Hair Restoration Blog

Q:

Hi Doctor,

Some doctors prescribe Dutasteride (Avodart) for hair loss prevention. I know you don’t 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 guessed I cannot recommend dutasteride solely for prevention of 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.
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 tem “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?” My answer 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 - Treat 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.

Searching for the best Los Angeles hair transplant surgeon may not be an easy task, but Los Angeles has always been a referral center for most cosmetic surgeries, even though hair transplant surgery is one of the newer branches of cosmetic surgery. You can find a wide variety in style and levels of Los Angeles and Beverly Hills hair transplant surgeons. Some of the most updated hair transplant surgeons practice in Los Angeles and San Diego, California, but you can also see lousy surgeries done by some hair transplant surgeons. Overall, hair restoration surgery like any other cosmetic surgery is a buyer‚Äôs beware market, and one must be careful not to fall into the trap of signs such as “Number one Beverly Hills hair transplant surgeon” or “the most experienced Los Angeles hair transplant surgeon”. You can see similar advertisements and a lot more like Extreme make over hair transplant surgeon or doctor 90210.

The good news is that today, most hair transplant surgeons offer free initial consultation. It is importantto take advantage of this situation and shop around. It is your look and your desire to live with it for the rest of your life after all. It is not enough to visit several hair transplant doctors; you also need to educate yourself on hair transplantation process, surgical techniques and hair transplant surgeon’s background before visiting the doctor. This way, you can appreciate a good technique and knowledgeable doctor when you see one while you can find the most affordable hair transplant. US Hair Restoration – a Los Angeles hair transplant surgery center offers free physician consultation for everyone. We offer state-of-the-art hair transplant surgery with exclusive follicular unit transplants (FUT), mega sessions for people with extensive hair loss and follicular unit extractions (FUE) or noninvasive hair transplants that does not leave an scar in the donor area.

Los Angeles is Hollywood and in Hollywood “appearance” is everything. Modern hair transplant surgery with undetectable results has become a demanding field in Southern California in last few years both because of the number of people looking for hair restoration surgery and the ones looking for the best hair transplant surgeon in Los Angeles, Beverly Hills and Southern California over all. Many people travel the world to get their hair transplant surgery done in Los Angeles or Beverly Hills. Los Angeles is and will probably always be the Mecca of hair transplant surgery for people who cannot accept anything but the best.

Q:

Dear Dr. Mohebi,

I hope all is well with you and the family. I wanted to see your opinion about something. Along with proscar, I use Murad shampoo (i dont know if you have heard of it) but it supposedly strengthens your hair and brings nourishment to the hair, therefore promoting hair regrowth. Remember how short my hair was when we first met, well now its relatively longer. Do you think i should keep it short for several reasons: easier to clean my scalp, exposure to vitamin d (sunlight). When my hair is long, I can see it shed, but when its really short it doesn’t seem that way. However, the downside to cutting my hair that short is that it will become pretty apparent that im experiencing hair loss. Thanks doc! take care!

Best,

Patient’s Name

A:

I hope you are doing well. Last time we met, we decided that you wait on doing a hair transplant procedure until your pattern of hair loss becomes more obvious. Here are the answer to your questions in the order you asked them:

• Murad shampoo has following active ingredients: Pomegranate extract, artemia extract, alpha hydroxy acids, phytantriol and Saw Palmetto. From all these only the last one or Saw Palmetto is proven for its anti hair loss properties through blocking DHT. However, the rate of penetration of this ingredient on deeper layers of skin where follicles reside is not completely clear. I don‚Äôt think it hurts to use it in general, but for someone like you who takes systemic form of DHT blockers (finasteride), I am not sure it can add anything in slowing your hair loss process.
• On whether or not keeping your hair short, it is up to you, you have to try them both and decide, long hair should not create any problem with cleaning hair. Do whatever you are more comfortable with. Neither of the two can affect the speed of your hair loss. If I wanted to choose, I would kept my hair long so layering can help covering the thin areas.
• Vitamin D could be absorbed from everywhere, especially in the sunny State of California.

Again, thanks for good questions,

Good Luck and have a great weekend
Dr. Mohebi

Toppik hair loss scam, does it really work? The fibers used by Toppik are made of the same material that hair shafts are made of and that is Keratin. The fibers of Toppik bond with hair and it’s nearly impossible with the naked eye to see that there is anything on your hair. It gives the appearance of fullness that you have a natural, thick looking head of hair. This is temporary because it does not grow hair but conceals it in the short term for a special meeting, date or party. Toppik is natural and safe and can eliminate the appearance of balding or thinning in only a certain group of patients.

The people who can get the most of Toppik are the ones who have hair with some degrees of miniaturization or thinning. If the hair is totally gone like in higher classes of baldness, Toppik does not help. Toppik needs some hair to be bond with to create the appearance of fullness.

A scam is only realistic if you want to believe in it. We all know that hair loss is a bitter truth that affects many men. Men do anything to improve their appearance and hid their baldness. There are many methods that can help someone with hair loss to improve the appearance of his hair including hair transplant surgery and medical treatment for hair loss. Cosmetics like Toppik offer another way to deal with the hair loss problem.

Toppik for hair loss is a scam or not, does not really matter. The fact is that you should do whatever makes you feel better about yourself. Hair restoration is a proven treatment for psycho-social adverse effects of baldness. If you can use any other method such as Toppik to look better and feel better, why not trying it?