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The documented mechanisms are: VEGF stimulation in dermal fibroblasts that supports the microvascular network feeding the follicle, collagen and glycosaminoglycan synthesis at the follicular basement membrane, anti-inflammatory signaling that calms the chronic micro-inflammation associated with androgenetic alopecia, and direct follicular signaling that extends the anagen growth phase

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Additionally, the article discusses how cobalamin may also help manage oxidative stress by promoting the synthesis of key substrates and cofactors necessary for NOS function, thereby balancing pro-inflammatory and anti-inflammatory processes