Don't Give Age-Related Hair Loss the Shaft! Treat it.

Unlock the secrets to combating hair loss. Discover why topical and oral minoxidil remain a cornerstone in hair loss treatment. Dermatologist Dr. Ronda Farah discusses the importance of accurate diagnosis from a credited dermatologist, empowering you to make informed decisions about your hair health journey.

Topics covered:

• Social Media and false claims that could be dangerous if followed;

• Oral minoxidil's emerging role in hair growth treatment;

• Exploring the benefits and timeframes for low-level laser therapy;

• Introduction to platelet-rich plasma (PRP) and its uses;

• The importance of assessing your diet and what supplements you already get before adding other supplements. 

Transcript

Hair Loss Treatment Options Discussion

Speaker 1 0:00

Welcome to Dermot Trotter Don't Swear About Skin Care where host Dr Shannon C Trotter, a board-certified dermatologist, sits down with fellow dermatologists and skin care experts to separate fact from fiction and simplify skin care. Let's get started.

Speaker 2 0:20

Welcome to the Dermot Trotter Don't Swear About Skin Care podcast. Today we have Dr Rhonda Farah, associate Professor of Dermatology at the University of Minnesota, and she's also opening her own practice here soon, aluma Dermatology in Minneapolis. Her area of expertise is hair loss and I know a lot of you out there you've experienced hair loss at some point in your life and we all know the emotional toll it can take on us. So I'm so excited to have Dr Farah here today to talk more about treatment and really give a lot of you hope out there. So welcome to the podcast.

Speaker 3 0:52

Dr Farah, Thank you so much for having me. I'm very excited to participate.

Speaker 2 0:57

Well, it's a pleasure to meet you and have you on today because I know I've kind of looked at some of your lectures and you've talked a lot about hair loss and the treatments, because I think that's what a lot of people come in. They're like I know I have hair loss, but how are you going to fix this? And you know, of course, a lot of people probably already tried or heard of minoxidil or Rogaine, which you can do topically or even orally, of course. But I wanted to touch upon you know, for that just real briefly, because I know we want to talk about other treatments when do you recommend you know, doing over the counter Rogaine? And you know, do you really talk people through? You know they read about it causes hair loss and how do you really kind of deal with that so that patients can accept that maybe that is a good part of treatment? A lot of people think it's bunk.

Speaker 3 1:40

Yeah, this is a great topic. So minoxidil, and then the brand name being Rogaine, has been, you know, a dermatology favorite for years. It's something that has been FDA approved to grow hair, it's topical, it's available over the counter. As a dermatologist, I would say if somebody's losing hair, of course diagnosis is always the most important. So what you and I are about to go through is medical information not medical advice, but just kind of gives the community access to some information to consider when they go in to see their dermatologist or their doctor.

Speaker 3 2:15

So one thing that dermatologists really like about minoxidil, also known as Rogaine, is it is atopical, so we're not having to take it internally by mouth and patients can typically buy it over the counter. One of our favorite things is it has some actual clinical studies demonstrating an increase in the thickness of the hair and the amount of hair coming out on the scalp, and that's been repeated over and over in dermatology. So that's why you see that long-lasting sort of alliance to minoxidil by many board-certified dermatology. So that's why you see that long lasting sort of alliance to minoxidil by many board certified dermatologists.

Speaker 2 2:51

And you know, I think for you know, hair loss. You know I got to kind of mention you know it's such a broad, you know thing to cover. You know alopecia medical term for hair loss, and you know, today what I really want to dive in is sort of that thinning that we all get, that happens sort of over time, what people will call androgenetic, you know, type hair loss or female or male thinning. And so Rogaine, as you mentioned, or minoxidil, often offered as an option for treatment. You know, beyond topical, there's been this new trend to talk about offering it orally. Do you feel like there are advantages to doing that or something you do recommend to patients?

Speaker 3 3:32

And when do you do oral versus a topical? Oh, those are such good questions. So I love topical minoxidil and oral minoxidil. And oral minoxidil has really surged in the last two to three years in the US in dermatology. I really like how you were just talking about generally minoxidil, topical or oral. Most dermatologists are using that for androgenetic alopecia. Now the oral version is not. You know, I don't think it's currently based on today's date.

Speaker 3 3:54

At this moment FDA approved for treatment of hair loss, but dermatologists use it in a way we call it like off label to treat hair loss, which we do with many, many, many medications. One thing about topical Vinoxil is I have my patients apply it nightly, use it for three to four months until hair slowly grows in it almost looks like grass growing in little tiny baby hairs and then go to six months and then a year. But that's a lot of work and it can be a little flaky or itchy or red. Some people can get allergic to it. Especially the topical solution contains some alcohol in it and something called propylene glycol which dermatologists know can sometimes be a bit irritating. And I've used minoxidil topically, rogaine topically myself and I've also experienced that. So one thing that we saw, you know, in the New York Times was that surge of that article of an old pill with a new use. And so minoxidil was initially FDA approved for high blood pressure and so doctors used to use it for high blood pressure, usually at higher doses, and they knew that patients could get hairy on it. And then we saw internationally in the last few years many, many dermatologists using it. And then we saw internationally in the last few years many many dermatologists using it internationally for hair growth, lower microdoses, with good success. So we kind of saw that trend unfold into the United States hitting the New York Times and then prescriptions for oral minoxidil surging In the dermatology world.

Speaker 3 5:18

I'd say in general, using small doses of minoxidil is really important because sometimes when we're taking it by mouth we can get a little hairy on the face, chest or back, which may or may not be something that our patient is looking for. So the dermatologist will typically go through that. And there's some other cardiac boxed warnings on it. I would say over 90% of my patients the boxed warnings, the heart warnings and whatnot are on there, not really relevant, and I've had really good success with that drug. But every patient needs to see their doctor to decide if it's a drug that's safe for them, if it can be combined with their other medications and if they'll have a problem with it. But it's been a huge help for anagenetic alopecia in my patient properly.

Speaker 2 6:08

And before we go on to other you know, treatment options, the one thing I want to get your comments on, because this is probably something I hear from patients all the time like I'm not, I'm not going to. You know, do minoxidil or Rogaine? I read on the label it causes hair loss, and so do you mind just commenting on that briefly, because I feel like that's sort of a you know to get patients over that hump and trying to explain to them. We're not going to recommend something to you that we actually think is going to make your hair loss worse, like how do you handle that for them?

Speaker 3 6:35

Yeah, hair is really tricky. So, as you know, as a dermatologist the hair has three cycles the growth phase, the resting phase and then the shedding phase. And I would say most dermatologists in their clinical experience know that if you quickly stimulate hair growth you're going to get movement of many of those hairs into shedding so that you can then sustain the new growth phase. That's just a way to explain it. It's almost like you're going to shed the hair. That's not going. It's almost like you're going to shed the hair, that's like not going to cut it and you're going to hold some hair longer in the growth phase.

Speaker 3 7:11

So I usually tell my patients that you know they may experience some shed at the top or the oral medication. I typically personally will see it between four and eight weeks. Three months is, you know, starting to get a little long, but I'll still monitor it. They may experience shedding, but I'll still monitor it. They may experience shedding, but I personally have never seen anyone where that's a persistent issue that they were not able to overcome. And then over time, going into months, three, four, six or even a year, we see hair growing in more and more and more and more, and then those sustaining for longer periods of time and then the hairs themselves are typically thicker. That means like wider in diameter, making the scalp appear more full. So it is one of those things where a small percent of patients might experience a shed.

Speaker 3 7:55

But we see that with other things. We see that with topical minoxidil, I see that with, you know, hair mask, the low level laser lights or photobiomodulation lasers, that caps and FEC over the counter. So it's kind of like sometimes there's just like a little bit of setback before you have the growth. But I will tell my if they call me and they're really worried about it. You know I always have a low threshold to bring that person back in. Let's make sure we haven't missed something, because hair loss is extremely complicated. Even the best dermatologists could think, oh, this is just regular old thinning and then, as time evolves over the first year, the second year or months from a treatment, it's not responding the way we thought it would. And in those instances the dermatologist can do more labs. They can take a biopsy, they can get a second opinion, they can do dermoscopy, they can do hair counts. They have all these tools that can help them refocus on is this the right diagnosis? Are we missing something else?

Speaker 2 8:56

So if I've already come in, maybe I've been experiencing hair loss and kind of we've talked about I've tried some topical Rogaine. Maybe we're talking about shifting me to oral because I just can't keep up with. It's too much maintenance for me. And I've also admitted to you hey, you know, I've also been taking some biotin or I've been thinking about other supplements, you know, just to add into my hair loss routine. You know, what would you say to somebody like myself? Like what's the evidence for that? Or do you feel like there's a strong, you know, set of data that really says, yes, you should definitely do this supplement or this much? Cause I think a lot of people are looking for that natural alternative or something else they can add in and often, like me the example they might've even tried it before they set foot in your office.

Exploring Hair Loss Treatment Trends

Speaker 3 9:42

So how do you respond to that type of question? Yes, so I would say that's something that just really makes me excited. I'd say about five or six years ago I got really excited about what I call hair-ceuticals, which are basically those things you find in the supplement aisle. Those aren't things that the FDA is regulating closely. They're not monitoring exactly what's going in there and whatnot. So I always, when I see my patient, I will ask them what is your diet like, what are your medical problems, what symptoms are you having? And then, as a physician, we're able to get those laboratory tests. I might test their iron, I might test their hormones, I might test their vitamin D, I might look at their zinc, depending on what their medical history is and other lab work also, and then I will typically adjust the nutrients. So if I'm seeing a low zinc, if I'm seeing a low vitamin D, if I'm seeing the patient's anemic, then I'll either replace or try to figure out if there's a medical reason for that, and that's the way I personally am the most comfortable. I will say I am excited in general for that parasitical market to continue to grow. I think it is important that we have options that are, you know as clean and natural as possible.

Speaker 3 10:59

The thing about these things that are available is they are just not that heavily regulated. One good example is biotin. We had that FDA statement regarding high-dose biotin and patients taking high-dose biotin and then having issues with their heart going to the emergency room. And then that high dose biotin making it hard for those doctors in the emergency room to find figure out that the patient's having a heart attack because the supplement is interfering with those lab tests. And so if you just Google FDA biotin you'll find that that was when I first like really got interested in that area, cause I'm like, wow, every patient's taking biotin for their hair. What is the evidence behind biotin? So if you look up Farrah like one R, kind of like Farrah Fawcett, but one R and biotin, you'll see my publication on biotin.

Speaker 3 11:54

So immediately after that we wrote into the Journal of the American Academy of Dermatology. We did an article reviewing biotin and at that time point I think it's you'll have to look at the article it may be dated 2018, 2019. It was around that time just before COVID. But there was no good evidence really for biotin for hair growth unless in the literature the patient had had a biotinase like a deficiency, like a medical disease, basically making it hard for them to keep their biotin level normal. So after that I said, wow, all these things over the counter say biotin for hair. But when you look in the medical literature there's not really support for that. And I think that that idea may have come from some of the nail literature, which nail is keratin and hair is keratin. I don't know if that was extrapolated.

Speaker 3 12:52

But so, like I personally, when I see patients on biotin, I have them, you know, look at the dosing, make sure it's not ultra high dosing. And I know I don't want to comment on the dosing levels. I will say you can look up what the FDA has stated on their site 3,000 micrograms. I start to, you know, just for sure, take a look at that. But then discussing with your doctor where you think that upper limit should be, because really high doses can affect your labs and probably are not really super helpful for hair and we can get biotin from things like an egg.

Speaker 3 13:31

So biotin was the first time I was like, oh, what else is in these? And then I would flip them around oh, vitamin A. And then I go to the literature Vitamin A actually in the dermatology world. If it's too high dose can actually result in hair loss, and a lot of these supplements have more vitamin A than the daily value. And then selenium if you get high doses of selenium many of them contain selenium you can get you know that could be an issue for you and your hair also.

Speaker 3 14:05

And so in that article, basically, I made a table and it lists like all the things that you know. I sort of found in many of these elements that I didn't feel like had, um, you know, a lot of good evidence behind them and so. And then there's a second article, if people are interested, it's, it's Farrah and it's, um, it's parasiticals. If you just look up parasiticals and FARA and it kind of shows you like social media trends and you know some issues with what's going on there. So long story short. Then in the last year there was a really nice publication in the dermatology world talking about supplements and what evidence there is for them, and it was an outstanding systematic review, which in the medical world means these authors did a great job looking at all the literature and they concluded like these might have a role.

Speaker 3 14:51

But the problem is many of these supplements that our patients sign up for and are paying these memberships for. The studies are done by the companies, right. So it's really hard to sort of like sort that out like more indigent research and more replication of data is needed. So for me to tell a patient to pay for a consistent subscription of a supplement all the time and these are expensive things and I don't see a deficiency or an issue like directly on their scalp or hair shaft disorder that I know would benefit for that that's really hard for me. So I typically stick with, you know, getting my patient's history, their diet, and testing them and going with the evidence that I see and walking them through that so that we can sort of, you know, make a joint decision on what is the best for them.

Speaker 2 15:47

Yeah, I think that's really important because you know the natural alternatives. I think there's a great need, there's a great demand for that, you know, for the public and all the people listening are looking for those options and there's a little bit of, like you commented on, sort of this assumption of safety and not understanding that supplements, you know they're not regulated by the FDA, the same way you know our prescription drugs are have to undergo that, you know, rigorous testing to really prove that they work. And I think that's something for the public to be aware of. And definitely we just said you know about the biotin thing. I literally think, minds blown, like people will hear that because that is just something everyone seems to do. It's marketed that way, you know, to people. They go into the grocery store or their favorite supplement store and they see biotin.

Speaker 2 16:30

You know it's hair, it's nails, it's going to give you that growth back. And you're right, without that data really being there, it's hard for us to strongly recommend it. You know some of my patients will say can it really hurt? And I said, well, potentially, especially by it. And, as you mentioned, you know the lab abnormalities with the cardiac enzymes or heart enzymes that they're potentially having a heart attack or potentially, you know, thyroid labs, as we know, can also be affected. So I think it's really important that people are cautious about that, you know, and really talk with their doctor before doing that, because just because it's over the counter and accessible doesn't mean it's necessarily a good idea, not only for your health, but is it truly going to make a difference, like you mentioned, for hair growth?

Speaker 2 17:07

You know, kind of along the lines of the supplements that you just touched, you know, kind of talked about too. I sort of want to shift gears, as we're talking about kind of these other sort of less known treatments for dealing with hair loss and you mentioned this a little bit earlier about light devices. I think this is something too people are trying to figure out. Is there really data to support this? And there's some that are FDA approved? There's some people can buy and actually integrate in at home, or even, you know, I've seen that some of the salons or even physician offices people can get lighter laser treatment for hair loss, especially, you know, age-related hair thinning. What do you think about those and what does the data suggest to you if they're really useful?

Hair Growth Devices and Platelet Therapy

Speaker 3 17:45

Yeah, so I am a fan of the. We call it low-level laser light, low-level light. These combs and helmets the ones in the United States have been FDA cleared since the first comb in 2007. I do think they did appropriate studies. And in the hair world so within the dermatology world, for everyone listening there's all these hair people that are very focused on the hair world and they have standards, these hair dermatologists, and they like to see the number of hairs counted on the scalp go up, they like to see the images at a certain quality. They like board-certified dermatologists on board who have hair clinics and are experts in hair loss and they like to study replicated at multiple sites. And, of course, we like FDA clearance.

Speaker 3 18:27

So I think these devices they're not magic, but I think they have good data that they can be helpful for hair growth in that androgenetic alopecia setting for many, many, many patients. So you can get some things like tingle, like and again, this is medical information, not personal medical advice. So when you're talking to your dermatologist in general, ask them like is this a good fit for me? I mean, it's not a drug. If someone's looking for not a drug, if they're looking for something they can you know, do you know, while they're doing something else, they can use a helmet or a cap, the combs you typically have to hold. So those are typically a little bit cheaper because the number of diodes or laser parts to them is less but you have to hold them to treat.

Speaker 3 19:16

But I do think they're low risk devices. And then, going back in all these treatments we talked about, like as a women physician, I always like to also just you know, we have pregnant women out there always say each of these things has not necessarily been studied in pregnant women. So those are discussions to have also specifically with physicians. So I'm a fan, basically I like them.

Speaker 3 19:41

I use them all the time but they take longer in my experience, six months or more to see improvement that's.

Speaker 2 19:47

I was just going to ask if you kind of give a time frame, because I think that's the hardest part. You know people lose hair very quickly but the regrowth process, even when we intervene, always tends to be slow and not very satisfactory. I know to people very frustrating to just watch it fall out at such a rapid rate and some some of that's been gradual. But for a lot of people they appreciate it being a faster process but then getting it back takes forever. So six months is kind of what you recommend doing it with, and do you do that as a part of a whole completely complete treatment regimen that you give to a patient or do you ever recommend it as sort of therapy just by itself?

Speaker 3 20:19

I mean, every patient is different. I mean I have patients on, you know, three hair loss oral medications and the topical and a helmet. Like that patient wants their hair, they want every hair. They've even had a hair transplant. And I have patients that are like I need drug-free options and I just want to, you know, talk about scalp health and I don't want to do anything. So you know, and you know, as a physician, and I don't want to do anything. So you know, and you know as a physician, my job is just to offer the treatment options and then to bring that to the patient, look at their medical problems and tell them what I think might be the best and then for us to kind of, you know, meet with what fits their lifestyle, what's possible, what's affordable, what can we actually do consistently? You know, if you're somebody who has three jobs, that it's going to be really hard to hold that comb over your head. I know that because I can't hold it over my head multiple times per week. But um, so I, I love it, it I.

Speaker 3 21:15

In my personal experience it grows hair not quite as much, of course, as oral minoxidil. In my mind, oral minoxidil. In my mind oral minoxidil grows is amazing, but more data is needed to substantiate that. That is my personal experience. But I'm comfortable with the FDA-cleared laser devices in the United States, very comfortable with those. But I would tell my patients, be wary of buying them randomly on the internet where you don't know what light is being delivered to your home. If that, where you don't know what light is being delivered to your home, if that light is safe, if that light is the correct wavelength and the experts who discuss this on the stage from a scientific basis. Many people ask well, what if I just do it every day, like three times a day? You know, we don't really know, but it could be that too much of a good thing is not a good thing. So in my office I typically have them use the device in the way it was cleared by the FDA.

Speaker 2 22:11

And finally, because I know we won't get to all these kind of treatment options that are available. One of the other topics that comes up and I'm not sure how often you may recommend or implement this into a complete treatment approach is potentially PRP or platelet rich plasma. Is that something that you feel like has a role, and when do you typically recommend it? And if you don't mind kind of briefly discussing it, because I know some of our patients are probably even wondering and listeners out there like, well, what the heck is even PRP? I haven't even heard of that as a treatment option.

Advancements in Hair Loss Treatments

Speaker 3 22:40

Okay. So plateletasmas when we draw a patient's blood, we spin it down, we inject what we believe to be the platelet-rich portion, and many people believe that in the platelets there's these growth factors and when we inject them they could be stimulating the hair. The FDA has not approved this as a treatment option for hair loss, so it is definitely something that you have to talk about directly with your doctor to see if it's a fit for you. I would say in the literature it is very hot, it's trending and it's gained a lot of data, especially the last five years in the United States, and so you'll find many, many dermatologists injecting PRP into the scalp and I've seen good improvement in antigenetic alopecia and, I think, a lot of the data patients who are younger, patients who are women, earlier disease probably going to respond a little bit better. But it's expensive, typically not covered by insurance, so that can be, you know, an issue. And then it hurts to inject people. I'm always like would you like a numbing cream? Would you like to wait for some ice? Would you like, you know, a massager? Are you doing? Okay, it hurts. I mean, I'm a dermatologist. I remove skin things all the time, but every time I numb someone or poke them. You know we feel it with you guys and I tell my patients honestly like it hurts. So and another thing too is definitely get this done by a board certified dermatologist because it is a blood product. So if you're you don't want to go somewhere where they could give you someone else's blood, where the um products could have been switched around Like that would be a medical emergency or you couldn't have been exposed to, you know, like an infection. You could get exposed to an infection and then you never want to go somewhere where they cannot handle the complications of the procedure Too much bleeding, pain, headache and there's some other things. But most people do great. So this is the, the sort of thing that is involves a blood product and I really encourage people not to go for the. The any sort of backdoor process with this one, because it's it's high risk to your health If it's not done in a very sanitary, clean way in the maintenance of the devices is not good and whatnot. So platelet-rich plasma sort of boomed just before oraminoxidil. So you've got people doing all this stuff now. And then there's all these offshoots now platelet-rich fibrin, which I'm just going to put that not sure about category right now. And then regenerative medicine is booming in hair loss and I will say in one plug, I have yet to be sold on this exosomes trend.

Speaker 3 25:35

I am concerned and the FDA has not approved exosomes for injection for hair loss, so that is something I speak on routinely approved exosomes for injection for hair loss? So that is something I speak on routinely, and just like these parasiticals, all of these things, it's important that patients and doctors demand the most data possible and the most regulatory input from the FDA so that we can be safe when we go shopping or when we go to a clinic. So the marketing is so powerful for some of these things, but when you look at the data, a lot of times it's evolving and it's just not there. So I have never injected exosomes in a patient and I'm not there yet with that whole exosome thing. If somebody asked me if they should get it at this point in time, at the date of this podcast, I would say no, medicine changes over time. But yeah, definitely talk with your doctor directly about that. So are you a fan of foot leverage plasma too?

Speaker 2 26:33

I have seen some good results with it. I think the dilemma you know, or the challenges that you just mentioned, you know it's it's costly. So that's probably my biggest obstacle, you know, and trying to get some patients to do it and just, you know, waiting to see those results, maybe having to do it obviously more than once. So it's the cost factor. I think that adds up, but I definitely think there is a role for it. So optimistic is that the options that are on the horizon.

Speaker 2 26:54

We are making improvements in hair loss, where I think for a long period of time we didn't have much to offer and not that it's still not challenging to treat. It is so for anyone out there with hair loss we understand. As dermatologists, we we get frustrated too because we know this is difficult to treat, no matter the type that you have, even if you have the more classic female or male thinning that we all get. That sometimes happens over time and for some of us it's more severe than others. So it's been a great conversation to touch on things, just kind of looking beyond. You know, minoxidil and the spectrum of what we just thought of that.

Speaker 2 27:32

Okay, I've got Rogaine, that's all I've got, because what you've heard today is that's not true. There are a lot of other options and there are even more that we didn't dive into today that we'll definitely have to have you back on Dr Farah to talk about that more, because I think this really has just opened the door for treatment options for patients. Like you said, you can go more aggressive or less aggressive, depending upon sort of your mindset, you know, as a patient, and just kind of how you want to approach it as well For our listeners, if they want to try to find you, where can they locate you online? Where are you available, and can you give us a little tidbit on that please?

Speaker 3 28:10

Yes, so I'm in Minneapolis, minnesota. I'm opening a new office called Aluma Dermatology. Right now we're doing the demolition and the build. I have spent a decade at the University of Minnesota very interested in hair loss, publishing on hair loss, speaking on hair loss, so I'm excited to really get to focus on my patient's experience. I'm excited because there'll be a hair transplantation room there. We've gotten the hair metrics device there where we're going to do hair counts for patients, global photography for hair. A lot of experts will do standardized global photography for hair loss and hair counts using something similar or called hair metrics. So I'm just I'm excited to be able to do a little bit more tailoring for the hair loss patients and so they can look on Instagram Dr Rhonda Farrow Rhonda has no H, farrow has one R and they can follow me there.

Speaker 3 28:59

If you just look up wwwrhondafarrowcom, you'll find me there can follow me there. If you just look up wwwrondaferrocom, you'll find me there. And then for anyone listening who does have hair loss, I think one of the biggest concerns I see I love social media, I love this podcast. I actually have worked in social media for our academy is people will self-treat their hair loss and they'll do it for years and then they'll come in to see a dermatologist and they don't actually have endogenetic alopecia, they have a different disease the whole time. So if everything you guys took away from this podcast, I hope that you can just take away, there's a lot of treatment options. They can be tailored for you. The safety can sort of be weeded out for you, specifically with a board certified dermatologist. Diagnosis is key. Don't let the marketing get too powerful. Go in, get an opinion so you can sort through it. Get the right diagnosis, because today we're talking about medical information, not medical advice. Thank you so much, okay.

Speaker 2 29:59

Of course. Thank you so much for coming on the podcast and stay tuned for the next episode of Dermot Trotter. Don't swear about skincare.

Speaker 1 30:07

Thanks for listening to Dermot Trotter. For more about skincare, visit Dermot Trotter dot com. Don't forget to subscribe, leave a review and share this podcast with anyone who needs a little skincare sanity. Until next time, stay skin smart.