Hair Loss and GLP-1 Medications w/ Dr. Kristen Lo Sicco

Your GLP-1 hair loss may not be from low protein or fast weight loss and the real reason could mean it never grows back on its own. Dietitian Ana Reisdorf is joined by NYU alopecia expert Dr. Kristen Lo Sicco on the warning sign and how to protect your hair on GLP-1s like Ozempic, Wegovy, Zepbound, or Retatrutide.

IN THIS EPISODE

• Why GLP-1 hair loss isn't always caused by rapid weight loss or low protein
• The 6-month shedding warning sign that means it's time to see a dermatologist
• How GLP-1s can "unmask" androgenetic alopecia (genetic hair loss)
• Low-dose oral minoxidil (LDOM) for GLP-1 shedding — does it work, and is it forever?
• The vitamin D, iron, and zinc levels that matter most for hair regrowth

ABOUT OUR GUEST
Dr. Kristen Lo Sicco, MD, is a board-certified dermatologist and full-time faculty member at NYU Langone Health's Ronald O. Perlman Department of Dermatology in New York City. With over a decade of clinical experience and more than 260 peer-reviewed publications, she is a nationally recognized alopecia expert whose practice and research focus on hair and scalp disorders. She co-hosts a show on SiriusXM Doctor Radio (Channel 110) and founded the Alopecia Justice League advocacy organization.

CONNECT WITH KRISTEN
Alopecia Justice League: https://www.alopeciajusticeleague.com
Instagram: @alopeciajusticeleague

SPONSOR
Folly — Hair support gummies for GLP-1 users. A 300-person study showed less shedding and fuller hair after 4 weeks.
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*The content of this show is for informational purposes only and does not constitute medical advice. The goal of this show is to provide various points of view about GLP-1 Medications. The personal and professional opinion of the guests and their content does not necessarily reflect the opinion of Ana Reisdorf or GLP-1 Hub.

Transcript

SPEAKER_00 0:00

I'm I am more biased toward optimizing medical therapy first and things that are more cost effective that one can do at home prior to incorporating more of the expensive procedural therapies that, yes, have science behind them and yes, have some studies, but not as robust as the ones that are being done for FDA approval of medications.

SPEAKER_01 0:19

Most of the time, hair will grow back if you lose it on GLP1. But there's a scenario where it doesn't, and most people don't hear about it until it's already too late. Welcome to the GLP One Hub Podcast. I'm Anna Reisdorf, registered dietitian and GLP1 user. And if you've been shedding on your GLP1, you've probably been told that it's the rapid weight loss, low protein, not enough micronutrients. And as a dietitian, that's what I've been saying too. But there's a third reason researchers are now investigating, and it might explain why some people's hair isn't coming back on its own. Today I'm joined by Dr. Kristen Losico, a board-certified dermatologist at NYU Lingone and one of the country's top alopecia experts. We're breaking down the three theories behind GLP1 hair loss, the warning sign that means it's time to see a specialist, and what you can do to protect your hair starting today. And I want to say thank you to Folly Nutrition for sponsoring this episode. Check out their hair health gummies at Follynutrition.com. And as always, if you enjoy this podcast, please leave a review on Apple Podcasts or Spotify. And if you're watching over on YouTube, drop a comment below. Let's get on to the episode. I want to welcome Dr. Kristen Losico today, who is going to talk about a topic you guys have been asking me for forever: hair, loss, and GLP1 medication. So could you introduce yourself and tell us a little bit about who you are and what you do as your profession?

SPEAKER_00 1:51

Absolutely. First hi, Anna. Thank you so much for having me on the podcast today. And thank you to the listeners who are interested in this topic. We're here to serve you and give you information that hopefully is evidence-based and will help to serve you as you're making your informed decisions, whether or not you want to take a GLP one, whether or not you want to stay on it, and what doses you want to be on, so on and so forth. So let me introduce myself. My name is Kristen Losiko. I'm a board-certified dermatologist. I'm a faculty member full-time at NYU Langone Health in the Ronald O'Perlman Department of Dermatology. We are based in New York City. I have well over a decade of experience in dermatology, and I am an alopecia expert. And so why do I call myself an alopecia expert? Because not only do I commit my clinical practice and our faculty practice to hair and scalp disorders or alopecia, but most of my research is also focused on alopecia as well. I have over 260 peer-reviewed publications. I also have my own radio show with Dr. Shapiro on Dr. Radio through NYU on Sirius XM Channel 110, that show once a month, and we talk about everything related to hair. And we are in Canada as well as the United States. I also am very big into advocacy. So I help to advocate through the alopecia Justice League, and that's a social media movement that I helped to start to advocate for alopecia patients at large, really mainly focused on wig coverage, trying to get wigs that we call in medicine cranial prostheses covered as a piece of what's called durable medical equipment in the United States, similar to how a breast prosthesis would be covered for a breast cancer survivor, because unfortunately, wigs can be very expensive and costly, prohibitive for many many people if there's no support from insurance companies. And then lastly, I also have a passion for advocating for children with alopecia. And so along with Maddie Lee, one of our founders of the alopecia Justice League, we co-wrote a children's book that just came out a couple of months ago called How Ari Got Her Cape. And that's available on Amazon and Barnes Noble.

SPEAKER_01 3:46

You are an accomplished lady. My goodness, that is a lot. That is a lot. So where did this passion for alopecia and hair loss come from?

SPEAKER_00 3:55

Yeah, that's a thank you for that question. It really came about in my residency. So in my residency, just to give context, and in general, dermatologists at large, right, in many places in the world, not just the United States, get maybe on average 15 minutes with a patient. So if you think about that, and you even in your own doctor's visits, oftentimes alopecia takes a long, a longer visit, not only to explain what the person has been through that led them to that moment in time seeing their doctor, but it's also a very emotional visit, right? Because hair is something that's very personal. It's how we define ourselves when we look, wake up every morning and look in the mirror and how we present ourselves to society, right? Um, and ourselves. And so oftentimes it can be counseling involved a very emotional visit as well as a medical visit talking about risks and benefits of medications. So if you can imagine 15 minutes is not enough time for the doctor or the clinician, let alone the patient to be satisfied that they've been seen and heard. So the more and more I saw that there was a need for this, and even sometimes other clinicians would say, oh gosh, you know, we're already behind in clinic and there's a patient coming in with alopecia. How are we going to get through this? And that's not to say that that's the fault of the dermatologist, it's the fault of the system itself, right? Where we don't really get enough time. I am very fortunate that I get to spend more time with my patients. And because of that, we can incorporate not just their story, but counseling as well as reviewing the risks and benefits of various topical, injectable, oral or procedural therapies to help their alopecia, depending on what type it is. And I think from a personal standpoint, I've always been one that wants to stand up for others that feel like there's there's been an injustice toward. And I'm a scrappy individual in general. And I think I really wanted to be an advocate and a voice for people who who often went unseen and unheard in their opinion, too. So I wanted to help give them their voice back. And I know it sounds corny, but it really is the truth.

SPEAKER_01 5:57

Sure, sure. So can you define for us what alopecia is, in case somebody doesn't know exactly?

SPEAKER_00 6:04

Absolutely. So alopecia is this simple medical term for hair loss or thinning. And they're actually two general categories: scarring and non-scarring. If you had to choose, of course, we would choose none, but if of the two general buckets of alopecia or hair loss, I would certainly choose the non-scarring because those are easier to treat and oftentimes can be reversible or at least sustained, right? If you can halt the progress of disease. Scarring alopecia, on the other hand, is often driven by inflammation. Oftentimes there are two phases: inflammation, and if that's not treated, it turns into fibrosis or scarring. And that's a potentially permanent condition. So it breaks my heart when sometimes uh, and and I see a lot of postmenopausal women with uh certain types of scarring alopecias that disproportionately impact women. They come in years after their scarring hair loss has begun and their hairline has receded several inches. And I have to tell them, listen, I can't magically get that hair back once those hair follicles have been scarred over. And so I really want to urge people when a lot of people will um, you know, seek over-the-counter treatments, which is a great thing, right? We like naturopathy and over-the-counter treatments, but if you give it a certain amount of time and it's not working, right, seek care from a board-certified dermatologist, or even better, do both, right? Start something yourself, right, based on your own research, maybe whilst you're waiting to see a board-certified dermatologist, or even better, an alopecia expert, even though I know that they're few and far of us. Because time is also of the essence, right? We do have some data to show that even non-scarring alopecias, when we don't treat them promptly, starting at the same level of severity, you might not reach the same point as somebody else who had the same type of alopecia, started at the same level of severity, and used the same treatments, never made it to the same endpoint. So, you know, that research is still ongoing. We've already shown that for alopecia areata. We're looking at that data right now for androgenetic alopecia, and we're gonna talk about that here in a little bit. But we really want to encourage people to, you know, you know your body better than everybody, than anybody else, you know, start with some simple things, but escalate, you know, it pretty quickly if you feel that that's necessary to seek help.

SPEAKER_01 8:16

So, how is alopecia different from male pattern baldness? My husband is bald.

SPEAKER_00 8:22

Great question. So, male pattern baldness is a type of alopecia, and it's the most common type of alopecia worldwide, actually, called androgenetic alopecia. It impacts many millions of people, over 80 million in the United States alone, and certainly more worldwide. It can impact women as well, right? So androgenetic alopecia. And so if we break down the term androgenetic, androgen, because testosterone or androgens are thought to be a big driver of that type of alopecia or hair thinning, and genetic, because there is a large genetic predisposition. But of course, there are other factors involved of when somebody presents with that type of alopecia and how fast they might progress. And in fact, there is some thought that shedding that occurs with starting new medications, including GLP1 medications, and I see this very often in my clinic, especially for postmenopausal women, they get shedding from some stressful trigger. Let's say it's the GLP1 medication, and we'll get into more detail about that, can potentially unmask a genetic predisposition for something like androgenetic alopecia. And the same thing can occur in men as well. And I and I explained to them, you know, there is some thought, and we'll get into to the nitty-gritty on this, there is some thought that the GLP1 medications may or may not actually stimulate the development of androgenetic alopecia, separate from just the shedding, and we can get into that. But let's just say we're talking about the shedding. If, and I'll say this to our listeners, if you're experiencing shedding that's not going away, right? It's chronic, meaning lasting longer than six months, or it's stopped, but then over the following six months, your hair is just never back to the way that it was. It's possible that you could have unmasked a genetic predisposition for that specific type of alopecia called androgenetic alopecia. That's when it's really time to see a board certified dermatologist so that you can intervene sooner rather than later to have the best chance of success.

SPEAKER_01 10:18

Sure. So is there hope for my children then?

SPEAKER_00 10:20

Yes.

SPEAKER_01 10:21

My beautiful red hair.

SPEAKER_00 10:23

I want him to keep his beautiful red hair. Yes. So it's it's not always a one-to-one and it can be passed on mom or dad's side. But I would say I do have um, you know, I do have a lot of younger individuals that come into my clinic that have a significant family history of um, you know, having early balding or thinning, right? I.e. antigenetic alopecia, and come seeking, you know, conservative approaches of how we can best preserve their hair based on what their comfort levels are, right?

SPEAKER_01 10:51

Real talk. If you're on a GLP one and your hair has been falling out more than usual, please don't ignore it. Folly can help. They did a whole 300-person study after just four weeks. People were seeing less shedding, fuller hair, and the whole shebang. It's just one package of gummies a day. That's it. Your GLP1 journey shouldn't cost you your hair. Use the code GLP1 Hub to get 20% off at follynutrition.com. That's F-O-L-L-Y-Nutrition.com. Sure, sure. Okay. So there's there's hope for his beautiful red hair. It's so yes, I don't want him to lose it. So let's shift gears in terms of the GLP one because that's what the audience is is interested in. We had spoken briefly before that my initial thought as a dietitian is that the hair loss people were experiencing was because they weren't eating enough calories, they weren't getting enough protein, they were missing micronutrients. So that's kind of where my education was. But that seems to have shifted a little bit to maybe it's the medication. So can we we talk about like the journey here for what might be the cause of this hair shedding and how common it is too?

SPEAKER_00 12:04

Yeah. Okay. So so the GLP ones, so just for context, right? And actually, those are two of the working hypotheses. You're spot on, right? There's just the third working hypothesis that we'll get into that's the potential for exacerbating androgenetic alopecia. But I think you're spot on. And those two variables that you said, the rapid weight loss and the micronutrients, are certainly part of this picture. I think it's going to be, you know, a multi-pronged approach and not just one thing. So you're spot on. So let's back up a second about the GLP ones, right? And I'm sure, you know, your listeners have heard this before and have done some of their own research. The GLP ones were first created for control of diabetes. There's over 500 million people worldwide that suffer from diabetes, more commonly type 2 diabetes than one. And over 10% of men and women suffer from obesity. And we know that the GLP ones are helpful for decreasing hemoglobin A1C, decreasing insulin resistance, and thus through decreased gastric emptying, other factors, right? Increased satiety, downregulation of the increased appetite molecules that we have in our body, all of those things can lead to weight loss, right? Which is also an important part of that journey. But like you said, rapid weight loss is a very common trigger for what, for another type of non-scarring alopecia that we call telegena fluvium. And that was the one that I was alluding to before that oftentimes will unmask people that have a genetic predisposition. So I think the jury's still out of whether or not you're potentially unmasking somebody with a genetic predisposition already that was going on slowly in the background, or if the GLP one medication itself can lead to an exacerbation. And some of these working theories are a change in the microenvironment around the hair follicle itself that's um that that's caused by the GLP1. One of one of the working theories is, you know, we know that the GLP ones can decrease fat or adipose tissue. Turns out there's a layer of fat tissue in our skin that's very important. It actually has a lot of metabolic activity that helps to sustain the hair follicle. And that's a special type of adipose tissue. And that has been shown already to be decreased with um GLP1 use. So that's one of the theories is that if you're going to take away some of the good fat layers in areas that are metabolically active or protective for the hair follicle, can you potentiate hair loss separate from weight loss, separate from micronutrients, right? Or calorie deficit or decreased protein intake. Right. And so that's a that's a really hot topic for research right now. And it's one that, you know, that that our group is working on and one that multiple, you know, alopecia expert teams throughout the US and world are working on as well. But I would say, you know, I don't want our our listeners to to listen and watch this and think, oh, I'm scared to start a GLP one.

SPEAKER_01 14:44

Right.

SPEAKER_00 14:45

We know that there are so many health benefits of GLP ones, and honestly, probably more health benefits that outweigh risks involved. But of course, we always encourage our listeners to speak to their doctor to make an informed decision, right? So that they can, we call it shared decision making, right? And you know, as a as a provider as well, right, where you're providing all the information and then somebody can decide what they feel comfortable with doing. We also want to do some more research into is the um is the dose impacting the loss, right? Because there are a lot of people that will microdose the GLP ones and have very slight weight loss over a very long period of time. So I'm very interested in looking into, you know, is it can if we decrease the rapidity of weight loss and we microdose and don't go up super high super fast, can we help to mitigate the risk of some of that hair shedding as well? And then lastly, you know, how do we treat it as well, which is really important? And can we get it a little bit into how we can um help people that come in with shedding?

SPEAKER_01 15:45

Yeah, yeah. Cause because from my understanding, one, the weight hair loss related to like rapid weight loss in this can be temporary, whereas these the more like alopecia, like you said, the genetic part of it could be more permanent. Is that correct?

SPEAKER_00 15:58

Yes. And so, but remember, the jury's still out of whether or not the medication can potentiate hair loss itself. So, so we don't know whether or not if, okay, so if the medication itself is decreasing some of this microenvironment or is less optimal, you know, less optimal for the microenvironment or decreasing the good fat tissue, is that reversible once you stop the medication? We're still very early on in that research. What I can tell you is that if based on the the hair measurements and your full clinical exam, or even sometimes people get scalp biopsies, we call that clinical pathologic correlation of putting all the information together. If your dermatologist feels that the shedding has unmassed a true genetic predisposition, that you're correct, is not necessarily reversible, but it's most certainly treatable. Okay. But it can be progressive over time if the excess shedding has unmassed something like androgenetic alopecia in men or women. And that can be progressive if left untreated.

SPEAKER_01 16:58

Okay. Okay. So let's say you're experiencing some shedding. What can you do to maybe try to slow it down, maybe with your diet and nutrition, lifestyle, and then medically?

SPEAKER_00 17:10

Absolutely. So I was actually going to start with the diet and nutrition first. So, you know, not just for GLP ones, but we see a lot of patients who have had gastric bypass surgeries, right? Or they're on other diets, right? Nutrition is incredibly important for hair cycling. That's one of the, you know, so some people that suffer from eating disorders, one of the first things that they notice, right, is that the hair sheds, or in in extreme cases can even lose its pigment and change color as well. And that's because the body says, well, we need to shift those nutrients to the vital organs. And they say, well, the hair is not vital in this, in this instance, so we're going to shift it away, right? And also, of course, the physiologic stress of going through things like that as well. So nutrition is very optimal. So there are, you know, I there are multiple studies on this, but I would say if you ask 10 different dermatologists, they we would all tell you 10 different things very slightly. But what I can say from what I do, from what the research that we've done, right, vitamin D is very important for hair cycling, iron, very important for hair cycling. Zinc also to an extent is important for hair cycling. There, there are multiple vitamins and minerals that are important for hair cycling and also metabolic activity too, thyroid, incredibly important for hair cycling. So, you know, I I oftentimes will check a battery of labs, including the ferritin, which is our iron stores, an iron panel, a vitamin D, a zinc, sometimes additional, depending on somebody's risk factors for things, to see if somebody is deficient in one of these things. And also on the flip side, one can actually be too high as well. So I always caution people to, you know, be very careful. Just because something is over the counter, you still want to make sure that you're taking the proper amount, right? You don't want to double or triple up on some of these things because some people don't realize that some of these vitamins are lipid soluble. So they're stored in your liver and you can't overdose on them, like vitamin D, E, A, and K, for example, amongst some others. And so, for example, and we actually wrote up a report on this that um, you know, sometimes I'll have people come in with supratherapeutic, meaning too high, or even toxic levels of vitamin D, not realizing that they're taking double or triple the amount that they actually need to. And, you know, and that's important for so we're gonna talk about in the context of hair. These levels have to be in a normal range. If they're too low, they can impact shedding. If they're too high, they can also impact shedding, right? So it's a it's a delicate balance. So making sure that the nutrition is optimal. And like you said, Anna, the the protein intake is very is, I think, going to prove to be very important for the GLP1 specifically as well, to make sure that you're optimizing your protein intake. Of course, you don't want to have all protein because then that might make your kidneys work too hard and then you end up in the emergency room. But it's really important to optimize nutrition. So we usually start with that battery of tests first, right? If you wanted to do simple intervention, nutraceuticals are very popular. You know, just pay attention to the ingredients and make sure that, you know, they're as evidence-based as possible. Another thing that I'll point out as well is that um women that are trying to conceive or breastfeeding, some nutraceuticals have um DHT blockers or dihydrotestosterone blockers in them, such as saw palmetos. You have to be careful that I personally would avoid um taking some supplements that have anti-androgen effect if you're um pregnant, trying to get pregnant, or breastfeeding. So make sure that you know you speak to your dietitian or your board-certified dermatologist to review your supplements to make sure that they're right for you as well. Another thing, too, is that you want to make sure, for example, if you have a history of autoimmune disease, so we treat a lot of people that come in with alopecia ariata. There have only been a few case reports of the GLP1 medications being a potential culprit of unmasking somebody who was genetically predisposed to get alopecia ariata. But on the flip side, there's also research showing that GLP1s are anti-inflammatory too. So it's like, you know, what came first, the chicken or the egg, is this going to be hurtful or helpful? And there are also, um, there are also people on the flip side showing that, or trying to prove or have the hypotheses that the GLP ones can be more helpful than hurtful for hair loss, or at least certain types of hair loss too, given it's anti-inflammatory activity. And if there are certain types of hair loss, and we now know that this is true for a certain type of scarring hair loss, that insulin resistance can help to directly drive scarring. So this research is ongoing now. Can the GLP ones actually be a treat for some of these other types of alopecia as well? So I don't want people leaving here thinking that all things are bad, right? For in terms of hair. And there are, and there are ways for us to likely mitigate those risks, right? Sure. So let's say you've started, you've checked all of your nutrient levels, your thyroid is good, you're on a good nutritional regimen, and you still have shedding. You go see your board certified dermatologist, and you know, they're you're you as the dietitian have already done some of That homework for us, thank you so much. So that helps to save us some time. And we say, okay, if your shedding has been ongoing for longer than six months, right, and we call that chronic telogenofluvium shedding, or that shedding has unmasked the genetic predisposition, right? Like androgenetic alopecia, those would be two instances where if someone came me, came to me, I would, I would recommend medical intervention, right?

SPEAKER_01 22:24

Okay.

SPEAKER_00 22:24

More than, you know, uh, in addition to obviously continuing their optimized nutritional, right, nutritional status as well. So what are some of the interventions? I would say one of the more popular interventions right now, because it helps to create cro treat chronic shedding as well as treat antragenetic alopecia is low-dose oral monoxidil or LDOM for short. And this medication, by the way, was created in the 19, was FDA approved in the 1970s for heart-to-treat hypertension or high blood pressure. And it's it's an immediate release tablet. So it was, it was designed to peak pretty quickly and then go away. Most of the medicine is gone within four hours. But even so, for a little over a decade, we've repurposed that medication in dermatology at lower doses, which is shown to not have a significant impact on blood pressure, but can have a significant impact on hair, right? Not only the density, but we also did a study a few years ago to show that it can also help to potentially thicken each of those individual hair strands as well. That's um that's one other cool thing that we have at NYU is that we have the ability to take these objective measures for patients as well, their density as well as their caliber. So the density is how much hair you have per centimeter squared, and then the caliber is how thick are each of those individual hair strands. And those are the measures that are actually used in clinical trials when new medications that are seeking FDA approval and actually, you know, making it to market use like robust studies.

SPEAKER_01 23:49

Yeah.

SPEAKER_00 23:50

So that's pretty cool. I will say that one of the next studies I want to do is actually looking at people that have already optimized their monoxidil prior to going on a GLP one, because my hypothesis is that if you're already on a medicine that's pushing more hairs into the growth phase, we call that the antigen phase. Are you going to decrease the risk of them having some initial shedding? Or if they have some initial shedding, would they have less and it would stop quicker? My hypothesis is yes. And so I would love to compare a cohort of people that are not optimized on monopsidal before starting the GLP one and then those that are going on obviously similar regimens, right? So we can help to minimize other factors that can confound our results.

SPEAKER_01 24:30

Right. So is the minoxidal something that you take forever?

SPEAKER_00 24:34

Okay, this is a great question. And so that this is typically this comes up either in the first visit or at the second or third visit where people feel like, okay, I'm great. I feel like I'm back at my baseline. I don't want to do this anymore. And it really depends on what we think the primary driver is. So if we think that the primary driver is the excess hair shedding and there's no underlying other type of alopecia going on, right? Whether we think the medicine caused the antrogenetic alopecia or unmasked it from the shedding, that's the biggest difference between, okay, can we stop this medication? We bring you back in six months to a year, redo your hair counts, redo your globophotography to see if you can maintain your hair counts on your own. Or am I to tell you, listen, I really recommend that you stay on this medication as long as you want to maintain your benefit because it's pretty clear that this other type of alopecia has been unmasked or is ongoing. And that can be progressive if we don't treat, or you're at risk of really losing your benefit if we stop treating it.

SPEAKER_01 25:34

Right. Right. So it's just going to depend on the underlying cause.

SPEAKER_00 25:37

Exactly. And sometimes people have multiple things going on too, and it can make things more complicated.

SPEAKER_01 25:41

Sure. So if you've got the minoxidil, that's the main treatment for it. Is there some anything else if it's is there like a possibility of that not working or anything else that you layer on top of it?

SPEAKER_00 25:54

Yeah, that's a that's a great question. So just think a little bit about the mechanism of minoxidil. We think that the main mechanism is um vasodilatation. So that's how it works mainly to control blood pressure. And that's how we think it can increase nutrient delivery to the hair follicle itself. But there are likely other things that monoxidil does, like increasing certain factors like VEGF or that it's important for angiogenesis, um blood flow, um, and other factors that are likely important that we're not actually completely aware of of how monoxidil works. But not everybody responds to immediate release monoxidil. And why is that? That's because we we need an enzyme to actually activate it. It's a it's an inactive drug when you take it and you have to, your body has to activate it for it to actually do its job. And the main enzyme that's responsible for that is called SALT-1A1. And there's actually no reliable commercial way in clinic for us to actually check for those levels, right? It would be very easy if we said, okay, we can check for this level. You're here, we have science and research to show that if you're a good metabolizer, we give you this dose. If you're a poor metabolizer, we give you that dose, or this is not a good medication for you, you're not going to respond well, or we'd have to give you too high a dose that we would increase the risk of cardiovascular side effects, which is real if you use over five milligrams. Okay. Actually, five milligrams of monoxidil is actually considered a real cardiovascular dose where you can increase somebody's heart rate when it is the lowest blood pressure lowering dose of monoxidil. So let's say, so so fortunately, and I can say this because this is public knowledge, one can go on clinicaltrials.gov. Um, there is a company that is working on an extended release form of monoxidil, and that will, you know, we'll see what the data shows. But the hope is that that will be even better than the immediate release monoxidil. And the thought of wise, if somebody is a poor enzyme producer, right, for the immediate release, that means the medicine spikes in your system but still goes away pretty quickly, right? So if your body doesn't have enough time because enough time or enough enzyme to activate it, it's not going to work very well. So since we can't actually change the amount of enzyme that's present in our body, right, the geniuses that thought of this idea for extended release monoxidil thought, well, if we can't change the amount of enzyme that's around to activate the medicine, can we change the length of time the medicine is present for so your body can actually have more time to metabolize it? Sure.

SPEAKER_01 28:17

Sure.

SPEAKER_00 28:17

And so, you know, hopefully the answer to that question is yes. I can say that the phase three clinical trial data, yeah, you know, one can look this up is out and looks very favorable. And, you know, hopefully the the data will be the same for women. And I'd be really interested to see, you know, how much more um beneficial it can be to do the extended release compared to the immediate release, right? Because then people will have to make the decision, you know, am I doing well on this medication or do I want to, do I want to switch over? One important thing, too, that I think is important for the listeners is that as a as a key opinion leader in alopecia, I'm asked by a lot of companies to consult for them. I do consult for the company that does make this medication. They're called Viridermic. So I think I think it's important to disclose those things as well.

SPEAKER_01 29:00

Sure. Awesome. Well, I mean, obviously they'd want to have you with so much knowledge you have. So with all this information and being being a thought leader in the space, what are you excited about for the future of alopecia, whether GLP1 related or not?

SPEAKER_00 29:12

Absolutely. I'd say, you know, the future is bright in terms of alopecia research. I would say, you know, I'm I'm grateful for the individuals and groups of people that are willing to commit time, resources, effort, money, finances toward advancing medicine for alopecia. And that's for all alopecias across the board, right? It really several years ago, it started with the first jack inhibitor, oral jack inhibitor ever approved for alopecia area. Prior to several years ago, we had zero FDA-approved medications to treat alopecia areaata, and now we have three. We have bericit nib, rhythmsit nib, and durexalit nib. So we went from zero to three pretty quickly in a few years. Obviously, it takes years to develop these medications. And if the extended release monopsidil is approved, that will be the first, uh, the second ever systemic medication approved for men with androgenetic alopecia or male pattern fitting, and the first ever four women systemic medication approved for androgenetic alopecia. Just to put this into context for our listeners, a lot of people don't know this, that it wasn't until our lifetime. I was born in 83, right? And it wasn't until almost a decade after I was born that um women were actually required to be included in clinical trials in the United States. Yeah. That is crazy to think that that is within our lifetime. Right. So women's health has not always been a priority. It's certainly not a priority right now for many institutions, but fortunately, we still have groups of people that are very interested in women's health research, myself included. Um, and this medication would be one of those, right? Where they've they've dedicated the time and resources to the impact in women as well as men simultaneously, right? So the hope is that that medication will be approved for both. Rogain, which was topical, and again, was also discovered from oral monoxidyl, was approved first in men, and then it took decades for the higher dose of the medication, the 5%, to get approved in women. And right now, topical monoxidal is the only FDA-approved medication in women with androgenetic alopecia, whereas one milligram of phenasteride and topical monoxidal are the two FDA approved medications for men with androgenetic alopecia. So we have the JAC inhibitors for alopecia areata, and then hopefully now we'll have one of the extended release monoxidal coming out for men and women alike with androgenetic alopecia specifically. Why can why can extended release monoxidal be used for shedding? Because of its mechanism, right? Even if it's FDA approved to treat androgenetic alopecia, it can be used for people with chronic shedding over six months. And we already use it, right? The the the monoxidal that's out on the market right now, the immediate release for that reason, because it does extend the anagon or growth phase. So my hope is that this extended release works even better and we can have better medications to offer our patients, right, for us to make an informed decision about what we want to do moving forward. Of course, there are always procedural therapies that can help plately rich plasma injections. We also have non-ablative lasers like the follic laser, red light therapy, near, near infrared light therapy, obviously optimizing nutrition as well. Again, that that goes without saying that's first and you continue that whilst you're doing your prescription regimen therapy as well. I am I am more biased toward optimizing medical therapy first and things that are more cost effective that one can do at home prior to incorporating more of the expensive procedural therapies that, yes, have science behind them and yes, have some studies, but not as robust as the ones that are being done for FDA approval of medications, right? And they're also not covered by insurance. So it's also devastating for somebody who's also, and again, a lot of the GLP ones, depending on the indication, might may or may not be covered.

SPEAKER_01 32:56

Yes.

SPEAKER_00 32:57

So some people, you know, might be desperate to seek results and are spending a ton of money and then end up with this issue. And then they're spending a ton of money on the issue as well, right? So try to find something, the balance between being effective in terms of the research that we have and the efficacy, right? And the ease of doing something at home because it's important for it to be sustainable, as well as the cost effectiveness of that therapy as well. To all of those things we really keep in mind when we're discussing these things in clinic and making an informed decision together.

SPEAKER_01 33:27

Yeah, awesome. Well, Dr. Lusico, this has been so informative. You really gave me hope that maybe there is a lot that we could do to reverse or or you know, not mitigate some of this hair loss. Cause I hear of so much from my audience that they're really struggling with this, but you really gave us so much hope. So where can people learn about your work or or connect with you?

SPEAKER_00 33:48

Oh, absolutely. If they, you know, once a month when we're on the Doctor Radio on Sirius XM um channel 110, we get live callers all the time. I love to take calls from people and hear their stories and and and help them. Um, some people that are shyer will send emails, and our producer will triage those emails as well. And also please check out alopecia justice league, www.alopecia justiceleak.com or at alopecia justice league on Instagram. We have all sorts of programs that we've created through um the alopecia justice league to help to advocate from pen pal programs to children with alopecia areata, and we link them to um young adults with alopecia areata or adults um, you know, philanthropy efforts that we have through the donations from our book, How Ari Got Her Cape. So check that one out on Amazon and Barnes and Noble. And please support alopecia research in any way that you can. Some great organizations include the the Scarring Alopecia Foundation or SAF for one. Another great organization is called NAF or the National Alopecia Ariata Foundation. And then the third is called the American Hair Research Society, or RS for short. So these are wonderful organizations that actually help like grant support research, have patient outreach programs as well. So please check out those websites as well for SAF, RS, and NAF.

SPEAKER_01 35:06

Awesome. Thank you so much, Dr. Lisico. Really appreciate your time. Thank you, Anna. Thank you, listeners. Thank you so much for listening to this episode of the GLP One Hub podcast. I know you guys have been asking for a hair loss episode, and it's been more challenging than I thought to find somebody to come on and talk about it. So I want to thank Folly Nutrition for sponsoring this episode and inviting Dr. Lisico to come on. Make sure you check out their hair health gummies at Follynutrition.com. And I hope you learned so much because I really did. This is such a dynamic and interesting topic about hair loss and GLP1. And I hope that you uh will leave a review for the podcast if you are enjoying it because it really helps us grow. And I'll see you in the next episode.