Health, Fitness & Personal Growth Tips for Women in Midlife: Asking for a Friend

Ep.169 The Truth About Female Hair Thinning: Hormones, Genetics & Hope

• Michele Henning Folan • Episode 169

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Is your shower drain trying to tell you something?
Hair loss is one of the most common and emotionally devastating issues women face in midlife, yet it’s often met with silence—or endless product promises that rarely deliver.

In this episode of Asking for a Friend, board-certified internist Dr. Mary Wendel—a physician who has dedicated over 20 years exclusively to women’s hair loss—joins Michele Folan to break the stigma and share the science. After witnessing her grandmother’s struggles and facing her own perimenopausal thinning, Dr. Wendel transformed her career to focus solely on helping women reclaim their confidence and their hair.

What you’ll learn in this episode:

  • Why 80–85% of female hair loss is caused by genetics and hormones
  • How testosterone therapy and hormone pellets can speed up thinning
  • The role of stress, weight loss, menopause, and GLP-1 medications in sudden shedding
  • Which diagnostic tests actually matter (and which don’t)
  • The truth about PRP therapy, red light, and laser treatments
  • Why washing your hair less may be making it worse
  • Simple, science-backed steps you can take now for healthier, thicker hair

Whether you’ve noticed extra strands in your shower drain, are worried about thinning at your part, or simply want to understand what’s happening to your hair in midlife, this conversation is packed with evidence-based answers and hope.

👉 Listen now to uncover the real causes of women’s hair loss, the treatments that actually work, and how you can take back control. Subscribe, share with a friend, and join us in removing the stigma around female hair loss.

_________________________________________
Are you ready to reclaim your midlife body and health?
I’ve walked this road myself—through menopause, stubborn midsection weight gain, and the fatigue that makes you feel like you’ve lost your spark. The Faster Way six-week group program set me on the path to strength, confidence, and sustainable change. You can get started here:
👉 https://www.fasterwaycoach.com/?aid=MicheleFolan

💌 Have questions about Faster Way? Reach me anytime at mfolanfasterway@gmail.com

✨ For more tips, science-backed strategies, and midlife health inspiration, sign up for my weekly newsletter:
👉 https://michelefolanfasterway.myflodesk.com/i6i44jw4fq

🎤 In addition to coaching, I speak to women’s groups, moderate health panel discussions, and bring experts together for real, evidence-based conversations about midlife health. If you’d like me at your next event, let’s connect!

Transcripts are created with AI and may not be perfectly accurate.

Disclaimer: This podcast is for general informational purposes only and does not constitute the practice of medicine, nursing, or other professional healthcare services. It is not a substitute for professional medical advice, diagnosis, or treatment. Always se...

Michele Folan:

Hey friends, Michele here, I bring over 25 years of health industry experience to everything I do as a certified fitness and nutrition coach and host of a top 2% global women's health and wellness podcast. And I don't just share these conversations on the mic, I bring them to live audiences. I've moderated women's health panels, interviewed top experts on stage, and spoken to women's groups about thriving in midlife through metabolic health, strength, and longevity. My mission is to help women feel strong, capable, and in control of their long-term health. If you're planning an event on women's health, midlife wellness or personal growth, I'd love to be part of it. Reach out through LinkedIn or the link in the show notes. Let's make your next event unforgettable and meaningful. Health, wellness, fitness, and everything in between. We're removing the taboo from what really matters in midlife. I'm your host, Michele Folan, and this is Asking for a Friend.

Michele Folan:

If you've strategically moved your part to hide thinning, or if your ponytail feels suspiciously skinnier than it used to, or if you're like me, you've held a wad of hair in your hand after showering and thought what the hell is going on, this is a great episode for you. Hair thinning and hair loss in midlife is incredibly common, but it's also incredibly frustrating, emotional and often brushed off as just aging the truth. There's always a root cause and there are actual solutions beyond buying yet another shampoo that overpromises and underdelivers. My guest today is Dr Mary Wendel, founder and chief medical officer of Meditress, a medical practice dedicated solely to treating hair loss in women. She's a board certified internist who took her own experience with hair loss and turned it into a mission to help other women get real answers and real results. We're talking hormones, hair cycles, hrt, prp, red light, nutrition, stress, and why we need to stop Googling and get serious about the right diagnosis. Dr Mary Wendel, thank you for being here today.

Mary Wendel, MD:

Well, thank you for having me. I'm always happy to talk about this subject. It's near and dear to my heart for many reasons, so thank you.

Michele Folan:

Yeah, and we're going to dig into that, but I love to start with your story and really, what inspired you to dedicate your medical career to women's hair loss, because that's not where you started, it's not where I started.

Mary Wendel, MD:

It is where I'm ending, but I am a board certified internist and I did primary care medicine for over 30 years and during that time my husband, who was an emergency room physician, transitioned into hair and has been doing hair transplants for about 35 years. And towards the end of my medical career we started to see more and more women walking through the door asking about hair transplants and what they could do. It took a lot of courage for them to come through a door that was primarily very male oriented, and so my husband said can you help me here? And so I started splitting my time between my general medical practice and the hair practice. And you know you mentioned the emotional component.

Mary Wendel, MD:

I will say that's the thing that surprised me the most, and I shouldn't have been surprised. But these, the women, came in. Many of them had seen many other providers before me for their hair and just felt discouraged and dismissed. There wasn't as much to offer initially, but I really felt for them and had a lot of compassion. My own family history is unfortunately fraught with female hair loss. My grandmother wore a wig. My parents' hair was pretty good, but I have several female cousins who are also struggling. My own hair loss started to become noticeable to me just perimenopausally, which is fairly typical. But it was interesting that I was surprised when I looked in the mirror and saw it happening. I'm like, oh no not me.

Mary Wendel, MD:

I'm sorry this can't be happening, but so it became a personal mission as well and as my medical practice, I started to move away from that. I spent more and more time here doing the hair, and now we have a whole lot more to offer and a lot more guidance to give Okay.

Michele Folan:

So what kind of extra education did you have to get to get where you are now?

Mary Wendel, MD:

Yeah, actually that's a good question. That I'm asked a lot because I am, you know, a highly trained internist and you know that took a long question. That I'm asked a lot because I am, you know, a highly trained internist and you know that took a long time and a lot of you know, many years. But actually, hair loss, although it can be complicated, it's a fairly narrow field. I did take a lot of classes, I did a lot of courses, both in person and online. I worked with a lot of dermatologists who, you know, specialize in hair loss and it has become its own specialty within the dermatology world. So it it, you know, I was interested enough and and always interested in learning something new, and it's constantly changing. Even since I started this you know we were doing the math just last night I've been doing this for over 20 years. A lot has changed, wow. So you have to keep up. Either way.

Michele Folan:

Oh, yeah, for sure. You know, when I got close to menopause, my husband would make jokes like God, it looks like a squirrel was run over by a lawnmower in the shower, you know, because there would be hair all over the place. Right, and I know I'm not alone. Other women deal with this. But I think it'd be good to just start with the basics, mary, and like what are the most common types of hair loss you see in women, particularly midlife and postmenopausal women?

Mary Wendel, MD:

By far the most common cause of hair loss is androgenic alopecia Fancy term for you've inherited these tendencies. Your hormones are playing into this and that's why we see it accelerate perimenopausally, premenopausally, and really that's the vast majority. That's probably 80 to 85% of the women that we see, and it's the most common. It's actually what causes men to lose their hair as well, and women don't really appreciate the fact that they're inheriting this. I often say you know who's sitting around the dinner table on Thanksgiving and take a look at everybody's hair, because the women are not excluded from that and it's a bit of a shock when it happens, but it is by far the most common and most you know truly most women by the time they hit in their mid-50s will say, oh, I don't have nearly as much hair as I used to when they're really pressed. But it's when it starts to notice the spaces between the hair Suddenly your scalp is a bit more noticeable. That's when women start to panic. So that is by far the most common and hormones play a huge role Hormones and aging and genetics.

Mary Wendel, MD:

We also see a lot of what's called telogen effluvium, which is a term that just means excessive shedding brought about by a long list of potential problems. Stress plays a huge role there. Some of the worst hair shedding I've ever seen has been as a result of extreme stress, and it can be physical stress, like illness, can be emotional stress for which there's nothing. You know, there's no number to test to see how bad it really is, but the hair will tell you, your outsides, will tell you what's going on to your insides, and it is also very common. But the most common is the androgenic.

Michele Folan:

All right, Two questions On average. How many hairs would we expect to lose in a day?

Mary Wendel, MD:

Yeah, that's a great question and it's something that creates a lot of anxiety for a lot of women. It's extremely variable. You know, women who have more hair are going to shed more. The statistics claim that anywhere up to a hundred hairs a day is considered normal. Well, if I lost a hundred a day, I'd be in shock because that's just not my pattern. I'd be like running for the hills. But like young women, like my grand, my 16-old granddaughter, her hair's everywhere and she's not losing it excessively. It's just she's got a lot of hair so she's going to lose more.

Mary Wendel, MD:

But when you have less hair to start with, you're going to shed much less than that 100. It's going to be more like 40 or so, and once you start reaching that 100 point, it's going to feel abnormal. Ethnicity plays a role as well. There's some types of hair that tends to shed more than others. That's more brittle, that's more likely to break. So a lot of things play into it and that's why it's a little deceiving when you read the articles that say well, you can lose up to 100 a day and then that would be considered normal. But that's not true. If you're normally hitting, you know, 30 to 40 a day and suddenly you're hitting a hundred. That's going to look very excessive. It's going to look you're going to know something's up. It's a change in your pattern.

Michele Folan:

There'd be a difference between losing your hair at the root and then losing your hair due to breakage, correct, okay, then the other question would be do we, at certain times of the year, lose more hair than other times of the year?

Mary Wendel, MD:

Yes, we do More. Women tend to have a little bit of a shed in the fall and there's a physiologic reason for that. Our growth cycle prolongs during the summer months with the heat or the sun. I think it's a lot has to do with vitamin D from the sunlight. Vitamin D is good for hair, but not everybody sheds in the fall. Some women never shed seasonally, but of women who do shed seasonally, more commonly it's the fall. I always shed a little bit in the fall. There are some women that shed in the springtime, which is sort of what you'd expect if you were a bear living in winter. You know you're hibernating, it's cold, you come out of the hole and suddenly you don't need that thick fur anymore and you're going to shed it. But that doesn't work for people. We don't need to lose a lot come springtime, so we tend to shed more in the fall. All right, we're not bears.

Michele Folan:

Then I guess my other question now these are popping into my head as we're speaking what about eyelashes and eyebrows?

Mary Wendel, MD:

Not usually cyclical, like scalp hair, but if you have a medical illness that's causing you to shed, there are certainly hair loss diseases that you can lose eyebrows and eyelashes, but the most common cause of androgenic alopecia generally doesn't cause excessive shedding and a telogen effluvium, which is again due to illness or stress, doesn't usually affect eyebrows or eyelashes.

Michele Folan:

So then, what are some of the biggest misconceptions you hear from women about hair loss, and what do you wish women would know earlier?

Mary Wendel, MD:

Yeah, I think the biggest misconception is that all the answers are on the internet, because they're not. But I also think that people women are surprised when they find out that they've inherited this. You know, I see we see a fair number of younger women in their mid-20s or so who have sort of advanced hair loss for their age, and I will always ask those young women what does dad look like? Well, dad's bald. I mean not just thinning, but dad's bald, so you can inherit that from your dad. It's both sides of the family. The genetics is very complex. Once in a while someone will come in and say there's nobody, but when you really get down to brass tacks, the genetics is very complex. Once in a while someone will come in and say there's nobody, but when you really get down to brass tacks, the genetics is fairly complicated. So really people don't understand that the genetics can be that strong for women as well as for men. Okay, that's interesting.

Mary Wendel, MD:

Yeah, and it's almost universal. When I see a young woman, yeah, and it's almost universal when I see a young woman, I see even women as young as 18 or 19 coming in with already you know advanced loss and sometimes dads will bring the girls in and dad's bald or dad has had a hair transplant, and you know they come in and when they find out that their daughter has inherited from them, they're heartbroken and I feel badly for them because they know how it affects their daughters, their young daughters. But it's very strongly genetic for women as well as men.

Michele Folan:

All right. So how about for male pattern hair loss? I used to always be told that it's the maternal grandfather that predicted no, okay.

Mary Wendel, MD:

No, no and yes, that is also a big misunderstanding. It's both sides equally. And they now know with studies, recent studies, that a man, a young man, of his dad's fall, he's got a more than 50% chance of losing his hair as well. So it's not you know the maternal grandfather, it's, it's both sides coming at you equally. And the more history of it, the greater likelihood that both men and women will will lose their hair. You know women are not expected to lose their hair. You know men are not, may not be happy about it, but they're probably not surprised, especially if you know dad's bald. But for women and that's the hard part is that they don't understand that and and they're they don't expect it. And suddenly you know they're 45 years old and their hair is thinning and they didn't expect it. So yeah, it's, it's hard.

Michele Folan:

It's hard. Yeah, it is very emotional, but now you mentioned stress, yep, are there any other lifestyle factors alone that can cause significant hair loss?

Mary Wendel, MD:

Diet nutrition is huge. We've done a lot of research here on diet, rapid weight loss. You know so many women are on the GLP-1s and you can lose weight slowly and carefully and with good nutrition and not necessarily shed. But if you've lost a lot of weight rapidly and you're not being careful about your protein intake, your vitamins, you're not taking any supplements, those women will shed a lot. So diet nutrition plays a huge role. It does.

Michele Folan:

We've heard about ozempic face, so now we get ozempic hair.

Mary Wendel, MD:

Absolutely yeah.

Michele Folan:

Yeah, I guess that doesn't surprise me.

Mary Wendel, MD:

No, when bariatric surgery was more popular. We don't see it much anymore with these medications now. Firstly, everybody who had bariatric surgery shed a lot of hair. It was expected. We knew it was coming and we would warn them. But nobody's warning these women, and so they're coming in, having lost 50 pounds in five months, which is too fast, and they're not eating any protein. They're barely eating one meal a day, no supplements, nothing. You know they're not checking their nutrition. And suddenly, you know they're fistfuls of hair everywhere. And so, again, doesn't surprise me.

Michele Folan:

Dr Wendell, we're going to take a quick break and when we come back I want to talk about hormones, hrt and hair loss. So how's that nightly wine o'clock working out for you? Or those 3 pm carb crashes that make you want to face plant on your desk? And let's not even talk about the look your doctor gave you at your last checkup yeah, that look. Listen, midlife isn't a free pass to let your health slide. You can't just hope your genes still fit and call it good. If you don't take charge now, your body's going to send you a bill later and, trust me, it's expensive. That's where the faster way to fat loss comes in.

Michele Folan:

We're talking real strategies, fueling with the right macros, strength training that actually works and habits that keep you out of the nursing home and on the dance floor. So what's it going to be? More excuses or more muscle? Your move, the link's in the to be More excuses or more muscle, your move, the links in the show notes. Come join me. All right, we are back. I would like to address hormones. What role do estrogen and testosterone play in the health of women's hair?

Mary Wendel, MD:

It plays a huge role pretty much across the board in terms of age, but particularly peri and postmenopausally. You know, our hormones change dramatically for that 10 year period. We all feel it, we all know it. Our estrogen levels sort of drop slowly over time. Testosterone drops as well, and so estrogen plays a very positive role in hair health. We see that in pregnant women. You know, hair tends to get full and lush and beautiful and shiny during pregnancy. Of course, afterwards it tends to fall out, which is very disturbing. But hormones play a huge role. So estrogen, yes, very positive. Even progesterone.

Mary Wendel, MD:

Again, those levels have to be in balance, though, and that's the tricky part about women who are on HRT. You know how well are these hormones being monitored? Is it a balanced, compounded program that they're on? Are they being checked periodically? The big issue for us is the testosterone, and it's a hard thing for some of these women to hear, but testosterone will drive androgenetic alopecia, and there are a lot of different ways to get these hormones. And again, if you're on a little bit of testosterone and your levels have been checked and they're considered what would be a therapeutic level, that's less of an issue.

Mary Wendel, MD:

But there are a lot of women on megadose testosterone, and I will tell you and warn women that pellets have no place in good hormone management. The pellets give you a very high dose and then it slowly trickles down and then they replace it and then it's really high again and those changes cause shedding, even if you're not on testosterone. Sometimes just the big swings in the estrogen will cause shedding, even if you're not on testosterone. Sometimes just the big swings and the estrogen will cause shedding. But mega dosing of of testosterone with those pellets. Women come in all the time with accelerated loss over the course of a year because they've been on these pellets and we tell them it's probably that they're very concerned. I know that there are some hormone specialists that will tell their patients that testosterone is good for their hair, but there's not one bit of science to prove that or back it. The science is all showing that testosterone drives hair loss. We know it drives hair loss in men. That's why they're put on medications to block it, but it also drives it in women.

Michele Folan:

I wanted to ask you about testosterone, because I'm on testosterone, I'm very open about that, and so I've been watching very closely because that would be a concern of mine. I'm just doing a topical compounded. You may not be able to tell me this, but is there a certain level that you would see In the blood that you would say, ooh, that's getting too high, that's going to put you at risk for androgenic alopecia.

Mary Wendel, MD:

Our hormones are very it's a very complicated system but there are levels that are considered normal and they vary by age. A normal level for a postmenopausal woman for testosterone would be very low. If you want to supplement, you can still supplement and keep yourself in what would be considered a normal therapeutic range, sort of like what maybe a 40-year-old woman would have instead of a 55-year-old woman. So you're above what usually would exist at 55, but you're not wildly elevated. So if you can keep yourself within what is considered that normal level, that normal range, it's not going to have the same effect on your hair as it would if it were really high.

Mary Wendel, MD:

Now, having said that, there's a lot of variability of people's sensitivities to these hormones. There are some women that come in and they've already got advanced androgenic alopecia and they're considering going on testosterone and I would caution them to do that If they already have advanced hair loss. You don't want to. You know you really want to do everything to maintain your hair and try to get some regrowth, and testosterone is probably not something that I would add to that mix. But again, if they're being monitored carefully and their levels are, you know, sort of on the lower side of normal, that's probably okay. I've changed my view on all of this because we just saw so many women come in with huge doses and high levels and various bad hair loss and I just we would say actually for a few years I've told everybody they're on testosterone. I can't fix it, but that's not exactly true. If they're well-managed and their levels are therapeutic, it's probably okay.

Michele Folan:

All right, I would say. Based on guests on my podcast and the reading I've done, it seems like pellets are starting to fall out of favor.

Mary Wendel, MD:

I think you're right. But every so often somebody still walks in the door and they said, oh I a new pellet put in, and I'm like oh, no, yeah because you have to wait three months for it to drop. You can't, you can't do anything. I think it's been a big money maker.

Michele Folan:

It is a big money maker for some of these doctors and I I think it's.

Mary Wendel, MD:

It's not ethical no, and and some of the med spas are doing it as well they do have a doctor or a nurse practitioner doing it, but they don't have the training and the expertise to manage it properly. And a lot of women have them and then they never get their levels checked. They have no idea where they're at and that's dangerous. You know, like any medication, you know it needs to be monitored carefully and the doses need to be appropriate for the reasons you're taking it. So that's the problem is it's there's a lot of misunderstanding. And yeah, I'm just. We just had a couple of people women come in last week. Oh, I just had my pellet put in and I'm like, oh no, I don't know. There are actually medications for postmenopausal women that do help block the testosterone. We sometimes would consider that, but it has to be postmenopausal. These meds aren't safe for premenopausal women, got it?

Michele Folan:

All right. Well, just so you know, I am getting my testosterone. I get blood work twice a year, so I keep very close tabs on it.

Mary Wendel, MD:

That's you know, and that's safe and that's fine, and yeah, that's I mean there's a lot of good reasons to take HRT. You know, I was a physician when we were doing a lot of hormone replacement and then suddenly we were not, because there was all this bad studies that actually just confused the whole situation. So we took everybody off them for about 10 years and then gradually we started putting them back on. So there's no question, there are physiologic benefits to HRT if managed well.

Michele Folan:

All right. Well, we've talked about hormones and kind of your approach, but when I come to you as a patient, what are you going to test me for?

Mary Wendel, MD:

Okay, we pretty much do blood work on everybody or we get a copy of their most recent blood work from their physician. If they're on hormones, we would like to see the levels within the last six months. We do test for certain nutrients like iron, zinc. Vitamin D is very important for hair health. The hormone levels again if they're on HRT, we will check the estrogen progesterone. The hormone levels again if they're on HRT, we will check the estrogen, progesterone and the testosterone. We always check thyroid levels because, again, very common in women postmenopausally, thyroid dysfunction is actually on the rise and can affect hair health significantly In young women under the age of 40, who we wouldn't expect them to be going through menopause quite yet. We do check testosterone if they have advanced hair loss, because we want to look for PCOS, polycystic ovary syndrome because those women have elevated testosterone and it can drive their hair loss. So it's age-dependent and it's also medical, history-dependent. But we do check, like I said, basically CBC, blood count, iron, vitamin D, zinc, all those hormones.

Mary Wendel, MD:

Sometimes we check a cortisol level which is sort of a rough estimate of how much stress your body's feeling. It's not a great, you know. It's one of those tests that I like to do sometimes and just to sort of remind me that these patients are really stressed out because you know some women just shed chronically and we can't find a reason for it. And those are the women. I'll check a cortisol and, you know, get a good stress history on them and you know their cortisol levels are usually normal but they're on the very high side of normal. So they're always running at a very stressful level and we believe that stress plays a big role in chronic shedding. So I will check that in some patients.

Michele Folan:

What other diagnostic processes would you put a patient through? And the reason I'm asking this is I would love to know how much scalp health plays into this.

Mary Wendel, MD:

Yes, it's a great question. We have a machine that's called a trichoscopy machine and where it magnifies the scalp so that we can get a great view of the scalp. It's the health how much inflammation is there? Is there buildup of product? Is there scaling? We also can see the hair follicle. So what kind of situation the follicle is in? Is there inflammation there?

Mary Wendel, MD:

We can sometimes see evidence of autoimmune disorders from the scalp. Yeah, so it's a very important part of the evaluation. We do it on everybody and you really cannot make a clear diagnosis of a cause of hair loss without doing tricoscopy. And that's something that not every, even not every dermatologist, does, but they're getting to it more, but we've been doing it for years. So without that you really can't make the diagnosis. We rarely do a scalp biopsy and we probably did more. We never did a lot of them, but there were doctors that did more of them, probably 10 years. Lot of them, but there were doctors that did more of them, probably 10 years ago. But there's really, unless you see evidence of some significant underlying autoimmune skin disease, there's really no need to do it. You can make the diagnosis without it. But it's important to do. It's really important.

Mary Wendel, MD:

We check the strength of the hair. It's so interesting it's beginning to change. But for the last five years or so there's been this trend towards shampooing less, and I mean significantly less. Women come in oh, I haven't shampooed in two weeks or I just rinse my hair out, even though I go to the gym every other day, and it's really interesting to see how unhealthy these scalps are, how much debris and buildup there is, and we actually do a scalp cleanse here where we clean it all off to take a good look. Sometimes you can't see enough of the scalp until you do that, oh Lord. So there's this trend with dry shampoos and all of this, and so there's been a bit of fear about using certain products and I think you know you need to respect them, but the scalp needs to be cleaned at least every two to three days. I mean, you don't have to use a harsh shampoo to do that. But there are scalp uh detox programs. We do offer it here with the cleanse as well as with some product, but that probably for most women who shampoo you know what a couple times a week, they probably only need to do that maybe once a month, but some women they build up seborrhea or dandruff, and we're just seeing more and more of it. I think some of it is lifestyle, it's diet related, but again there's this fear. You know, don't shampoo too much and again, that varies from ethnicity.

Mary Wendel, MD:

Different types of hair need to be cleaned at different points and the curlier the hair is, the more fragile it is and the drier it is. So you need to be careful to add back moisture to really curly, tight, curly hair. Straight hair tends to be less fragile, believe it or not, and tends to be greasier. So it's interesting, it's variable. But again, our recommendation for more straight hair is at least twice a week. Women who have tight curls, I'd say at least once a week. But they're not doing that. They're coming in. You know I haven't shampooed in two weeks and we're always afraid to look at the tricoscopy and you know we're going to find it's just not pretty. And then you know you can't grow a good strand of hair unless your scalp is clean. So it's it's important to have to do that and and once in a while we, a lot of our patients, will come in every couple of months and just just get a good cleanse, a good scalp cleanse and and that's it feels great. Your scalp is healthy. It takes away all the debris.

Michele Folan:

So it's a good idea, all right. That was definitely one of my questions because this comes up all the time about how often should I wash my hair. And I wash my hair two or three times a week. It's a pain, but I don't know. My hair just feels better and I work out, I go to the gym, I I can't, I just can't just yeah, okay, and that's, that's the appropriate amount.

Mary Wendel, MD:

It really is okay PRP.

Michele Folan:

PRP. I do want to talk about PRP, but I if you could kind of back up and talk about the PRP process a little bit. And also, is it painful, and who's a good candidate?

Mary Wendel, MD:

okay, prp. It's one of those treatments that is like, who thought to do this? Prp was being used for many other purposes before the hair industry decided to give it a go. But PRP stands for platelet-rich plasma. So what we do is we take a blood sample and it gets spun down in a centrifuge and the blood gets separated and the platelets are a certain type of cell that normally helps prevent bleeding and helps stop bleeding.

Mary Wendel, MD:

But amazingly, hanging around those platelets are all these beautiful growth factors and proteins and things that stimulate healing and growth, things that stimulate healing and growth, which, when you think about it, it's a beautiful system because if you have an injury, that area needs to heal and grow back. So with the platelets, when they go there to stop the bleeding, they bring all that rich blood with them and the healing starts immediately and healing usually means regrowth of cells. So somebody figured out let's try it on hair, let's see if it will help the hair grow better. And so I'm going to say, probably about 20 years ago, people started experimenting with it and again, the blood is drawn, it's spun down. The layers of the platelets are a very specific layer. They're pulled out and they're injected into the areas of the scalp that to grow, and so there have been various modifications of how to do this over the last 10 to 15 years, which is good, because we know much more about the science, we know the best way to do it, we know how much fluid we need, what's the concentration that works best, and through all of that research and there's been thousands of studies done, which is a good thing we know that the best way to do this is to have a series of PRP. It's three treatments, three to four treatments one month apart. Then you wait until about six to seven months, reevaluate, see what kind of growth you're getting, and if you're getting a benefit and it seems to be helping, then you really need to get boosters. It's not something that causes a permanent change. It only works while you're doing it. So most boosters now are about every six months. Initially we were doing it once a year, and there's some women who can get away with once a year boosters, but most people it's about every six months, and so it's an understanding that we're not curing this, we're treating it, and that's true of everything. For the most part, you're not really curing it, you're treating it.

Mary Wendel, MD:

Now the different ways of doing it and there are still many different ways of doing it. The needle way most people are doing they're numbing up the scalp so that it's not as painful. You know, getting the numbing is a little discomfort. There's some discomfort, but you really need the scalp to be numbed in order to get the number of injections that are required to get a good benefit. We are starting to do something that's called painless PRP. It's a different method of injecting. It is an injection but there's no needle. It's called a jet peel. There's a high-intensity flow that is actually able to make a canal through the skin to get that PRP solution down to the hair follicle. So that's a nice alternative.

Mary Wendel, MD:

I can't tell people with 100% honesty that it works equally well as the needle PRP, but I will tell you that it works. I know that it works. I've seen it work in patients that didn't do well with the other methods. And so for women who have, you know, they're afraid of the needles, and there are a lot of patients that have been, you know, gone through some illnesses, chemotherapy they're not going to let us inject their head, and so this has been a nice alternative for them and it works very, very well. So that's been a nice added benefit. So who is a good candidate? I'm going to tell you pretty much anybody Virtually all the types of hair loss that we know about can get some benefit from PRP.

Mary Wendel, MD:

We know that androgenic alopecia it works the best for that. That's been the majority of the research, and some women get wonderful responses within six to nine months. It's noticeable, and so when we see that, it's great. We do know that PRP works better when you have other treatments added to it, and so things like laser therapy which I know you asked, you know you put on your questionnaire we certainly can talk about that but also medications like minoxidil and spironolactone and young women, sometimes hormonal therapy, will be beneficial. So those things all work together. They're additive. One plus one does make three in this particular instance. So we do know they work better together than they do individually better together than they do individually.

Michele Folan:

Okay With PRP. As we get older, is our platelet-rich plasma as effective as it would have been when we were younger?

Mary Wendel, MD:

Yeah, I mean the answer to that question is yes, and it's interesting. The only people that it might be a problem for is someone that might have chronically low platelet count, because you need a certain concentration in order to get those growth factors to do their job. And so there are some people as they age, their counts drop a little bit Not dangerously so, but it makes it a little bit more challenging. But we're always a little surprised when we see a person in their 80s, for instance, coming in. They want to try the treatment and we know that research has shown that it works best in women who are a little bit younger, but also who start their treatment before their hair loss is really aggressive.

Mary Wendel, MD:

It's easier to maintain hair than it is to regrow. You can regrow it, there's no question. But PRP works better on women than men for some reason, and it seems to work better on younger women. Now that doesn't mean if you're older it's not going to work for you. One of my nurse practitioners has a patient who's in her 80s. Her hair loss is profound and she's getting the most remarkable result and I'm just in awe of that fact. But again, we are less I'm not going to say enthusiastic, but we know that it doesn't work quite as well in the elderly population. Doesn't mean we won't try, just means they need to understand that and they usually come in understanding that.

Michele Folan:

What about minoxidil? Where do you stand on that? Right now, come in understanding that.

Mary Wendel, MD:

What about minoxidil? Where do you stand on that right now? Minoxidil has a real place here. There are thousands of studies to show benefit. It doesn't give you that big wow. That's the problem is that when well, particularly the topical, you know you're putting something on your scalp, women don't tend to like it. It leaves a bit of a residue. You know, virtually 100% of the studies done on minoxidil in six months show that you have more hair than you did when you started it. But it's not like you look in the mirror and go, oh, my hair is so much better and so a lot of women will give up on it, which is unfortunate because it does help maintain hair.

Mary Wendel, MD:

With the reinvention of oral minoxidil very low-dose oral minoxidil that seems to have a bit of a better response to it. You don't have to put anything on your scalp. It is a medication you take orally, but in very low doses. The likelihood of potential side effects is pretty low. So I think that women should consider it. If you don't want to put it in your body, then you need to put it on the scalp. If you're not concerned about, you know, have any risk factors, which would include, you know, cardiac disease. If someone who was elderly, we wouldn't give them low-dose minoxidil, and if they had a heart disease, we wouldn't either. As long as it's well, you know, you ask all the right questions and we screen for the proper patient, it can be done safely. So I think it should be considered. I really do.

Michele Folan:

Are there any other drugs or therapies that are kind of on the horizon that have you excited?

Mary Wendel, MD:

There actually is a lot of research being done, which is exciting. For the longest time, particularly for women, there was nothing happening. It was just until PRP came along. It was just very, very hard. Laser therapy was a nice addition, but, yes, there are hormonal treatments being researched, particularly for younger women. There are new types of laser therapy which is being considered, and there are. It's funny because there are medications. They don't give them a name yet. You know, it's like QX200 is still being studied, but yes, fortunately, there's a lot of research being done now, and so it's interesting that the medication that a lot of women know about is Latisse, which actually helps your eyelashes and eyebrows grow. That can be compounded into a solution on the scalp which can help stimulate some growth. It can be compounded with or without minoxidil and that can have some benefit. And so, yes, there are some newer things that people are working on, and that's reassuring actually.

Michele Folan:

You know, I don't know who told me this, and maybe it's something that I saw on the internet Using Rogaine on your eyebrows.

Mary Wendel, MD:

Oh, yeah, yeah, yeah, you just don't want to get in your eye. A lot of minoxidil solutions have alcohol in the base, so, yeah, just have to be careful. But yes, it will stimulate growth.

Michele Folan:

Your husband still does the hair transplantation? Yes, will he do eyelash and eyebrow transplants? Yes, all right. How common is that these days?

Mary Wendel, MD:

You know it's it's as women feel more comfortable coming in. We're seeing more and more of it. You know, from my generation we over plucked our eyebrows for decades until they were gone. And then, you know, a lot of women are getting, you know, microblading done, which is in good hands, looks great, but you have to have it touched up. Um the the the eyebrow transplants are permanent but you do have to groom them cause they'll grow, which is so interesting. But it's easily managed.

Mary Wendel, MD:

Eyelashes are a little trickier. There aren't a lot of surgeons that do them. He does do them and he actually likes to do them. But again, they grow faster than your normal eyelashes. So you have to train them to grow a certain way. They have to put them in very carefully. They place them in a very specific manner so that they'll grow properly. But we see more and more of it.

Mary Wendel, MD:

We've done a few eyebrows on men, which is interesting. There was a gentleman that came in. He has a very unusual type of hair loss and he lost his eyebrows 10 years ago and he said, yes, he didn't like the fact that he lost the top of his hair, the scalp hair, but he said, because he lost his eyebrows, everybody thought he had cancer and was undergoing chemo. And he said he got tired of answering those questions. And so he came in and we gave him a little bit of hair on the top and they transplanted the eyebrows. And he came in and his wife said he's so happy with the eyebrows. That's what really made him happy. So it's you know, whatever makes you happy, it's okay.

Michele Folan:

Yeah, I think hair in men is overrated. I'm totally cool with a bald man.

Mary Wendel, MD:

You know I hate to say this, but I agree with you. You know I you know and I will never say that in my husband's office and you know he doesn't. He doesn't need a hair transplant, so he's fortunate. But you know, under my breath I'll say you know, real men don't need hair.

Michele Folan:

I'm like what do you need hair on your head for? I kind of think it's sexy that you know if they're losing their hair a little bit. I'm okay with that. Yeah, it's okay.

Mary Wendel, MD:

And you know hair transplants are variable. My husband's been doing them a long time and he's surgically very good at it, and so his hair transplants look very natural. But I mean there are some out there that look awful and I'm like, oh, you should have just left it off. You know, it's just, you know. But his, you know, I have to say his look great, but, um, that's not the case all the time.

Michele Folan:

Oh yeah, and, and you know, with all these women doing these fake eyelashes, our eyelash extensions, it has to be a boon for you all, because I have seen some horrendous results of women losing, like, all their eyelashes with those things.

Mary Wendel, MD:

Yes, yes, unfortunately that's. We're seeing that more and more. You know, the more that women do it, the more we're going to see it. And, yes, the eyelash situation is not a great one. And, yes, the eyelash situation is not a great one.

Michele Folan:

Yeah, yeah, my, my optometrist, she, she's like, uh, no, um, you are not not doing it because I have dry eye. You know, she doesn't even like you using any kind of eyelash serum because because of the prostaglandin. So I've been very obedient when it comes to that.

Mary Wendel, MD:

I just depend on cover girl to give me some eyelashes?

Michele Folan:

Yeah, exactly, exactly. When it comes to that, I just depend on CoverGirl to give me some eyelashes.

Mary Wendel, MD:

Yeah, exactly, exactly.

Michele Folan:

So we talked a little bit about sleep and stress, maybe, over styling of our hair. There was one more that I wanted to ask about Does alcohol play a role in hair quality?

Mary Wendel, MD:

I'll be honest with you. I haven't seen any research on that. I haven't heard anybody talk about it at conferences. I really believe everything in moderation. I think that a little bit of alcohol is fine. The effects that it has on your nutrition it's always dependent on how much you enjoy. You know, enjoy it. So I don't think it's a it's a big issue.

Michele Folan:

I really don't All right. And then I forgot to ask you red light therapy. Oh yeah, so I have a red light mask that I wear. And then I was like I'm going to just pop this thing on my head, so I'll just put it on my head, and you should see my husband. He just looks at me sometimes and he's like you are just out of control. But will that work if I wear that on my head enough?

Mary Wendel, MD:

Yeah, it's a great question and laser therapy is not the same as red light therapy. Red light therapy are LEDs and there's been a little bit of research on LED and hair growth and there seems to be some minimal benefit to it. But when they compare it to the true laser light therapies, the low level light therapies, there's a huge difference. Light therapies there's a huge difference. True laser diodes have a much more beneficial result for hair growth than just the red light and we're seeing some of these newer. I mean, we recommend a lot of low-level laser here, but we recommend the apparatuses that have complete laser.

Mary Wendel, MD:

It's more expensive, there's no question. The caps and the bands that have just lasers are more expensive than the ones that have just red light. There are some companies that are sort of mixing it up a little bit. They'll throw a few red lights in with the lasers to make it less expensive, but they're not going to work quite as well, they're just not. So there has been some research to decide. You know, is that equivalent and it's not? Probably a little bit of benefit, Okay, but not like laser therapy.

Michele Folan:

I would love to know for the women listening who's feeling defeated by thinning hair or shedding, what would be your message for her? What would be the first step she should take If someone's experiencing a lot of shedding, a lot of loss.

Mary Wendel, MD:

I think that they really should, first of all, get a good physical. They can talk to their primary care physician. When I did primary care, patients would come in. Of course, I was a bit more open to it than maybe a lot of people. But a good set of blood work, making sure nutritionally they're in good shape.

Mary Wendel, MD:

But you really want to see somebody who knows about hair loss and dermatologists are trained in it. They have varying degrees of interest in it, but that's a place to start. I mean, we have offices in Massachusetts and New York and there are good people all over the country, but you never know quite what you're getting when you walk through the door and a lot of women have been dismissed as, oh, your hair's fine, don't worry about it. Or the other side of it. They're told oh, you're going to need a wig in 10 years. None of which is true. You know, neither side is true, so don't get discouraged. If I would just say you know, get a good physical, get your blood work checked and then see a specialist. Don't wait. Don't wait and don't go on the internet, because it's scary. There's a lot of misinformation there.

Michele Folan:

Oh, that's great advice. And then one kind of a personal question what is something that you do for yourself every day? What's one of your core pillars of self-care?

Mary Wendel, MD:

Oh, I, always I take before I start my day. I've become an early riser, which I never used to be. I think that comes with aging. I take about 30 minutes in my chair with my coffee, do a little meditation, a little messaging for the day, a little bit of journaling, just to sort of settle me, and that's important. Otherwise you jump out of bed and you're running 100 miles an hour and you don't give your brain a rest and you don't give your spirit a rest. So I think it's so important, just take that 30 minutes If you have to get up a little earlier, just try to fit that into your routine. And I think it's so important.

Mary Wendel, MD:

And I have, you know, I have several apps that help me to meditate a little bit. Or you know just messaging, you know things to help you feel stronger and more ready for your day. I mean, it's tough, things are very stressful, and you know the pandemic did a number on our hair, I will tell you that for sure, and so we're still much in recovery of that. But there's still a lot of stress and whatever you can do to minimize it. I don't do yoga every day, but I do it a few times a week and again it's a very meditative slow yoga, appropriate for my age. But I think those 30 minutes I love those 30 minutes.

Michele Folan:

I love that. That's a good one.

Mary Wendel, MD:

I need to do that you know something I've just started to do, I think really since COVID, you know I was home. What am I going to do all day? So I just kind of started that and I've kept it up, and when I miss a day here or there, I feel it it's like oh, I want my chair.

Michele Folan:

I got to run home and sit in my chair for 30 minutes. Oh, that's great. It's a good reminder for all of us. Dr Mary Wendel, this was incredibly informative. I appreciate you being here today and I will let you know if I need you at some point.

Mary Wendel, MD:

Okay, I'm here. I'm here. Thank you for inviting me. You've been, you're obviously very informed and that's a nice thing to share. I really appreciate it.

Michele Folan:

Well, thank you. Thank you for listening. Please rate and review the podcast where you listen and if you'd like to join the Asking for a Friend community, click on the link in the show notes to sign up for my weekly newsletter, where I share midlife wellness and fitness tips, insights, my favorite finds and recipes.