Black Boomer Besties from Brooklyn
This is what the world needs now: two free-thinking “seasoned” Black women speaking their truth and inspiring others to do the same. Shaped by 45 years of friendship that began at the prestigious Brooklyn Technical High School through the Ivy League, medical school, marriages, divorces, triumphs, parenting queer children, life-threatening illness and many many amazing adventures. Each week, besties Leslie Osei-Tutu and Angella Fraser will push against boundaries in love, culture, careers, faith, politics and out-dated assumptions about women of a certain age. Remember, you’re never too old to change your mind…or your hair! (but more on that later :-)All views are our own and do not reflect the views of our institution/company. Information provided is not intended to serve as medical advice.
Black Boomer Besties from Brooklyn
The Nitty Gritty on Hair Loss
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“I don’t have a problem with a hairstyle unless that hairstyle has a problem with you”. Sounds simple enough when coming from an expert like Brooklyn, NY based Board Certified Dermatologist Dr. Achiamah Osei-Tutu. For the rest of us we just spend time, money and energy trying to get our tresses to cooperate. In this episode, besties Angella and Leslie get to the ‘root’ of the types and causes of hair loss, discuss how hair may manifest systemic disease and describe the ways in which culture influences hair health.
Docs For Hair: The Trusted Resource for Hair & Scalp Issues
Visit Black Boomer Besties from Brooklyn website for behind-the-scenes extras.
Hey and hey Les, how are you? Doing well. Good. You're looking smashing. Oh man, that shirt is so much better against that background.
SPEAKER_04Thank you. I don't look like a heel anymore.
SPEAKER_01You do not look like a heel. You look gorgeous. You look gorgeous. Well, folks, we're here. We're back for another episode of an episode of Black Boomer Besties from Brooklyn. Brooklyn. And we have another guest. Yes, we do. And I'm gorgeous.
SPEAKER_04Fabulous, wonderful, smart, savvy, cool. What do the young people say? Fire.
unknownFire.
SPEAKER_01Fire with a Y A H, not a F-I-R-E. Exactly. A Y A H.
SPEAKER_04We're showing our age, but that's okay. Yeah, but I'm happy to introduce a um a beautiful person, a smart lady. We have a board-certified dermatologist with her with us this evening. Her name is Achama, or say to two. And anybody that knows me may think that that name is a little bit familiar. And it is, because Achama is my niece. And she is someone whose trajectory I've watched for many years now. And she's just made me such a proud auntie in the woman that she is, in the brilliant physician that she is. And we brought her on today to talk to you a little bit about something that's important to a lot of people across many spectra. But Achama is a dermatologist, and one of her specialties is hair loss and um alopecia. So before I go into that a little bit more, I'm gonna have Achama speak, introduce herself, and we can get started. So welcome.
SPEAKER_02Welcome. Thank you. Um it's so good to be here. And I feel like I need to hang around with you more because you've made me feel so self-esteem back up. Um, thank you guys for inviting me. I'm humbled and very thankful, and think it's so, so important to continue to spread the word about the epidemic of hair loss in black women so that people can get seen and get treated and managed um as soon as possible. So I am a board-certified dermatologist. I practice in Brooklyn, New York. Brooklyn! Brooklyn! Um, I'm actually in uh in East Blackbush. Uh I went to downstate for residency, so I'm very, very familiar with this area. Um, my practice is probably like 80% hair loss, and the other 20% comprises uh mostly acne, hyperpigmentation, uh, you know, and some cosmetic procedures, lots of chemical peels, a little bit of laser, and some a little bit of filler and Botox, but lots mostly hair. And I do everything with respect to hair. Um I do non-surgical and surgical hair restoration, including hair transplants, various injections. Um, we also have a stylist who is in the office as well. Uh Diane, who's been an amazing addition, uh, really partnering with me to help to provide various options for patients suffering with hair loss in terms of styling is concerned. So uh it is my absolute passion. And fortunately or unfortunately, a few months ago I was also diagnosed with uh one of the very common hair loss conditions that I see in my clinic. So it's now a personal crusade of mine. Uh is why I actually got started uh even interested in this is because uh a family member of ours developed alopecia when she was in her 20s. I'm now 47, so she's had it for a long time. And but unfortunately, by the time that I learned everything, uh, it was a bit late. Uh, she already had significant scarring. So when I see patients in front of me, I really do see her and try to use it as an opportunity to sort of pay back what I couldn't really do for her. So it was a passion of mine. Yeah.
SPEAKER_01Wow. That's incredible. Listen, I just need to make a little segue after that um wonderful welcome and um uh all of the the information that you presented. Um, just before we start a recording, um I've I've heard of a chama for forever. I'm meeting her now for the first time. I've heard her voice, um, probably talked on the phone, but we just realized that her office is directly across the street from where I lived throughout high school and early in my college years. Um, actually, no, it was all throughout college too. I don't even remember, but it's where I lived when Leslie and I started hanging out together. And now a chama, it is such a small world, it is such a small world, it is so crazy. It's so crazy. So I just had to just because I my mind is blown. When you said 84 Lynn, I I my mind was blown. Anyway, I think that um when the the thing that drives one to pursue something that becomes their life, um, their their their life goal, their life passion, it is so beautiful that you made this commitment because of someone, a particular person that you wanted to help. And now you're helping hundreds and thousands of people. And so, even though you were not um trained to where you are now to help her, that she is the cause for you being able to help so many. And so um a particular interest we had in having you on beyond you being this brilliant person that we wanted to present to the world, is that your focus is on um hair loss in um black folks, and that is um so important to Leslie and I. Um we love everyone. Why do people always say that? We love everyone, but we love everyone. Um, the more that we try to um uh just think of well, everyone, blah blah blah, you that often leads to ignoring the groups that aren't served by the broad. And so it is particularly important to Leslie and I to um to have you on to talk about hair loss in um black men and women. Um, and you know, the fact that that is what you specialize in, it's it's it's just all all goodness. Um, a little later on, I actually asked my um list, my email list, which is uh friends and clients and supporters um if they had questions for you. And so many. I didn't give them a lot of warning. So later on, I'll ask some of those questions. Um, but um tell us a little bit about your story. Like where did this all start? Where are you from and those types of things?
SPEAKER_02Well, um, I'm from Ghana. Uh and I came here, I was actually born in Ghana and came here when I was about two or three. Okay. We live in Brooklyn, uh actually on um on Beverly Road. So same in East Lapers, I'm not too far away from where I was. And then um we moved to Long Island, was about 10 years old, and I went to Catholic school. Actually, my whole life I was I went to Catholic school. Um, I went to St. Anthony's uh on Long Island and then went to Binghamton uh for university, and then did a master's in public health after I was done um at the University of Illinois, Chicago. And then I went to Stony Brook Medical School, took a year off and did um a Howard Hughes Fellowship. I looked at pediatric sarcomas and did some immunology work, and then went to Mount Sinai for a year for internship. And I I loved, can I say this? I loved my Mount Sinai Medic Medicine internship. Great experience, it's a great hospital and great mentors there. Um and almost was like, oh, I want to switch to medicine. That's just how what a great time I had. Wow. And then did my dermatology residency at downstate and uh my last year I was a chief resident, and then afterwards I, you know, did a little bit of uh working for other people and probably a year out, I started my private practice. I was on Long Island for a long time. Um, probably for I would say maybe eight years or so, and then recently in the last two, three years post-pandemic, I've been exclusively in Brooklyn.
SPEAKER_01Yeah. Wow. Nice, very nice. All right, Les. You know, I can hog, I can hog. I just want to talk to her. Yeah, so you you have to jump in. Go ahead.
SPEAKER_04So I just want to mention that when we initially contacted you about being a guest on our podcast, we asked you to speak about some of the dermatologic skin problems that manifest in women of an older age. And that's when you said to me, wait a minute, I've had three patients in my office just last week crying about hair loss, and that the issue that needs to be out there and discussed is hair loss. These other skin issues can come later, but it's critical right now, and it's hair loss, is as you said, is a big problem in our community. Um here's another thing that's interesting. Um you mentioned one of our family members um that had alopecia. Um I was speaking to Omari today and told him that I would be um interviewing you today. And he said, Wow, that's a coincidence, mom. I was just speaking to one of my colleagues today about alopecia. You may or may not remember, but Omari presented with alopecia, and that was one of the ways that was helpful in diagnosing his lupus.
SPEAKER_02Uh-huh. Now that you yes.
SPEAKER_04Yeah, yeah, I re I think I re uh you did his skin biopsy, actually, another confirmatory test for his lupus. But um he went to the barber one day, this was many, many years ago, and he came home and said, Mom, you know, after he got the short uh haircut, the barber, you know, um cut a bald spot into my head. Wasn't a ball spot, it was uh it wasn't cut by the barber. Right, right, right. It was a uh a silver dollar sized um bald spot in the back of his head.
SPEAKER_00Wow.
SPEAKER_04And then um months later he went on a Caribbean trip and came home with the mail a rash, et cetera, et cetera. So we finally put everything together. I'm like, that's not sunburn.
SPEAKER_02That's you know, so um I think that that's very important that you just said that, right? It speaks to the point that when somebody does have hair loss, we don't we don't just say it's hair loss, right? Because it can be a manifestation of systemic disease. Oftentimes people say, oh, it's a stress spot, you can put an oil on it. And it just really emphasizes the point that if you have an area of hair loss, you should go seek the advice and recommendation of a dermatologist so that they it's better to you know go in and say, Oh, it's there's nothing wrong. It's fine for you to go on for months and or years and be diagnosed with something that somebody actually can't help you with because you've waited.
SPEAKER_01Right. I'll be booking an appointment, so just look out for that phone call. Absolutely, because I've you know, there's some little thinning, you know that that's one thing. And although I want that to stop, I associate that with age, but I see some areas that are just smooth, they're not very big right now, but there may be three in a you know, one or two inch um radius. I'll see three little spots that doesn't look like too much is going on there. And um, I think you're right uh that just just go get a yes or no, just find out, you know?
SPEAKER_00Yeah, yeah.
SPEAKER_01Yeah.
SPEAKER_04Well, we've been I've mentioned the word alopecia a few times, so have you. Um, what is that? What is it?
SPEAKER_02So alopecia is an umbrella term for hair loss, and as dermatologists, we tend to categorize it in two ways. So we have non-scarring and scarring. So with non-scarring, the hair follicle underneath the microscope or underneath the skin is still intact, right? But there's some biologic process, whether it be systemic, whether you're taking medications, post-pregnancy, for instance, chemo.
SPEAKER_04I've heard that.
SPEAKER_02Autoimmune alopeciariata, where there's an immune attack around the hair follicle. But with medications or with a resolution of the systemic issue, the hair can usually grow back because the the areas of the hair follicle that actually grow the hair are still intact.
SPEAKER_03Yeah.
SPEAKER_02However, with scarring alopecia, inflammation, the hair follicle is a primary target of the inflammation. And if left long enough, the inflammation leads to scarring because the the inflammatory cells will recruit scar cells. Once that scar lays down around the follicle, it renders it completely inactive and quote unquote. And so that's why it's really important to identify what what category of alopecia it is, because sometimes they look very terrible. You can have multiple types of alopecia on one head, right? So you have to identify yes, sure. I have people with two and three types of alopecia, either clinically and then also with biopsy as well. And then um, you know, once you do that, then you you you want to identify the subtype of non-scarring or scarring alopecia because under those categories there are multiple names. So nobody should ever tell you you I have alopecia. It has to have a first, as my colleague Yolande Lenzi says, Dr. Yolanda Lenzi, it has to have a first name and a last name. So that name will help us to identify what treatment modalities we can use.
SPEAKER_04I see. So I've heard of alopecia ariata.
unknownYep.
SPEAKER_02So alopecia ariata is an autoimmune type of non-scarring alopecia, where um the body for some reason sees one of the hair follicle components as foreign, right? Because the immune system is supposed to protect us against various infections and viruses and cancers. But unfortunately, sometimes our self cells, the reason why we all don't disintegrate is because our body doesn't fight against ourselves. But in this situation, the body sees one of the hair proteins as foreign and it starts to attack it. And then you get um basically cessation of the hair growth cycle, and then you get a circular bald spot, and those happen, you know, kind of rather suddenly. Various stress, stressful situations can exacerbate them because we all also have stress receptors on our hair follicles, right? What?
SPEAKER_01Wait, stop. Yes, what? And wait, stop what we have stress receptors on our hair follicles.
SPEAKER_04All right, so here I am. Um what are you doing, Les? You are I am growing my hair. Managing patients. What the hell?
SPEAKER_02Are you kidding me, Ashama? No way, it's not, but you know, the the the cycling of the hair is regulated by so many, so many things, things that we don't we are even yet to find out, but it's a very complicated dance, even though, okay, it's growing at a constant pace. It takes a lot to get it there. Um, and that's why if you have a thyroid problem, you can get shedding, right? Because it just kind of throws the whole the whole cycle off. Um, but yeah, so alope shariata usually happens in about 2% of the population. Most of the time you get like little patches that even without treatment can sometimes grow by themselves. You know, it's interesting. I'll see these commercials on a various hair growth oil, and it says, Oh, I use the hair growth oil, and then within a few months, like my hair grew back, right? And oftentimes they show pictures of alope shariata, and 75% of these patches can grow back on their own without even the help of a you know a doctor. I see, I see. And so, okay, was it the oil or the body just kind of healing? Right.
SPEAKER_01Or that you're massaging the, you know, that the follicles, yeah, you're stimulating them. Yeah, yeah.
SPEAKER_02So that's that's one that we see very commonly in the office. I see. But the one that typically affects that we see a lot in black women is traction alopecia, right? That we get from repetitive pension type hairstyles. And you don't just see traction alopecia in black women, right? We see that any person, black, white, eight, or anybody who tends to pull their hair in a in a in a way that it doesn't necessarily naturally flow.
SPEAKER_04So you so now I'm gonna sit back and take the ball out of my hair. That's right.
SPEAKER_02That's okay.
unknownExactly.
SPEAKER_02So you take a ballerina who constantly has her hair in a ponytail, or uh, you know, a Sikh man who wears a turban, um, you know, sumo wrestlers, and of course, with being a woman of all the beautiful hairstyles that we have available to us, um, you know, unfortunately, because of time, expense, life, you know, we can constantly get in a cycle of repeating these styles over and over again. And then unfortunately, sometimes you'll notice some thinning and then you'll do it again to kind of cover some areas. Right.
unknownRight.
SPEAKER_02And that can and that can, you know, create a situation where you get traction alopecia. And traction alopesia is one condition that you don't have to have.
SPEAKER_03Right.
SPEAKER_02We don't have to have thin edges. That is an unfortunate choice that we make subconsciously or consciously because of the styles that we do.
SPEAKER_01That's a choice, ladies and gentlemen. A choice.
SPEAKER_02We're gonna talk about that because there are many things that are choices, but and and like I don't there's no judgment because the reason why we choose a particular hairstyle is based on so many sort of psychosocial reasons, right?
SPEAKER_03Yeah, yeah, yeah.
SPEAKER_02A family, you want something for convenience, um, you know, you're the way that you're supposed to present yourself at work, just our ideas of what is supposed to be beautiful, right? You make it hairstyle and beauty is currency, yeah, yeah. What does this book provide for me, right? How what kind of responses am I getting for people? And so you you do something because you're getting a particular response, whether it be or from somebody else. And so it's very difficult to change that, yeah, just because somebody says it might not necessarily be good for you, right? And say that about multiple things that happen or choices that we make in our lives.
SPEAKER_01Right, right, right. But at the bottom, at the end of it all, it's knowledge is power, right? You have the knowledge, you make your choices, but you know, it's not like you don't know anymore, right?
SPEAKER_02Exactly. And not, of course, not all hair uh hair loss in black women is due to the things that we're doing to ourselves, right? There are actually organic, like medical issues that we have, you know, like this central centrifugal secretrice alopecia. There's other autoimmune scalp conditions, one particular one called lichen planar pylaris, another one called frontal fibrosing alopecia that actually looks very similar to traction alopecia, where you have, you know, thinning of the hairline. This one actually causes recession of the hairline. It's also associated with darkening of the skin and loss of the eyebrows. So when we say when you have hair loss, go to the dermatologist, like I mean go to the dermatologist and make sure that you don't have any number of these things. You might think, oh no, this is from this is genetic.
SPEAKER_03This is how yeah, right.
SPEAKER_02Like, no, maybe it's actually frontal fibrosin alopecia or or something. So again, it's just really important to have somebody talk to you and tell you, you know, yes or no.
SPEAKER_04So let me um if I could add if if you can look at my face, I'm almost frightened as I'm listening to you.
SPEAKER_01So go ahead, Ange. So, you know, um one of the things as black people um is um when you go to a medical professional and They look at you for five minutes, or they discount what you say is your experience, or they um, you know, oh, it's alopecia or or whatever, and send you on your merry way. Um as a black woman dermatologist, can you say anything about how we might be able to find those um doctors who will actually listen and and and help us and not just, you know, take the money and say thanks for coming and do this. And you know what I mean? Yeah. Like, is there anything we can do?
SPEAKER_02Yeah, I mean, I think what you said has actually been documented also in the literature. You know, most black patients want to see race concordant physicians because of all of the um unfortunate sequella sometimes that we get from seeing doctors of you know other races. And it's not to say there are obviously uh a number of um amazing dermatologists who you know focus on hair and who don't, who treat patients of color. There's not even enough black uh dermatologists to be able to see all the black patients, right? So everybody needs to be able to treat every issue in all races of people, right?
SPEAKER_04And that's what we talk about culturally competent medicine. You know, we see it everywhere, yeah in all specialties.
SPEAKER_02Because you're you're you're white, I don't treat this particular hair loss or you're Asian, no, right, right. I I you know we studied on on patients of particularly being in in Brooklyn, black, white, Asian. Um, so I can treat everything. And so it's important that people just have to be interested in, right? You just have to ask the right questions. Maybe in your residency training program, you didn't have a lot of um, you know, a lot of black patients, but if you practice in an area where you happen to see this population of patients, it's your job, it is your actual job to be knowledgeable. Your responsibility, their cultural practices and the things to tell them so that you can get them better. The only reason why you're there is to create improvement in somebody's life. And so if you're if you're not knowledgeable about how they live their lives and you can't meet them where they are, then what is our actual purpose? Like we're not drug dealers, no, we're physicians. We treat the entire person. I'm a dermatologist, yes. I focus on skin, yes. I focus on hair, yes, but I also focus on the person. I have a good referral base of primary doctors, OBJYNs, endocrinologists, stylists, therapists, because hair loss affects all of these different avenues in life. So, in order to address the particular question that you had, I have created two directories. One of them is called Blackderm Directory.com that lists many black dermatologists around the world that I know. And so far, there we probably have maybe almost 300 doctors on there. So my gosh.
SPEAKER_01Yep, a chama. Listen, this was not a setup I did not know that this was so, but I am so grateful. This is like that is like the perfect answer. That is the perfect answer. When I was looking for a therapist, you know, I don't know what I would have done if therapy for black girls wasn't available, right? It would just have been a very different experience. The the weeding out process would have taken much longer, would have been much more stressful, probably would have sent me on a trajectory that I didn't want to go. This is amazing, folks. This will be in our episode notes. Don't you worry about that. Yeah. Don't you worry about that. All of this contact good employees. Okay, continue. I'm so sorry, continue, continue. I'm just so excited. I can't.
SPEAKER_02And the other one is called um Docs for Hair. So this is a directory of dermatologists, irrespective of race, who have a little special focus on hair loss. So as dermatologists, we're trained to treat hair, skin, and nails. But obviously, with any type of profession, you're gonna sort of sub-specialize in, you know, a different topic. Right. So there's some dermatologists who are basically cosmetic dermatologists who focus on, you know, either lasers, their, you know, their focuses on um injectables, filler, Botox, things like that. Um, so these stuff, these dermatologists have a special focus on hair loss. They treat everything else, but they've either done additional study, you know, added various things to into their office to accommodate patients who have hair loss and also time, right? Maybe they spend a little bit more time on their hair loss patients. So there's a directory for that as well. Um, and and this is really all born out of the the need when I need to refer patients out. Um, I don't take insurance. And so I want patients to have an option of other places to go to. The other thing, if my patients travel or go anywhere else, I want to have a good referral base for them to go to. I always tell my patients when they're in my office, you know, if you have a brother, sister, cousin, niece, daughter who has hair loss, you know, make sure that they go to the dermatologist. And instead of like giving them a name, I just give them the directory so that they can find somebody local in their area. And lastly, there are lots of obstacles to women of color getting treated, right? Black women getting treated. And so it's my little way in my little corner of the world to reduce obstacles to being seen.
SPEAKER_01Um that is such a generous and kind um thing to do beyond wanting to do it, to actually have have done it. And um, it's so kind, period. Yeah, and humanistic. Yeah. Look at you with your humanistic. You just want to mention your award again, didn't you? Don't you? Don't you? I recognize a humanist when I see one. You guys are gonna have to listen. I think that was season one, episode two or three, maybe. You'll know what that's all about. We've like our whole lives are on these episodes, by the way. You know that, right, Les? You know that, right? Okay.
SPEAKER_04That's why we're here. So, Achama, I have a question. You mentioned um patients that may say, Well, my mom had hair loss, or my grandmother. It's funny that you say that because my mother was just um telling me when I told her I was speaking to you that um she said, ask her. Well, I have hair loss in the um, it almost looks like male pattern baldness. Um, and she said, and my mother had that. And I think that I got it because it's a genetic predisposition. Um, is there any genetic components to hair loss or a particular pattern of hair loss?
SPEAKER_02Yeah, definitely. So the it, you know, you can have genetic cultural, because everybody's doing the same cultural practices in the in the family, right? Like right, we're all wearing our hair the same way, we've all used the same chemical um property, right? Genetic.
SPEAKER_04But then you know, of course, Afro sheet.
SPEAKER_02Right, the things that oh my god, burn in our scalp. You know, that have a genetic uh predisposition. And women um can actually have a male type pattern alopecia, and actually androgenic alopecia. You know what men start to lose their hair, women can have um the a counterpart to that as well, called female pattern alopecia. And that's actually the most common type of hair loss that we see in in women just across the board in general. Oh that's where you see the thinning, the miniaturization um of the hair. You can the parts start to get a little bit wider and things like that. So, and then you can have all these other things in addition to that as we get a little bit older.
SPEAKER_01Let me tell you, I I am turning my microphone on and off because um my dog has um decided to wake up and um do her little um so uh I have if you see my mouth moving, um like make a signal because remind me to turn my mic. Um but Les, could you how how much time do we have? Because I feel like there are like a zillion questions we've obviously you obviously you'll be back. Obviously, because there's a whole conversation around the products that we use. Oh my god. A whole conversation. Whole conversation. That's true. What? Beyond Shea Butter, God bless Shea Butter, but beyond that, oh yeah.
SPEAKER_02Well, there are all these, you know, these new report news reports and studies about the association between chemical relaxers and um uterine cancer breast pin.
SPEAKER_01Yes, yes, yes, that's starting to show up in my inbox, you know, getting those um those letters from legal firms trying to, hey, do you have this? Well, I haven't prone my hair in a long time, but um Les, can I ask the questions that that I got from I think now would be a good time to ask some questions because I just have so many questions.
SPEAKER_04It's like okay.
SPEAKER_01Okay, so here's one. Um this one asks about um edges, front edges thinning, but also eyebrows. What causes that? And is that something that they should see a dermatologist about?
SPEAKER_02Yeah, so um I say if you can get to a dermatologist, then see them about any level of hair loss that you have, especially if you're starting to have eyebrow thinning and you haven't been plucking away. So eyebrow thinning can be caused by systemic issues such as um thyroid problems. Um, it can also be caused by autoimmune alopeciariata that can affect the scalp. And then um just another common one that we see is this it actually used to be a rare condition, but I'm starting to see it a lot more. This frontal fibrosing alopecia where you get eyebrow loss and um also thinning of the frontal hairline as well. But the most common cause of thinning of the hairline is either traction alopecia and also uh female pattern alopecia or androgenic alopecia.
SPEAKER_01Okay. Okay. Um and if you could, since I wear wigs, I make wigs, I um I, you know, I my reason for starting a wig line is to give black women some more choices with with their hair. And I wear it as a protective style, but also just to change up my look. I don't wear wigs all the time and you know, I'm not like wearing them around the house and so on. But can you speak to some of the maybe best practices uh around um wearing wigs um that you might share with our audience?
SPEAKER_02I mean, I would say, you know, the medicine part is probably the easiest part because I read a lot. I love to read about alopecia. The most challenging part about my job is talking about how women should style their hair. It's a very, as you can imagine, a very, very touchy topic, particularly with a hair loss issue. So I don't have a problem with the hairstyle unless it has a problem with you. So that's like how I start most things. That right there.
SPEAKER_01Hashtag okay? That right there, yes. Okay, okay. That is a hashtag.
SPEAKER_02The issue with any hairstyle is based on so many factors your genetic predisposition, the current fragility of your hair, how the style is installed, and on and on and on and on. You shouldn't do anything and shouldn't, you know, you can do anything you want to, but it's probably not the best idea to do any one thing, unless it's your own hair for any extended period of time on a repeated basis, right? If we if you brought up wigs, right? Most wigs, the undersurface of them is a little rough. And what happens is that you can get something called frictional alopecia, where the frontal part of the hair obviously it's a continuation of your skin. So those hairs in the front are quite fragile. You're washing your face, the hair is just, you know, can break a little bit easy. So it can cause the hair to break in that area and it can cause thinning. And then in some people, it can actually cause traction alopecia. And when we talk about traction alopecia, there's there's always a continuum, right? Like see, you can have a traction alopecia that is reversible, so you stop that particular, you know, practice and then the hair comes back. And then you have traction alopecia that's irreversible, where you have to pay thousands of dollars for a hair transplant because that's the only way that you can get the hair to come back. So if you're wearing wigs, braids, and your hairline is completely fine. Although I say, you know, wear your hair out every once in a while, then that's your business, right? But if you are doing that and you're starting to notice thinning, and then you keep doing the same thing, that is where the problem comes in. Because yeah, there are there are lots of examples of women who wear braids, you know, who wear cornrows, they wear their wigs and their hair grows down to their butts and then their hairline is perfect. Um, that's fine. But you know, people come to me when they have problems. And so we need to do risk reduction when we're talking about any particular hairstyle. So um, if we talk about wearing wigs, if you if one insists on wearing a wig or because of the the level of hair loss that you have, you need to wear a wig for it to transition while we try to grow some of your hair back. You want to try to wear a silk or satin cap underneath of the wig so that whatever is gliding against your hairline is you know it is smooth and soft and not sort of rough and rubbing, you know, try to avoid those stocking caps because they're they're quite drying.
SPEAKER_03Yeah, yeah.
SPEAKER_02And you can find a lot of on at sea where you can, you know, maybe make them yourself. Um, and I don't like the word protective hairstyling, I don't know where that came from. Um, I get it, but don't at the same time. Yeah, yeah. Because some of these practices, again, because they're done on a repeated basis, because people think that it's going to grow their hair, ends up, you know, creating problems, right? If you I'm I'm from Ghana, I uh freaking raise our our life, right? But me, I can't do braids. Yeah, I've been worn braids for a while because it causes we need to have tract shell opecia. This the the um the braiding hair, the synthetic braiding hair, she also fractures my hair shaft because yes of the way that my hair shaft is, it's just really fragile.
SPEAKER_03Right.
SPEAKER_02Whenever I take braids out, my hair is is worse off than it actually started. Um, and some synthetic hair can actually cause eczema in some patients as well. So you it's it's you don't look at what every anybody else does. Look at what happens to you when you do a particular something, right? If something hurts you, it's not the style for you. Do you know what pain is? Pain is a signal in the body that there is danger approaching.
SPEAKER_01Danger, Will Robinson. Danger.
SPEAKER_02So if there is pain in a hairstyle, that means your inflammatory cells are acting up. You know, they're they're coming to protect you. And if they keep doing that over and over again, they're gonna start releasing factors that in their attempt are gonna shut things down, which produce a scar. So you should never have pain when you do a hairstyle. It just doesn't make any sense. You don't shouldn't have to braids that's not the person.
SPEAKER_04And that used to be the sign that the braids are gonna last a long time. I know, you know, and it's like, oh exactly. So sad. We're not so ignorant.
SPEAKER_01That's what that's what mummy used to say, though, poverty is such a thing, you know, because you it's like you want these things to that's why you buy your children shoes that are two sizes too big because they'll grow into them, and then the child suffers for two years until until they fit the shoes. You want your hairstyle that you pay this much money for to last a long time. So you end up losing your hair over it. But we we can do better. We can do better.
SPEAKER_04Yeah. Well, we do better when we know more. Yes, you know, but the more we know, the better we can do. What I heard you say though, Achama, just reminds me of a vicious cycle of traction alopecia, perhaps in hair loss, where we notice that our hair we're losing hair in certain ways. So as a result, we want to cover it up and continue wearing um a wig or a hair piece or a braid style or whatever it is, you know, that might be exacerbating the problem, but it's like now we really have to cover it up.
SPEAKER_01And yeah, that's right. That's what happens. Um, okay, I have one or two other questions that I okay. How do you stop or prevent hair thinning after menopause?
SPEAKER_02Well, I think the first thing to do is to identify what the condition is, right? Because just because you're post-menopausal doesn't mean that you still also don't have another hair loss condition. So I would say the first thing just get a proper diagnosis. If you have female pattern hair loss or androgenic alopecia, you know, in women, it's multifactorial, you know, due to a little bit of androgen sensitivity. So the the androgen um receptor on the hair follicle just becomes a little bit more sensitive and really binds a lot more to these male androgens, and you can get um, you know, um thinning of the hair that's caused by um slowing down of the hair growth cycle and miniaturization of those hairs. And so there are lots of things that we can do for that now. Um various medications, topical preparations, lots of procedures, injections. I mean, you name it, you know, there's at least four or five procedures that we do in the office in order to help.
SPEAKER_04Um and that's if it's due to that androgen uh insensitivity. Yeah, exactly. Yeah. I see. Is there any relationship between menopause and and a particular type of hair loss?
SPEAKER_02We tend to see more androgenic alopecia as we get older, right? Because the the the um ratio or proportion of um uh estrogen to testosterone changes a little bit.
SPEAKER_03So yeah.
SPEAKER_01Okay, I had to make sure it was turned back on. Okay, just one more. Um are there recent approved treatments for hair loss? Um this person has been having hair loss for over 10 years and was told that they have alopecia. But like you just said before, that's the overarching term, right? So we never want what is their last name? Is it middle name and last name or just the last name? Never accept the word alopecia, it's not a first name basis, it's not a do not name Mr. Alapecia. Do not accept, never accept alopecia just so, absolutely.
SPEAKER_02Our own, right? So if it's alopeciariata, which um Auntie Leslie, you want to tell me that was the only thing I remembered from that. Um there is actually an FDA-approved medication called barasitinib that's been a game changer for us. It's the first FDA-approved medication for this condition. And uh study, it's actually a rheumatologic medication, but uh some of the early studies found patients who are being treated with that and had concurrent allopicariata, maybe for 20 years, because alpiciariata you can actually lose all of your hair, can become completely bald from that condition. That's the most extensive case, alopecia universalis or totalis. And even after having it for that long and they use the medication for the person grew all of their hair back. Wow.
SPEAKER_04Can you repeat the name? So that that means there was no scarring involved, right? Exactly, exactly. There that means that they're exactly and the medication, it sounded like an immunologic exactly. So it's okay. So let's explain what that is.
SPEAKER_01You see what you see what they're doing, guys. The two doctors are ganging up on the engineer. It's it's it's not fair, but it's okay, it's their show. Go right ahead. Go right ahead.
SPEAKER_02Yeah, so it's in the category of medication called a jack inhibitor, and so um, it's an immunologic medication, and so that's why it works because it it takes away all those inflammatory cells that are causing the problem in allop chariata, and because the hair follicle is like really still working, once you get those inflammatory cells out of the way, then the hair follicle can just get back to doing its job, which is my gosh, it's a miracle, it really is. It's amazing.
SPEAKER_04Wow, yeah, is there like a old uh monoxidil? Yeah, but what about those things? Yeah, I remember that, you know, from years ago. Still use monoxidal, it still works, yes, depending on the cause.
SPEAKER_02Depending on well, I would say monoxidal is sort of a non-specific hair growth stimulator. So if you have any fine, small hairs, monoxidal can work across the board and all types of hair loss. But now we're also using oral monoxidal. So monoxyl was originally a blood pressure medication and still it's blood pressure medication, and actually the reason why we we made it into a topical is because people found when they were using it for blood pressure, they were also growing hair. But in order to reduce some of the systemic side effects that they were getting from the oral, they started giving it topically, and that's why road FTA proof were uh, however, we now use low-dose oral monoxidal, which has been also a game changer in my office and many um dermatology offices across the country and world in the world because it works very well. Um, with topical monoxidal, sometimes the vehicle that they make it in can be a little bit drying. It has glycol in it, which can be irritating to some patients, um, and particularly when you're already starting out with hair that's fragile because you have an underlying inflammatory scalp disease, using topical or Monoxyl Rogan is, you know, sometimes not a great idea. Um, and it's often easier to use the the oral version as long as you don't have any contributions.
SPEAKER_01Okay. Um, this is the last question. It it's yeah, I think we just have time for the question. It's more about hair where you don't want it than hair loss. So maybe I don't know. Yeah, yeah, yeah, yeah. So this one is about um chin hairs and then um, I guess um some some scarring or hyperpigmentation um when they try to address the chin hairs. Yes. And that's the last one I have for you.
SPEAKER_02Sure. So chin hairs, we always, depending on your age, we always want to make sure that there's no systemic hormonal abnormalities, right? Because women are not necessarily supposed to have hair in that area. So you go to your your primary doctor, your GYN, or your endocrinologist or me, and we rule out things um called polycystic ovary, right? PCOS. Um, and we can put you on medication to help to um sort of balance out your hormones a little bit more. Um topically, there are medications that we can use. I they used to they used to have a medication called Vanica Cream, which slowed down the hair growth cycle on the chin, but I believe they stopped making it um several months ago. Um give oral um spirinolactone, which is also a blood pressure medication, but also blocks the androgens or those sort of bad acting hormones that tend to cause you know excess hair growth on the face. Um, with psychologists, you can do electrolysis. Uh it's the hair that's kind of growing in back into the skin that tends to cause the bumps in the hyperpigmentation. So getting the hair out will really help to reduce that that problem. And I think lasers line.
SPEAKER_04I always thought it was the constant messing with the hair or plucking it or pulling it that causes that hyperpigmentation or irritation. That's part of it.
SPEAKER_02That's absolutely part of it.
SPEAKER_04I point to my chin.
SPEAKER_02I don't have that problem. That is absolutely part of it. Yes, constant picking, rubbing, any constant manipulation of your face is going to cause hyperpigmentation. So if you get rid of the hair in the first place, then you don't have the sensation of wanting to pull the hair out. And then, of course, there's a number of various creams, lotions, potions, and chemical peel of the hyperpigmentation.
SPEAKER_04Let me tell you, our episode notes are gonna be like three pages long. In other words, we just have to go see the doctor.
SPEAKER_01We just have to go see the doctor. And how about this one? How about this? Do you do televisits?
SPEAKER_02I do, I not for hair. Uh, not for hair if it's an initial visit. I gotta like go through every single part, but I do televisits for for for the face, definitely, and for lashes and things like that. Yeah.
SPEAKER_04I know. I just have to say, like, I've called you a couple of times and and said, like, sent you a picture. What do you think this is? You know, it's like here I am texting her these photos. But you've always been sweet. And I gotta thank you also for the recommendation for the skin regimen. I've been using it and I'm looking 10 years younger by the day. It's working for me.
SPEAKER_01Listen, she's been showing off with it. Let me just make it she's been showing off with it very much so, but it's okay. It's all right. I'm coming fruit, Leslie.
SPEAKER_04I think listen, I've been like this.
SPEAKER_02Like me too. I'm so glad that you know we were able to do this. I think it's um it's important to reach all audiences. And again, I mean, I'm only one person. There's so many doctors and dermatologists who really care who want to help you. Um, and just go and see somebody locally, right? Go on Black.
SPEAKER_04Only one of them is my niece.
SPEAKER_02Um, but I'm sure I don't take insurance, and that might not be, you know, okay for people.
SPEAKER_04Yeah, that might be a barrier to some people, maybe. Yeah.
SPEAKER_02Okay. Um, there are lots of other doctors who are amazing, um, a lot of other dermatologists who are amazing, who do great work, and who really, you know, care about uh patients with alopecia and who are very, very knowledgeable about how to treat them. So, you know, you got to also do your due diligence and look them up. And you know, if you don't like the answer from one person, then you, you know, you there you got two or three hundred more.
SPEAKER_04Yeah, I got it. And this is a typically a covered condition, it's not considered cosmetic.
SPEAKER_02No, you can no. When I used to take insurance before, I would I would send it through the insurance company. Yeah.
SPEAKER_04I see, I see.
SPEAKER_02Okay.
SPEAKER_04You know, just on the all these nuggets of information.
SPEAKER_01Just on the lack of insurance. I mean, obviously, um it it's it is something that has to be considered. However, um it you you you can make a choice about where you spend your money, how you spend your money, you know, uh to get what you need, you know, to get what you need for your life. And so I um I know that it is something that um um is an important consideration, but it doesn't have to be, oh, well, I'm not doing that because of that. It could be that that is the best doctor, you know, a chama is the best doctor for that situation, and so you know um save your money someplace else to to get this. I'm just saying that that is also a possibility.
SPEAKER_02You know, I what I often will do, I will maybe start the initial workup, um, make the initial diagnosis. Um, if they can't do the biopsy with me because it's it's you know out of pocket, then I I will write down what it where I think the biopsy should be, and then I'll refer them to a dermatologist who takes their insurance where they can get the biopsy, where you know it might be covered by their insurance. And then if they want to come back and see me every three, four months or every six months, then we can share there. I think that they're you have to do things that work for your budget. Yeah, we all have budgets, right? It sounds good that yeah, just go see the person who's the best, but that might not actually be practical. So we have to do the best practical that works for our and that we're going to be able to do for a long period of time, right? Because most of the time treating hair loss requires a good long-term relationship with your doctor. Maybe you have to go for injections or you know, it just kind of depends. So either I start and you finish with somebody who you know is is is in your network, or we share you and you come every six months or so just so I can make sure everything is going okay, or you come you see me once and then you just follow up. You know, there's any number of permutations of what we've want and what you need in order to make it feel better, right? Because we're all here for the same goal. With whether I can do that for you, that's amazing. But if not, I'm perfectly okay with that too.
SPEAKER_01Right, right. That's so collaborative. Oh my gosh. All right, we're gonna have to book her right after this call. We're gonna book you on our calendar for the next one, the next specialization. Thank you so much. Oh much.
SPEAKER_04Oh my gosh. This is just wonderful and so informative. I learned so much, and I have so many more questions. So, you know you're gonna come back, right?
SPEAKER_02Oh, I don't have a choice, you know. We're gonna end with we're recording.
SPEAKER_04Exactly, exactly. All right, love. Okay, thank you so much, thank you so much, everyone. This has been another wonderful, informative episode of Black Boomer Besties.
SPEAKER_01Black Boomer Besties from Brooklyn.
