Month: January 2011

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In the News – Balding and Stem Cells – Balding Blog

Snippet from the article:

An inability of stem cells in the scalp to develop into the type of cells that make hair follicles may be an underlying cause of male-pattern baldness, according to a new study. The discovery gives hope that people who are bald could regrow their hair with a future treatment, said study researcher Dr. George Cotsarelis, a professor of dermatology at the University of Pennsylvania.

In people who are bald, hair follicles have shrunken and become microscopic, Cotsarelis said. And scientists long thought that bald people also had a depletion of hair follicle stem cells, which are necessary to grow hair.

But the new study shows that bald people have the same number of stem cells as those with hair. So if scientists could coax the stem cells into producing more hair follicle progenitor cells, then it would be possible to generate bigger hair follicles that could grow hair, he said.

Read the full story at Livescience.com- Balding may be a stem cell problem

Our work on using plucked hair to grow a new hair in the balding area may touch on the subject material mentioned in that article. With new hairs growing from plucked hairs, does this mean that the new hair came from the plucked hair and its stem cells — or do the stem cells in the recipient plucked hair area stimulate the original hair to grow from “the stem cells which were unable to complete their normal development and become hair follicle progenitor cells“?

There is still much to learn here, but we have suspected for a long time that the bald areas contain the elements that can grow hair, but because of various defects that are described in brief in the reference here, they just don’t grow. I can imagine that some day we will harvest stem cells in enough quantity such that injecting them into the bald skin may bring back the original hair and cure baldness permanently. More research is surely needed and being done as this is the big lotto hit.


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TV Chef Gordon Ramsay’s Hair Transplant – Hair Loss Information – Balding Blog

Check this out:Keep it under your hat but Gordon Ramsay’s had a £30,000 hair transplant

They mention that chef / TV personality Gordon Ramsay had a hair transplant using a “radical new treatment” called follicular unit extraction that “leaves no scars”. The press is so uninformed about things they report on sometimes. Hasn’t FUE been around for like a decade? What’s radical about it now?

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Gordon RamsayOf course, you know that I pioneered follicular unit extraction (FUE) and published the first article in the medical literature on the technique in 2002. As for why the press is misreporting information, I don’t know why it happens. Perhaps it’s just laziness on their part.

FUE is far from a radical technique and it is incorrect to state that it leaves no scars, as anytime the human body is cut upon, there is ALWAYS a scar to some degree. The difference here between traditional hair transplants with strip harvesting (which leaves a linear scar) is that FUE leaves punctate scars that can be seen through the hairs in the donor area if the scalp is shaved very close there. Most people who have longer hair do not have visible scars, but that does not mean that it “leaves no scars”.

Good luck to Gordon Ramsay for the courage to address his hair loss concerns.

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In the News – Interview with Dr. Christiano in NY Times – Hair Loss Information – Balding Blog

Snippet from the New York Times article:

Angela Christiano, 45, an associate professor of dermatology and genetics at Columbia University Medical Center, studies hair. Last summer, she announced the discovery of the genes implicated in alopecia areata, the hair-loss disease that she herself suffers from. The interviewer spoke for two hours in her Washington Heights laboratory and then later on the telephone. An edited version of the two conversations follows.

Q. When did you first learn that you had alopecia?

A. In 1995, a time of big transitions in my life. After doing highly successful postdoctoral research on genetic blistering skin diseases at Jefferson Medical College, I’d arrived here at Columbia to start my own laboratory. I had just turned 30. I was getting a divorce. When you start your first lab, a researcher is expected to find something different from their postdoc work. For my first six months here, I sat thinking, “What am I going to do when I grow up?”

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Dr. ChristianoRead the full interview [login required] — Living and Studying Alopecia

Dr. Christiano is among the top doctors in her field, and her advances made in the understanding of alopecia areata (and thus future treatments) are to be applauded. I particularly admire her, because she is a person who identified a problem and made the decision to understand it as thoroughly as anyone.

The NY Times article may require you to login (it’s free to create an account), but it’s a good read for anyone interested in Dr. Christiano’s story.

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Patients with DPA Can’t Get a Transplant? – Hair Loss Information – Balding Blog

In response to: Is Taking Propecia to Prevent Shock Loss an Indefinite Necessity?

I’m confused by Dr. Rassman’s response to this question. For the longest time you have written that sufferers of DPA have a stable permanent zone and they can usually can receive a transplant at the appropriate time. You’ve written that it’s suffers of DUPA that aren’t appropriate candidates for transplantation. Has something changed?

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Nothing has changed. We always look to the health of the permanent zone when considering if someone is a candidate for a hair transplant. We weigh the balance between the supply of hair from this permanent zone and the demand of hair from the balding or thinning area.

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Hair Cycling and Miniaturization – Hair Loss Information – Balding Blog

Question about the balding process…

My understanding of how we bald is that an individual hair follicle will start miniaturizing. It can go through many further cycles, but it will eventually become shorter, thinner, smaller and eventually non-existent. Is that correct?

If so, when we do see relatively thicker, longer and healthier looking hair shed/fall out, we shouldn’t assume that hair will never grow back, right? Rather, that’s just part of the natural cycle of hair growth.

Thanks in advance.

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You are essentially correct. As it miniaturizes, hair becomes thinner and eventually ceases to regrow. Note the diagram on this page to see what miniaturization looks like in various stages.

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Propecia and Healthy Sexual Function in Men? – Hair Loss Information – Balding Blog

Hi Doc, I had a question about finasteride, because I’m thinking of starting Propecia for hair loss and I’m worried about the sexual and other side effects. Basically, what is more responsible for healthy sexual function in males? DHT or testosterone? If testosterone is responsible, then shouldn’t Propecia help to increase sex drive – because speaking from a chemistry perspective, if Propecia reduces the forward reaction rate of the reaction that converts testosterone to DHT, then shouldn’t that lead to excess testosterone in the body? Unless Propecia inhibits testosterone as well?

Because I don’t understand how herbal DHT inhibitors like Procerin claim to have no sexual side effects, if they ultimately perform the same function. Unless of course there are other factors into play which I’m unaware of.

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We have written about this over and over. Here’s some bulletpoints:

  1. See your doctor (as only a physician can prescribe Propecia) and ask him/her these questions in detail after they take your history and examines your scalp to determine that Propecia is something that would be recommended.
  2. Propecia has a side effect of decreased erection/libido in 1 to 2% of men. This side effect has been greatly exaggerated on the Internet. Moreover, many other drugs that treat blood pressure from cholesterol lowering drugs (any many other drugs) can also develop depression and have a similar negative sexual side effect.
  3. If you have a negative side effect, talk with your prescribing doctor and you may choose to stop taking Propecia. The side effects are reversible.

We can all hypothesize about the biochemical reaction of Propecia and testosterone and DHT, but in the end it works for male pattern baldness… and ultimately it is your choice to take it. I do not mean to brush off or not answer your question on the mechanism, but it will spiral us down a never-ending hole of “if this” and “if that”.

Healthy sexual function in men has nothing to do with drugs, Propecia, testosterone, or DHT in normal men. If you are a healthy individual in a healthy relationship, then you should have a healthy sexual function with or without Propecia. Propecia will not enhance or impede your sex life or health in greater than 98% of patients. If you think it does, then talk to your doctor. Of course, if you have your testicles removed, then you will have reduced testosterone and DHT, and will have wiped out your sex drive. DHT comes from the degradation of testosterone in the body, so if you do not make testosterone, then you will have very, very low levels of DHT.

Procerin is not a medication or a drug. It is a clever marketing name for an over-the-counter herbal product (saw palmetto) that sounds similar in name to Propecia. Procerin is not regulated by the FDA, nor has it been proven to actually treat hair loss.

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Ethics in Medicine – What Do Doctors Do? – Hair Loss Information – Balding Blog

In a recent ethics article summarizing questionnaires from 10,000 doctors, the findings showed that doctors are human with the limitations that go with it. From the article:

“Honesty is the best policy” and “the patient always comes first.”

As absolute and correct as those aphorisms may be, they can be hard for doctors to apply in the complex world of modern medicine.

A recent Medscape medical ethics survey of over 10,000 physicians found that when it comes to patient treatment, a significant number of physicians struggle when it comes to topics relating to honest, straight-forward communication, and even pain management.

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Areas that are particularly focused and difficult to deal with include death and the ability to openly discuss the subject of death with patients. The article continues:

From the patient’s point of view, “If I don’t know my time is limited I can’t put my affairs in order. I can’t say, ‘I’m sorry,’” …. What’s more, “it’s not like patients are asking Dr. Kildare, ‘What are my chances, Doc?’ Patients are increasingly educated. If you don’t tell them, they’re going to be looking it up on the internet the next day, so you should probably be the source of the data, because you’re a human and you care about them.”

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Read the full story at Medscape — ‘Doctor, Are You Telling Me the Truth?’ Exclusive Ethics Survey Results

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Australia Hair Transplant Recommendation? – Balding Blog

Hi, im from Australia. Unfortunately i can’t come visit you for a consultation due to the distance and all, so i was wondering, if you could suggest any hair restoration clinics here in australia, or doctors? I heard Dr. Richard C. Shiell is good? any suggestions?

thanks in advance

I rarely give specific endorsements of doctors. I would suggest you see as many doctors as possible, find a fit with your personality, and ask the doctor to see their patients results in person. Before/after photos may be a good starting point, but nothing compares to seeing results in person and speaking with unbiased past patients.

Also, I believe that Dr. Richard Shiell has retired from surgery, but there are physicians at his clinic that he trained. You shouldn’t consider this a personal recommendation, but it might be worth researching it further — Shiell-Knudsen Clinic. Or you can find other doctors in your area by using the physician search at ISHRS.org.




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Hair Loss from SSRIs? – Hair Loss Information – Balding Blog

I’ve seen several sources on the internet saying that SSRI’s like Zoloft CAN cause hair loss. But how likely are they to cause hair loss in terms of percentages? Do they have a 10% chance to cause hair loss, or maybe a 20% chance?

I’m a 31 year old male and have been taking Zoloft for the past 6 or 7 years, often at 250 milligrams, or 2 and a half pills per day. Whenever I got out of the shower, I always noticed that hair would be clogging up the drain. However, I never worried about it because I never looked like my hair was thinning or balding. Now though, my hair has been noticeably thinning for about 1 and a half years with a receding hair line on both sides and thinning on top and in front. Is it likely that taking Zoloft over an extended period of time caused me to lose hair at such an early age? Or could the Zoloft have caused male pattern baldness to affect my hair sooner (at 30 years old) rather than later? Could that likely have happened?

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ZoloftAs we’ve said over and over, the most common cause of hair loss in men is androgenic alopecia (AGA). This is often referred to as male pattern baldness (MPB). It’s a genetic issue and just as the term implies, the hair loss happens mostly at front and top (as you describe, in a pattern). Certainly many medications may list “hair loss” as one of its MANY side effects, but medications are often the last culprit. In other words, your loss may be completely unrelated to the medication.

There is no documented percentage of patients who experience hair loss from SSRIs that I am aware of, but in the end you need to speak with a doctor about this. With your doctor, you can discuss your options and obtain a good diagnosis of your particular cause of hair loss.

On a side note, for those who are always preoccupied about the sexual side effect risks of Propecia (1-2%), I believe SSRIs have a much higher percentage of sexual side effects than Propecia has.