Hair Restoration Blog

Q:

Hi Doctor,

My mother is obsessed with my hair loss and gives me a whole bunch of vitamins and mineral tablets everyday to help regrow my hair.
Do you think they work? Or should I stop them.

A:

Although lack of certain vitamins and minerals could cause hair loss in their sever form, living in north America and having a normal and balanced diet; it is unlikely that you are suffering from vitamin or mineral deficiency. On the contrary, if you look at your family pattern of hair loss, you probably can find other male members of the family who has similar male pattern hair loss. As I always say, you need to have the triangle of baldness, which is “Gene, Male gender, and time” to become bald. Vitamins deficiency is not to blame as part of triangle of male patterned hair loss. You can continue taking vitamins to please your mom, but don’t overdo it since vitamins are not going to bring your hair back. Instead you need to see a good hair specialist or dermatologist and undergo a good hair loss evaluation with miniaturization study and start taking one of the effective medications to prevent further hair loss or to use hair transplant to restore your lost hair.

Q:

I underwent a gastric bypass surgery about 2.5 years ago and since a few months after surgery my hair has been thinning. What do I need to do to prevent further loss?

A:

Losing hair or changing the quality and color of hair after gastric bypass surgery is commonly seen within the first few months after the gastric bypass surgery. This condition can mimic shock loss that could be seen after hair restoration surgery. Right after the gastric bypass surgery your body goes through a period of severe starvation and tries to divert nutrients toward more vital organs instead of skin and hair. Although carbohydrates, proteins, minerals and vitamins especially the family of vitamin B has been blamed for the hair loss in patients who had gastric bypass, it can happen while all of those elements are within normal range and the exact mechanism of hair loss after gastric bypass surgery is not completely known.

The great news is that the hair loss after a gastric bypass surgery is always temporary. Your hair condition should return to normal within a few months of hair loss occurrence. Patients who had gastric bypass should have serial examinations within the first few months of their gastric bypass. Your surgeon should check many elements because gastric bypass surgery could increase the incidence of iron, folic acid, vitamin B12, calcium, and vitamin D deficiency. Most people need to stay on supplementation of these minerals and vitamins. Close monitoring with regular laboratory tests for these deficiencies should be done by your surgeon or primary care physician.

Q:

I have heard high estrogen in males can contribute to hair loss. Is that true? I am a 40 year old man with low sex drive and female patterned hair loss.

A:

High levels of estrogen in men could be seen in many other conditions such as estrogen-producing tumors, congenital adrenal hyperplasia, chronic alcoholism and advanced liver disorders. Elevation of estrogen in men can cause sexual dysfunction, change in body fat distribution in a female pattern and breast enlargement and secretion.

Balding is not a typical sign of excess estrogen. In fact one of the signs of estrogen deficiency could be hair loss in female patients. A common type of this kind of hair loss is seen in telogen effluvium that women lose hair due to sudden drop of estrogen and progesterone levels. Although excess estrogen is generally not the trigger for hair loss, it can affect the balance of other hormones and indirectly cause hair loss. The latter is not a common cause of hair loss in men or women though.

Q:

Hi Doctor,

Some doctors prescribe Dutasteride (Avodart) for hair loss prevention. I know you do not recommend Dutasteride for hair loss for obvious reasons, but based on available research findings on this medication, what do you think are the most likely possible side effects from using Dutasteride if worse come to worse. Would it be like multitude of finasteride side effects? Again, I know your view of non-FDA approved drugs.

A:

Dutasteride (Avodart) is one of the selective inhibitors of the type I and II of the enzyme 5-alpha-reductase, the enzyme that converts the male hormone testosterone to 5-alpha-dihydroxytestosterone (DHT). In comparison with dutasteride, finasteride (Propecia) acts as an inhibitor of just type II of the enzyme 5-alpha-reductase, which is more specific. Studies around dutasteride mechanism of action shows that, blocking both type I and type II enzyme can be more potent that only one in reducing the levels of DHT in the body.

If you are taking dutasteride for other indications, you may get some hair growth as a good side effect. As you may guess cannot recommend dutasteride solely for prevention of male patterned hair loss; not until it is approved for hair loss treatment by FDA. Other than not being FDA approved my other reasons are:

1. The optimum dose of dutasteride for hair loss prevention is not determined.
2. The side effects of dutasteride are much more prominent comparing to finasteride.  That include the negative effect of the medication on sex drive in men.
3. If you are considering the cost effectiveness of dutasteride, with new price reduction of finasteride that should not be in the picture any more.

Q:

I have diabetes. Can I have a hair transplant procedure?

A:

Patients with diabetes can successfully have a hair transplant surgery if diabetes is under good control. Diabetes used to be a life limiting disorder and diabetic patients could not have many elective surgical procedures due to their increased risk of wound complications and infection. With the new medications and methods for controlling diabetes, patients with diabetes can safely have hair transplant surgery or any other elective procedures without significant increased risk of infection or complications with their healing phase. Here at US Hair Restoration, we need to have a clearance from the doctor who follows patient for his/her diabetes to make sure patient’s blood sugar is in normal range and diabetes is effectively controlled.

Dear Dr. Mohebi,

I was doing a quick research on the hair loss solution, that I came across your weblog. I wanted to ask you regarding my hair loss problem. I am 28, with history of hair loss in male members of my family. My hair loss started more than 10 years ago, and I started using Minoxidil (first 2% and then 5%). At the time, I was told that Minoxidil will just postpone the total hair loss. Well, I never went bald that much. About four years ago, I started taking Finasteride 1mg, and I think it worked out really well. But the concerns regarding the side effects for men made me stop it about a year ago. Now, I am seeing more hair loss. I was just wondering how careful should one be in taking Finasteride, especially when all the researches are doomed to an inherit uncertainty, and that the side effects might prove much more severe only in future.

So, I would appreciate if you please advise me and let me know about the solutions that is out there for my case.

Thanks very much,

Patient’s name

A:

I understand your concern. You have stopped finasteride (Propecia), despite of experiencing good results. Finasteride has been out in the market and widely used for prevention of hair loss in past 10 years. Finasteride has a few side effects that they are all reversible with discontinuation of the drug. The most problematic side effect of finasteride is decreased libido that if occurs should go away in about 3-7 days after stopping the medication. I have seen this side effect mostly in elder patients who recently start taking finasteride. I have never seen any patients who won’t recover from this side effect within a few days. In fact, instead of stopping the medication, I usually change the dose to half or prescribe it in alternate days and that way I have been able to manage the side effects in the most cases.

You are concerned with delayed Propecia adverse effects that may have not been discovered or reported and could potentially be a cause for concern in the future. That could be brought up for almost every medication, but I believe we had better stick to the proven facts. All medications that are used in the United States are regulated by the FDA after thorough evaluation of solid results from extensive clinical research.

There are other medications that are prescribed by some doctors for hair loss treatment. Some are currently being evaluated for hair loss prevention such as Avodart (dutasteride), which works through a mechanism similar to Propecia. Avodart is even more effective for hair loss prevention in comparison with Propecia, but it also causes more side effects and that is why the FDA has not yet approved it for hair loss treatment. I do recommend Propecia to most of my patients with male pattern baldness because even if you want to treat your hair loss with hair transplant, you are still better off doing a lesser number of sessions and preserve your own natural hair as much as possible.

Q:

Is Hair cloning or multiplication being done anywhere yet?

A:

Hair cloning or multiplication has been in the news in the last few years. I prefer to use the term hair multiplication, rather than cloning because cloning refers to production of genetically identical organisms. Dolly the most celebrated sheep was the product of first cloning. When it comes to hair, we do not really clone the cells, but we culture them and try to get a whole organism from cultured cells. Unfortunately the process of culturing hair follicle cells has not been as simple as some other tissues in human body. The complexity of hair physiology is due to participation of many different stem cells in development of each hair follicle. In this process, we do not multiply genetic material or DNA of cells.

Hair cloning news

Hair multiplication if become a reality could bring about a great opportunity for bald people with violated donor scalp who cannot be good candidates for hair transplantation with current techniques. Despite our enthusiasm about hair multiplication, hair cloning news in last few years has not been filled with many success stories.

Hair cloning 2007

Year 2006 intercytex company announced that they are going to start phase 3 of hair multiplication study soon. Hair cloning has been in the news and many people are eagerly following that news to see when and how they can get a full head of hair using hair cloning techniques. Unfortunately, cloning hair has not been going that well and in last few years we only had limited research results on hair multiplication in animal models and in human. Here is the question that people usually ask me: Is hair cloning being done anywhere yet? And my answer usually is: Not except on experimental levels. Several investigations are in process on hair multiplication field and hair stem cell research.

Hair cloning 2008

Hair multiplication or as people call it hair cloning is a method that allows us to culture hair follicles and multiply it so we can increase the final number of hairs. So far, we know that it is doable on animals, and there are some reports of its feasibility on human volunteers. Safety has been one of the biggest questions on any research involved with stem cells. Stimulating growth of stem cells has always raised the flag for possible tumor formation. In year 2008, we should witness some results of the phase 3 studies on the procedure. During this year or in next few years, we should have a better understanding of the effectiveness and safety of hair multiplication. I know many of my patients are following hair cloning news carefully. Unfortunately, hair multiplication news has not been very fruitful in last year, but the process is complex and one way or another it will become clear in next few years that we can or cannot use hair multiplication methods in hair restoration surgeries.

Q:

How are you doing? All I have to say is TGIF.

I was doing a little bit research on hair loss, and I stumbled over retinoic acid. I read about it and have a basic understanding. Have you heard any claims that it could possible revive hair loss?

Have a great weekend!

A:

This is a good question. There are several claims on therapeutic effect of all-trans-retinoic acid (tretinoin) alone and in combination with 0.5% minoxidil for hair loss based on limited studies.

In one study the combination of tretinoin and minoxidil was used for 56 patients who had androgenic alopecia (male pattern baldness) and hair growth was followed. The growth of terminal hair was studied after one year of treating balding scalp with combination of topical tretinoin with 0.5% minoxidil. Increase in hair growth was reported in 58% of the patients who could complete the study.

Although tretinoin has been stated as a promoter of cell proliferation and vascular creation, which are both important in hair growth, there is still not enough scientific evidence from large studies to prove these effects. Also double blind studies on the efficiency and adverse effects of the product is lacking.

Alopecia areata

Alopecia areata is an autoimmune condition and causes patchy hair loss in any area in body. The bald areas of the skin usually look normal with no gross evidence of irritation or inflammation. A genetic association could be found in some cases and it could also be linked to other autoimmune disorders. Alopecia areata is usually a self limiting disease, but could be treated by a dermatologist with injection of steroid or with topical medications if necessary. See my article on alopecia areata “Treatment of Alopecia Areata РTreat or Not Treat”

Traction alopecia

Traction alopecia is very common cause of hair loss in children. This condition that is particularly seen among girls happens mostly due to the fragility and weakness of hair follicle in children. Tight ponytail is the common cause of traction alopecia that can cause hair loss at sides and frontline in most cases. Traction alopecia could present with elevation of hair line as an initial sign. Treatment of traction alopecia of children is by cutting hair short and by eliminating the physical assault. Recovery is generally spontaneous, and may take a few months. In some cases of prolonged traction alopecia, damage to the hair follicles could be permanent and hair transplant might be necessary.

Tinea Capitis

Tinea Capitis is a fungal infection of scalp that affects head and neck hair. Approximately 3 to 8 percent of American children are affected. Many of these children are never diagnosed. Tinea Capitis is more common in children between 2 to 8 years of age and like other fungal diseases can be transferred through direct contact or contaminated comb, brush, towel and cloth. Fungus attacks hair shaft and decrease its integrity and makes it fragile. Again a good dermatologist should be involved for treatment of this condition, which may need systemic antifungal medications.

Trichotillomania

Trichotyllomania is one of the other common causes of hair loss in children. It is a compulsive disorder that the patient has a constant urge to pull his or her hair. It is not limited to scalp hair and could be seen in any hair bearing area. Parents are not aware of this condition in many cases and treatment is through psychotherapy and behavioral therapy. Most cases resolve completely after treatment of the compulsive disorder.

Telogen Effluvium

Telogen Effluvium could be seen in adults and children. Many factors like sever infection, big surgery, trauma, fever, and emotional distress will cause this condition through converting the growth phase of hair follicle into resting phase. The hair in resting phase starts to shed. This hair loss is typically self limiting and recovers spontaneously without treatment especially in children. Diagnosis of this condition is often through excluding other causes of hair loss. Complete recovery is expected within 4 to 6 months.

Q:
Our 2 year old son has very fine hair and his hair growth has been very limited around his scalp. Is he going to lose his hair or you think his hair may grow as he gets older? Is there anything we can do that his hair gets better.

A:
Hair loss in children is generally not associated with their pattern when they become adults. In fact, most hair loss cases or limited growth patterns during the first two years is hereditary and if you search child’s family hair growth pattern, you should be able to find similar pattern in other family members when they were that age.

Children’s hair loss usually resolves spontaneously in vast majority of children. Other than congenital hair loss of children, they may lose hair due to a variety of other causes including: Alopecia Areata, Traction alopecia, Tinea Capitis, Trichotillomania, or Telogen Effluvium due to different disorders. Although most types of hair loss is self limited and resolves without treatment, any child with a hair loss should be evaluated by a dermatologist to rule out treatable causes of hair loss.