Hair Restoration Blog

What is Saw Palmetto?

Saw Palmetto is an extract of the fruit of Serenoa Repens. It is rich in fatty acids and phytosterols. It has been used in alternative medicine for a variety of indications, most notably benign prostatic hyperplasia (BPH).

Indications:

Prostate treatment

Saw Palmetto has also been used in treatment of benign prostatic hyperplasia (BPH), a condition known by enlarged prostate size to the degree that it makes urinating difficult.

Hair loss prevention

The role of Saw Palmetto in hair loss prevention has also been documented. Saw Palmetto is one of the few effective herbal treatments that can reverse hair loss process in some people to some degree and slow down the process of  balding in men. Saw Palmetto bio active ingredients prevent conversion of testosterone into dihydrotestosterone (DHT).

That is how Saw Palmetto helps to stop the process of balding on the hair follicle level. It can help increase the thickness of miniaturized hair and make them grow longer. The Saw Palmetto effect is comparable to finasteride or other DHT blockers by mechanism. Saw Palmetto is available in oil extract for topical use on scalp or as pills used for prostate enlargement treatment.

Demodex folliculorum is a widespread skin parasite.  Demodex folliculorum is a microscopic creature in the form of an elongated and jointed worm.  Demodex folliculorum could be found on the skin surface, particularly on those parts of the skin with large sebaceous glands and on individuals affected with acne or seborrhea oleosa.

Demodex feeds on the oil and skin sebum so the more sebum the greater the number of Demodex folliculorum. While it is sometimes found on the surface of the skin, it is more commonly encountered in the substance of hair follicle comedo plugs, where five to twenty worms may be discovered in a single follicle. A similar species which is considered to be a variety of that discovered upon the skin of man infests dogs, mice and other mammals. However, none of these related demodex species are known to be transmissible to humans.

Demodex folliculorum infection is very common and around 80% of the adult population, both men and women, have a Demodex folliculorum infection. It is believed that the frequency of Demodex folliculorum is less in children.

There have been sporadic claims made about Demodex folliculorum and hair loss for over many years. Quite recently a theory has been put forward that patterned baldness could be associated with infection of hair follicles by the Demodex folliculorum parasite. By infiltrating the sebaceous gland of hair follicles the parasite causes an immune response and inflammation of surrounding tissue - so it is claimed. Through long term invasion, the parasite “exhausts” the hair bulb and shifts the hair cycle from anagen to telogen so more hair follicles stay in resting phase rather than growth phase.  That means less hair is seen on the scalp at any given time.  This theory is promoted by certain companies that just happen to have a range of products that destroy Demodex folliculorum. At least one of the companies has conducted research that allegedly showed 88% of 240 men (more than its rate in normal population) with male patterned baldness had Demodex folliculorum infection in their hair follicles. However, there are several problems with this theory:

1. Eighty percent of the normal population has Demodex folliculorum whether they have hair loss or not. The company conducting the research conveniently forgot to study normal haired people to find the frequency of Demodex folliculorum in people with a full head of hair.
2. Research has shown that there are frequently excessive numbers of the Demodex folliculorum parasite in eyelash follicles. However, people with pattern baldness do not lose their eyelash hairs.
3. There is a clear bias towards men having pattern baldness hair loss even though women are equally susceptible to Demodex folliculorum infection and at least some children are also infected. If Demodex folliculorum infection was causing inflammation that pushed hair follicles into telogen then one would expect to see some children with pattern baldness and women would be equally affected with hair loss. Indeed, women have a stronger immune system and so one might expect more women than men to have pattern baldness, but this is not the case.
4. If Demodex folliculorum was a key cause of pattern baldness it would be impossible for hair follicle transplants to work. Given thousands of transplant procedures are done every year and 80% of men have Demodex folliculorum infection, then most of the men with hair transplants must also have a Demodex folliculorum infection. In a hair transplant, follicles are moved from the back of the head to the top of the same individual. If the individual is infected with Demodex folliculorum one would expect that the transplanted follicles would either already be infected, or become infected in their new location. However, transplanted follicles grow in every individual who has had the procedure done and pattern baldness does not redevelop.
5. there is a widely available treatment to Demodex folliculorum infection called pilocarpine gel. However, using this gel on the skin does not promote any hair growth.

A theory for Demodex folliculorum infection in people with pattern baldness is that the sebaceous glands of alopecia affected hair follicles become larger and more active, producing oils at a faster rate, under the influence of dihydrotestosterone (DHT). The oils combine with dead cells from the hair follicle to make sebum. The sebum is a rich source of nutrients and this is the food that Demodex folliculorum eats. The oily food supply increases in most hair follicles affected by pattern baldness so these hair follicles can accommodate a greater number of Demodex folliculorum parasites. Rather than the parasites causing pattern alopecia. The parasite infection could be simply a consequence of pattern baldness rather than a cause of the hair loss.

Q:

I just had a few questions following the consultation,

As you said I have slightly more miniaturization in the crown than the donor area, but still in normal range, what would cause me to have more in one area than another other than MBP, is that normal for non MPB scalps?

• Could finasteride worsen the hairline due to the rise of testosterone, or is that irrelevant?
• Are there any safe and minor treatments to slow the progress of maturation or reverse it that you would recommend at this stage?

A:
I will be sending you a letter with all information that we discussed during our consultation at US Hair Restoration Beverly Hills Office.  You may have very initial signs of MPB, but the numbers for miniaturized hairs are not far from high normal.  Let us wait and see your progress before putting you on hair loss medication finasteride.  Early stages of male patterned hair loss may not always be obvious enough in our scalp microscopic evaluation to be differentiated from having upper normal levels of miniaturization.  Propecia (finasteride) is a great hair loss medication to prevent balding, but I know many people who went on it without the proper documentation of their miniaturization.  These hair loss patients may have to take it for the rest of their lives without knowing that they have really needed it to start with.

The main cause of hair loss is DHT (Dihydrotestosterone) and not testosterone, so finasteride can not deteriorate your hair loss or hairline maturation changes. Maturation of hairline is a natural phenomenon and should not be mistaken with balding.  We do not want to stop it.  I do not recommend any medications to stop the maturation of hairline either.

Q:

Hello,

Do you map hair for miniaturization, and are you able to tell which, if any, hairs are currently being attacked by dht, testosterone, or something else entirely such as a disease? Or should I be looking into a dermatologist?

Thinking about getting on Propecia, but I am not sure if my receding hairline is caused by dht (androgenic alopecia), or just naturally receding from testosterone. If it’s the latter then Propecia might affect my hairline negatively due to an increase in testosterone. Or perhaps something else entirely, deficiancy, or disease. Just a bit precautious and want to stay ahead of whatever is causing it.

Please advise,
thanks!

A:

Yes, as part of our hair loss evaluation, we do perform a miniaturization study on all of our hair loss patients before planning any medical or surgical hair restoration.  This helps to determine the candidacy of each individual before starting them on medical treatment.  A miniaturization study needs to be done before starting hair loss medical treatment so you have the mapping of the scalp before the treatment that could be used in the future to assess the effectiveness of the medication.  Miniaturization study also can predict your destination when hair loss is concerned.

You can call our main office at 1 (888) 302-8747 and arrange a hair restoration consultation at one of the California offices of US Hair Restoration - Beverly Hills, Encino or Orange County.  We look forward to assist you to come up with a master plan for the prevention or treatment of your hair loss condition.

Q:

Hi,
my hair is very thin, i went to a dermatologist and he requested many tests, hematological and hormonal tests, they were all normal except for the modified form of testosterone, he prescribed me chronostim, i used it to 3 months, some times i missed some doses and i noticed that the problem came back, now after i finished the 2 bottles i feel like i did nothing,i want to have thick hair without taking medications for ever…my wedding is after 2 months and i have empty areas, would u please tell me what to do? i need your help deadly?
thank you

A:

I am sorry to hear about your hair loss condition.  As we previously discussed on this website, Chronostim cannot replace oral DHT blockers for people who have male patterned baldness.  At least it has not been proven as an effective treatment of typical baldness in men.  You need to be seen by a good hair restoration surgeon and your scalp needs to be evaluated through a miniaturization study.  If you are truly suffering from androgenetic alopecia or male pattern baldness with progressing hair loss, finasteride should become part of your hair loss treatment regimen to prevent further hair loss.

Hair transplant surgery can restore the areas of obvious loss by transplanting permanent hair from your donor area or permanent zone of the scalp.  Obviously it would be difficult to evaluate your condition before having more information about your situation.

Unfortunately, with only two months to your wedding date, none of the above medical or surgical options allows you to enjoy a full head of hair by your wedding ceremony.  However you can use cosmetic products such as Toppik or microfibers to cover the balding or thinning areas of your hair for the wedding night and wait a few more months to see the actual effect of medical treatment and the growth of newly implanted hair.

Good luck,

Dr. Parsa Mohebi
Hair Transplant Surgeon

Q:

Dear Mr. Mohebi,

I would like to ask you a question concerning possible side effects that finasteride (Propecia) may cause. I read on the manufacturers instructions that broken tablets must not be handled by women who are or may become pregnant. Can finasteride cause damage to pregnant women health or to the health of the developing fetus? Here I’d like to know also if finasteride can be found in body liquids such as men’s saliva, sweat or sperm? In such case is there any risk that a pregnant woman is exposed to finasteride? Are there any recommendations concerning taking or not propecia before planned or during wife’s pregnancy?

Could you please comment on this?
Thanks in advance.

Best regards,

A:

This is a common question that many of my young patients ask me.  Finasteride (Propecia) blocks the conversion of testosterone to dihydroxytestostrone (DHT).  DHT does not have any known role in adult men development, but it is crucial in development of a male fetus and child external genitalia (their penis).  We at our Los Angeles, California hair transplant clinics don’t recommend taking finasteride for hair loss prevention and treatment before adulthood while maturation of external genitalia is not completed.  Pregnant women should not take finasteride because of its effect on the external genitalia of their male unborn baby.

The pharmaceutical company (Merck) recommends that pregnant women or any women who might have a chance of being pregnant should not be exposed to finasteride.  They should not even be cutting pills that might increase the chance of inhaling small particles of finasteride.  You are right about finasteride being present in body secretion such as semen and saliva.  However, the amount of the medication is so small that it is considered negligible or safe for pregnant women.  So the research shows that it is safe for pregnant women to be exposed to the secretions of a man whom takes finasteride.  That is why we do not recommend men to stop taking finasteride if their wife becomes pregnant.  There has been no evidence of any risk to a male baby from secretion of finasteride through the father’s saliva, sweat or sperm.

Dear Dr Parsa Mohebi,

I have been experiencing male pattern baldness for some years now. Initially used Rogaine, it worked at first but now no longer respond to it. Next used Propecia, but had to stop due to side effects. Lasercomb failed too. I am currently saving up and considering getting a hair transplant maybe in 4 years time. I’ll have enough money by then.

There’s one thing I’m really curious about. Would you happen to know anything about Revivogen from www.revivogen.com. It’s a topical lotion combined with shampoo/conditioner that was invented by Doctor Alex Khadavi, MD, a US Board-certified dermatologist. I have a question below which I hope you can answer and shed light on.

All I just want to know before trying the product and applying the lotion to my scalp is for my “safety” concerns. If this product was developed by a dermatologist is it okay to allow myself to test it out even if it may not grow/and or stop hair loss but at least I can be rest assured it won’t cause allergic reactions on the localized surface of my scalp. Although I don’t have sensitive scalp skin, some of the things I’m scared of are like more hair loss(worse than pre-treatment) or cause unknown severe harm like scalp dermatitis/acne/burn/swolleness, stain my scalp permanently orange etc.(I’ve probably just exaggerated every side effect.May or may not true!). This is what I mean by safety. What’s the worse a topical solution like Revivogen could do to my scalp anyway? Any potential risks? Are the ingredients mentioned on the website even safe on humans?
Finally, do you believe it is safe enough and whether its worth a try for me to test out what appears to be a very safe and sound consumer product and hopefully not a scam? There’s nothing else on the market and I’m really desperate too to give it a go.

Please do feel free to take your time and answer me whenever you can. Your comments and recommendations would be very appreciated. Thanks.

Kind regards,
-

A:

It seems like you tried everything for your hair loss, but stopped them all due to either side effects or inefficiency. You are now exploring other options before you can get a hair transplant surgery. You are not alone and there are many other young men who are going through the same path.

First of all, I really like to know what kinds of side effects you experienced with finasteride (Propecia), because finasteride is an effective hair loss medication, although it has been blamed unfairly for many side effects. I put most my patients at our Los Angeles and Orange County Hair Restoration Clinics who have significant miniaturization on finasteride. Finasteride can help prevent further hair loss. Some of your hair loss might be irreversible by medication and you may need hair restoration surgery, but at least you can stop further hair loss by the time that you can restore your hair surgically. Revivogen® is a hair loss product with some natural compounds that mainly inhibit 5-Alpha-Reductase. 5-Alpha-Reductase is the enzyme that converts testosterone to dihydroxytestostrone (DHT). Prevention of DHT production can slow down hair loss in male pattern baldness.

One of the components of Revivogen is Saw Palmetto Extract, which is a DHT blocker and is used systemically for prevention of both hair loss and prostate enlargement. The efficacy of its topical product is not studied as extensively in large human experiments. Other components include a variety of fatty acids like: Gamma Linolenic acid (GLA), Alpha Linolenic acid (ALA), Linoleic Acid and Oleic Acid without strong human research on their absorption from skin level as well as their efficacy on human hair growth. Other components such as Azaleic acid, Vitamin B, Zinc, Beta-Sitosterol and Procyanidin Oligomers have shown some effects on the DHT production in labs, but the extensive studies to compare their effect with more researched medical treatments for hair loss is lacking.

The absorption level of the ingredients of Revivogen® from human scalp skin is not studied as extensively as well. I personally have not heard anything about any serious side effects of Revivogen, but I would rather have more information about long term studies, which are published in peer reviewed medical journals, before I can recommend the product to my patients. There are many hair loss products out there, which are safe, but you do not have a life time to go around and try them all to find out whether they have any effect on your hair or not.

You need to establish a good relationship with a good hair specialist that you can trust. He or she should be able to document the level of your current hair loss and miniaturization of hair and can come up with a master plan, which includes medication treatment, surgery and even cosmetic alterations that can make your hair look better. Side effects of the medications that you tried before need to be re-evaluated closely by your doctor.

You don’t want to deprive yourself from effective, FDA approved hair loss medications that their safety and efficacy are confirmed in scientific studies and instead start looking around to see what else is in the market. If you have no alternatives, your doctor may have some suggestions for your individual condition to preserve whatever hair you have with a product with minimal side effects.

Dear Dr. Mohebi:

Hello, my name is KT I am a chemistry student at Kwansei Gakuin University in Japan.
I found your email address on the ISHRS website. I am doing research on solving hair loss, and I wonder if you might be able to help me. I noticed on your website that you are working with hair loss, so it seems you have knowledge about these issues. I know you must be very busy, but I hope you do not mind if I ask you a question.

In your research and in your opinion, do you think that the biggest cause of hair loss is inheritance?
Thank you very much for your time and attention to my question. I hope to hear from you at your convenience, and I am grateful for your assistance with my research. Thank you once again, and have a nice day.

Sincerely,

KT
Kwansei Gakuin University
Japan

A:

You are right about inheritance and hair loss as male patterned baldness is concerned.  When you are a man (have testosterone) so your body can make DHT (dihydroxy testosterone) and are genetically prone to male patterned hair loss, you have two of the three sides of the balding triangle.  You only need the third side which is time to force the other two factors to work on your hair and cause miniaturization of hair and have them fall out.  Considering that men have testosterone, genetics become the most important factor in men who experience male patterned baldness.

DHT or dihydroxytestosterone is a byproduct of testosterone that causes hair loss in men who are prone to baldness. Another negative effect of DHT is increasing the incidence of prostate enlargement and prostate cancer. Other than above effects, no other major physiologic function is known for the hormone DHT in adult males.

During infancy and childhood, DHT accelerates the development of male genital organs. This effect of DHT stops when a male external genitalia matures completely.
By using 5 alpha reductase inhibitor medications such as finasteride in medical hair restoration, we can block the enzyme to slow down the process of baldness in men and prevent prostate enlargement in elder men.

There is a congenital disorder in which the enzyme 5 alpha reductase is lacking that leads to the lack of DHT production. Congenital 5 alpha-reductase deficiency is also known as familial incomplete male pseudohermaphroditism type 2, seudovaginal perineoscrotal hypospadias, 5-ARD, 5-alpha-reductase type 2 deficiency, ambiguous genitalia or male pseudohermaphroditism.

Deficiency of the type 2 isozyme 5-alpha-reductase, which transforms testosterone to DHT is the cause of this disorder. DHT major role is in development of male fetus external genital organs and without that effect male newborn can develop immature or ambiguous external genitalia.

Diagnosis of congenital 5 alpha-reductase deficiency is through testing the testosterone to Dihydrotestosterone level. Elevated ratio is an indication of 5 alpha-reductase deficiency. The Level of testosterone is also elevated. There is also alteration in HCG stimulation test. In congenital alpha reductase deficiency male fetus develops a female phenotype without presence of uterus.

Congenital 5-alpha reductase deficiency could be treated to some degrees and the symptoms could be controlled with high doses of testosterone to make the deficient enzyme make normal or close to amount of DHT in this patients.

Q:

Do you recommend Finepecia for treatment of hair loss?

A:

Finepecia is another name for finasteride or Proscar. Finepecia, Propecia or finasteride is a medication that blocks the production of Dihydroxytestosterone (DHT) and can stop or slow down the process of baldness. The medication is also prescribed for treatment of enlargement of prostate by physicians. You need to be evaluated by your hair doctor preferably with a miniaturization study before starting on Finepecia. For more on Finepecia or generally medical treatment of hair loss you can visit the website of US Hair Restoration.