After the groundbreaking 1999 study on mice, some researchers were mildly optimistic that SHH activation could also have positive implications on human hair growth in balding men and women. A new company that was formed in 2000 called Curis partnered with Procter & Gamble in 2005 to try and develop a topical Hedgehog agonist product for scalp hair growth.
Finasteride inhibits an enzyme that converts testosterone to DHT, or dihydrotestosterone, the hormone that causes hair loss in men, and unlike minoxidil, this drug can actually help hair grow back, as well as prevent further loss. All you have to do is take one pill a day, and according to Dr. Evan Rieder, dermatologist in the Ronald O. Perelman Department of Dermatology at NYU Langone Health, two-thirds of men taking this treatment will see improvements in hair density over time.
The more upsetting problem is central centrifugal cicatricial alopecia, a type of baldness that starts at the crown of the head and spreads outward. "It's hugely, hugely difficult," said Susan Taylor, a dermatologist at Penn Medicine who specializes in treating women with CCCA. "It affects quality of life." She said it is seen "almost exclusively" in women of African descent. One study found it in 10 percent to 15 percent of black women, but Taylor thinks it's more common. "I could see women all day, every day, with this problem," she said.
Female pattern baldness: Treatment and genetics While most women lose between 50 and 100 strands of hair per day, this hair is usually quickly replaced by new growth. When bald patches or thinning occurs, however, it may be a sign of female pattern baldness. In this article, learn more about the common causes and treatment of hair loss in women. Read now
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Try balayam yoga. Balayam yoga (also called balam yoga) is an ancient acupressure exercise associated with hair growth. It comes from the Hindu words, Bal, which means hair, and Vyayam meaning exercise. The exercise involves rubbing the fingernails on both hands together to stimulate activity in the scalp. It has been known to help cure pattern baldness in men and women if done correctly and frequently over a long period of time.
The vampire hair loss treatment takes after the vampire facelift, which is completed on the face to reduce lines, acne scarring, and wrinkles. While not a new method, it is just becoming popular in its ability to treat the cosmetic condition of hair loss. This is also known as platelet rich plasma therapy. Scientists reported in the British Journal of Dermatology May 2013 issue that restoring hair growth on bald patches is possible by injecting them with platelet rich plasma.

In February, though, Ms. Telford, 46, flew from her home in London, Ontario, to Sarasota, Fla., for a new $1,400 hourlong treatment known as platelet rich plasma (P.R.P.), which is said to stimulate dormant hair follicles. The procedure involves drawing blood, spinning it in a centrifuge to extract the plasma, adding various nutrients (like more protein), then injecting the resulting mixture in one-inch intervals in a grid on the top of the scalp, which has been numbed with a local anesthetic.

The optimal treatment for this condition is not known, and psychiatric referral may be indicated. Treatment options include cognitive behavior therapy19 and selective serotonin reuptake inhibitors, although strong evidence of a treatment effect has not been demonstrated. Preliminary evidence suggests positive treatment effects with acetylcysteine, olanzapine (Zyprexa), and clomipramine (Anafranil).19 A combination of cognitive behavior therapy and medications may be more effective than either approach alone.19


Hair changes about as fast as grass grows, which is to say it’s extraordinarily slow and not visible to anyone checking impatiently in the mirror every day. But during regular follow-up appointments, Harklinikken uses high-tech equipment to photograph and magnify the scalp and count new hairs and active follicles, which motivates users to adhere to the regimen. Too many people give up on treatments like Rogaine and low-level-light devices before they’ve had a chance to work, Dr. Senna said. 

When you're investing considerable time and money on a mix of hair treatments and cures, the last things you should be doing are those that will only aggravate your condition. Likewise, when your hair has finally grown back, the last thing you would want is for you to go through another horrific episode of hair loss. Preventing further - or another case of hair loss, and stopping it before it actually happens should be your goal.
In-office laser light treatments or at-home handheld devices, such as the HairMax LaserComb, supposedly grow new hair by stimulating blood flow to the area (think: an amped-up version of a scalp-stimulating shampoo). Just don’t expect the device to make your noggin go from looking like George Costanza’s to Jerry Seinfeld’s. “These lasers won’t grow any new hair. If anything, they may just help you hang on to some of the hair that you already have a bit longer,” says Dr. Joyce.

Certain foods have also been found to aggravate or worsen hair fall, such as sugar, which triggers the overproduction of the male hormone, androgen, which in turn causes the hair follicles to shrink in size and for hair to fall out or stop growing. Fish products that are known to contain high levels of mercury like tuna, mackerel and swordfish can also cause hair weakening and excessive hair fall. Studies have also found that fried foods are associated with the production of high levels of DHT.

“If you don’t want a scar because you like to wear your hair short, you might opt for a “scarless” hair transplant,” says Dr. Joyce. Also known as follicular unit extraction (FUE), grafts are harvested one at a time with tiny punches that heal virtually undetected so you can still buzz your head. “If you’ve gone so bald that you don’t have a lot of donor hair on your head, we can do FUE extractions with body hair such as on your chest, stomach, back, and sometimes even the pubic area,” says Dr. Joyce.

This shampoo has one of the top ratings of any shampoo sold online. KIMI Naturals must be doing something right! Saw palmetto, biotin, argan oil, and keratin are some of the highlight ingredients in this shampoo. They offer a 60 day money back guarantee, so if you’re not happy with the results after you give it a go, get you’re money back. On their KIMI Naturals website, they also sell a vitamin supplement and scalp treatment which they sell together with this shampoo as a 3-pack system.
There’s no cure for baldness, but there are ways to hold on to what you've got. The six dermatologists and the clinical studies point to three methods: minoxidil, laser treatments, and prescription finasteride. The key is finding the combination and hair loss regimen that works for you. A doctor is your best bet for that kind of guidance — but we found a few trustworthy products that will work for most people.
Alopecia areata. This condition, called patchy hair loss, is the opposite of pattern baldness. Whereas in the former, thinning hair follows a pattern, alopecia areata is marked by smooth and bald patches anywhere on the scalp. The bald patches are circular, and can be as small as a pencil eraser or as big as a quarter. It begins with one or two spots that multiply on other parts of the head. The condition is caused by an autoimmune disease where the antibodies mistake the hair as the "enemy" and start attacking it, resulting into hair loss.
Our specially formulated natural remedy for hair loss and shedding is made with natural ingredients. We use high quality products, such as D Panthenol, tea tree oil and evening primrose, to nourish the scalp. This eliminates current hair loss and prevents future problems. It targets the root of falling hair, and penetrates the scalp and hair follicles for itch free, flake free skin that is nourished and ultra hydrated. Our formula rejuvenates and regenerates skin and hair follicles for revitalized, beautiful hair.

Clearly, minoxidil is not a miracle drug. While it can produce some new growth of fine hair in some — not all — women, it can't restore the full density of the lost hair. It's not a quick fix, either for hair loss in women . You won't see results until you use the drug for at least two months. The effect often peaks at around four months, but it could take longer, so plan on a trial of six to 12 months. If minoxidil works for you, you'll need to keep using it to maintain those results. If you stop, you'll start to lose hair again.


Besides cost considerations, a hair transplant is generally prescribed as a last resort for permanent hair loss problems. It is also not allowed for people under the age of 25, those with a continuing problem of hair loss, as well as those with other health conditions like uncontrolled diabetes, serious heart problems and hypertension. Patients whose hair loss is caused by other factors, such as a skin or scalp disorder or who suffer from a psychological condition that causes them to pull at their hair are not recommended for this procedure. Since the procedure requires taking a sample from the back of the head, those who do not have enough follicles from this section that can be used for transplant are not also eligible.
Weinstein has big dark eyebrows and a kind face. Kind of an Elliott Gould vibe. I looked at his head. There was a spotty, thatchy outcropping of gray-black hair. Not exactly an overflowing abundance, but hair, to be sure. “I had nothing on top,” Weinstein said. “You can see—I grew my hair back! And it grew back more or less the color I had when I was young.”
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In-office laser light treatments or at-home handheld devices, such as the HairMax LaserComb, supposedly grow new hair by stimulating blood flow to the area (think: an amped-up version of a scalp-stimulating shampoo). Just don’t expect the device to make your noggin go from looking like George Costanza’s to Jerry Seinfeld’s. “These lasers won’t grow any new hair. If anything, they may just help you hang on to some of the hair that you already have a bit longer,” says Dr. Joyce.
A study led by Dr. Noha Doghaim of Tanta University in Egypt showed that carboxytherapy may be a promising treatment option for both alopecia areata and androgenic alopecia. The study comprised 80 subjects who were treated over the period of three months with either placebo or carboxytherapy.  Both groups found favorable results from the carboxytherapy, however during a follow-up examination the improvements in androgenic alopecia subjects had decreased over time. The researchers noted that continual treatments would be necessary to maintain and bolster the benefits for AGA.
"Firstly, even the very good ones won’t get to the root of the issue - pardon the pun - and prevent or treat male or female pattern baldness which is caused by genetics, nor deal with hormonal issues at the heart of female hair loss. But they can help make the hair you do have stronger and healthier. And they can be useful in putting a hair loss regime in place, along with medication like Minoxidil or Finasteride and/ or a hair transplant.

It appears that the gene-editing company Sangamo Therapeutics has an interest in hair growth technology. Sangamo is an interesting company with technology applications in gene therapy, genome editing, cell therapy, and gene regulation. Gene therapy, especially, is at the cutting-edge of medical technology innovation. The company has multiple therapies at phase 1/2 of the clinical trial process for various diseases. 

Certainly a company with a unique background and game plan, HairClone has received some recent media attention. The UK biotech startup was featured in this month’s publication of “Consulting Room” online magazine. In the article both Dr. Bessam Farjo and Paul Kemp of HairClone provided insight as to the company’s current progress and plans for the future. Things seem to be coming along well for HairClone and we should expect to hear from them again within the next several weeks. Full story is on Articles main page.
If you’re a lady and can remember the one difference in directions (or just scope out the instructions online) we recommend saving the cash. Similarly, you could go generic with Equate Hair Regrowth Treatment for Men or Costco’s Kirkland Signature Hair Regrowth Treatment Minoxidil Foam for Men. These alternatives offer the same percentage of active minoxidil and near-identical inactive ingredients for as little as half the price — a great option for both genders.

"The majority of men lose their hair not through stress, or bad diet, or lack of sleep, but through the genetic trait of male pattern baldness which is hard to treat through shampoos or supplements alone. Women lose their hair for very different reasons, but the argument still stands that a lot of the hair loss products on the market are just offering false hope. That said, there are a few that really work."
“Smelling” Receptor Keeps Hair Growing – Many of you may have noticed the headlines regarding sandalwood and hair growth over the past week. The research everyone is talking about comes from Ralf Paus and his team at the Monasterium Laboratory GmbH. For the record, Paus is also the main researcher behind the WAY-316606 hair growth discovery. This time Paus et al identified an olfactory receptor in hair follicles, OR2AT4,  which plays a role in regulating hair growth or inhibition. Olfacory receptors are responsible for detecting odors in cell membranes and provide the basis for our sense of smell, they do carry out additional functions though, as demonstrated by Paus. 
Kuntzman described the “snake oil” era of hair restoration, in the early twentieth century, when salesmen offered nonsense treatments, often with horrific results. One involved “cylinders of skin taken from the abdomen and sewn into your scalp to function as a sort of belt loop” for new hairs, Kuntzman said; another used paraffin injections that left some customers with lifelong horn-like head bumps. Most of the really ugly stuff ended in 1938, when the Food and Drug Administration began regulating the industry.

"Firstly, even the very good ones won’t get to the root of the issue - pardon the pun - and prevent or treat male or female pattern baldness which is caused by genetics, nor deal with hormonal issues at the heart of female hair loss. But they can help make the hair you do have stronger and healthier. And they can be useful in putting a hair loss regime in place, along with medication like Minoxidil or Finasteride and/ or a hair transplant.


Natural hair that is subjected to constant physical trauma from excessive brushing or combing, tight braids or ponytails, or extreme scratching or massage can cause hair at the temples to become weak and to stop growing to its normal length. Clean shaving, especially for men, can cause white bumps to appear on the area where the hair was shaved short, and at times can become infected with pus and leave permanent scarring, affecting hair growth.
As promised, I am providing an update on the highly anticipated development of Shiseido and RCH-01. This may not be the exact update everyone was hoping to hear, but nonetheless, progress and continued development are what we need to succeed. The update in summary is this: according to my source we will be getting the data from Shiseido’s trial of RCH-01 in 2019. There is no scheduled date for the data presentation, but I anticipate it would be within the 1st quarter of the year. 
Hair loss is not a hopeless condition. While there are certainly cases of permanent hair loss in men, there are still cases when it's only temporary and therefore can be treated, controlled and prevented. There are treatments and cures available, and many of these, especially those for temporary cases, can be as simple as lifestyle changes -- eating the right foods, learning to manage stress properly, and doing away with unhealthy, nasty habits that can aggravate the condition.
Anti-androgens. Androgens include testosterone and other "male" hormones, which can accelerate hair loss in women. Some women who don't respond to minoxidil may benefit from the addition of the anti-androgen drug spironolactone (Aldactone) for treatment of androgenic alopecia. This is especially true for women with polycystic ovary syndrome (PCOS) because they tend to make excess androgens. Doctors will usually prescribe spironolactone together with an oral contraceptive for women of reproductive age. (A woman taking one of these drugs should not become pregnant because they can cause genital abnormalities in a male fetus.) Possible side effects include weight gain, loss of libido, depression, and fatigue.
However, the high incidence of androgenic alopecia is caused by the male hormones. Testosterone in the scalp is converted into dihydrotestosterone (DHT) that causes the follicles to shrink in size, therefore inhibiting the growth of hair, which eventually leads to baldness. However, hair follicles on the sides and back of the head do not have as much DHT compared to the top, hence why hair loss is concentrated on the crown of the head. Interestingly, DHT is known to help in the growth of the beard and hair on the chest, a reason why most bald men have hairy chests and grow their beards much faster.
Harklinikken does not advertise, but the 25-year-old multinational company is beginning an aggressive expansion into the $3.6 billion hair-loss market in the United States, meaning you’re likely to hear a lot more about it. A New York clinic opened in June inside the Core Club in Midtown (you don’t need to be a member to get an appointment); and in August, Harklinikken consultations became available at some 70 Women’s Care Florida obstetrics and gynecology clinics. (Roughly 75 percent of the company’s 50,000 active users are female.)

These days, when forced into windy outdoor situations, Trump is nearly always seen wearing a Make America Great Again cap. But, one wintry, blustery day this February, Trump walked up the steps of Air Force One capless. In the engrossing video footage, you can see the hair on the back of Trump’s head part and rise, shooting up with power, almost in two separate flaps—one to the left, one to the right.

Each follicle produces hair for 2 to 6 years and then takes a break for several months. While the hair follicle is in its rest phase, the hair falls out. There are around 100,000 follicles on the scalp, but because each follicle rests at a different time and others produce hairs, hair loss is usually unnoticeable. More noticeable hair loss occurs when there is a disruption to the growth and shedding cycle, or if the hair follicle is obliterated and replaced with scar tissue.
It wasn’t quite the “accident” it was portrayed to be. He worked out that the drug targeted a protein called SFRP1, which affects follicle growth. He looked into the literature and discovered there was a pre-existing osteoporosis drug, WAY-316606, designed to target this protein with much more precision. So he applied that to leftover slabs of scalp donated by hair transplant clinics. “We usually do experiments for over a week. We put the hair follicles in a dish and this drug enhanced hair shaft elongation within two days. But it also kept the hairs healthier. When you look at them, they’re larger, thicker hair follicles. So, it’s quite promising.”
Due to the concern of several readers, I’ve removed the link to the new Trinov website that has popped up on the net. For now, the website only contains an email address subscription box which really poses no issue to anyone who subscribed. At this time, it’s not confirmed who the actual owner of the new Trinov site is, so use your discretion until we find out more regarding this matter. Until more information is known the website will not be shared on Follicle Thought.
The dermatologist also will carefully look at your scalp and hair. During an exam, the dermatologist may pull on your hair. Sometimes a dermatologist needs to pull out a hair to get the necessary evidence. And sometimes a dermatologist needs to look at the hair on the rest of your body to see whether there is too little or too much hair in other areas.

In the operating room, Bernstein prepped the robot patient for implantation, puncturing the man’s scalp with a long needle. These are the “sites” where the hairs will go. Blood bubbled over his scalp, but the patient didn’t seem to notice. The patient and doctor chatted loosely about summer houses and beers and boats. “Would I be a candidate for a surgery after this surgery?” he asked.


Side effects and concerns: Minoxidil is safe, but it can have unpleasant side effects even apart from the alcohol-related skin irritation. Sometimes the new hair differs in color and texture from surrounding hair. Another risk is hypertrichosis — excessive hair growth in the wrong places, such as the cheeks or forehead. (This problem is more likely with the stronger 5% solution.)
Hair growth company, Follicum of Sweden, announced today that their phase 2a trial for scalp hair growth has reached over 50% enrollment. The trial is scheduled to enroll 60 patients total who will receive injections of FOL-005, Follicum’s hair growth peptide. The study is designed to evaluate the hair growth response from different dosages of FOL-005.  Patients receive injections 3 times per week for 3 months total, for the duration of the study. The study is expected to be completed in 2018. Let’s hope Follicum finds some healthy and eager volunteers to round out their study pool asap.
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The average person loses 50 to 100 hairs per day naturally due to this cycle. But if the process is interrupted at any stage—for example, if the follicle doesn’t come back out of resting mode or starts to shrink—hair loss and hair thinning can result. Interruptions to the cycle can be caused by hormones, stress, poor diet, chemical hair treatments, certain medications, and, of course, good ol' genetics.
I am a 45 yr female that has experienced hair loss to the point of having to hire a plumber twice (over 3 years) to unclog our drain in our main bathroom although I am pretty cautious about picking up my hair. My ponytail is about 1/2 the size that it was 5 years ago. i had excessive hair loss after the birth of my last 2 of 3 children. It is noticeably thinner although my employees, friends and husband seem to think my hair is thick. I can see my scalp very easily. (No patchy alopecia though) I started using viviascal professional strength about 2 months ago and hair surge shampoo only about 2 weeks ago. The bottle has about 1/3 left and i am wondering what is to be expected from this product. I have to use at least 8 pumps ( it seems to be double the volume of normal shampoo that i use) and it does not seem to later that well until after a min or so. Additonally i am using the hair surge supplement. When should i see less hair falling out? When should i expect visible results. Any other suggestions? I know it says to use 5 of 7 days, but i use it daily to make sure i am getting the full benefit ( if any) from this product. Currently i am looking at 100 buck a month for the shampoo alone if i keep this up. Any advice is welcome. Thanks
A diet that is poor or lacking in certain nutrients, particularly iron, protein, and vitamin B, which are essential in the production of keratin, can cause a long telogen phase and a very short anagen stage. On the other hand, excess supply of vitamin A in the body, especially those taken through supplements, can prove to be toxic and can cause a range of adverse body effects including loss of appetite, fatigue and consequently, hair loss.
Aloe vera. Aloe vera is one of the most traditional and common natural hair loss treatments. It is known to possess enzymes that promote hair growth and a healthy scalp by regulating the hair and scalp's pH level. Known as a hair miracle, it is also used to treat other hair/scalp conditions like scalp itchiness, scalp redness, and inflammation. It also helps in minimizing dandruff and making the hair shinier and stronger.
Retin-A, or topical tretinoin, is sometimes used as a combination therapy with minoxidil for androgenic alopecia. It’s important to use this type of medication under the guidance of your doctor. In some circumstances, tretinoin can actually cause hair loss. Some people who have used it at home report that topical retinol creams, serums, and lotions may make hair loss worse.
Scientists from the Indiana University School of Medicine have for the first time created skin with hair follicles using mice stem cells. Research was led by Professor Karl Koehler. The team was able to grow both the epidermis and dermis layers of skin to create a realistic skin model. An interesting quote from Professor Koehler: “It looks like a little ball of pocket lint that floats around in the culture medium. The skin develops as a spherical cyst and then the hair follicles grow outward in all directions – like dandelion seeds.”
These days, when forced into windy outdoor situations, Trump is nearly always seen wearing a Make America Great Again cap. But, one wintry, blustery day this February, Trump walked up the steps of Air Force One capless. In the engrossing video footage, you can see the hair on the back of Trump’s head part and rise, shooting up with power, almost in two separate flaps—one to the left, one to the right.
The test involves plucking about 50 hairs from the head, typically at the back of the scalp, so your dermatologist can look at them under a microscope and determine how much of the hair is in the resting, growth, and fall-out phases. Next, a vial of blood is sent to a lab to check hormone and nutrient levels ($100 and up, depending on insurance). If low levels of iron, or high levels of male hormones, like androgens, are contributing to your hair loss, for example, both can be treated through oral supplements or medication.

If you have flakiness or dryness, Dr. Zeichner notes that it's a good idea to use anti-dandruff shampoos, rather than hydrating products, because they're specifically made to treat inflammation and yeast on the scalp — two underlying causes of dandruff. One ingredient to look for in these options is Zinc Pyrithione. "It's very important to choose the appropriate type of shampoo for your hair type," he says. "The wrong one may not get to the root of your scalp issue."

In Michael Wolff’s “Fire and Fury,” Kuntzman’s theory is bolstered. Wolff writes that Ivanka Trump “often described the mechanics behind it to friends: an absolutely clean pate—a contained island after scalp-reduction ­surgery—surrounded by a furry circle of hair around the sides and front, from which all ends are drawn up to meet in the center and then swept back and secured by a stiffening spray.”


Hair grooming, but more importantly, having a head-full of hair is as important to men as it is to women. To women, it may be an important accessory of beauty, and for men, it adds to a sense of manliness, enhances their looks and makes them more appealing and attractive to women. Balding to men is associated with aging (only old men are expected to lose hair) and therefore, having hair on one's head is a sign of virility and masculinity.


This shampoo has one of the top ratings of any shampoo sold online. KIMI Naturals must be doing something right! Saw palmetto, biotin, argan oil, and keratin are some of the highlight ingredients in this shampoo. They offer a 60 day money back guarantee, so if you’re not happy with the results after you give it a go, get you’re money back. On their KIMI Naturals website, they also sell a vitamin supplement and scalp treatment which they sell together with this shampoo as a 3-pack system.
A little farther up the follicle is the mysterious feature called the bulge. That's where follicle stem cells live. When they get the right set of chemical signals, these self-renewing cells divide. They don't divide like normal cells, in which both halves become new cells that keep splitting and developing. Only one half of the follicle stem cell does that. The other half becomes a new stem cell, and stays put for future regeneration.
Hey there, I'm Shawn, the founder of Tools of Men! This site was created to help out other guys by teaching them proper grooming habits and the basics of sensible style. We try to make things here a bit of fun while giving you clear info. If you want to get in touch with us, drop us a line on the contact page or via social media. Thanks for checking out the site - and make sure to come back again!
But, there’s an even more important step to take – your participation and contribution. The topic of “a cure for hair loss” or “a hair growth treatment”, for many of us, is one of the most important issues in our lives. What are you doing to support its success? I realize that question may not have previously crossed the mind for many. It’s here now. For a personal example, I’m not a scientist who creates molecules in a lab, so I decided I would organize the hair growth treatment news and spread awareness. It’s been a gratifying practice for me. 
But there is a Canadian company who has been working diligently to change that. And if they’re right—and so far the research indicates they are—baldness may become a thing of the past for those who choose not to tolerate hair loss anymore. And they're not only attacking baldness, Aging skin and tendon degeneration are on the cutting block as well. It's great news for the tens of millions of older Americans who suffer from these malladies. But the most fascinating part lies in the source of the cure. It’s you. The company focuses on the development of cell therapies using a patient's own cells.
Aclaris Therapeutics, the company who acquired the rights from Angela Christiano to use JAK inhibitors in alopecia disorders, is currently involved in a wide range of alopecia trials. The company has multiple ongoing trials for alopecia areata, including a trial for eyebrow regrowth, and also a new trial planned for AGA or androgenic alopecia. Full article here.
At the Sanford-Burnham Medical Research Institute, they showed that stem cells derived from human skin to grow hair when grafted onto the skin of mice. A paper describing this research, which was published on January 21st 2015 can be found here in the PLOS One medical journal. Dr. Alexey, a member of the research team made the following written statement: “Our stem cell method provides an unlimited source of cells from the patient for transplantation and isn’t limited by the availability of existing hair follicles.” Once successfully developed, this could transform a fully bald man or woman to the head of hair they had as a teenager. The main challenge now will be replicating their results in large-scale human trials.
Many other women, though, start noticing thinning hair on top of their heads. Doctors say the defining sign is a widening of the part. The hairline itself is usually intact, but the hair becomes less dense behind it. Doctors will often run a battery of tests to make sure there are no treatable medical conditions, such as anemia, thyroid problems, tumors, or hormonal problems. "Ninety percent of the time, it's normal," Patel said. 
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