Mane Matters: Tackling Hair Loss Head-On with Expert Solutions

Trina Renea  00:07

Hey, everyone, welcome to Facially Conscious. I'm Trina Renea, a medically‑trained Master Esthetician here in Los Angeles, and I'm sitting with my rockstar co‑host, Dr. Vicki Rapaport, a board‑certified dermatologist with practices in Beverly Hills and Culver City, Rebecca Gadberry, our resident skincare scientist and regulatory and marketing expert, and Julie Falls, our educated consumer who is here to represent you.

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Trina Renea  01:27

Good morning, everybody. Welcome to Facially Conscious. I am Trina Renea, the esthetician co‑host on the show. And with me today, I have Rebecca Gadberry. Hello, Rebecca.

Rebecca Gadberry  01:38

Hello.

Trina Renea  01:39

And Vicki Rapaport.

Rebecca Gadberry  01:42

Hi, Vicki.

Dr. Vicki Rapaport  01:43

Good morning.

Trina Renea  01:43

Good morning, both of you. Doctor, too, I'm sorry. Dr. Vicki Rapaport.

So, today I'm excited because we're going to talk about hair loss, which I feel is constantly a problem for so many people, men and women. Men, most men, I feel lose their hair when they get older. And so do women.

Hair loss is an issue and, like, what do you do about it? Everything we try. I have issues with thinning hair and everything I've tried I feel like doesn't work. I've tried it all, basically.

So I'm excited about this episode because why do we lose hair, Dr. Vicki? Can we start with that?

Dr. Vicki Rapaport  02:32

Yes, absolutely.

Trina Renea 02:33

Why do we lose hair?

Dr. Vicki Rapaport  02:34

Hair loss is such a problem, I think for both the patient and the provider, because it's scary. It's trouble on somebody's self‑esteem when you lose hair. You feel less virility.

Hair defines sometimes our personalities and our sexuality and all the things that go along with lots of beautiful hair, our youth. So, as we lose hair, we get nervous. Is something wrong inside? Am I less beautiful? Am I getting old? There's lots of psychological problems that are associated with hair loss in both men and women.

Why do we lose our hair is a huge, beautiful question. And it boils down to what kind of hair loss people have. There's so many different kinds of hair loss.

I think today we're going to talk about the gradual male pattern and female pattern hair loss. But just to remind people that hair loss can be any kind of hair loss. A little bit, a lot, on the hair, on the eyebrows, on the eyelashes, on the body. It really should be evaluated, because some hair loss is quite easy to treat, other hair loss can take a little bit of time to treat and can be more chronic. It's good to know what kind of hair loss you have and why you have it.

So, going to a provider, i.e. a dermatologist, sometimes an internist will be good at hair loss. But it really does need to be evaluated so you can give a definition, give the actual diagnosis as to what kind of hair loss. And then of course, all the amazing treatments that exists, which I know you're excited to hear about.

Trina Renea  04:07

Yes. I found out about hair loss that I didn't know happened. It's after if you have something so stressful and traumatic that happens, three months later, you lose a bunch of hair, which I found out on myself.

I went to a doctor about it and I found that out. And he's like, "It'll grow back." But it was caused by that, which I had no idea you could lose hair from stress.

Dr. Vicki Rapaport  04:38

Right. As you know, when we were derm residents, we're taught about the different kinds of hair loss. The two big overarching themes is scarring versus non‑scarring.

Most hair loss, luckily, is non‑scarring, because if it is scarring, it's forever hair loss. It really is very impossible to get that hair back. So we won't really talk about the scarring hair losses, but they do exist.

What you're talking about is the non‑scarring hair loss called telogen effluvium, which is a stressful kind of hair loss, which is very common. The classic example is a woman who delivers a baby and, three months later, sheds the hair like crazy about from month three to month six.

Trina Renea  05:17

That's so mean to the women. Why? We just had a baby, then all our hair falls out. It's just terrible.

Dr. Vicki Rapaport  05:27

Totally uncool. It's like, "Wow, just sock me again in the stomach." No, it's a good question. It's just the stress on the body, from the plummeting of the hormones when you deliver the baby. Just literally the stress on the body, the changes on the body.

And then, of course, all the physical stress, the lack of sleep and the stress of caring for the baby. It's such a beautiful classic example of telogen effluvium.

But when people don't have a baby and have telogen effluvium, the other common causes would be some super stressful event, like a hospitalization, a divorce, a move, a death. Those are the four most common personal things in our lives that can cause telogen effluvium.

Typically, like your doctor told you, it does go away on its own, but some people are thrown into what's called chronic telogen effluvium where they actually don't get back to the full, beautiful growing‑hair state that they were used to before the TE started.

Trina Renea  06:29

So what do they do?

Dr. Vicki Rapaport  06:34

In terms of how to treat hair loss, it's all based on, first, the exam. You have to get a history and physical. So, get the history. Find out if there's a stressful event. Find out if there are any new medications, new supplements. Really important to get the hormonal history, if somebody started, stopped or changed their birth control.

Rebecca Gadberry  06:55

What about drugs? Because I've been on blood thinners for 30 years and I'll be on them the rest of my life. My hair has thinned so much over that time. They say it's due to the blood thinners.

Dr. Vicki Rapaport  07:08

So many medications can cause hair loss. Specifically blood thinners can. It's on almost every single side effect list of almost every single medication, because it can happen.

Blood thinners are not necessarily like a red light, like a blinking red light when we ask for medications that patients are on, but it's typically more hormonal medications. Sometimes blood pressure medications can cause hair loss.

But it's interesting. It's not so glaringly obvious with blood thinners. I'm not certain if your hair loss is from that or if it's just from the big aging question.

Trina Renea  07:56

When you say hormonal drugs, are you talking about thyroid medicine? What are you talking about when you say hormonal drugs can cause it?

Dr. Vicki Rapaport  08:05

Typically, birth control pills. Birth control pills.

Trina Renea  08:07

They can cause hair loss?

Dr. Vicki Rapaport  08:11

Absolutely.

Trina Renea  08:12

Oh, I missed that.

Dr. Vicki Rapaport  08:12

Yeah. Blood pressure... excuse me, birth control pills are a massive cause of hair loss. Anything hormonal, whether it's progesterone, testosterone, estrogen, they all can cause hair loss in a susceptible person.

So, we get the history and physical. We find out what's happening. If they're telling us absolutely nothing changed, absolutely no stress in my life, no medications, no new supplements, I haven't changed my diet, I haven't lost a ton of weight, these are all questions that we kind of rifle off quickly to get the background.

Then we typically do what's called a hair loss panel. The hair loss panel is blood test that checks for the following. Checks for thyroid, because that is a pretty common cause. Low or even high thyroid can cause hair loss.

We check to make sure somebody's not anemic. Anemia is a typical cause of hair loss.

We check iron. Low ferritin, low iron can cause hair loss.

ANA, which is like a blanket test to see if somebody has some kind of autoimmune disorder, because people with lupus, other autoimmune disorders, chronic disease can get hair loss, can experience hair loss.

There's a bunch of things in the hair loss panel that we check. We definitely check hormones, we check testosterone, we check estrogen, we check DHEA. Basically, a blood test is important.

Sometimes we'll even actually do a hair biopsy, like a quick little punch biopsy to see what is happening to the hair follicles and that is very telling.

And I think the thing that is the most common would be something called androgenetic hair loss, which is something that, again, nothing will be positive in the hair loss panel. Everything will be fine. Your thyroid will be fine, the hormones will be fine, but it's this overarching theme of hormonal influence on the hair follicles which, unfortunately, make us lose hair over time. Very chronic, very slowly.

Trina Renea  10:01

So, then, what would you do once you work up that hair loss panel and you figure it all out? What do most people usually do?

Dr. Vicki Rapaport  10:16

There's a whole host of medications that help a little bit and everything has to be done for forever, basically. We start with topicals, and Rogaine does work. It's a $100 million product that’s out there. It's even locked up in the shelves in the stores, because it's not cheap. I think it's 40 bucks or something like that for a month's supply. It's definitely not cheap, but it does work.

What is Rogaine? It's minoxidil. It dilates blood vessels, brings more blood flow to the hair follicle, which, in turn, helps grow hair. That's number one. It's over‑the‑counter. It's something that people can start right away.

There are a whole host of oral medications that we give, which actually work as well. Spironolactone works really well for people with telogen effluvium or hormonal hair loss. It's safe and it's very effective. It's cheap. It comes in generic.

Then there's now oral minoxidil. Oral minoxidil is basically an oral version of Rogaine, which also helps. Very, very low doses, very few side effects, if any, and can be very effective. This is actually kind of a new discovery, in a sense, which is kind of weird because the topical Rogaine was actually invented when the studies of the oral minoxidil showed hair growth. But the problem was that there were too many side effects in the dosage, in the high dosage that people were taking for oral minoxidil. Oral minoxidil is used for blood pressure.

So, in the original studies for oral minoxidil, when they saw hair growth, they couldn't really safely FDA‑approve it for hair growth because you would have low blood pressure, tachycardia. But then they realized topically it was very safe. That's kind of how topical minoxidil came to pass for treatment for hair loss.

And there are a whole host of other oral medications that can be prescribed that do help. But, again, it's something that has to be taken for a very, very long time.

It's typically like a multimodal approach. We tell people, "You really should do something topical and something oral."

Then there are the fun things that people can do. Like, there are lasers. Well, I shouldn't say injections are fun, but it's a fun new concept that we inject PRP.

Trina Renea  12:36

Does that work? Have you seen that work?

Dr. Vicki Rapaport  12:41

Yes, injecting PRP does work. It does not work on everybody. It is not cheap. It's about 500 bucks or more. I've seen doctors charge like $2,000 a treatment and you need three to six treatments. It's definitely not inexpensive and not affordable for most people. But it has been shown to work pretty well in a lot of patients, but not everybody.

Trina Renea  13:02

You didn't mention the drug Propecia. Is that still used?

Dr. Vicki Rapaport  13:07

Yes. The other oral medication that we love is Propecia. I think Propecia works the best. It was only FDA‑approved for men, but we definitely use it for women. It is safe, safe, safe. Some women will experience maybe some breast tenderness or some headache, but actually really love Propecia. Women, in fact, whenever I give Propecia to some female patients, it is pretty unusual that they stop taking it. They take it for years, because they really do feel that it works.

Trina Renea  13:36

So, do you feel that there's a difference between female and male hair loss? Do you treat them differently when it comes to the medications and the drugs and everything?

Dr. Vicki Rapaport  13:46

Yes, that's a great question. The pattern is really important when you go in for your history and physical and your evaluation with your provider.

One thing that we were taught, the very first thing as a resident when we evaluate hair loss is you have to look at the pattern. Look at every part of the head. Where is the hair thinning?

Female pattern, typically, is center‑front, and it goes back a little bit. Men, of course, get it on the sides and on the front. You know, the bowling alleys. And then men get it on the vertex scalp, which is the crown, the very, very top of the scalp.

Females don't get that that bowling alley‑look on the sides, but, yes, females can sometimes get it in the vertex scalp thinning.

So, the pattern is really important, but, interestingly enough, the treatment isn't actually that different between men and women, except men cannot do spironolactone unless you want to grow breasts, which I don't think they typically want to grow.

Trina Renea  14:38

Wait, do girls not grow breasts when they take spironolactone?

Dr. Vicki Rapaport  14:43

Not really. Sometimes they'll experience a little breast tenderness and some irregular spotting or irregular periods, but usually spironolactone is really well tolerated in females. Once in a while, it's not tolerated so we have to stop it. But, again, that's where having an experienced doctor really take care of you because it's a long‑term treatment. Changing medications, increasing doses, lowering doses, it's something that you really should continuously be seen for at least twice a year to make sure you're doing well.

Trina Renea  15:15

Okay. I've heard that there's some of the natural remedies. You take biotin and you eat tons of protein. Do you feel that those are helpful? Is there anything else natural that people could do at home to fight or combat hair loss?

Dr. Vicki Rapaport  15:36

I think it's really good to have just a really good healthy lifestyle. People ask me about biotin all the time. I say biotin alone has literally never been shown to improve hair loss and definitely not to stimulate hair growth. But biotin in a multivitamin or in some kind of hair, skin and nails supplement is fine, but by it alone I think you're missing the boat.

I love when people eat a really clean diet, generally speaking, for a healthy lifestyle in general. So, packaged foods, processed foods, I would just get them out of your life. A really balanced diet. Yes, absolutely protein, obviously fruits and vegetables. You know, the clean stuff. The fast foods and the sugars and the processed foods, just get them out.

Does it specifically cause hair loss? No. But if their diet is poor, they need to clean up their diet.

People ask all the time, like, "Well, what can I do? What's the one thing I could do?" There isn't one thing. It really is a multimodal approach.

Then these other supplements that you see being advertised on Instagram, I think that they all work a little bit in terms of potentially supplementing things that you might be missing in your poor diet.

I do think the collagen supplementation helps, like the powders. Some studies show that there is an improvement in decreasing inflammation, which plays a role in hair loss as well. So I do like adding the collagen powders to the hair loss regimen.

But can I actually say one other thing about the oral medications? There's one oral medication that, because we talked about Propecia, but there's one that's been shown to even be a little bit better. It's called dutasteride. DHT is dihydroxy...

Trina Renea  00:17:25

Testosterone.

Dr. Vicki Rapaport  00:17:29

It's the inactive form of testosterone turning into the active form of testosterone that is blocked by Propecia. Dutasteride is actually allowed to get onto the receptors even better than the Propecia.

Dutasteride, although it's never been FDA‑approved for hair loss, it actually works almost even better than Propecia. I have really savvy patients who asked me about it. I'm like, "Oh, yeah, that one definitely works better. Let's put you on that one."

It's only FDA‑approved for BPH, which is benign prostatic hyperplasia for an enlarged prostate, but it definitely works for hair loss as well in women and in men.

Rebecca Gadberry  18:08

Could you repeat which one that is?

Dr. Vicki Rapaport 18:11

Dutasteride. There's finasteride, which is Propecia, and dutasteride, which is only generic. I don't even know what the brand name is.

Rebecca Gadberry  18:21

Is that N-E-U? Neutasteride? How is that spelled?

Trina Renea  18:25

It's a D.

Rebecca Gadberry  18:26

D as in 'dog'.

Dr. Vicki Rapaport  18:27

D-U-T.

Rebecca Gadberry  18:27

Got it.

Dr. Vicki Rapaport  18:28

Dutasteride. Yeah, D as in 'dog'.

Rebecca Gadberry  18:30

Okay. Got it.

And, Vic, I have a question for you. Can any dermatologist run these tests? And do all dermatologists know what you're talking about? Or do you have to go to a special hair loss clinic or something like that?

Dr. Vicki Rapaport  18:49

I love that question because, yes, we're all trained to help evaluate and treat hair loss, but hair loss isn't everybody's favorite. You know why? Because the patients are really needy.

And that's fine. If you have that gene in your body to be able to really help these needy patients, any dermatologist really could do, but some just don't have the time and energy or even the desire.

So, these hair loss specialists, not only are they really up on all the studies and they have all the tricks of the trade and the injections and maybe the exosomes that are off‑label, which we'll talk about in a second, I also think they have the empathy. I think they have the empathy for these patients who need it. They need the time. They need the evaluation.

One of the things I absolutely hate is when a patient comes in and they book their appointment for a skin check. Then at the end, we've done a whole skin check, we've talked about sunscreen and preventing skin cancers, all this stuff and I'm practically walking out the door. "Oh, oh, oh, by the way, I've been losing some hair," and I just take the biggest sigh. The biggest sigh, because that needs a full exam.

But I want to give them... I'm empathetic to that, because I know it's a problem. And, really, you have to jump on it now. If you notice hair loss, you probably should have treated it a year ago or even two years ago, typically, because it takes people a long time to come to the doctor or even notice it themselves.

So, when they mention that, I'm like, "Oh, my God, I need you to... like, we can do a quick overview, but you need to come back, because we need to have a full evaluation of that."

So, these hair loss experts, I guess in conclusion, are probably a little bit better than a dermatologist who doesn't really have the time or the interest to treat you.

Trina Renea  20:42

And do you think that derms, when people come in for hair loss that aren't interested in really treating them, will refer them to a hair loss specialist? Do you guys do that?

Dr. Vicki Rapaport  20:54

Yeah, sometimes we do. Absolutely. I mean, we offer all this stuff. We offer the PRP injections. I don't have laser for it, but we do a lot of things that the other hair loss specialists do.

One of the things I will warn the patients about, though, is these hair loss specialists have very pricey procedures and services that they offer. They are not doing it just for an office visit that they're going to get $60 on reimbursement. They are selling them products and upselling them on services. So just be very aware, too, that it might get pricey.

I mean, I just really try and be the doctor that I want to go to. I can offer them these things and I'll be very clear about how much it costs. But we can also give them $7 generic medications and really help that person who really wouldn't be able to afford it still get really good results without needing to spend a ton of money.

Trina Renea  21:50

right. Okay, so we have to wrap this short little beautiful episode up. Can we have our final questions?

Rebecca Gadberry  21:58

Yes, I have two questions. One is what about this home light treatment that people are wearing on their heads?

Dr. Vicki Rapaport  22:07

The laser caps. They're low‑level light therapy and it actually does work. They are low‑level light, I believe it's a red light and that red light decreases inflammation and stimulates a little bit of hair growth.

They only have to wear it three days a week. Excuse me, yeah, three days a week for about a couple of hours at a time. The cap makes it very convenient.

I think they're about $1,000 and they're not typically covered under insurance. And I think it's worth it. But, again, hair loss treatments can get pretty pricey and it's not the only thing that will help. It's, again, one arm of the multimodal approach to treating hair loss. But I don't think it's BS. I think it works a little bit.

Rebecca Gadberry  22:46

So you might use it along with, let's say, one of the treatments that you were just talking about, the oral treatments.

Dr. Vicki Rapaport  22:55

Yeah.

Rebecca Gadberry  22:56

Then what about exosomes? We were going to talk about those at the very end.

Dr. Vicki Rapaport  23:01

Yes, exosomes are showing us a lot of promise. Unlike PRP, which comes from your body. We take your blood, we spin it, we re‑inject the platelet‑rich plasma back into your scalp, which have all the growth factors that we hope stimulate hair growth. Exosomes are lab‑made nanoparticles from stem cells that have the DNA to stimulate hair growth.

They're only FDA‑approved for topical use. So what we'll do is we'll microneedle or microchannel the scalp and we'll basically topically apply it and press it in. Seems kind of archaic, because they are not FDA‑approved for injection. But there are plenty of doctors who inject it off‑label. We haven't really seen any terrible adverse events, so it's going to eventually be approved for injection.

And, again, expensive. It is not cheap. I think the cheapest I've seen is maybe $500 per injection. You need a couple a year.

Rebecca Gadberry  23:58

Does it work any better than what else we've been talking about?

Dr. Vicki Rapaport  24:03

Too early to say, but it's showing a lot of promise. And, again, an adjunct. Not probably a standalone treatment, but most likely an adjunct to a topical and an oral and a lifestyle change and the collagen.

Trina Renea  24:17

Oh, my God. That's so much work. So there's no perfect fix. You can't just take a pill and grow your hair back?

Rebecca Gadberry  24:23

You can buy a wig.

Dr. Vicki Rapaport  24:28

Or get hair transplant.

Rebecca Gadberry  24:29

Or change your hairstyle or wear a hat.

Dr. Vicki Rapaport  24:31

Oh, and hair transplant, just to briefly touch on that super quick. That is a very effective treatment, hair transplants. It's done robotically now and it's done beautifully, but it's very expensive, thousands and thousands and thousands of dollars. But it's permanent and it's very effective.

Rebecca Gadberry  24:48

It's done robotically. That's amazing.

Trina Renea  24:50

That's amazing.

Rebecca Gadberry  24:54

Yeah, wow.

Trina Renea  24:53

Okay. Well, we can probably, once we find out some more information on these exosomes, is that what they're called? Exosomes?

Dr. Vicki Rapaport  24:50

Exosomes.

Trina Renea  25:04

We can come back and talk about this again and maybe have another chat about hair loss in the future.

Rebecca Gadberry  25:12

Yeah. And Dr. Vi and I were also talking about the microRNAs that are working with the epigenome in the stem cells. We don't know enough about those yet. They've just been approved for research by FDA, so it's a wait‑and‑see.

One of the things that we did talk about was don't fall for anything being on the market yet. It's not. So, unless you're going to partake in a study, which you're going to be told it's a study and you won't pay for it, be cautious. Be cautious about what you're falling for.

Trina Renea  25:49

Good point. All right. Well, Dr. Vicki, is there anything else you'd like to add before closing up this episode?

Dr. Vicki Rapaport  25:59

Again, on that 'be cautious' idea, nothing is take a pill and you're going to be fine. Nothing is take this supplement and you're going to be fine. Oh, my God, all this luxurious hair, use this shampoo. It's a complicated problem, hair loss, so get it evaluated. Get it evaluated correctly with some blood work and be able to find a doctor that has empathy and compassion and helps you on this journey. Because, unfortunately, once you start noticing it, typically, it's kind of a forever problem.

Rebecca Gadberry  26:32

And get to it early. Don't put it off. As soon as you suspect...

Trina Renea  26:33

I'm coming in for an appointment Dr. Vicki, time to get a panel.

Rebecca Gadberry  26:39

I'm just going to keep wearing the cap somewhere every day.

Trina Renea  26:42

I'm going to buy a wig.

All right. Well, thank you so much for talking with us about hair loss, and we will see you guys on the next episode.

Dr. Vicki Rapaport  26:53

Have a lovely day, guys.

Rebecca Gadberry  26:56

You too. That was great. Thanks, Dr. Vi.

Trina Renea  26:59

Thank you.

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