Ep 17: Understanding Hair Loss with Dr. Nancy Echefu

For many women, hair is more than just an appearance—it’s tied to identity, femininity, and confidence. Hair loss can be difficult to navigate, especially with hormonal changes from pregnancy, perimenopause, and menopause. Many women, however, are left unsure of the cause and how to address it.

I’ve been there too—brushing off hair shedding as "just stress" until a dermatologist friend pointed out that it was actually female-pattern hair loss. It’s easy to overlook the signs, but ignoring the issue can end up making it worse.

In this episode, I’m joined by Dr. Nancy Echefu, a hair transplant surgeon, who breaks down the different types of hair loss, including scarring and non-scarring alopecia, and explains how to spot the signs early. She also provides a simple, actionable guide to help you start addressing hair loss before seeing a doctor—because awareness and early intervention are key. Tune in now to learn how you can start taking control of your hair health today.

References

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Eastside Menopause & Metabolism

Audio Stamps

01:35 - Dr. Echefu shares her background and expertise and what pushed her towards  pursuing her career in hair restoration. 

07:00 - Dr. Patil-Sisodia shares her own experience of hair shedding and hair loss.

08:33 - Dr. Echefu explains the two major classifications of hair loss: scarring and non-scarring alopecia.

13:18 - CCCA, a type of scarring alopecia, is identified through symptoms like itching and burning, with biopsies used to confirm a diagnosis when needed.

15:27 - We learn the difference between hair loss and hair shedding and how much hair shedding is considered normal.

21:45 - Dr. Echefu customizes treatment based on history, symptoms, and prior care, tracking progress over a year with in-office and at-home therapies.

26:48 - Dr. Echefu combines medical treatments with PRP, microneedling, or laser therapy, tailoring care to patient needs and referring to specialists when needed.

32:18 - Trichotillomania is often linked to anxiety. Even mild hair-pulling can cause hair loss, so awareness is key.

35:54 - Before seeing a doctor for hair loss, Dr. Echefu recommends simple hair care practices to track and assess your routine.

Thanks for listening. Find more info about Reset Recharge on the website or Instagram.

Transcript

Dr. Komal Patil-Sisodia 0:01

Welcome to the Reset Recharge podcast with your host, Dr. Komal Patil Sisodia, a board certified endocrinologist, internist, and obesity medicine specialist. This podcast is focused on empowering women's health and aims to help you reset your understanding of your metabolic health. And recharge the conversations you are having with your healthcare providers. While I am a physician, this podcast is purely for educational purposes. No individualized medical advice is being given on this podcast. If you do find information that is helpful, please discuss it with your healthcare provider at your next visit. Hi, everyone. Welcome back to Reset Recharge. Today, I am very excited to have Dr. Nancy Echefu here with me. She is a hair transplant surgeon based out of Georgia and has been running her practice, Havila Hair Restoration. She is here to talk to us about hair loss in women. And this is something women come to my office as an endocrinologist about so many times. And I had the privilege of being on an Instagram live with Dr. Achefu, where we talked about it from my perspective, but I thought it would be a great thing for our listeners to understand from. a hair transplant surgeon's perspective. What are all the different things we can be doing for hair loss? Because as women, we start losing hair, post pregnancy and then we hit perimenopause and menopause. And then there, there are so many other hormonal and nutritional issues that can pop up. So without further ado, I would like to welcome Dr. Achefu and pass the mic over to her to talk a bit about her background and expertise and what pushed her towards. pursuing a career in hair restoration. Dr. Ocheifu, welcome.

Dr. Nancy Echefu 1:49

Thank you, Dr. Patil. My name is Dr. Nancy Echeifu. I'm a board certified internal medicine physician and hair transplant surgeon. I'm the owner of, owner and founder of Habila Hair Restoration. Also the owner of Hair Loss Exhibition Shows in Georgia, which is a hair loss exhibition from the name. Hair Loss is a visual show we do annually in Georgia where we showcase everything about hair loss, hair restoration, machines we use for hair loss, everything about hair loss, basically, where people get to ask their questions. Everything hair loss, that's your girl, Dr. Chaim.

Dr. Komal Patil-Sisodia 2:27

Alright, fantastic. And how did you decide to pursue that? We don't often hear of people going from internal medicine towards hair restoration. What was it that made you feel passionate about this?

Dr. Nancy Echefu 2:39

Now, if you know me, my pathway has never been straight. So, from internal medicine, I've practiced as an emergency doctor. So, internal medicine, emergency physician. Right after residency, I jumped into emergency medicine because I liked it. The adrenaline and all that. Helping people on the spot. Let's say fast forward a couple of years. Two years down the line, I started losing my hair. Oh. I was the doctor in the hospital that you would never catch me with the same hairstyle every month.

Dr. Komal Patil-Sisodia 3:09

Like, you know,

Dr. Nancy Echefu 3:11

so I didn't know that was damaging to my hair. So I started losing my hair. And I never, and I ignored it, it's one thing to lose hair. That is one thing to recognize. You're losing your hair. You might be in denial because well, we have the wigs, the extensions so what, and how did I come to, how did I come to the realization that, hey, Nancy, you need to do something about it. It made me depressed. I was depressed looking at myself like, you know, when you get back from work, you take out your scrubs, take out your weave and your wigs. Then you have to face yourself. I didn't like what I was looking at.

Dr. Komal Patil-Sisodia 3:50

So I

Dr. Nancy Echefu 3:51

had traction and lopecia. I was having hair shedding. And with the stress in the emergency room, I was doing like 20 shifts, 25 shifts a month. I want you to understand that. The stress of that, I can tell you that. In addition to the traction that I was having with the different hairstyles I was having to keep up.

Dr. Komal Patil-Sisodia 4:13

So

Dr. Nancy Echefu 4:13

I had to say, hey Nancy, you need to do something about it. So I went to a couple of doctors. And I went to a couple of hair transplant doctors, but the problem I was having is that one, there's no continuity of care and there are no options. You see, continuity of care and options. So why do I say that? A lot of people complain that when they just go see their doctor, talk about their hair loss. They just, give them medication and send them home, I'll see you back in six months and they can't get into the doctor's office. Yeah, so that's number one. And when there's no continuity of care, guess what patient will stop taking your medication. It's not like it's blood pressure. It's not like it's diabetes that you need to keep up with it. And that's number one. Then number two is that there are no options on what to do with my hair.

Dr. Komal Patil-Sisodia 5:00

Yeah.

Dr. Nancy Echefu 5:02

African American as an African American. And I'm like, okay. You have to go see someone that can, that is able to teach you, tell you what to also do to your hair. So it's not just the hair loss. It's also someone that can tell you, Hey, you need to stop doing this. Why don't you substitute this for this? Okay.

Dr. Komal Patil-Sisodia 5:22

So

Dr. Nancy Echefu 5:22

the options, the education was lacking. So guess what? I'm like, what am I doing with my life? What am I doing with myself? So I had to research, look up so many options, came up with my own treatment plan. My own treatment plan. And I took care of myself, took care of my hair. And that's where we are right now.

Dr. Komal Patil-Sisodia 5:45

That is so inspiring. And it's amazing to hear how your purpose was born out of a personal struggle. I feel when we find our passion it's oftentimes due to something that we have experienced personally and it's deeply impacted us in a way. I can say that your patients are so lucky because you yourself have walked in their shoes and you understand and you took the Have The impetus to develop your own treatment plan. And now you're sharing that wealth of knowledge with other people. That's such a beautiful thing. Thank you for sharing that. I know that's a deeply personal story.

Dr. Nancy Echefu 6:22

The one thing that my patients tell me, I try not to use the word patients. I love to use clients, one of my clients, they tell me is that, yeah, where have you been all my life? You're almost like my long lost sister.

Dr. Komal Patil-Sisodia 6:36

Yeah.

Dr. Nancy Echefu 6:37

You know why? Because I don't just talk to you as just as a physician, I talk to you as someone that has pastoral and what I did. And I tell you my own personal story. You don't have to, your treatment option might not be the same as mine. But you have to understand that the struggle is the same. Oh, absolutely.

Dr. Komal Patil-Sisodia 6:56

It's funny, you were talking a bit about how we we as physicians tend to ignore our own symptoms and things like that. And I think I had kind of downplayed the same thing. Like, oh, I'm having hair shedding and hair loss. Because of stress, this, that, and the other. I went to see a friend of mine, who's a dermatologist for a skin related issue. And she said to me, she said, well, are we going to talk about your hair loss? And I just kind of stare at it. And she was my friend, so she could be really blunt with me. She said, girl, you are losing your hair. Like it's, what is happening here? And I looked at her and I said, it's just stress. She said, no, no, this is female pattern, hair loss pattern that you're seeing. What did your mom's scalp look like? And I thought back to it and I thought, oh my gosh, my mom was around my age where, the hair started thinning and there's such a big genetic component to it, but I would have never acknowledged it. I was just, putting my hair up in a ponytail or, moving my part further and further to

Dr. Nancy Echefu 7:53

the side. No, no, no, you're right. And I tell people that. How people tell me when I give lectures or talk and all that, I tell people if it's not bothering you, you're not my client, you're not my patient. until it starts bothering you. Yeah. Then you come and see me. Cause you know, so that's when you acknowledge that there's something wrong.

Dr. Komal Patil-Sisodia 8:12

Absolutely. And it took her to point it out to me, because it was bothering me. I was doing all the things to try and cover it up, but I wasn't acknowledging it. Because a lot of times we tend to. ignore and hide the things that are uncomfortable. So I'm very grateful to her for saying something because it actually put me on a path to start treating it. Yeah. I would love to hear from you how you classify different types of hair loss. When we were on the Instagram live, I loved your breakdowns of what different types of hair loss are and then what the most, what I'd also like to hear, and I'm sure our listeners would like to hear as well, is what are the most common types of hair loss that you see?

Dr. Nancy Echefu 8:51

Okay, so I'm going to use this analogy so that people can understand. When you look at your hair, imagine a tree that has roots, okay? Yep. So when you're planting, there's a root and there's a tree, and let's assume there's some branches, okay? So I want you to imagine your hair is a plant. That has root and a tree. So if you understand that, so every other thing I'm going to discuss moving forward, I'm going to use this analogy. Okay. So now the major thing, major, major classification of hair loss. It's for easy classification. It's called, we say scarring alopecia

Dr. Komal Patil-Sisodia 9:35

versus

Dr. Nancy Echefu 9:36

non scarring alopecia. Why do we say that? We're looking at the roots. Remember I said the tree and the roots. So the scarring, there's an inflammatory process going on. There's attacking the roots that you cannot see that's underneath the skin. So that's the scarring. Then the non scarring is what is a lopecia that there's no inflammatory process going on. It's just natural progression of life. You get that? So if we look at that, we'll understand that. So when we say non scarring, let's start with the non scarring. Most people that come into my office, let's say 50 percent of them, almost everyone you see suffering from some form of pardon hair loss. What we call it, male pardon or female pardon hair loss. That's what we're, so that's the non scarring. What do I mean by that? Your friend told you about, you're having some hair loss. How does your mom look? How was her hair? So that's what we're trying to spot on hair loss with his genetics. So most everyone that walks into the office is suffering from genetic hair loss. So that's easy. If you understand that you've won the battle, 50 percent that everyone that walks into your office, they're likely to suffer from that. So for non scarring, for scarring alopecia now, that's what we're worried about. That's what every hair loss physician is worried about. Why? Because those ones are difficult to treat.

Dr. Komal Patil-Sisodia 11:04

Yeah.

Dr. Nancy Echefu 11:05

Because there's an inflammatory process going on on the scalp on the scalp. The roots, something is going on. The roots have been damaged. There's no regeneration. It's not going to grow. Because the roots are damaged. Oh, wow. Okay? So there are so many of them. We hear CCCA, LP, uh, there are so many of them. But it's easy for people to understand. When you walk into the office, or when you walk into my office, that's what I'm worried about.

Dr. Komal Patil-Sisodia 11:34

What was the first one, the first acronym that you gave the CC, what was that?

Dr. Nancy Echefu 11:39

CCCA is centrifugal alopecia. It's like a whole long name, centrifugal. What does that mean? It's just alopecia when people are losing their head right in the center of their head.

Dr. Komal Patil-Sisodia 11:51

Oh. And it's

Dr. Nancy Echefu 11:52

mostly in African American women. Oh. Because of our hairstyles. Oh, interesting. Okay. Okay? So CCCA is a whole long name. Centrifugal alopecia and all that. So talked about the scarring and non scarring alopecia.

Dr. Komal Patil-Sisodia 12:08

Yeah,

Dr. Nancy Echefu 12:08

Talked about the concept behind it once we make sure that it's not a scarring alopecia, then the Non scarring, which is the parting. Parting hair loss is easy for us to treat. Did you get the concept?

Dr. Komal Patil-Sisodia 12:23

Yeah, I love the analogy of the tree that actually breaks it down in such a great way So if you think of your hair as a tree The non scarring is just a regular life cycle process. The scarring is where the roots get damaged. Did I sum that up properly?

Dr. Nancy Echefu 12:41

Yes. Okay.

Dr. Komal Patil-Sisodia 12:42

I love that. That is such a easy way to break it down where I can actually see it in my mind better. I'm a very, you see,

Dr. Nancy Echefu 12:51

and that's the way I tell people that if I cannot explain things for you, ABC. Then that means that's too long. That's why you can see some of our patients can't understand. They can't relate the message because well, we use a lot of medical terms so they don't understand what we're saying. So that's why I like to break this down. So for the whole concept, for the CCCA is central, centrifugal, cicatricial, and lopecian. It's a long name. So what it just short form is CCCA. Okay. Perfect. Okay.

Dr. Komal Patil-Sisodia 13:22

How do you differentiate that? Is that just the pattern or do you need to do a scalp biopsy? What are the, how do you differentiate that between, the regular like genetic hair loss?

Dr. Nancy Echefu 13:33

So now let's say someone walks into my office and say, Hey, I'm dealing with hair loss.

Dr. Komal Patil-Sisodia 13:38

Yeah.

Dr. Nancy Echefu 13:39

That I'm going to, I need to ask. Any itching, any burning,

Dr. Komal Patil-Sisodia 13:43

any

Dr. Nancy Echefu 13:44

redness of the scalp, any tingling sensation. See, these are the questions that are going to lead you towards scarring. Okay. There's an underlying issue, so once it, that's number one, then number two is your physical exam. Where is the location of the alopecia? Yeah. Like from the name, it's central. So it means that it's going to be central area of the scalp.

Dr. Komal Patil-Sisodia 14:07

Yeah.

Dr. Nancy Echefu 14:07

Like the top of your head.

Dr. Komal Patil-Sisodia 14:09

You

Dr. Nancy Echefu 14:09

look at that, then remember I was talking about African Americans. Yeah. Okay. Then biopsy is just to confirm what you're already thinking. So you have to do your history, make sure if they have the signs of the inflammation. I tell people, I tell other practitioners, hair loss practitioner, when I give my lecture, once they complain about it's itching, it's burning, that is out of your scope.

Dr. Komal Patil-Sisodia 14:36

Yeah. They

Dr. Nancy Echefu 14:36

need more. They need more treatment. They need a professional to take care of them, they need a physician to take care of them. Okay. So that's how you know, then you cannot decide to get a biopsy to confirm what you're already thinking.

Dr. Komal Patil-Sisodia 14:51

Yeah,

Dr. Nancy Echefu 14:51

so someone can come to my office when I do my virtual consults. And I asked them Hey, have you had a biopsy? I said no. Do they have a dermatologist a doctor that can do biopsy where they are to say? Yes, I say I think this is what you have. Yeah Let's go ahead and get a biopsy and when they come back and tell me this is what the doctor said They have CCCA. I'm like I already knew it, but I just wanted to confirm it to document it for you So it just to help you comment. It's not everyone that needs a biopsy

Dr. Komal Patil-Sisodia 15:16

Okay.

Dr. Nancy Echefu 15:16

But it's just to confirm, what you're already thinking that this is what might be. Okay.

Dr. Komal Patil-Sisodia 15:21

Okay. That makes good sense.

Dr. Nancy Echefu 15:23

And then,

Dr. Komal Patil-Sisodia 15:24

With the, I know we're going to talk a little bit about a treatment, but one of the other things that you and I talked about on the Instagram live that I think was very interesting, and I think it requires probably a little bit more breakdown for people who are struggling with hair loss and may not have that medical background is what is the difference between hair loss and hair shedding? It's important to understand the distinction between the two, because there, there is a, probably a normal amount of shedding that can happen, but people have a hard time differentiating between the two. And you

Dr. Nancy Echefu 15:57

know, that's why when we're having an interview, I kept on saying hair loss or hair shedding.

Dr. Komal Patil-Sisodia 16:01

Yes.

Dr. Nancy Echefu 16:01

Hair loss or hair shedding. Yeah. Because people tend to, now you can have both at the same time.

Dr. Komal Patil-Sisodia 16:06

Yes.

Dr. Nancy Echefu 16:07

Because remember I told you one is genetic. Yes. No. male pattern or female pattern hair loss, then the hair shedding is almost like the trigger. So let's go back to my analogy, the roots and the tree. So when there's hair loss, true hair loss, which is progressive, it's coming from the roots. When there's hair shedding, it's just the tree or the branches that are just falling off. I see.

Dr. Komal Patil-Sisodia 16:32

Oh, I like that.

Dr. Nancy Echefu 16:33

Yeah. So it's easy. So whatever trigger.

Dr. Komal Patil-Sisodia 16:37

Postpartum,

Dr. Nancy Echefu 16:38

flu, COVID, fever, surgery, Viretric surgery, weight loss, GLP medication, stress, yeah. That can cause head shedding. So that's just a bit of head shedding.

Dr. Komal Patil-Sisodia 16:55

That is such a great way of breaking it down. It makes so much sense. That's

Dr. Nancy Echefu 17:01

why you hear them, they say, Once that phase, once the stress is gone. When you want to take away the stress, the hair will stabilize because the roots are still there. It's just the trees that fell

Dr. Komal Patil-Sisodia 17:12

off. The question that people ask is how much is normal hair shedding? How much hair can you expect to lose in a day on average? And I know it will be different for different people but what would you consider a normal amount of hair loss per day? Okay. Or hair shedding, rather.

Dr. Nancy Echefu 17:29

We can lose anywhere a hundred hair fifty to a hundred or eighty to a hundred. But hair shedding is the terminology when you're losing more than normal. Okay. Okay? So, eighty to a hundred is normal for us to lose every day. Then, when you're not having, when there's a trigger that you're having hair shedding, you can lose more than normal.

Dr. Komal Patil-Sisodia 17:48

And those are like the underlying illnesses that are not the inflammation of the root. Okay. Okay. Okay. Yes,

Dr. Nancy Echefu 17:54

it's not it. This is not inflammation.

Dr. Komal Patil-Sisodia 17:56

Yes.

Dr. Nancy Echefu 17:57

We're not talking about inflammation now. We're just adjusting normal. There's a trigger. There's a norm. What happens with that? Remember I told you about the tree?

Dr. Komal Patil-Sisodia 18:04

Yeah.

Dr. Nancy Echefu 18:05

So what happens is that there's growth cycles of the hair.

Dr. Komal Patil-Sisodia 18:09

Oh,

Dr. Nancy Echefu 18:09

there's growth cycle. Yes. There's growing phase. There's a transitional phase. There's a resting phase. So that hair shedding is all about. There's a trigger that stopped that arrested the growth phase. Let's say arrested. Arrested the growth cycle to the, in the resting phase. That means the hair stays in that resting phase. So it's not growing. It's just resting. It's just lazy. Right there. Oh, I see. So that's why it's shedding.

Dr. Komal Patil-Sisodia 18:37

How long is the hair cycle from start to finish usually? So it depends.

Dr. Nancy Echefu 18:42

So growth phase can last anywhere to three to eight years. Oh, wow. Okay. Three to five years. Now, it depends on what area of the hair we're talking about, the scalp hair, or, the eyebrows. So it depends. Growth phase for different places are different, but we're talking about the scalp now. Okay. So the growth phase is between anywhere from two to eight years, which is the longest phase. Okay. So our hair is always growing. That's why you can shave off your hair now and the next week is great because it's always growing. Okay. Okay. Then we have the resting phase. Remember when it grows, it rests. When it grows, it transitions to the resting phase. So growth growing phase, transition phase and resting phase. So the resting phase can last maybe two months, two to six months. Usually I can give an average of three months for the resting phase. So that's what happens when you start a new medication. That's a hair loss medication sometimes is a trigger and it stays in that resting phase. So you have hair shedding. I

Dr. Komal Patil-Sisodia 19:45

see.

Dr. Nancy Echefu 19:46

That phase, if you understand how the analogy I gave to you and the growth phases, or the cycle. You understand each cycle when someone walks into your office, what's going on. And it also helps when we do hair transplant. To understand what phase, the hair is in right now.

Dr. Komal Patil-Sisodia 20:03

That makes sense, so if I were to break it down a little bit more, the resting phase is where, if the fall, if the leaves on a tree are going from summer to fall, the leaves are falling off and that's the resting phase.

Dr. Nancy Echefu 20:17

Okay. And that's why where the telogen uvv, when people say telogen effluvium that's resting phase.

Dr. Komal Patil-Sisodia 20:22

Okay?

Dr. Nancy Echefu 20:23

It stays in that resting phase.

Dr. Komal Patil-Sisodia 20:25

Okay?

Dr. Nancy Echefu 20:25

So if that's, but the roots are still there.

Dr. Komal Patil-Sisodia 20:27

Okay, that makes sense. So if that's lasting two to six months, then to me it seems that if somebody is starting a hair loss treatment, they would need to try it for. At least that period of time in order to see a difference,

Dr. Nancy Echefu 20:41

right? Yeah, I tell them like, you need to be, number one, you need to be patient. Number two, your hair is going to go through an ugly phase.

Dr. Komal Patil-Sisodia 20:49

So

Dr. Nancy Echefu 20:49

once you realize that, just give your hair some time, we don't expect any miracles. We just have to wait till four to six months.

Dr. Komal Patil-Sisodia 20:57

I love that. And that's such a, it's such an exercise in patience, right? For most of us, so much of our identity is tied to our hair. For women, their concept of femininity is tied to their hair. And so it seems unfair that we lose it so much faster than we can grow it back. I

Dr. Nancy Echefu 21:15

know, I promise you, Lea, it's easier to take care of a man's hair than for women when they're dealing with hair loss because we have to think about everything like age

Dr. Komal Patil-Sisodia 21:25

yes

Dr. Nancy Echefu 21:26

what phase at what stage of their life they're in what is going on so so many things how many are in that so many things for women yeah so that's why it's very important here

Dr. Komal Patil-Sisodia 21:35

It is definitely a challenge. It is much more complex. So when, what is your approach? You talked about your clients coming in for hair loss. I, and we've heard how you divide them into, is this scarring or non scarring alopecia? Could you break it down like for your patients with non scarring alopecia versus scarring alopecia? What are some things you have each group try and obviously the scarring alopecia will probably be more complicated because it really depends on what's causing that. But for the non scarring alopecia, I guess maybe we'll focus on that. What is your formula? What is your approach to, thinking about like how you can help treat those women?

Dr. Nancy Echefu 22:17

Okay. So someone walks into my office. He should take him. First of all, I send them the medical history before they come to the office so they can really have time to just read through their medical history.

Dr. Komal Patil-Sisodia 22:29

Yeah.

Dr. Nancy Echefu 22:29

Then talk to them. Is this hair loss progressive? How long have you had it? Or just, it's just sudden. Cause it's very important. Cause we want to make sure is this an arrest?

Dr. Komal Patil-Sisodia 22:38

Yeah. Or

Dr. Nancy Echefu 22:38

is this, a progressive hair loss? No? So it depends on what they say. Then I have to do a physical exam. Remember I already talked to you about the itching, the burning and all that. To help me, is this scarring versus non scarring? So it depends on what I see. Or what I also, based on the history that I take, I have to determine, do they need blood tests? Do they need a biopsy? Okay. Now, if they need blood tests, what do I do? I have to ask them, Hey, do you have a regular doctor? If they say yes, when was the last time they had their physical exam? Yeah, they're about to have it within the next one, one to two months.

Dr. Komal Patil-Sisodia 23:18

I will

Dr. Nancy Echefu 23:18

add the blood test. I want them to add together with their physical exam.

Dr. Komal Patil-Sisodia 23:22

Okay.

Dr. Nancy Echefu 23:23

Okay. So I give them a whole comprehensive list to add to what they're already going to be doing with your regular doctor. So they don't have to, do it twice. That makes sense, that number. Then number two, have to determine do they need a biopsy? You have to explain, Hey, have they been dealing with these hair loss for a long time? Some of them come in and say, Hey, I would just want hair transplant. That's what I want. Yeah. Or I've heard of microneedling, or I've heard of this. I have the PRP and I have to ask them, what have the most important question I have to ask que clients now. What have you tried before? Who have you seen? Most of them have seen trichologists, dermatologists. Most of them have been given medication. So I have to know the back history.

Dr. Komal Patil-Sisodia 24:03

So once I

Dr. Nancy Echefu 24:04

know the back history, then I know what to do build on that. Have they tried Minoxidil, which is like almost everyone knows about minoxidil at this point. What dose have they tried? So everyone that walks into my office basically depends on age, history, what they've tried. So everyone was typically start everyone make sure you're minoxidil. Then what dose of minoxidil have they tried? Whether taking it every day or every two days or every three days. So are they taking the foam? Are they taking, are they using the foam or the liquid? So it depends really. On the history on water. So everyone starts on minoxidil. Then we build on what we want. So I have a whole protocol what I want you to ask. Now if they don't have a primary care doctor, I will have to do all the blood tests.

Dr. Komal Patil-Sisodia 24:48

Yeah. But

Dr. Nancy Echefu 24:49

I'll have to also make sure they go and get a primary care doctor. Or I look for a DPC physician.

Dr. Komal Patil-Sisodia 24:54

Yeah.

Dr. Nancy Echefu 24:55

To refer them to. Because I have to make sure that you have someone else, that makes sense. Watching over you, not just your head.

Dr. Komal Patil-Sisodia 25:00

Because hair loss is often a symptom for other things that are ongoing systemically, right? Like we talked about.

Dr. Nancy Echefu 25:07

Yeah.

Dr. Komal Patil-Sisodia 25:08

That makes good sense. How often can a patient who comes to see you expect to follow up with you? Are you checking in with them monthly, every few months knowing how long it takes for hair to actually come back? How do you track that progress?

Dr. Nancy Echefu 25:22

So what I do is Now, what I do is that when someone comes in with me, I'll tell them, you have to give me one year of your hair's life. You understand that? You have to give me one year. Why do I say one year? Because your hair is going to go through different phases and your emotions are going to be all over the place. So I've had patients I've placed on, we've started treatment and they call me, I feel this part is falling off. I feel I'm not, they will start noticing so many things that I didn't, that was not there before. So I do three months, six months, nine months, 12 months. And it depends on what treatment you're also getting. The couple of treatments I have, there are some of the treatment, which is my TED Hair Restoration, which is good for women because there are no needles, no blood draw, nothing. The TED Hair Restoration is almost like an ultrasound based machine. We induce hair growth. Interesting. The numbers. So we induce it. We, it's almost like vibrational. We use our hair serum, our hair vitamins that has everything you need. Then we use that machine, the TED machine and induce hair growth. So that's what we do. It's most especially women love that. We use that treatment once a month for three treatments. If they decide to go with the Ted Hair Treatment, I have to see you every month in my office. After that, I'll let you go for another three months and watch your hair grow and give you other treatment options that you'll be doing at home. So while I'm taking care of you in the office, I also give you what to do at home.

Dr. Komal Patil-Sisodia 26:42

What do you generally recommend? there's so many things that we hear, topical minoxidil, I'm happy to hear, right? Because that is the first line. Are there like other things like laser hair caps, the derma rollers for the scalp and the scalp massage,? Are these things that you think are more myth versus fact, or is there some data to it that might be helpful to women?

Dr. Nancy Echefu 27:07

What I do is medical, that's why, we're medical doctors. Yeah. We believe in medical science. Yes. So standard treatment, minoxidil, finasteride, spironolactone. That is a standard. We don't have to give spironolactone to everyone, but I'm just saying these are the three medications you would generally see. So that's the standard. So medical treatment in addition to plot that. What I mean is plus

Dr. Komal Patil-Sisodia 27:29

PRP

Dr. Nancy Echefu 27:31

we want to do because PRP number one is number dependent. The dose of the growth factors you need is almost like 1. 4 million. And your PRP as you age decreases. So PRP is basically has so many factors. Then we have the microneedling, which is good. I love microneedling a lot. I have the TED hair restoration, and we also have the laser cap. You can do that at home. I also tend to do the laser treatment too, which is the low laser light therapy. We also have to make sure there is a medical device. We're not just buying something on the internet and all that. We have to make sure it's the range we're looking for. Because it's low laser. You can't buy a high laser and burn your scalp. Ugh.

Dr. Komal Patil-Sisodia 28:17

That sounds like that would be scarring. See? So.

Dr. Nancy Echefu 28:20

The roots. It has to be low laser light therapy that you can do at home, but you can't do that alone. Your head is not going to grow. Like it's going to grow, but it's the rate at it is going to grow compared to you adding the medical therapy that you need because they all have different mechanism of action. Medical treatment in addition to either PRP. Or microneedling or the third hair restoration or hair transplant. The best one is the hair transplant. That is for sure. Your hair is going to grow. The way I combine the treatments is if someone doesn't like needles, Have to stay away from anything needles. Some people have this ov vagal syncope where you try to draw blood. You don't wanna do all that to a client, so you have to respect people's wishes. That's the way I approach my taking care of clients.

Dr. Komal Patil-Sisodia 29:05

It's such a comprehensive approach, and I love that you've developed your own treatment protocol. My next question would be is how closely are you working with the other specialists? So it sounds like you are very much pro them having a primary care at baseline minimum. But are you referring out to other specialists as well if you're suspecting other things?

Dr. Nancy Echefu 29:26

I always refer. Like I have a young lady coming to me with PCOS. I'm like, when was the last time you saw your regular doctor? I need to see your labs.

Dr. Komal Patil-Sisodia 29:34

Yeah.

Dr. Nancy Echefu 29:35

I need to see, what it said. So where is he at? What are you taking? So I need to know. I have, I've had clients that come in and they break down crying. Then I have to think about their psych history. That's the one part that I have to deal with a lot in the office because they get so emotional with the hair loss. And, we always have to think about trichotillomania. Are they pulling your hair?

Dr. Komal Patil-Sisodia 29:56

Yes. How common is that? I was reading actually that it

Dr. Nancy Echefu 30:00

I'm sorry. people like, oh, let's say denial. That's what we face. We're faced with for physicians. Anyone that is dealing with a hair loss practitioner or hair loss physician. Denial trichotillomania. I've had clients coming in and we do our the mitoscopic exam, which is, we take a look, we have a specialized camera

Dr. Komal Patil-Sisodia 30:19

or

Dr. Nancy Echefu 30:19

microscope. Let's put microscope. We take a look at the. that we're missing. Remember what I was telling you? What everyone see is their hair, but what I'm looking for is that roots. Is that roots? Okay.

Dr. Komal Patil-Sisodia 30:30

Yeah.

Dr. Nancy Echefu 30:31

What is underneath your skin, your scalp? Is it okay? To make sure and the assigns we look for to see if this person is dealing with trichotillomania, like he's pulling their hair by themselves. Do they have an autoimmune disorder going on? So these are the things we look for in our examination of the scalp.

Dr. Komal Patil-Sisodia 30:48

Yeah.

Dr. Nancy Echefu 30:49

Okay.

Dr. Komal Patil-Sisodia 30:50

So

Dr. Nancy Echefu 30:50

this is what, then I'd have to have a different conversation because you want to also, are this person dealing, are you dealing with body dysmorphia?

Dr. Komal Patil-Sisodia 30:58

Yeah.

Dr. Nancy Echefu 30:59

You see what I'm saying? So I have to have this different conversation. I've had someone come in and I want microneedling. Oh, she'll change her mind. I want this. I want that. I'm like, okay, let's sit down and talk about this. I need to refer you back to your psychiatrist.

Dr. Komal Patil-Sisodia 31:13

Yeah.

Dr. Nancy Echefu 31:13

Talk about it. Then we come back, and you have to present in such a way that you're not dismissing their complaints.

Dr. Komal Patil-Sisodia 31:20

Or

Dr. Nancy Echefu 31:20

what, you have to say, no, you're stressed out and you're already on this medication. Maybe your medication needs to be adjusted or something. Walking in the emergency room, I've seen so many kinds of people. So I'm exposed to so many behavioral situations when people go from happy to sad to crying. I have to think about that before I do any procedure because sometimes we have to think about physicians. It's not really about what they're presenting with, there's something that's going on. If not, you're going to see a client coming to your office every week.

Dr. Komal Patil-Sisodia 31:48

We see that in our weight management clinic as well. If there is underlying depression or anxiety. The treatment, that also needs to be addressed before you put somebody or body dysmorphia, somebody down the line of weight management treatments that, so I can see the analogy there. Same thing with hair loss. Now with the trichotillomania, The pulling of the hair. I've read traditionally it can be scalp hair. It can be eyebrows. Is there an age range or a demographic like that is more susceptible to this? Like where is there an age group or gender that you see it more commonly in? It's more in women. Okay.

Dr. Nancy Echefu 32:28

More in women. But I don't think there's any age range, but I think it's more people dealing with anxiety, panic disorder, that have other undiagnosed, mental disorders, sometimes that's the way we say, okay, maybe there's something else going on. But they never, agree that this is what they're dealing with. I know. There's always a denial. That's number one. There's always And I don't have to argue with you. I just have to give you my opinion. That's what I tell my clients. I don't have to argue with you. You don't have to agree. But this is what I'm thinking. And this is the way we're going. Because that changes your treatment option because you don't want to keep treating and treating and treating. We don't even do hair transplants. Why? Because what they're still going to pull it out. Then they're going to blame you that the hair doesn't grow. So you want to be really, really be cautious. So that's one thing I deal with heavily. Mental disorders in association with hair loss.

Dr. Komal Patil-Sisodia 33:17

I imagine that's much more common. I was seeing a patient a few weeks ago and I just noticed that when they were stressed out, they were talking about some stressors that were going on and we were trying to figure out whether there was a hormonal issue. But the whole time, the hands were in the hair, pulling at the back or pulling at the front. And I just thought, oh my gosh, I wonder how much of the hair loss is going to jump the gripping of the hair, right? They weren't even actually pulling, but you could see them clenching on the roots of their hair. It really makes it better.

Dr. Nancy Echefu 33:50

Always see people reading a book or watching something, see them playing with their hair, like, rolling it on their finger.

Dr. Komal Patil-Sisodia 33:55

Yeah, oh gosh. You know, you're

Dr. Nancy Echefu 33:57

breaking

Dr. Komal Patil-Sisodia 33:58

that.

Dr. Nancy Echefu 33:58

I should monitor myself. So, we're looking at severe cases, but there are mild cases too.

Dr. Komal Patil-Sisodia 34:06

Yeah.

Dr. Nancy Echefu 34:07

Oh, that's so interesting. Yeah, so when you're watching TV or eating something or, you're lost in thought and you're just really curling that hair around your finger like, you

Dr. Komal Patil-Sisodia 34:15

know. That might be me watching TV, watching Netflix.

Dr. Nancy Echefu 34:23

I mean, you can do that, but let you not get to the point that you're breaking the hair. God that's fascinating.

Dr. Komal Patil-Sisodia 34:27

I'm gonna have to, yeah. I'm gonna have to observe that a little bit closer for myself. Is that, yeah. I just never really made that association. So it can be something as benign as just like staying with the ends of your hair and you don't realize what you're doing,

Dr. Nancy Echefu 34:42

even when you do ponytails. I would just want people to be more aware of it. I'm not saying don't do what you're supposed to do, but just to just be more aware of it. This can cause you losing your hair because you can be on all the Minoxidil and all that.

Dr. Komal Patil-Sisodia 34:55

But

Dr. Nancy Echefu 34:55

behavioral changes are number one,

Dr. Komal Patil-Sisodia 34:58

yeah, we got a pizza oven last summer and I was not being careful and I leaned over to look in it And I like burned off the front row of my hair. I was just standing there like turning the pizza around. I was like It smells like hair burn Oh my god, it's my hair At a freakout moment and then I just had this like very thin layer of hair here that you would see had been burned down to like one centimeter now I'm super careful with that, but I think we, there's just so many like daily hazards that we don't think about, right? Hot tools, I'm sure doesn't help with hair breakage and things like that, which is not a real problem, but still. Can contribute to that, but yeah. Dr. Fu, thank you so much. This has been so enlightening.

Dr. Nancy Echefu 35:44

Thank you so much. Thank you for having me.

Dr. Komal Patil-Sisodia 35:47

I have loved this conversation. I have two things that I wanted to ask. you. The first thing will be is if you were to give advice to, somebody, some listener out there that's sitting here thinking, gosh, I'm losing my hair and I don't even know what to start with or what to do right now before I get in to see my doctor, what would be the one thing that you would recommend they start doing to start addressing their hair loss? That they can do before. Is it like tracking their symptoms or their habits? Is it trying to make an outline? Like what would you want them to do before they come in to see you as a patient?

Dr. Nancy Echefu 36:23

Like I always say, behavioral, you have to see what you do every day with your hair. How do you wash your hair? Your hair washing days? What do you do? Because once you wash your hair, I noticed some people after washing their hair, they had a pack. It depends on what you do when you have your hair washing days. Depends on what you use. A lot of oils. lotions on your hair and all that. So you need actually need to know what your hair practices. That's just what I'm getting to. What are your hair practices? You just need to be more aware of it. All I, all what I always tell people, you need to stop whatever you're doing, just stop and start all over again and watch. Okay. What am I doing today?

Dr. Komal Patil-Sisodia 37:02

Yeah,

Dr. Nancy Echefu 37:02

what am I putting on my head today? What am I doing? And once you catch yourself doing that you need to stop

Dr. Komal Patil-Sisodia 37:07

Oh, that's so interesting.

Dr. Nancy Echefu 37:08

Simple. Yeah, simple minoxidil over the counter five percent. You can't use that You know, but if you, but you have also have to be careful if you're having burning sensation with, with the Minoxidil and all that. If you're itching. Yeah. If you have scales, if you have dandruff, you have to think about, then you need more.

Dr. Komal Patil-Sisodia 37:26

Yeah. The

Dr. Nancy Echefu 37:26

minoxidil is just one part of it. That's

Dr. Komal Patil-Sisodia 37:30

so interesting. Okay. Yeah,

Dr. Nancy Echefu 37:32

so I also encourage people to do demo rolling. Get a derma roller has needles, 0. 5, which is like the shortest needle you can find. Whatever treatment you're doing, add a derma roller to the area of hair loss, use that. Don't use it excessively, but use it. It's just going to help.

Dr. Komal Patil-Sisodia 37:50

So I guess that's a great question. And I've had somebody ask me whether they could use a derma roller. And I was like, I have no idea because I'm not a transplant specialist or a dermatologist. With the derma rollers, is there ever any concern of scarring the scalp? Or, my assumption is that would be from overuse. But if people are like, what is the appropriate cadence to use a derma roller? Should it be like twice a week, once a week, That's

Dr. Nancy Echefu 38:16

why we also have a protocol in our clinic. Yeah, we send people protocols. Protocol in a clinic. Why do we need protocols? Protocol saves us from the headaches.

Dr. Komal Patil-Sisodia 38:30

Yeah.

Dr. Nancy Echefu 38:30

You see, helps me know what you're doing wrong and what you're doing right. I send you the protocol. You don't have to follow the protocol to the T, but at least you have guidance. So you do how many drops today and you roll it. How to roll it.

Dr. Komal Patil-Sisodia 38:42

Yeah.

Dr. Nancy Echefu 38:43

How many times to roll it today, the next day, how many times to roll it. So it's simple. You can start with once a week with just to know, because some people also have sensitive scalp. Yeah. Their pain tolerance is like zero. So 0. 5 millimeters. That's the side of the Dermaroller. You can use that with your Minoxidil. Once you put the drop, you just roll it once, start with once a week. I'm talking about the, Dermaroller, You can use Minoxidil every day. So once you do that, then once you build tolerance for it, you can do twice a week, then three times a week, and just improve that.

Dr. Komal Patil-Sisodia 39:18

That's really great. My last question for you is how can people connect with you? Where can they find you? Where's your practice? And do you see people outside of your area and then do you have social media that they can follow you on?

Dr. Nancy Echefu 39:31

Oh, yeah. So my name is Dr. Nancy Achebe for one more time, owner of Javila Hair Restoration. Everything hair, hair loss, hair restoration and aesthetics. We also do skin because skin, we have the face and the hair because sometimes we have to do both at the same time. Anyway, so Javila Hair Restoration, we're in Peachtree City, Georgia. You can also connect to us on Facebook, Javila Hair Restoration. Website, hh restorations.com, or you can put in Illa hair restoration. You also find us, okay. Also, we have a hair loss exhibition show coming up this September, 13th, 2025. And what is the exhibition show? Everything. Hair loss. People that have dealt with hair loss. growing.

Dr. Komal Patil-Sisodia 40:21

Yeah.

Dr. Nancy Echefu 40:22

We also have something called head tattoo. Sometimes people don't want treatment, but you just want to shed off the shininess of their scalp. When you walk into a room and that the light hits your bald spot. People don't like that. So sometimes we do something called scalp micropigmentation, which is head tattooing. Oh, that's so interesting. Yeah. A lot of ladies love that. But sometimes, especially people that have been on chemotherapy, because their hair is finer, their density is lower. So sometimes they are on treatment, but they are not getting that oomph they want.

Dr. Komal Patil-Sisodia 40:54

Right.

Dr. Nancy Echefu 40:54

So sometimes we can shade up that scalp, the shininess. It gives them that. Fullness they have except when you come closer, you say, okay, there will be there's something going on with the scalp, but it makes you feel it makes a whole lot of difference. So we have hair loss exhibition show September 13th. So we're

Dr. Komal Patil-Sisodia 41:14

here. Yeah, that's phenomenal. That's so exciting. Thank you again for coming on and sharing your knowledge, sharing your personal story. We're just lucky to be able to hear from an expert like you. I hope

Dr. Nancy Echefu 41:28

I didn't give them a whole lot of things to process. I tried to break it down so they can understand.

Dr. Komal Patil-Sisodia 41:33

I thought your analogies were great, and I'm sure that our listeners will think so as well. And thank you again for your time today, Dr. Achefu.

Dr. Nancy Echefu 41:42

so much.