23: Hair Restoration – What Works, What Doesn’t and What’s Coming

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Hello Fellow boomers, In Episode 23 I talk about subject which is on a lot of our minds…figuratively and quite literally. If you’re a baby boomer here in the US chances are that you are in that special group of us 50 million men and 30 million women who are experiencing androgenetic alopecia or more commonly known as male-pattern and female-pattern baldness. It is the most common for m of hair loss. I’m going to look at what causes it and what, if anything, you can do about. Male and female pattern baldness presents itself differently in women than in men and each has its own separate but related causes. So what does cause hair loss? There are a lot of myths out there. Let’s look at a few of the more prevalent ones.

A lot of people believe that it’s Your mother’s genes that determine your hair loss future. I wish, my grandfather on my mother’s side had a full head of hair for his entire life. Nope, this isn’t the case, though your mom’s genes do have a slightly stronger influence. Hair loss can be inherited from both sides of the genetic family. My hairline and its glacial-like migration south is EXACTLY like my fathers.

Another common misconception is that It’s the high levels of testosterone that causes baldness. Nope… hair loss is related to testosterone, but it’s not the amount, it’s the fact that your head has a greater sensitivity to DHT or dihydortestosterone. Which causes the hair follicles to shrink and eventually disappear.

Another myth is that Genetic Baldness causes a large amount of hair to fall out of your head – Again, not so. It’s actually your hairs getting smaller, and smaller that makes it look thinner.

Many people believe that hair loss is caused by a decreased blood flow to the scalp. – Nope, it’s actually just the opposite. The loss of hair causes a decreased blood flow to the scalp.

Another popular belief is that wearing a hat will make you go bald. – Nope, wrong again. Your hair gets oxygen from the blood stream and not from the air like some plant. But, there is one exception to this rule. If you wear a dodger hat than it can precipitate rapid hair loss.

Do you think that clogged pores causes hair loss? – wrong again. True, clogged pores may give you one heck of a case of acne, but if clogged pores caused hair loss than rigorous shampooing would be the ticket for a thick mane of hair…and obviously that doesn’t work.

This leads us to the next common myth, that frequent shampooing causes your hair to fall out. –Wrong again. This is the genesis of this myth. 1 – somebody believes that shampoo is causing their hair loss because they see a bunch of hair in the tub after a shower…so they then stop shampooing their hair and it therefore builds up in the scalp until the next shampoo when they see even more at the bottom of the tub. Soon, they have a very stinky head, no friends AND no hair.

Many people think that only men suffer from genetic hair loss – Not True. Over 40% of women suffer from significant thinning of their hair during their lifetime.

The last myth is that hair loss eventually comes to a halt when we get older. – Well, yes and no. for most of us It does continue throughout our entire lives but it does halt when either A – we are cue-ball bald, or b – we are cold stone dead. The rate of baldness may vary but don’t kid yourself. It’s a constant southern migration happening there partner.

There are many causes of hair loss in both men and women including:
Physical Stress
Emotional stress
Pregnancy
Too much vitamin A
Not enough vitamin B
Not enough protein
Male pattern baldness
Heredity
Female hormones
Anemia
Hypothyroidism
Autoimmune-related hair loss
Fast and dramatic weight loss
Chronic illness
Chemotherapy
Anti-depressants
Blood thinners
Over styling
Aging
Pulling your own hair out
And….Anabolic steroids

Many of these causes are temporary or reversible. So when the factor causing the hair loss is removed than your hair will typically return. Today, I’m going to look at the most common form of hair loss. I’m going to be focusing on androgenetic alopecia or what is commonly known as Male Pattern Baldness, though as mentioned earlier, it does also effects 30 million women and is called female pattern baldness.

For men, the cause of hair loss is more well-known in that testosterone somehow goes through a conversion to dihydrotestosterone, or DHT. Now the problem with DHT is that it shrinks the hair follicles so that the actual hair becomes thinner. It’s technically called miniaturization. What causes this conversion is still being researched though there is a strong genetic component. Recent studies suggest that it may be caused by an abnormal amount of a protein called prostaglandin D2 in the scalps of men. This seems to be a factor in blocking the growth of hair. The bottom line is that in male pattern hair loss there is a slow, but steady receding of the hairline over the course of your lifetime. This can result in total baldness or the eventual loss of hair on the crown of the head while you still cling to the hair on the sides and the back.

For women, the female pattern baldness also exhibits a typical pattern and is caused by hormones, aging and genes. It can be harder on you ladies because it is a lot less socially acceptable for a woman to be bald, as a man. The causes are less known for women though there is a strong hormonal and genetic influence. Luckily for most women, it does not cause nearly as much baldness as men. For women, it’s typically more of an overall thinning while men usually experience a receding hair line, leading to a steadily growing bald patch which eventually envelopes much of the head like a polar ice cap in winter. The bottom line is that both men and women baldness patterns are caused by the thinning of the hairs in the follicle, called miniaturization, as mentioned earlier.

Treatments for hair loss heavily favor us guys. Women are in a real catch 22. First, let’s take a look at minoxidil topical solution, better known as Rogaine.

Minoxidil has been used for decades as a treatment for high blood pressure. People started to notice that when using minoxidil that they were starting to grow hair in places that they had previously lost it so, 2% minoxidil has become the main drug of choice for women to restore hair loss. The results are usually mixed with the potential results peaking around the 6 months point of use. According to Johnson & Johnson, 80 percent of women experience hair regrowth up to 48% thicker than prior to its use. In truth, there is a wide range of results for women but it’s for the most part the only game in town. And for both men and women, if you stop using it than all the hair regrowth will abandon you likes rats on a sinking ship.

For Men, they upped the percentage to 5% because it’s more manly and then put in a foam solution which appears to cause less scalp irritation. Still, the results are quite mixed. This solution is now available for women too.

Only 38% of patients report significant improvements so this is definitely not the magic bullet for most people. It seems to work best at holding on to the hair that you already have.

There are some potential side effects too that you should be aware of. It’s safe for the most part, but may cause a difference in hair color and texture from your surrounding hair. Another possible side effect is hypertrichosis – excessive growth in the wrong places. By wrong places I mean cheeks and the forehead. I would think that this would far outweigh any positive benefits to hair in the right places.

So now let’s take a look at Finasteride, better known as Propecia, which is really the only medically proven treatment for hair loss on the market though it’s not approved for women because the hormonal mechanism for hair loss is different in men than women. It actually works by inhibiting the enzyme that converts our beloved testosterone into the hated dihydrotestosterone (DHT), the hormone that shrinks the hair follicles in men.

Most studies show that Propecia is fairly safe and very effective for treating mild to moderate hair loss in men, particularly those between 20 and 61. Studies show that the hair growing benefits may continue to improve for up to 10 years. According to some studies good results of the first year of use may predict a better overall long term experience. But…and this is a HUGE but…The possible side effects which seem to affect about 6% of users, include impotence, loss of libido, swelling of the hands or feet, swelling of breasts, dizziness, weakness and headache, Symptoms seem to diminish with continued use. I wouldn’t call these minor side effects too. What would you prefer, a good sex life or more hair on your head. To me, it’s a no brainer.

Another possible side effect according to a June 2011, FDA released safety announcement is that finasteride may cause the most serious for of prostate cancer which is very aggressive and may spread to other areas. This risk appears to be low but you should know about it. Oh, and I forgot to mention one possible side effect of Propecia…Permanent sexual dysfunction.

Yep, there is a growing concern that long term use and then going off the drug may lead to a condition known as post-finasteride syndrome, or PFS. Now this is the stuff of male nightmares. There is a percentage of males that develop extremely adverse sexual side effects upon terminating their use of the drug. These effects include a partial to complete loss of libido, partial to complete erectile dysfunction, a decrease in the size of the penis, and resulting depression, which is completely understandable. Some men have reported neurological side effects too. The really scary part of this is that this condition could last for years and actually be permanent in some users to the point where they describe themselves as sexual zombies. There are some class action lawsuits pending against Merk because of this. Now that is food for thought and cause for serious reflection when it comes to using this drug in the first place. I’d do my homework if I was considering going on this drug.

Again, the women get the short end of the stick here. For women, Spironolactone, a drug used to treat high blood pressure and heart failure, may have some beneficial results for hair restoration but the common side effects include vomiting, dizziness, headache, breast pain and irregular menstrual periods along with vaginal bleeding. Hardly what I’d call a miracle drug so I’d have a long chat with my doctor before running to the drugstore with this prescription.

 Hair transplantation

Hair transplantation is a surgical procedure where the hair on the sides and or back of the scalp, which is considered permanent, is moved to the areas of the scalp that are thinning and or bald. The hair will continue to grow for the patient’s lifetime. Hair restoration is a good option for 90% of the balding men but unfortunately its not the same story for women. Very few women have the same type of hair loss as men where there is a fairly thick forest of hair on the sides and back to harvest for the crown of the head. Women tend to have a more overall thinning and thus more thinning on the sides and back which are the usual donor sites. The result is that the hair used to re-forest the thinning areas tend to fall out. Also, women have more of a thinning type of hair loss so the hair transplants don’t increase volume…they just add more hair to places that don’t have hair. So women get the short end of the stick here too.
There are two types of hair transplantation that have been proven to be effective, predominately for men, of course.

Follicular Unit Transplantation (FUT) – In FUT hair follicles, consisting of one to four hairs are removed from a small strip of hair from the side or back of the skull, separated and then planted like turnips into tiny slits in the scalp. If well done, this can result in very natural looking hair. This technique tends to result in a thicker head of hair but there may be a linear scar from the area that the strip was harvested from. This could be particularly visible with shorter hair.

Follicular Unit Extraction (FUE) each individual hair follicle directly from the scalp using a special instrument called a john Deere scalp harvester…just kidding. I don’t know what it’s called. Then the little hair follicle sprout is planted in small slits in the scalp just as in the FUT method. This technique does not produce a linear scar, which, as I said, may be a side effect of the FUT method.

There is another high-tech sci-fi method used for the FUE method utilizing the ARTAS robotic system which is a computerized image-guided robot that automates the labor intensive process of plucking hundreds or thousands of hair grafts in a session. It tends to be more precise and therefor more consistent as most robots are.

So, How do you know if you’re a candidate for FUT or FUE hair transplantation? First of all, this is not a technique to prevent hair loss. It is meant to be a means to replace lost hair after yours has migrated south, so to speak. And, as mentioned earlier, this precludes a lot of you ladies due to the different hair loss pattern that you experience as compared to us guys.

So, the good news for most of us boomers is that there is no window that will be lost by waiting for your genes to do the job of clear-cutting your scalp. You also need to have enough hair on the sides and back to provide for the needs of planting your hairy crop on the topside. If you’re very light on the sides already than you would only be sending the bald areas south…which would make for a very odd look.

The procedure typically takes around 4 – 8 hours and in about 2 – 3 weeks all of the transplanted hair will all fall out, but don’t freak. New hair will start to grow in after a few months. Most people experience about 60% of new growth in about 6 – 9 months.

Of course there are risks with this procedure too, including surgical complications, infections, scarring, poor density and bizarre and unnatural looking results. You don’t want to end up looking like the head of a betsy wetsy doll. The techniques used now are way better than the techniques used decades ago so the outcome if done by a competent practitioner, can look very natural.
Hair transplantation typically costs around $4,000 – $15,000 and is surprise, surprise, rarely covered by insurance.

Another option is Laser Therapy which can be beneficial to prevent hair loss in both men and women. Studies show it to be on about the same level as some topical hair loss medications and can be especially useful when used in conjunction with these medications. Some physicians completely reject its use for hair loss. Others see it as beneficial when combined with other treatments such as hair transplant surgery. There are several different modes such as caps, helmets and combs. Many women opt for laser therapy combined with topical therapy with varying degrees of success.

Now Platelet Rich Plasma (PRP) or sometimes referred to as Vampire PRP is relatively new and is presently being used with mixed results. It is not approved by the FDA and doctors can’t claim its effectiveness. Platelet rich plasma (PRP) is concentrated blood plasma which contains approximately three to five times the number of platelets found in normal circulating blood. In addition to the platelets, it contains growth factors and other bioactive proteins that aid in wound healing and hair growth. PRP is used to halt or reverse miniaturization, the process that causes common baldness. The procedure is relatively quick, pain-free and safe.

The most common method is drawing your own blood to use your own plasma. Another technique uses the blood plasma that comes from the bladder of a pig and is more likely to cause inflammation. This technique works the best for people who are thinning and not completely bald. It takes 2 sessions for optimum results and costs around $3000 and it requires an annual maintenance at additional costs.

It’s worth a mention that good nutrition and some food supplements, particularly biotin and marine-derived proteins and polysaccharides may help SUPPORT hair quality, it’s not going to have much, if any effect on hereditary hair loss. Be aware of hyperbolic claims from a lot of food supplements and off the grid hair loss remedies that are really no more than snake oil type rip-offs.

What is on the Horizon for hair restoration?

Hair Cloning is a promising hair replacement therapy where your own follicles, harvested from the back or side of your head are remove, and then cloned, and then injected back into the scalp. Early results are encouraging but not ready for prime time. So far the hair may be considered “filler hair” only and may fall out after a short period of time requiring more treatments. Most doctors following this procedure seem to feel that it is a least 8 to 10 years away from actual human trials. So don’t hold your breath boomers.

Also. Scientists have developed a method using human stem cells to create new cells capable of initiating hair growth. Again, don’t hold your breath. This is probably decades away too.

Of course, I would be remiss not to mention the promise of the Sonic Hedgehog for hair restoration ? Yes, sonic hedgehog is the name of a gene that can convert resting hairs to growing hairs thus stimulating hair growth. A company called Curis is working on this as I speak. Again, don’t hold your breath for this though it may become a great video game prior to human trials.

So boomers, you can see that the whole hair restoration area is full of promise, particularly for men, but fraught with potential side effects that makes baldness look positively desirable in comparison so I’d say to make sure that you do your homework, talk to doctors that you trust, and weigh your options. I’d rather be a healthy old bald dude than a eunuch with a full head of hair. That’s just me.

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Jim Jensen