
• Native hair keeps its own course: it can continue to thin after surgery, which is why doctors usually recommend ongoing treatment. We explain more in Why Transplanted Hairs Can Still Fall Out.

It is still not yet known whether people who have had a transplant can join trials like AWAKEN, or how they would respond.

What Helps Today

1. Get diagnosed early: ask a doctor or dermatologist to confirm the type of hair loss and check for iron, thyroid or other triggers. Follicles that are still thinning have more to work with than those that have been dormant for years.

2. Doctor-guided treatment, even after a transplant: evidence-based options such as minoxidil, finasteride and low-level laser therapy work on different pathways and can be combined in one plan.

3. Daily scalp massage: a small 2016 study found that 4 minutes of daily massage for 24 weeks was followed by thicker hairs, possibly because massage stretches the cells at the base of the follicle. In a 2019 survey of people using daily massage, most reported their hair loss stabilised or improved. The evidence is early, but massage is gentle and low-risk. See our guide to scalp massage techniques.

Support the basics: regular sleep, enough protein and a clean scalp in Singapore's humid climate.

Tip: The hands-free Growband Pro gently lifts and relaxes the scalp in 10–20 minute sessions, making a daily massage routine easy to keep. It supports scalp circulation during use and is a drug-free add-on, not a replacement for medical treatment. After a hair transplant, wait until your surgeon clears you before using it over new grafts.

Key Takeaway

Thinning follicles are often dormant, not dead: their stem cells can survive even when the hair above looks gone. A new 12-month trial is testing whether a topical drug can switch them back on, but it is still experimental and results are about two years away. Whether or not you have had a transplant, the best steps today are the same: get diagnosed early, follow a doctor-guided plan, and look after your scalp every day.

This article is for general education and is not medical advice. Speak to a doctor before starting or changing any hair loss treatment.

References

• Pelage Pharmaceuticals. Pelage Pharmaceuticals announces first patient dosed in Phase 2/3 AWAKEN trial of PP405 for androgenetic alopecia. Business Wire, 14 October 2026. Read the release
• Phase 2/3 efficacy and safety of PP405 in adult males with NHS type IV–V. NCT07819435. Trial listing
• Pelage Pharmaceuticals. Positive Phase 2a clinical trial results for PP405. 17 June 2025. Read the release
• Flores A, Schell J, Krall AS, et al. Lactate dehydrogenase activity drives hair follicle stem cell activation. Nature Cell Biology. 2017;19(9):1017–1026.
• Garza LA, Yang CC, Zhao T, et al. Bald scalp in men with androgenetic alopecia retains hair follicle stem cells but lacks CD200-rich and CD34-positive hair follicle progenitor cells. Journal of Clinical Investigation. 2011;121(2):613–622.
• Koyama T, Kobayashi K, Hama T, et al. Standardized scalp massage results in increased hair thickness by inducing stretching forces to dermal papilla cells in the subcutaneous tissue. Eplasty. 2016;16:e8. PMC4740347
• English RS Jr, Barazesh JM. Self-assessments of standardized scalp massages for androgenic alopecia: survey results. Dermatology and Therapy. 2019;9(1):167–178. PMC6380978

Explore the Hairguard Growband Pro