Royal Hair Loss at the Royal Wedding

Congratulations to Prince William and Princess Catherine!  We wish you all the happiness in the world!

With all the Royal Wedding media buzz, we can’t help but wonder….. Are the next generation of royals going to inherit male pattern baldness?  To answer this question we must first look at the royal family tree.

Prince William and Princess Catherine

Prince Charles: Prince William’s Father

Prince Edward & Prince Andrew: Prince William’s Uncles

Prince Philip Mountbatten: Prince William’s Grandfather

There are many theories on the genetics of hair loss. You most likely heard the popular myth that hair loss is passed down to men from the mother’s side of the family and to women from their father’s side. These myths travel alongside countless other genetic theories about how hair loss could be transmitted from one generation to the next.

While it is clear that male pattern baldness, medically known as androgenetic alopecia (AGA), is genetically based and common baldness cannot occur without the presence of specific inherited genes.  Physicians and scientists know these genes are transferred to children from either parent, but it is still unclear the exact mode of inheritance and the relative importance of each parent contributes to hair loss in the children.

Current genetic models have focused on one particular dominant gene, but  it is becoming clear genetic hair loss is a polygenic trait.  This would mean genetic hair loss is a complex condition most likely involving several genes.

A new genetic test has recently become available for hair loss by DermaGenoma. The Hair Dx Genetic Test™ is available for men and women and is offered by hair restoration physicians. These tests assist the patient and physician in making future medical and/or surgical treatment decisions.

Understanding the genetics of hair loss has practical implications for both the diagnosis and treatment of baldness. Early Diagnosis is the key and identifying those at high risk of becoming bald is critical. Treating hair loss in its earliest stages has the greatest chance of successfully reducing hair loss.

Hair Loss in Young Men: Balding Before They’re Legal

Hair Loss is commonly thought of as a problem for older men. But when it happens in younger men, even those who are not yet 21 years old, it can be considered an emotionally and medically serious problem requiring anti-anxiety medications.

Since hair loss is generally unexpected before age 21, it can be a shock for a young man 15 to 20 years old to discover he is losing hair. The first sign of hair loss to occur is thinning or miniaturization of the hair follicle in the frontal hairline. This can result in having the appearance of a high forehead. A person may also notice excess shedding when combing or shampooing the hair.

Hair loss has a very close association with family background or genetics.  There is a misconception in society that genes associated with hair loss are only passed down through the mother’s side of the family.  The truth is the genes involved in hair loss are passed down through either the maternal or paternal genes.

Hair loss before age 21 can be very disturbing for a young man, even if he expects to eventually undergo hair loss similar to other male members of his family. Loss of hair at this psychologically and emotionally vulnerable time in his life can leave him feeling disfigured, less attractive socially, and hindered in the job market. He can be an easy target for expensive but ineffective “miracle cures” advertised in print media, on TV and on the Internet.

The best first step is to have a hair restoration consultation with a physician hair restoration specialist who is a member of the International Society of Hair Restoration Surgery (ISHRS). A physician member of ISHRS is skilled and experienced, and importantly, follows ethical guidelines that make the needs of the patient the physician’s primary concern. Ethical considerations are especially important when the patient is vulnerable, distressed, and not yet an adult. The minor with hair loss should not be “pushed” into any decisions about hair restoration, especially surgery, and should be educated and counseled against making any hasty decisions that may not be in his best interest.

The best advice a physician hair restoration specialist can give is, “Don’t panic. I understand.”  Male pattern hair loss is a common, inherited condition and it is normal to be bothered by it. We can almost certainly find a way to manage it by making decisions tailored to your individual needs.”

When the patient is under eighteen (18), the physician hair restoration specialist must insist that a parent or legal guardian be involved in the decision-making process. Inclusion of a parent or legal guardian resolves questions of legal responsibility and gives the patient support in making informed decisions. Close parental support is important in the success of any treatment recommended to a teenager.

While male pattern hair loss is the most common reason for hair loss in men there are many other causes that need to be considered and ruled out.  Hasty treatment before a diagnosis is established may be ineffective and could be counter-productive.

Of Mice and Men- A new hair loss treatment is on the horizon:

John Steinbeck’s 1937 novel based on two migrant workers during the Great depression, really did not have to do anything with mice,men or hair loss.  But recently scientists studying a gastrointestinal disease discovered a medical breakthrough in hair loss. The resulting treatment, discovered by accident, offers promising results in the treatment and prevention of baldness or alopecia.

It’s being reported that researchers came across the discovery when testing a chemical compound on genetically altered mice. The mice’s bodies are programmed to overproduce a stress hormone, called corticotrophin-releasing factor (CRF), which, in addition to other things, caused them to lose their fur as they aged.

As part of the study, the balding mice were given five daily injections of a recently developed anti-stress hormone, astressin-B, and then returned to their habitat. Three months passed, and when scientists returned to collect the rodents for follow-up studies they unexpectedly discovered the once-hairless subjects had re-grown their fur. Reports show the injections were 100 percent effective in re-growing hair.

Younger mice that hadn’t yet lost their fur were given the anti-stress hormone injections as part of a follow-up study; research showed the treatment prevented their hair loss.

Additionally, scientists found the effects of the anti-stress hormone were more than fur deep. Initial test results also show the hormone had a positive impact in the gastrointestinal system and other areas of the body were receptors are located, including the cardiovascular system.

According to researchers, the most encouraging part of this hair-raising discovery is that the hormone triggered the mice’s follicles to start working again. Some scientists are hopeful the same mechanism can potentially be applied to treat other forms of hair loss including alopecia, pattern baldness and hair loss from chemotherapy.

Only time and science will tell if the potential treatment will help humans prevent and reverse hair loss. Researchers say the next steps will be to find out how the anti-stress hormone works to re-trigger follicles and pinpoint what cells are affected.

The complete study is published in the online journal PLoS One .

Ben Affleck’s Bald Spot

Ben Affleck caught the eye of the media and public when recent photos revealed a bald spot on the back of his head, referred to as the Vertex or crown region. While many adoring fans may think Ben’s bald spot is temporary, the truth is this bald spot represents a permanent loss of hair.

Did you know you can shed up to 100 hair follicles per day? Or you may see more hair loss at certain times of the year than others? While there are many causes for hair loss, a common type of hair loss affecting men and women is called “effluvium.”  To understand male hair loss, or what Mr. Affleck may be facing, it is important to understand the hair folicle cycle.

Hair follicles are not always in the active growth stage. A hair follicle cycles through a growth (Anagen) phase that can last two (2) to seven(7) years, then the hair follicle transitions to a regressing (Catagen) phase lasting a couple of weeks. Afterwards,  the hair follicle  enters the last and final phase (Telogen) for up to two to four months. The hair follicle then is shed when the hair follicle root re enters a new growth cycle. At any time on a healthy human scalp, about 80% to 90% of the hair follicles are growing hair. That leaves up to 10% to 20% percent of scalp hair follicles in a resting state.

Telogen effluvium (TE) is probably the second most common form of hair loss. Generally speaking, TE happens when there is a change in the number of hair follicles currently growing. If the number of hair follicles producing hair significantly decreases for any reason during the resting (telogen) phase, there will be a significant increase in dormant hair follicles. This is known as TE hair loss.

TE hair loss can be more severe in some areas of the scalp than others. It is uncommon to have hairline recession with TE hair loss, except in a few rare chronic cases.

The hairs that begin to shed are typically telogen hairs, which can be identified by a small bulb of keratin on the root end.

People with TE never completely lose all their hair, but the hair can be noticeably thin in severe cases. TE is often limited to the scalp and is fully reversible. The hair follicles are not permanently or irreversibly affected; there are just more hair follicles in a resting state than there should normally be.

How Does TE Start?

• Environmental condition or injury that “shocks” the growing hair follicles. If the trigger is short-lived, then the hair follicles will return to their growing state and start producing new hair fibers pretty quickly. This form of TE usually lasts less than six months and the affected person has a normal scalp hair density again within a year.
• The second form of TE develops more slowly and persists longer.  The follicles enter their normal resting phase but instead of returning to a new anagen hair growing state after a month or two, they remain in their telogen state. 

 In this form of TE, there may not be much noticeable hair shedding, but there will be a slow thinning of the scalp hair. This form of TE is more likely to occur in response to a persistent trigger.
• In a third type of TE, the hair follicles do not stay in a resting state but rather cycle through shortened growth cycles. When this happens, the individual experiences thin scalp hair and persistent shedding of short, thin hairs.

What Stress and Diet Cause TE?

TE can affect women after giving birth to their child, this is called Postpartum Alopecia. It is caused by a sudden change in hormone levels at birth but most women regrow their hair quickly. 
Vaccinations, crash dieting, physical trauma, and having surgery can sometimes  precipitate hair follicles to go into hibernation or the resting phase.  Some prescription drugs may also induce TE, especially antidepressants which resolves after a prescription change.

Chronic illness or metabolic disorders may lead to TE.  The two most common problems are chronic stress, thyroid disorders and diet deficiency. There does seem to be a link between stress, a change in hair follicle biochemistry, and more hair follicles entering a resting (telogen) phase.

 Dietary changes can cause a deficiency of required nutrients for the hair follicle causing TE. A deficiency in thyroid hormones can be treated with hormone supplements.

 What can Ben do for that bald spot?

The best method for treating hair loss is finding the cause. This will require either a well-trained primary care physician who has the time to evaluate your medical condition, or a hair restoration specialists, or a dermatologist. 

However, a specific cause may not always be identified.

“Mr. Affleck’s choices are intially based upon medical stabilization of any hair loss with medications and photostimulation therapy with a Laser Cap,”  says, Irvine hair restoration surgeon, Dr. Ken Williams, of OC NeoGraft Hair Restoration Center. After Ben’s hair loss is stabilized according to Dr. Williams,  he would  then recommend the “no scar hair loss” restoration surgery using the automated FUE device called NeoGraft.  He says, “it is considered the best technology available that will not leave any scar in the back of your scalp.”

To Rogaine or Not To Rogaine…..

Minoxidil was the first drug approved by the FDA for treatment of male pattern baldness. For many years, minoxidil was in pill form and widely used to treat high blood pressure.  Then just like with finasteride, researchers discovered previously an unknown side effect of the minoxidil pill.  Patients who were taking the medication for their high blood pressure began growing hair in unexpected places like on their cheeks, the back of their hands, and even on their foreheads.

After documenting hair growth as a side effect of Minoxidil,  researchers believed applying minoxidil topically directly to the head  would cause hair to grow in balding areas. Their scientific theory proved correct.  The original FDA approved studies found Rogaine was successful in regrowing hair in the vertex or crown.  Although, the original FDA indications of Rogaine was  for hair loss in the vertex region of the scalp, soon thereafter, everybody figured out the hair growth characteristics of the vertex were no different than the other regions of the scalp. So today we tell patients to apply Rogaine to all parts of the scalp to maintain the hair follicle longer in the Anagen or growth stage of the hair cycle.  By the way, Minoxidil should be applied to and massaged into the scalp in the morning and night.   Failure to massage the product into the scalp leaves the product on the hair shaft and transdermal absorption of the minoxidil does not occur.

With that said, Dr. Ken Williams, physician and surgeon for OC NeoGraft Hair Restoration Center, and The American Hair Loss Association (AHLA) still recommend daily use of minoxidil.  Dr. Williams and most hair restoration surgeons recommend finasteride be apart of the daily treatment program to stop existing hair loss and prevent further progression.

2% Minoxidil is a recommended medical treatment for women who suffer from diffuse androgenetic alopecia.    The FDA has approved the 2% minoxidil concentration for hair loss in women but many hair loss surgeons recommend the 5% solution.   Small clinical trials were conducted on 5% minoxidil for androgenetic alopecia in women showing that indeed it  is significantly more effective in both retaining and regrowing hair, but the 5% solution tended to cause facial hair growth.

“There are limitations of topical minoxidil treatment in the fight against female androgenic alopecia” stated Dr. Williams.  ” That is why I recommend, women especially, to seek out the advice of an informed hair loss specialist who can provide accurate and up to date information on medicinal and non-surgical treatments, as well as surgical treatmentoptions.”

My Hair Restoration Story….

Hello! My name is Dr. Ken Williams, I am currently 52 years old, and I had hair restoration surgery over 2 years ago……

Like most men, my hair loss story begins in my early thirties.  As a teenager and young man, I always had a thick and wavy hair style, but once I turned thirty, my frontal hair-line began to thin and recede, and in my mid forties my hair-line for the most part disappeared.  I was left with a couple small patches of hair my kids called “the landing strip.”   When I initially started losing my hair I researched hair restoration, but was not enthusiastic with the notion of surgery, referred to the STRIP method, that removed a large section of my scalp.  I waited many years for technology to catch up with my desire for a minimally invasive hair restoration procedure  that could implant thousands of hair follicles in one surgical session.

Finally in 2009, my patience had paid off as an Automated FUE hair restoration device, i.e., NeoGraft, was FDA approved here in the United States where over two thousand (2000) hair follicles could be transplanted in a single session.  In April 2009, I had my first hair restoration surgery with over 2300 grafts harvested and placed in my frontal hair-line. Since then I have had two more smaller surgical sessions with a total of 4500 grafts transplanted to my frontal hair-line and mid scalp.  I need an additional 2500 grafts to restore the crown of my head but I am thrilled with my results thus far.

Having hair restoration surgery profoundly changed my life.  I am more confident, more comfortable speaking in public, and I am happier in life not being teased about my hair (even by my family).  I want to share my great experience with hair surgery with other men who find themselves experiencing similar circumstances.  NeoGraft changed my life and it could positively impact your life also.  There is no need to go through life bald!  The No Scar Hair Loss Surgery is an incredible procedure to restore your youthful appearance. Call my office at (949) 333-2999 to schedule your complimentary hair restoration surgery consultation today.

A New Recession Hits Hollywood

There is a new recession hitting hollywood, and it is not about the economy.  Tinsel Town’s leading men are experiencing significant hair loss and thinning of the Frontal Hairline, midscalp, and Temporal Points.

Statistically speaking Androgenetic Alopecia (AGA) or common male pattern baldness (MPB) accounts for more than 95% of hair loss in men. By the age of thirty-five  over 60% of American men will experience some degree of appreciable hair loss, and by the age of fifty approximately 85% of men have significantly thinning hair.

The psychological effects of male hair loss varies. Some men pay minimal attention to their thinning hair and usually start to shave their head once the thinning becomes increasingly noticeable.  While others are greatly affected by their hair loss. It becomes a fixation for some men, as they feel self-conscious about their hair and appearance. Some men have a profound emotional reaction that psychological support or counseling is necessary.

Hair transplantation for many young men is not best decision for younger men. A delayed approach to hair transplantation for a young male, even when distressed by his hair loss and who has expressed a desire for immediate hair transplantation, may be the right approach.

 In some men, hair loss may be slowed or even new hair growth stimulated by medical hair loss treatments.

The two such treatments approved by the U.S. Food and Drug Administration are finasteride (Propecia®) and minoxidil (Rogaine®).

Minoxidil is topically applied and is available without a prescription. Finasteride is a prescribed medication taken orally in pill form. The medical treatments may be used separately or in combination, as recommended by a hair restoration surgeon.

“Medical treatment reduces the rate of hair loss and preservse an acceptable appearance until the physician determines hair transplantation can be undertaken,” says hair transplant surgeon Dr. Ken Williams of Orange County NeoGraft Hair Restoration Center.  Williams adds, “medical treatment is sometimes used as a complement to hair transplantation to preserve any future hair loss.”

Fergie’s Widening Part

Fergie has an amazing voice, a body to kill for, money, fame……… and HAIR LOSS!!

How can this be you ask.  Sadly, that’s not a simple question to answer.  Female hair loss is actually very complex to treat, and even harder to diagnose the cause.  Female hair loss is a medical diagnosis that requires medical treatment before you can even start to think about surgery.

Medical factors that contribute or cause female hair loss:

* Low or High Thyroid

* Low Hormones (Testosterone or Estrogen)

* Stress (Physical or Emotional)

* Autoimmune Disease

* Polycystic Ovary Syndrome (PCOS)

* Psoriasis

* Dermatitis

* Anemia

* Weight loss

* Adrenal Gland Dysfunction

* Traction Alopecia

* Birth Control

* Medications

* Genetics

Non-Medical factors that contribute or cause female hair loss:

* Bleaching Hair

* Consistently Changing Hair Color

* Tight Braids and Ponytails

* Perms

* Chemical Relaxers

* Brazilian Blowouts

* Extensions, Weaves, and Attached Wigs

There are three primary types of female hair loss:

* Localized Hair Loss- occurs from scaring and non-scaring diagnoses. Alopecia Areata is a genetic condition and is the most common non-scaring etiology of hair loss. Scaring hair loss is seen in Lupus, Lichen Planus, or local radiation. Baldness from injuries, or from local medical problems that have been cured, are usually amenable to hair transplantation.

* Patterned Hair Loss- Some women have a hair loss pattern similar to men. Women with male pattern loss typically have thinning in the frontal hairline and the top of the scalp, while the sides of the scalp remain relatively spared. Women with this hair loss pattern make excellent candidates for surgical restoration.

* Diffuse Hair Loss- Diffuse thinning of the scalp is the most common form of female hair loss. Diffuse thinning involves a reduction in the diameter and thickness of the hair shaft. The medical term for this type of thinning is “Diffuse Un-patterned Alopecia”. These women have thinning that involves the donor area so that women with this type of hair loss are generally not good candidates for surgery.

Once you know the cause, and type of hair loss you have there are three main treatment options.  Your first option is medical treatment, which involves using Rogaine or minoxidil topically, taking an oral medication like finasteride (if genetic tests indicate benefit), and using Low Level Laser Therapy.  The second option is hair restoration surgery- Linear Strip (FUT) or automated FUE using a device like NeoGraft.

Prevent Pregnancy… but Lose Your Hair?!?!??

Women who use oral contraceptives might be surprised to learn that hair loss is a common side effect of birth control pills.

Since first being on the market in 1960, “the pill” has been the most popular form of birth control.  The main purpose is for preventing pregnancy, but over the years physicians have learned birth control pills have other medical benefits such as:

* Maintenance of regular menstrual cycles

* Acne treatment and control

* Decrease the symptoms of premenstrual syndrome (PMS)

Since hormones are also the primary trigger for hair loss, women who use birth control pills run the risk of inducing sudden or spontaneous hair loss.  Women who have a family history of hormone related hair loss have a greater risk of experiencing sudden or spontaneous hair loss when using birth control pills.

Hair loss from birth control pills might be minimal or severe, and may only occur once a woman has stopped taking the birth control pill.  Oral contraceptive are generally safe and effective, but for women who have a family history of hormone related hair loss….. BEWARE!!!

It is important to choose the right birth control pill.  If you do have a family history of hormone related hair loss try a birth control pill with a low androgen index, these pills are less likely to cause hair loss.  Ask your doctor if your birth control pill is right you, or if there are any non-hormonal birth control methods that you could try.

Propecia: Link to Post Finasteride Syndrome?

The internet is all a buzz this morning about the latest “study” released about the long term side effects of Finasteride, aka Propecia.  The study was published online by the International Society for Sexual Medicine in March 2011, by primary investigator, George Washington University Andrology/Endocrinology Professor, Dr. Michael Irwig. His study consisted of interviewing  71 otherwise healthy men aged 21–46 years who reported the new onset of sexual side effects associated with the use of finasteride, in which the symptoms persisted for at least 3 months despite the discontinuation of finasteride.

The current controversy centers around his findings not being consistent with the clinical experience of practicing physicians and previous published data. Over the past decades numerous medical studies have demonstrated the general safety and success rate of this medication. In one German clinical trial involving more than 1,500 men, a significant increase in hair density was seen in 48% of patients at one (1) year, and  66% of patients at two (2) years had greater hair density.  In this study and others like it, less than two(2) percent of patients experienced sexual side effects. The only established relationship between Finasteride and sexual dysfunction is a reduction in ejaculatory volume.

While Irwig’s findings are surprising, problems are observed in the details of his study design and his intended goals to characterize the types and duration of persistent side effects of Finasteride users.  To begin, he uses the Arizona Sexual Experience (ASEX) scale, a simple screening five question rating scale of sexual satisfaction having its own limitations and controversy. The ASEX scale was originally and primarily developed as a less intrusive method for evaluating pyschotropic drug-induced sexual dysfunction in depressed patients by mental health experts and psychiatrists. The ASEX scale was not meant to be used in the non-pyschiatric setting  or to evaluate the long term side effects of non psychiatric medications.

Other inherent limitations of  sexual dysfunction studies using the ASEX scale include personal bias or religious views influencing the interpretation of results; as well as the definitions of sexual dysfunction, sexual activity, and perceived sexual dysfunction are being subjectively evaluated. Also, the description of the ASEX scale in original published medical literature “does not establish the etiology of  a patient’s sexual dysfunction.”

Another aspect drawing  criticism of Irwig’s study are patients selected for the study were not randomized or compared to control groups. The subjects were selected from an anti-Propecia web site (www.propeciahelp.com) and consisted of a subgroup of men “who were victims of Propecia side effects.”

Irwig personally interviewed 71 men between the ages of 21 and 46 who self-reported long term sexual side effects associated with Finasteride use. According to his published study he found:

92% of participants reported developing erectile dysfunction

94% of participants reported experiencing low sexual desire

92% of participants reported a decline in sexual arousal

69%  claimed trouble achieving an orgasm

But what do the previous decades of published data give us? Well, numerous published studies  have demonstrated the general safety and success rate of this medication. In one German clinical trial involving more than 1,500 men, a significant increase in hair density was seen in 48% of patients at one (1) year, and  66% of patients at two (2) years had greater hair density.  In this study and others like it, less than two(2) percent of patients experienced sexual side effects.

According to Orange County hair restoration surgeon, Dr. Ken Williams, “I have problems with Irwig’s study and methodology.  The selection of his patients from an already skewed patient population will not give good scientific based results.  I am surprised he did not have 100 % of his study subjects experiencing sexual dysfunction considering these men were recruited from a biased web site for men with alleged existing sexual side effects from Finasteride.”

Williams adds, “the debate on the effects of DHT inhibitors on a male’s sexuality is well documented in medical literature.” “Finasteride inhibits the conversion of testosterone to DHT, a known inhibitor of hair growth, and decreases DHT by 70% according to most research studies. It is generally safe to take.”

After completing the study Irwig told AOL Health, “It’s obviously having some effect on the brain, it’s messing up different hormonal pathways.  Some of these pathways are important for things like libido and sexual function.”   To his credit though, Dr. Irwig stated his study did have limitations including selection and investigator bias, lack of serum testosterone and other hormone levels, and “post-hoc approach.”  A “post-hoc approach” defined as a randomized, doubled-blind,placebo-controlled or scientific validated results can’t be drawn from this study.

Most hair restoration specialist/doctors/surgeons, remain confident Finasteride will still be available for use because of several previous studies reflecting its general safety and efficacy. Nonetheless, the concern for men who suffer from long term sexual side effects from Finasteride, also referred to by the lay public as “Post Finasteride Syndrome,”  will be unknown until further better designed and less biased studies are available.”

So what did we learn from this study? Are Irwig’s results consistent with the existing clinical experiences of prescribing physicians?  In a few short words, many  hair restoration physician and surgeons don’t feel Irwig’s conclusions are consistent with their  clinical experience and the bottom line that there is no cause-effect relationship established by Irwig’s published study. More studies are needed to understand the etiology and pathology of patients experiencing long term sexual dysfunction.

So what is your opinion?

Go bald and still be able to have satisfying sexual experiences, or  keep your hair and maybe experience some sexual dysfunction?

I think I can guess Jason Statham’s answer……