-2.jpg)
Skincredible
Skin education for ALL! A board-certified pediatric dermatologist (skin doctor) combats social media misinformation for YOU. Informative, fun, and clear episodes that debunk myths, explain real science, and help patients and parents make confident decisions about their skin and their child’s skin. No fluff. No fear. Just facts.
Dr. Lisa Swanson is a board-certified dermatologist and pediatric dermatologist. After going to college at the University of Colorado at Boulder, she obtained her medical degree from Tulane University School of Medicine in New Orleans. She performed her dermatology residency at Mayo Clinic in Rochester, Minnesota.
After that, she completed a fellowship in Pediatric Dermatology at Phoenix Children’s Hospital in Arizona.
She was in private practice in Colorado for a decade and then moved to Boise, Idaho in summer 2020 to become the first and only pediatric dermatologist in the state of Idaho. She is active in local and national medical societies and organizations. She loves lecturing at conferences discussing pediatric dermatology with audiences across the country. Since moving to Idaho, she works in private practice at Ada West Dermatology and she is also on staff at St Luke’s Children’s Hospital.
In her spare time, she enjoys binge watching television shows with her boyfriend Larry and cuddling with her 2 doggies Mosby and Maggie.
Skincredible
Alopecia, GLP-1s, and the Truth About Red Light Devices with Dr. Michelle Tarbox
Use Left/Right to seek, Home/End to jump to start or end. Hold shift to jump forward or backward.
This week on Skincredible, Dr. Lisa Swanson sits down with Dr. Michelle Tarbox for a deep dive into hair loss that goes way beyond “is it falling out?” Dr. Tarbox is associate professor of dermatology and dermatopathology at Texas Tech University Health Sciences Center and co-host of the Dermasphere Podcast! Fun fact-- her identical twin sister is an opera singer performing across Europe.
They start with diagnosis: why pattern is the first and most important clue, how a “swarm of bees” attacking follicular melanocytes causes hair shafts to thin and narrow over time in alopecia areata, and the key question that separates telogen effluvium from androgenetic alopecia — are you seeing, feeling, or catching hair coming out, or just noticing it’s thinner over time?
From there, a thorough look at GLP-1 related hair loss: why it happens, the emerging retatrutide (which targets both GLP-1 and GIP), the dysmorphia concerns around extreme weight loss, and Dr. Tarbox’s reminder that patients should always tell their doctors what they’re taking because “we don’t judge, we just need to know.” They discuss getting enough protein and the right vitamins to fill nutritional holes, and why hair loss can act as a canary in the mine for patients hoping to stay on their GLP-1.
On the OTC and device front: which supplement has the best data and price point (Viviscal, reviewed in an article on Dermasphere), a rundown of red light therapy devices (the Hairmax laser comb, iRestore vs. Revlon Red, why Theradome isn’t recommended, and capless options that need a power supply), and the science of why red light works — it’s attracted to copper ions, kickstarts senescent cells, decreases DHT, and improves blood flow. They also cover scalp massage, fingers vs. the “Comfier” device from Amazon, and a fair worry about head fires.
The conversation moves into JAK inhibitors as a game-changer for alopecia areata, the frustrating reality of insurance companies labeling it “cosmetic” despite the real burden it places on patients, and how hair loss is portrayed in media. They get into scalp micropigmentation (“drug tattooing”) — including the epinephrine science behind it, what a typical treatment series costs and involves (three treatments back-to-back, paired with oral or light-based support), and how Dr. Tarbox chooses between anti-androgens like spironolactone and finasteride depending on the patient.
Dr. Tarbox’s PSA for anyone googling hair loss: those miracle-growth ads aren’t real (cue a tangent about the cult movie The Peanut Butter Solution) — get diagnosed and come in early, because it’s far easier to maintain hair than regrow it.
Plus, a rapid-fire round: paper vs. digital calendars, guilty-pleasure reality TV, lottery dreams, ideal dinner time, and — naturally, given the Texas Tech connection — predictions on when Taylor and Travis are finally tying the knot.
Keywords
Dermatology, Alopecia, Alopecia Areata, JAK Inhibitors, Hair Loss, GLP-1, Peptides, Anti Androgens, Dutasteride, Finasteride, Spironolactone, Minoxidil, Rogaine, The Peanut Butter Solution, Scalp Massage, Red Light Therapy, Vitamins, Nutraceuticals, Viviscal, Nutrafol, Opera, Travis Kelce, Taylor Swift
Links, Attachments
More about Dr. Tarbox: https://providers.texastechphysicians.com/provider/michelle-tarbox/2676236
Dermasphere Podcast:
https://www.dermaspherepodcast.com/
Chapters
00:00 Intro and Welcome Dr. Michelle Tarbox
02:35 Alopecia Clinical Observations
06:29 How Important is Time in Alopecia?
08:38 GLP-1 Related Hair Loss
14:38 GLP-1 Related Body Dysmorphia
16:32 For Patients Experiencing GLP-1 Hair Loss
18:50 Over the Counter Recommendations
21:18 Red Light Therapy
24:17 Science of Red Light
25:39 Dermal Stretching & Hair Growth
29:23 Alopecia Areata & JAK Inhibitors
32:30 The Lost Years with Alopecia Areata
33:20 Insurance Calling Alopecia
34:45 What Dr. Tarbox Wishes Patients Knew About Alopecia
36:50 False Ads for Vitamins That Do Not Work
39:00 Drug Tattooing
44:40 Anti Androgen Therapies
48:30 Rapid Fire Questions
53:26 Like/Subscribe/Follow, Thanks & Goodbye
The information shared on this podcast is for educational purposes only and is not a substitute for personalized medical advice. Always consult your physician regarding your health.
Hello, everybody, and welcome to another amazing episode of the Skin Credible Podcast. I have a wonderful, talented, vocally accomplished guest on today, which is rare. I don't have a lot of singers on the program. I want to introduce everybody to Dr. Michelle Tarbox. Michelle, go ahead and introduce yourself.
SPEAKER_00Hi there. My name is Michelle Tarbox. I'm an associate professor of dermatology and dermatopathology at Texas Tech University Health Sciences Center, where I also serve as chair and I co-host the Dermosphere Podcast.
SPEAKER_02Yes. And I have been a guest on Dermosphere on a couple of occasions. Honored, so honored. That is a big deal podcast. You guys do such a good job. You guys take it to another level. Your level is higher than the Skin Credible level. It's it's pretty great. What do you guys think?
SPEAKER_00I think there is room in the Dermosphere for all parties. I'm very, very proud to be podcasting alongside you, Dr. Swanson.
SPEAKER_02Oh, well, thank you, Michelle. I should mention I had introduced you as vocally accomplished because not only can you sing, but your identical twin sister is an opera singer in Europe.
SPEAKER_00Yes, she is. So my twin sister Rebecca Nelson, it's N-E-L-S-E-N, if you want to look her up. She has a bit had a very accomplished career in opera. I'm so proud of her. She's premiering at La Scala in the spring of next year. I can't wait to see her perform. And she lives in Vienna. Mm-hmm. Yep. So she lives in Vienna. She has what they call a fest contract there, which is the primary players in each of the opera houses, but she also guests all over the world.
SPEAKER_02Wow. And so EADV is in Vienna. Are you going to go and hang out?
SPEAKER_00I am trying to secure the time off for that one because it would be an awesome opportunity for her to visit what I do and for me, of course, to visit what she does.
SPEAKER_02Yes. In preparation, because I'm excited. I'm going to get a chance to go to EADV in Vienna. And I watched the show The Reluctant Traveler with Eugene Levy. Have you heard of this?
SPEAKER_00I think I may have seen an episode of that. I love Eugene Levy. His eyebrows just make me so happy.
SPEAKER_02I know, right? He's so great. And apparently he doesn't like traveling. He was given this like travel show, and each episode they go somewhere different. And he has one in Vienna, and it's really good.
SPEAKER_00I will have to check that out. That sounds awesome.
SPEAKER_02Yeah. Yeah. I did it in preparation. And he had this amazing looking breakfast thing that looked like pancakes, but stirred up with a whole bunch of other stuff. So it was almost like a pancake cinnamon roll, just kind of like mushed together. I made a mental note to try that when I'm there.
SPEAKER_00Oh man, the name of that is on the tip of my tongue. It's tasty.
SPEAKER_02Yes, yes. And the name is very long. I wanted to have you on to talk about alopecia because this is something that you see a lot in your clinic. You're a big, a big advocate for good care of patients with alopecia and appropriate diagnosis of alopecia. And so when you first see a patient who comes in and you see chief complaint, alopecia, hair loss, what do you want to know from them about the history of it all, how it's kind of evolved over time? What questions do you ask before you even take a look at their scalp?
SPEAKER_00That's a great question because it really guides your exam as well as your therapeutic options. So first I ask pattern. I think pattern is one of the most important defining features of an alopecia. Are you losing hair from all over? Do you feel like some more from one part of the scalp? Are there any bald patches? That's going to give us some clues as to whether we're dealing with telogen afluvium, whether we're dealing with androgen, uh, androgenetic alopecia, where it would be more involving the vertex, or whether we might be dealing with alopecia aereata. I do always want to put a caveat there with that pattern discussion, though, that there is a generalized form of alopecia aerata that looks very, very much like androgenetic alopecia. And if you don't use your dermatoscope, you're going to miss it every time. And I teach with a case of that that was quite striking. Very young lady had had previously a very thick ponytail, had a very sudden loss of hair, but it was very generalized, very diffuse, no individual patches at all. And from a clinical photo, you cannot tell her apart from a patient with real androgenetic alopecia, but trichoscopically, the findings were unmistakable for a very active alopecia areyata and a biopsy confirmed that. So it's a very good teaching case. She's an excellent patient. She's doing very well now. We have been treating her alopecia areyata appropriately with, you know, medications we wouldn't use for telogenofluvium. So that correct diagnosis in that pattern is crucial.
SPEAKER_02I'll admit that I am not great with trichoscopy. I always look, I do it. Um I look at everything basically with my derm light, but I I wish I knew more about trichoscopy. And so what did you observe trichoscopically? Yes. That pointed you in the direction of alpacariata.
SPEAKER_00So you have this swarm of bees, inflammatory cells, surrounding the hair bulb. And they're attacking it and trying to destroy it because they've gotten confused and they're actually targeting this, gets a little technical, but they're targeting the follicular melanocytes, the pigment-making cells. And they've lost immune privilege there. So the immune cells are going after things they shouldn't even understand are there. Right. And that attack causes the hair shaft to become thinner and thinner until it's very, very fragile and then it stops growing. So the findings that you see for alopecia areata are usually some variation of narrowing of the hair shaft over time. Because of the way hair grows up out of the scalp, you'll start off with a thicker fiber that then gets thinner and thinner as it's closer to the scalp. Now, when you're dealing with a short hair that has that finding, because it's pretty active alopecia areata, that'll look like an exclamation point. If you're dealing with a patient that has a flare and relapse kind of cycle to their alopecia area, you may have multiple constrictions along that hair that make it bend in funny ways. And if you have a longer hair that's got that thinning, it may be what they call a cuddayable hair, which is like a hair that bends with pressure. And then the end stage is an empty follicle, which we sometimes refer to as yellow dots because oil, skin oil, sebum, and dead skin cells fill up the opening where the hair follicle was supposed to come out from. So those are the chief findings of alopecia areata and help you to distinguish it from, for example, androgenetic alopecia, which wouldn't have that thinning of the hair shaft over time. We do get follicular miniaturization with androgenetic alopecia, but on a scope of time, it is glacial in pace in comparison to what can be caused by the inflammatory process that's present in that immune process of alopecia areata, which makes patchy hair loss most of the time, unless it's the generalized pattern.
SPEAKER_02And you segued very nicely to my next question. Like, how important is time course to you during that initial evaluation? Somebody who's noticed a smaller ponytail over the past 10 years versus somebody noticing a smaller ponytail over the last five months?
SPEAKER_00Those are really key questions. And so I kind of build those together with a pair of questions that I ask. You're here for hair loss. Question number one: are you seeing, feeling, catching it coming out? Like, are you perceiving the loss in your hands in the shower after you brush your hair on your pillowcase? My patients that have really bad telegen offluvium, they have hair everywhere. It's in their refrigerator. You know, it's like everywhere. I've personally been through some bad telogen effluviums because I'm susceptible after COVID, especially.
SPEAKER_01Yeah.
SPEAKER_00Um, so we want to know are they losing hair that they're perceiving, or did they just notice that their hair appears to be thinner over time? That can help us distinguish a bit from a telogen afluvium versus an androgenetic alopecia. Because androgenetic alopecia is a quietly thinning ponytail. Right. A telogen of fluvium is my body is dying, my hair is coming out, I must have something horrible. Because every time we see that in popular media, that's what's happening. Right.
SPEAKER_02Very true.
SPEAKER_00Very scary for them. And then it's like, let's stress out these people who are already stressed out more.
SPEAKER_02No, I know. That's the thing. It's like you're you're something is stressing your body, triggering the telogen of fluvium, and then the telogen of fluvium is stressing you even more. And so it's it's hard to tell those patients, like, you gotta just calm down and take a beat. Because meanwhile, they're like, I have hair in my refrigerator.
SPEAKER_00Right, exactly. Exactly. So we find out are they shedding clumps or the is the ponytail just quietly thinning? And then we ask the time course. And there's a very key differentiator with that time course. So, having personally experienced COVID-related telogen of fluvium twice now, the telogen of fluvium from COVID tends to be very quick, usually within about a month or a month and a half of having a very severe viral illness with COVID. And it's just different than telogen of fluviums from other courses, which usually take about three to six months after the inciting stressor. Um, so that's a helpful differentiating point to kind of go back and reflect. Do you think this might have been because you maybe had COVID? Did you have that kind of upper respiratory illness that tends to be very severe, or are you just um having, you know, some stressors in your life? We're seeing a lot of GLP one-related telogen ifluvium.
SPEAKER_02Right. I wanted to ask you about that. And so do you feel like that is something that happens to a lot of people who go on a GLP one? Do you think it's dose related? Do you think there are certain people who are predisposed?
SPEAKER_00My answer to all of those questions is yes.
SPEAKER_02Yeah.
SPEAKER_00So I think there are people who are genetically more predisposed to lose hair in periods of caloric restriction. Yeah. I think that there are also um variances, and this has actually been shown in the literature between the different GLP ones that is very closely in parallel with their propensity to cause weight loss. So trusepatide has caused much more profound and much quicker telogen of fluvium in the literature than semaglutide because the weight loss from trusepatide tends to be much more significant. Now we have retitrutide coming out, and you know, I haven't seen patients yet in my clinic presenting for telogen of fluvium on that medication. And I am asking my hair loss patients what they're taking. But there's an important caveat here. A lot of people are obtaining these medications on the internet, right? Um, without necessarily a doctor's supervision from labs that are all over the website saying this is for research purposes only. And I don't fault people for looking outside the traditional medical system for solutions because it's very stressful just to be a human being right now. It's hard to adult every day. There's so much going on. And if there's something that's promising you you're gonna feel better, you're gonna feel like you felt 10 years ago, we're gonna give you your energy back. That's really, really exciting and interesting to most people, I think. And then you compare that with also potentially being able to shed some very stubborn pounds, it's a very attractive proposition.
SPEAKER_02Yeah. Well, and it just arrives at your doorstep.
SPEAKER_00Oh, yeah, exactly. Exactly. It can just come in the mail. Yeah. We also don't know if the thermal characteristics of how it's being transported are safe. Right. But with the GLP ones that are kind of obtained outside of traditional streams, some people are a little hesitant to share with their physicians that they're taking these drugs. And I want to blast out to any patient that's listening, any person that's listening to this, your doctor cares about you. We are not the police. Yeah, we're here to help you achieve your best health. If you think that you've found a solution and it's helping you, we're not gonna turn you in or anything like that. We might talk to you about the health risks or the risk-benefit analysis of taking something in a pattern that is a little less traditional, like that. But no one's gonna put you in peptide jail or something like that if you tell your doctor what you're taking. Right. So let us, you know, in the words of Cuba Gooding Jr., this is the wrong person. Is it help me help you? Was that Cuba Gooding Jr. or was that Tom Cruise?
SPEAKER_02Help you. I think it was I think it was Tom Cruise saying those lines. Yes, to Cuba.
SPEAKER_00Yeah, to Cuba, yes. So yes, but help me help you.
SPEAKER_02Because yeah, some of the medicines that you're obtaining through these non-conventional routes can still have an impact on the the issue you're coming in to see us for. And so it is important for us to know. And we we don't we don't care in a judgmental sort of way, or we don't care that you're getting it this way. We just need to know what you're on.
SPEAKER_00Yeah, yeah. Yeah. You know, we're really just here to help. So figuring that speed out um is important. And we were talking about how some of the GLP ones are really pre predisposing patients to having pretty profound telling ifluviums. Now, there are ways around this. We don't believe that there's a direct toxic effect of the GLP1 agonist on the hair follicle or anything like that, but we do know that severe caloric restriction can significantly impair hair growth. And we also know that sometimes patients who are on the GLP1 agonists are choosing a more, how to put this, recreational diet than a nutritional one because there is no real appetite so much. The appetite is heavily suppressed. Right. And to a certain extent, that's one of the things that helps us to eat things that are healthy for us, but not necessarily our favorite food. Like it's hard to eat pureed green peas when you don't feel hungry at all. But if you're a little hungry, you're like, I'll try these peas. They're probably nice and warm in the filling, you know. Yeah. So I think that there's a the difference in the foods people are choosing. So if you are using a GLP1 agonist or if you're experimenting with reditrutide, I mean, you do want to make sure that you're watching your macros and getting enough protein and also getting enough nutrition that balances your um vitamin intake. There are special vitamins that are being made to support people who are on GLP1 agonists to fill in the nutritional holes that tend to develop on those medications. And I think that those might be crucial as we partner with our patients who want to continue their peptide journey with proper information and who also would like to retain as much of their hair as possible.
SPEAKER_02You mentioned a new GLP1, and I'm not sure I've heard of it, or maybe I know it by another name. Can you say that one one more time?
SPEAKER_00So I'm gonna make sure I'm pronouncing it correctly, but um, retitrutide is how I pronounce it in my head. Yeah. Um it's in investigations. And you know, it's in investigations by a legitimate pharmaceutical company. Okay. Um right now, outside of the trial, there are other creative ways to obtain it, um, but it's not available for prescription, I don't believe, at this point. Um, so it is different in that it has GLP1 and GIP. Those are different peptides that can modulate appetite along with glucagon, and that can help stimulate the body to burn fat for energy and increase energy expenditure or metabolic rate. So it is going to be interesting to see how this, you know, how the trial study, the trial results come out. GIP is a glucose glucose-dependent insulinotropic polypeptide. And so these are both incretins. So they're hormones that kind of signal that you're full. So between those two hormones that signal that you're full, and then another hormone that increases your metabolism, there's going to be profound, I would think, weight loss for this medicine. It sounds like it could be very, very helpful for patients for whom the traditional GLP1 agonists have not really moved the needle enough in terms of morbid obesity. Wow. Um, I do worry a little bit about very slender people taking it on an already very slender body. Right. And we are, I think, seeing some dysmorphia from Hollywood.
SPEAKER_01Yeah.
SPEAKER_00And I I do worry about that because I lived through the 2000s and I remember what that was like. And yeah, you know, it was not a fun time to be a young woman.
SPEAKER_02So Yeah, me too, me too. In fact, I brought that up. We had an episode on GLP1s with a family medicine doc and the pharmacist that works in their clinic to help with all of these medicines. And and I brought that up. I'm I'm concerned that we're starting to go back to those times. And I too was, you know, kind of a teenager, 20-something, when to be stick thin was was the thing. And that it's that's damaging to a lot of people. And so I am worried with some of the trends, especially out of Hollywood, like you said. It's it seems scary to me. And it to me, it's almost like the medicine in somebody can even induce almost like an an eating disorder. In fact, I think I heard somebody coin the term like GLP Rexia.
SPEAKER_00Yeah, I think I've heard that too.
SPEAKER_02Yeah, yeah. Where you kind of get the you you get thin, but then you like get addicted to being thin, and so you want to be m more thin. And and I I think somebody else might alter their dose of the GLP one just to kind of maintain, but they kind of try to keep going, which can be very very scary to me.
SPEAKER_00Yeah, well, and and you can get it through so many pathways now as well.
SPEAKER_02Yeah.
SPEAKER_00So, you know, a person could conceivably be taking more than one of those drugs at the same time. Yeah. And so, you know, as this is in you know, developing and creating a space for itself in the world of medicine, and I do think there's a lot of potential with this class of drugs, we do need to be aware of the environment it may also be creating and the pressure it may be putting on vulnerable populations because I can't imagine being a teenager and possibly being able to access these medications.
SPEAKER_02I know, I know. Now, if you saw a patient who was on a GLP one, was experiencing um hair loss as a result, but wanted to stay on their GLP one, what would you recommend? Would you adjust the dose or encourage them to speak with their uh medical professional to adjust the dose, or would you add in some low dose oral monoxidyl? What would be your strategies?
SPEAKER_00So, first I would want to make sure that they are nutritionally sound enough to tolerate anything like that that I might add, because you know, we know that there's a little tachycardia, a little bit of extra um metabolic work that happens when we are on um the minoxidil. It's a it's a great treatment for hair loss, but I would actually be very careful about starting it on a person that has potentially an eating disorder. I've had this conversation a couple of times now. The way that I've phrased this is your body's telling us something with this weight loss. It's telling us that it does not have enough nutrients and it is going into crisis mode. Crisis mode is not where your body was designed to stay.
SPEAKER_02Right.
SPEAKER_00So we have to find a way to get you out of the crisis mode. We need to meet you, have you meet with a nutritionist so that you can go over if you're getting enough protein in your diet, if you are balancing your nutrition well enough, and if you're taking care of your body's maintenance needs, because what happens when you don't do maintenance is that things break down. Yeah. And so if your calorie budget doesn't have enough in it to cover your maintenance costs, you're eventually going to pay a price for this weight loss, and we have to work together. Your hair is functioning as a canary in the mine to let us know that something is off enough that it's compromising potentially important internal organs and structures, and you need to readdress how you're taking care of your body. Yeah. And it's not always an easy conversation for exactly the reasons you pointed out, because you know, for so many people, they're almost euphoric over their weight loss. And for many people, these medications have allowed weight loss for people who've never been able to lose weight. So I don't want to take away from the successfulness and the utility of the drug. Right. But we just have to be balanced as we approach this very powerful tool.
SPEAKER_02Yeah. Well, and let's say, kind of segueing a little bit away from the GLP ones, although it might, we might circle back to that. But for patients who are dealing with hair loss, are there any over-the-counter recommendations that you make to them? You know, you see the commercials for Neutrophil, Viviscal, um, you see all of this stuff. What's your do you recommend those to patients? What is the hype true?
SPEAKER_00So um, we actually got to review an article about uh hair loss supplements that are mostly in the world of complementary alternative nutritional medicine.
SPEAKER_01Yeah.
SPEAKER_00On the Dermiser podcast a while back. And one of the ones that we reviewed actually kind of pardon my pun here, was a bit of a head-to-head for different oral supplements for hair loss. Yeah. And I am not in any agreements with any over-the-counter hair loss supplement companies. So these are just the recommendations I'm bringing from the literature and the medicines I take myself. The one that has the best data behind it and also has a very good price point and is very reliable to break a telegent afluvium, in my opinion, is Viviscal. Okay. So Viviscal is a marine mineral supplement. It has some vitamins in there as well as apple enzymes, and it's in these little tablets that are sort of the shape of a sweet tart and they sort of taste like fish. So they're kind of like a fish-flavored sweet tart. It's not terrible. Swallow them on an empty stomach. They don't tend to make me nauseated, but I always tell patients to take vitamins with food because they tend to absorb better. Totally. But the um, you know, viviscal is a very good, very achievable supplement for most people. Yeah, some people really like the neutral, and there are circumstances where I think it's a good choice. I like their postpartum formula for breastfeeding moms.
SPEAKER_01Oh, I think.
SPEAKER_00And that works very nicely for the postpartum hair loss that tends to occur in that patient population. Yeah. And if you have a male patient that either you or the patient is uncomfortable putting on a pharmaceutical five alpha reductase inhibitor, then putting them on the men's formula of the neutrophil, which has some natural five alpha reductase inhibitors in it, is a is a good strategy. So I think that those are both good to use.
SPEAKER_02Is that like the natural five alpha reductase? Is that like the sawweed palmetto? Saw palmetto, yeah. And um, and there's like another one in that pumpkin particular. Yep, pumpkin. Yep, exactly.
SPEAKER_00Pumpkin seed oil has a five alpha reductase inhibitor in it, and then stinging nettle also can inhibit those conversions. And so those medications can be beneficial. Azaleic acid even has some inhibition of androgens as well. Um, so all of those can be helpful in vitamin supplement format. I also do believe in the efficacy of photobiomodulation, which are the red light devices. If patients are on a budget, then I I encourage them to look up the Hair Max laser comb on eBay because if they have the time to use it, they can make hay out of somebody else's mispurchase. Because many people buy them and then they never use them because you have to hold it and then move it through your scalp and hold it and move it through your scalp. Arguably, for people with longer hair, it may be more efficacious to do it that way because it's parting the hair and getting the light down to the scalp. But you can usually find those resold on eBay for around $50 to $75. And I tell the patients this is a plastic comb. You can clean this. Yeah. So there's no reason why it would be on. safe to use. I mean certainly look for look at it. And if there's something yucky on there, I would send it back or, you know, clean it aggressively. But these are all good options for patients.
SPEAKER_02It also sounds like an arm workout. Yeah, exactly.
SPEAKER_00You know, you're getting a little buy, a little try, maybe a little trap action on the side. So the um the red light co caps are also helpful for a lot of patients. I have many of them. I've got one sitting over here by my desk. So this is one of them. I actually have two that I predominantly use. That one's an iRestore. The other one is a Revion. Okay. Red. Those are really easy to use. The iRestore is nice because the battery is in the cap. It looks like a little writing cap. Very um equestrian looking. And it's very light. It it has an app that turns it on. The only downside of that one is you can only use it once per day because it actually tracks your usage because the company provides a money back guarantee if you have like an 85% usage rate and you're not seeing hair growth. So they actually have a pretty legitimate like stand behind their product. So the the first one that I was talking about is called the Revion red, the one that's like a little riding cap. Okay. And then the iRestore I like it does have to be physically attached to a battery pack or to the plug in the wall. And it looks like a Tron helmet, but it's very sturdy and I'm hard on technology. So this one also would be a good choice if you're using it for more than one person because you can turn that on as many times as you want to in a day it doesn't lock out like the Revian does.
SPEAKER_02So the iRestore is something that say you had two members in the household that wanted to utilize it. The iRestore could be shared but the Revion not so much.
SPEAKER_00Yeah the Revion's programmed for just one user because they have that really robust money back guarantee. So I like both of those products. I've had two Therodomes that both died and I had terrible customer service both times. So I don't recommend that one for several reasons. It's also very heavy so that one doesn't have to be plugged in the battery's in the Tron like helmet but it's a very heavy device. And then Capitalist has a good one. It looks like a baseball cap. It also needs a power supply so the only one that has a light battery that I've found is the Revion red. They're all good devices they have the essential wavelengths of light. So there's somewhere under somewhere between like 630 to 660 nanometers and then sometimes in the 800 range as well for the red lights to be therapeutic. And it's really kind of cool how red light works on the scalp. Can I geek out with you for a minute? Yes yes please do like super fun. So part of the problem that we run into when our hair loss starts is senescence of the cells that grow our hair shafts. And the senescence can happen over time for multiple different reasons stress, age hormonal changes all kinds of things can affect it. What's very interesting about what occurs there is you get a little nitric oxide muscle molecule that's stuck on the terminal enzyme of the respiratory chain of the mitochondria. So it's called cytochrome C oxidase. An important way to think about this is it's like a part of an engine that's stalled. And so you can't get the engine to turn on. Because if you remember mitochondria are the powerhouse of the cell.
SPEAKER_02Yes I do remember that it was very deep but I do remember it.
SPEAKER_00So what's kind of really cool is the red light is attracted to that copper ion. And so the red light hits the copper in that enzyme and it knocks that nitrous oxide molecule off the end of that last enzyme in the respiratory chain the cytochrome C oxidase and then it refuels with the new oxygen molecule and starts to respirate again. So it really like kickstart cells that have become senescent. It also decreases DHT formation in the scalp and of course it improves blood flow. So red light has a lot of effectiveness at the level of the scalp and can be beneficial. Another thing we do is scalp massage which there's a really cool article we reviewed on dermosphere where the dermal stretching forces appear to activate the fibroblast in the dermal papilla which is this little clutch of blood vessels and nerves and connective tissue and it's where the hormonal sensitivity to hair loss resides in the scalp. That little wad of tissue actually has these little cells in it called fibroblasts and when they're stimulated they put genes out that actually tell the hair shaft to grow more and it decreases the gene expression that was telling the hair shaft to thin or fall out. So we think it's because of the way the scalp is programmed to behave in development. So you take care of a lot of kids.
SPEAKER_02Yes.
SPEAKER_00And so you've probably had the experience of having a toddler come in that had like no hair at all and then you see them back on their five and their curls and ringlets everywhere. Yes. Yes. So we think one of the reasons that happens is that the stretching forces on the fibroblasts in the scalp as the child's scalp grows helps to reinforce that it needs to grow more hair. And so you're kind of stimulating that reflex when you massage the scalp. And so there's many devices that can do that for the patient or they can use their own fingertips. About five minutes a day really does make a difference and literally changes gene expression.
SPEAKER_02Huh and do you think there's an add to like if you just wanted to do scalp massage with your fingers versus like buying something to do it. Do you think there's a reason to spend the money on a device to help you or do you think the your finger massage works great?
SPEAKER_00So if the patient doesn't have fingertip arthritis and they have the patience to do the massage which I actually show all of my patients how to do this. So I'm going to try to do it on the part of my head that's not covered by my headband. Right. But you can see how I'm like wiggling the scalp. Yeah. So you actually have to feel that zigzag force. So if I was going to do pretend my forehead is my scalp. So like it's really moving the skin.
SPEAKER_01Yeah.
SPEAKER_00So if they have the fingertip strength and lack of fingertip arthritis to do that. Then like you can use your own hands if you want to but if you want to here's the little device. There's a device I have no relationship to at all. It's on Amazon. It's called the this is such a stupid name. I have nothing to do with this device. But it's called Comfier scalp massager.
SPEAKER_02That makes me feel cozy.
SPEAKER_00I think I like it's a very cute name and it's a it's a cute little device. It has four little paws I kind of call them paws and they have little rubber uh connection points that go onto the scalp and then they like work about a footprint like this. And then the important thing with that is you use it for a minute in each spot is what I tell my patients to do. So and then you when you're moving it you don't drag this thing through your hair. You lift it right and then you place it back down. That is especially yeah if you have curly hair like me which is like little tiny grappling hooks all over the place. Yeah and you try to use that your hair will get stuck in it. So you have to lift it to move it. You don't drag it. But that does the great job of doing those kind of shifting forces and moving the skin back and forth on itself and really stretching those fibroblasts to help it reinforce growth.
SPEAKER_02I love that I love all of those tips. I think once upon a time I bought one of the one of the red light head things. It's the one you said you had two that that failed and had horrible customer service.
SPEAKER_01Yeah.
SPEAKER_02But I and I was worried that it would light on fire on my head I understand. Have there been any reports of you know you hear about these batteries and things like no absolutely I I just started to worry that there would be a fire on my head.
SPEAKER_00Well that would be a horrifying experience. So I understand why you wouldn't want that to happen. I have not heard of any reports of that happening but I would probably use caution in maybe purchasing like a TMU version of one of these things. Yeah. Because you know if it costs probably less than you know if it's not the comb the comb you can get very reasonably priced. But if it's like a whole cap and it costs less than about $100 you might be very cautious about that because perhaps inferior technology may have been used to create it especially if it's something you plug into the wall.
SPEAKER_02Yes. Right? Yes. Okay. Okay. All good tips. Kind of transitioning to alopecia areiata, you know, we've had a lot of developments in alopecia areiata. How have the Jack inhibitors changed your practice when it comes to treating these patients?
SPEAKER_00You know the Janus cannase inhibitors were like magic for allopice areiata. Like you know you've got these patients that have larger patches of alopecia areiata. You know that realistically injecting all of those at least every month is not only going to be uncomfortable for the patient, but it's going to require consistency over time and quite a lot of discomfort.
SPEAKER_02Yeah.
SPEAKER_00And you still might not fully regrow some of those areas. You know you may end up with some skin thinning um you may end up with some divots in the scalp. Certainly a viable option for smaller patches.
SPEAKER_02Yeah.
SPEAKER_00But to look at a patient and know that you can give them a medication they can take comfortably that has a pretty darn good safety profile. I know there are some side effects we have to counsel about when we use these medications. And certainly you want to use your brain and select patients carefully for any medication you prescribe. Because every medication has side effects. Right. But it has been really transformative because it can be so consistently beneficial for patients.
SPEAKER_01Yeah.
SPEAKER_00Yeah and it's kind of magnificent to see um you know especially somebody's really bothered by their alope shariata which is very normal. Yeah. You know it's it's also something that we have to be guarded about how it gets presented in the media. So you know if you show a character on a movie that has large patches of visible hair loss that person is either very sick or crazy.
SPEAKER_02Yep.
SPEAKER_00Or possibly both of those things. Right. Or somehow becoming an evil villain. Like there's you know there's a very narrow trajectory in most modern media for people who are losing patches of hair.
SPEAKER_02Yeah.
SPEAKER_00And you know the patients already feel because of that conditioning like there's something very very wrong with them like they're, you know, maybe sick in a way they don't know that they're sick yet.
SPEAKER_01Yeah.
SPEAKER_00And then you add on top of that people's curiosity slash reactivity to the presentation. And that's a lot for people to carry. So you know it definitely makes sense that it would be a distressing experience for people to have. But when you have a patient that's got that presentation that has that anxiety or or discomfort over the way they present to the world and you're able to give them something that helps improve that and see them get their confidence back. I mean that's like it's the best. It is it's the most reinforcing thing probably you might get to do as a dermatologist. It's it's a very special thing.
SPEAKER_02I agree wholeheartedly like treating my alope chariata patients with the jack inhibitors it makes it makes my life better. Like I they're my favorite visits. It's so wonderful to see them kind of you see like the spark come back in their eyes. And you see them kind of become them again. It's really it's really wonderful. It makes me it's one of the things that makes me happiest at work.
SPEAKER_00You know I I take care of a kid that developed really bad allopiciata during COVID.
SPEAKER_02Yeah.
SPEAKER_00And we treated her and she eventually responded beautifully and she has this gorgeous thick head of like straw sort of nice sandy blonde hair now. It's beautiful gives me so much joy to see her. But her parents still talk about the lost years where she just wasn't herself you know for about two years when she had really bad alopecia areata she kind of pulled back from many of the things that used to be enjoyable for her like participating in sports because it was hard for her to wear her wig if she was doing those things. Stuff that used to make her light up like a Christmas tree she just rejected during that period of time where she had really severe alopecia areyata because she didn't feel comfortable in her own skin.
SPEAKER_02Wow. The lost years I got I got goosebumps when you said that that really and I think there are so many patients out there and families out there that can really identify with that. How do you handle it if you're trying to get a jack inhibitor for a patient with alopecia areata and the insurance denies it saying that it's cosmetic.
SPEAKER_00Does it make your head explode like it makes my head explode it makes me so furious because you know I I have this is going to sound so horrible. No. I wonder if I should share this but I'm going to anyway. Definitely I have this horrible fantasy that I have in my mind where the insurance people I know they're just doing their job but sometimes it really feels awful. Or the people who make them do these things.
SPEAKER_02Yes.
SPEAKER_00Are when they're going when they pass away going to go to a very special level of Hades in which they will suffer from a horrible malady for which there is a cure just out of reach. And they will just suffer like that.
SPEAKER_02Well and and you know I have a similar thought we you know the the companies that enforce these policies and say these things, part of me part of me and again, you know, this isn't great to say but part of me hopes that somebody in their family somebody close to them or themselves develops periodic. And and that they can see the burden that it really is. And so yeah I I push back against that. Fortunately the companies that make the jack inhibitors currently approved for for LPRiata, they do have policies in place that allow patients to receive these medicines even if insurance denies for cosmetic reasons. So that is that is a very fortunate thing. But yeah it just really grinds my gears when insurance companies say that it drives me crazy. What do you wish people knew about hair loss? If if you could have like a public service announcement for people, you know what would you what would you say?
SPEAKER_00The first thing would probably be the ads that you see on the internet are not real. Yeah. Because people are seeing these ads where they're saying in just six weeks and they have five centimeters of growth. Right. And you're like that is physiologically impossible. Like there's not a way I can get you get any human there. I don't care how much monoxidal I gave them. Right. There was this crazy movie that came out like a very long time ago where this kid has what I think they were representing actually alopecia to tell us they never called it that in the movie but he lost all of his hair. Yeah. And he makes this magic potion um that has like peanut butter in it.
SPEAKER_02Oh I'm in I do like peanut butter. Yeah.
SPEAKER_00And um the solution he makes is too thin so he adds more peanut butter because he doesn't know how else to make it like stick on his scalp. Yeah. And because he adds so much peanut butter to this magic potion, it makes his hair grow like crazy. Okay, I I Googled it because this was driving me crazy. So it's called the peanut butter solution. So I did remember this correctly. So he supposedly he's frightened so badly he loses all his hair which there are many people who think that that losing your hair going white overnight is um actually alopecia areata totalis like happened very suddenly after a severe stress. Yeah. But anyway so he uses too much peanut butter and his hair grows insanely fast. And then for whatever reason he has this crazy art teacher that starts cutting his hair and making it into magical paintbrushes that paint everything like perfectly if you just like dip them in water or something like that. Oh my God. It's the weirdest movie. It's so I wish we had something that worked that well to grow hair that fast. Right. But unfortunately hair grows at the speed hair grows at you know so these ads that show this rapid hair growth in like six weeks because they threw some B vitamins together in a capsule right they give people such a false sense of hope because they're like well if a vitamin that I don't even need to see a doctor for can grow my hair like that long in six weeks imagine how much more growth I could get if I had a prescription.
SPEAKER_02Yeah if it if it seems too good to be true it probably is. You know? Yes. Yeah yeah yeah and and you know patients can spend a lot of money on those products that they see. I've heard of a lot of people buying stuff off social media too these days that you know it's just it's it's a waste of their time and money and energy and it gets their hopes up only to be dashed later. And and so I think it is good for patients to come in and at least get an evaluation know what kind of hair loss you're dealing with. Cause there are several as we've covered today there are lots of different types of hair loss they they present differently and they have different kinds of natural course outcomes and they have different therapies. And so go to see you know your local dermatologist so that they can appropriately diagnose you and then get you on a treatment plan. And that treatment plan might consist of some over-the-counter products which you have so nicely gone over. That was really really good. I didn't know about a lot of those and so there might be some over the counter approaches but at least get the right diagnosis. And also I would say come in earlier rather than later because it's a lot easier for us to preserve and maintain hair and and prevent hair loss especially with things like androgenetic alopecia than it is to regrow.
SPEAKER_00Yeah. It usually takes a lot of very directed effort and procedural intervention to significantly regrow hair.
SPEAKER_01Yes.
SPEAKER_00There are some very big procedures we do sometimes to help with hair growth. I've learned how to do for example the drug tattooing which you know you have to be really committed to do if you have a tattoo about having that on your scalp that is something that some of our patients do go through because they really are motivated and they're very brave and strong people and I'm very proud of them every time they get a session done. And it's I haven't seen anything improve hair growth the way that that works. I think it's a combination of the physical stimulation and the medication going right into the dermis. But you know procedural work can sometimes get us to significant recovery but you're absolutely right our best opportunity is to maintain as much healthy hair as we can.
SPEAKER_02And I don't do the the tattooing what drug is administered with that?
SPEAKER_00So you can do minoxidil and either phenasteride or doasteride. And I usually put them actually together with some lidocaine with epinephrine. The reason for the lidocaine with epinephrine is to do a little vasoconstriction to help with drug diffusion. So we actually keep the medicine in the scalp longer. The basis for that rationale was an article that was published about using intralesional triamcinolone, so injected steroids for allopita being blended with lidocaine with epinephrine to see just if they could improve the pain of the injections and as a side effect figuring out that it was actually more effective that way, hypothesizing that it was because of two things the epinephrine's basoconstrictive properties keeping the blood vessels from being dilated enough to take the drug away from the scalp where they were placed. But secondly epinephrine has a direct effect on the hair bulb itself and can help stimulate hair growth. There was a crazy experiment where they took a bunch of rats and they this is mean they took all of their hair off of their back and then they were sympathectomized mice rats. So they had had their sympathetic nervous system disabled.
SPEAKER_01Yeah.
SPEAKER_00And so those those rats were able to regrow hair when they were given an agonist of like the epinephrine system. And the rats that were not supplemented could not regrow their hair. So there is a stimulatory effect by the epinephrine on the scalp hair follicles by itself. And so I do blend things together when I'm doing anything for hair growth on the scalp except PRP we don't tend to numb together with the um PRP injections. We don't put them in the same container.
SPEAKER_02Right. And so when you're doing the tattooing you mix up this formulation that contains these different components and then is there a special device that you use is a tab I don't even know tattooing device?
SPEAKER_00It's a it's a it's a tattoo gun. So I have a Cheyenne I think it's called a Scorpion tattoo gun and I use a 15 pin soft edge shading tip. And it's a really cool line that they make because they make these safety cartridges that have an impermeable membrane in the middle so that there's no way that the tattoo gun could become contaminated with any kind of blood or fluids. So it's increased safety for the patients and it's a very quick motor which makes a difference. It's very calibratable and you can also calibrate the depth that you use for the needles so that you can make sure it's the right depth because as with many things more is not always better. Right. So your kind of sweet spot on the scalp is like 0.25 to 0.5 millimeters or so. Now when you have somebody who has a lot of hair that you're tattooing around you may have to have a slightly like longer what we call throw on the tattoo needles but it's a very um individualized experience for each patient. And it is you know it's it's real it's very metal. Like the patients that go through it they get great results but they are very very committed. And I'm super impressed with um how significant that is in their lives that they can get some recovery of their hair loss. It is not a procedure for everyone. Right. Yeah. But for those patients that go through it it's yeah. How long does it take? So it depends on how comfortable we can make the patient. If we're able to get them we do tumid um anesthesia so it helps tumescent anesthesia um uses a lot less of the lidocaine with epinephrine um so you can use more of it.
SPEAKER_01Yeah.
SPEAKER_00And so we mix up our tumescent solution from our pharmacy and then we go ahead and we inject that into the scalp in a sort of tiara block and then you do sort of like carpet bombing for the the top part of the scalp where the especially near the vertex where it tends to retain sensitivity. Because our nerves come up to the top of our scalps from the sides. Gotcha. So we have to kind of go around but then sometimes there's a place in the middle that's a bit of a watershed. Wow. So that it has leftover sensation. And then you kind of tattoo the scalp if you get them numbed well on the first kind of go it takes about five minutes or so to numb the patient because it's it's a lot of shots. You have to let people know it's a lot of shots. Yeah. And then to do the whole scalp it's usually about 30 minutes if you're very very thorough.
SPEAKER_01Wow.
SPEAKER_00And so you know a good in out of the door would be about 45 minutes. We also do topical numbing for many patients before we do the injected anesthetic to decrease some of the discomfort associated with the procedure.
SPEAKER_02Wow that's interesting and I assume insurance doesn't cover this it's probably a c considered cosmetic yeah.
SPEAKER_00It is it's out of pocket and the medications are not cheap because they have to be compounded sterily.
SPEAKER_02Gotcha.
SPEAKER_00So it's a if you do the paired treatment where it's monoxidyl plus finasteride or doutasteride, then you will have about $150 in the vials themselves. Yeah. The the tip for the tattoo gun is not expensive, which is interesting. It's not a the consumable piece is not quite so expensive, but the time has to be taken into account as well. Okay. It is something that people invest in.
SPEAKER_02Yeah. And do they have like multiple treatments?
SPEAKER_00Yes. Usually you'll do three treatments back to back months. Yeah. And then once you start to really see the hair regrowth to kind of take hold, then you usually are going to be supporting them either topically or orally with monoxidil, potentially also an anti-androgen and/or light devices, many of those different add-on things. You always need multiple modalities to treat hair loss because hair loss is always caused by multiple system failures, basically. You know, if you look at most mammals, they usually have hair. Yeah. So when we're experiencing hair loss, there's multiple system failures where we've got genes activating hormones, we maybe have nutritional holes, we maybe are overstressed. The combination of things predisposes us to that more significant hair loss.
SPEAKER_02And what is your favorite anti-androgen? You mentioned adding something like that in. What do you tend to go to? Do you do sporonalactone? Do you do phenasteride? Do you do doasteride?
SPEAKER_00It's a great question, and it really depends on the patient. Yeah. So in younger women, spironolactone is a great choice. You just have to make certain that they're not actively trying to get pregnant. Spronalactone is also a great choice for women in their later years, so long as their cardiologist is comfortable with that, if they have a cardiologist, and you have to follow labs after 45 because we may have some problems with potassium accumulation in that setting. Spronalactone also has a very nice safety record when it comes to breast cancer. So it's been looked at very, very carefully, especially because there was a very badly done rat study where they kind of fed rats huge quantities of sponalctone and it caused what we know it causes, because we use this drug for transitioning patients male to female, caused breast hyperplasia. So for if we have a patient that's born male transitioning to female, one of the drugs that's used is high-dose speronolactone because it causes mammary hyperplasia. In this study, that rat mammary gland hyperplasia was overread as cancer. And so an artifactual connection between speronolactone and cancer exists in the literature, but that has been overturned so thoroughly that it's now the recommended agent to treat especially hormonal related and side effects to medications like raloxifen and tamoxifen-related hair loss in cancer survivors, in breast cancer survivors. So I'm very comfortable using that drug when patients have more of a worrisome family history for anything like breast cancer. The question about detasteride, finasteride, I think in a person with a normal breast cancer risk is a reasonable thing to sit down, have a risk-benefit analysis and talk about. You do have to be thoughtful again about pregnancy with those drugs. So you have to really be sure everybody's on the same page about not getting pregnant at this time. And then in men, I actually go ahead.
SPEAKER_02Isn't it true that you can't even touch the phenasteride or do you think that's they don't want women to handle the pills, especially if they're broken?
SPEAKER_00Yeah. Yeah. And that was, you know, part of their package insert actually for finasteride. And they had they'd have to read it on air for the ads also.
SPEAKER_01Yeah.
SPEAKER_00For young men, the um androgen blocker question, it's always okay. So you've heard that there's there's some side effects about that. I kind of get a temperature gauge for the patient about how worried they are about that. We do have a different generation of young men that we're treating now because many of them have been brought up in the age of the internet and have been exposed to a certain kind of content that may impact their wellness in the sexual arena. Yeah. Yeah. And so having a conversation with them about at baseline, do you find that you have trouble with sexual function? You know? Sure. Sure. So just to kind of get a bellwether for, you know, if that's something that's really pressing on their minds and if they are hesitant about that or concerned, then we can use the natural products and also the light modulate photobiomodulation to kind of attenuate the male hormonal axis. Whereas, like if it's a person that's like, no, I'm not, you know, super worried about that, I'm healthy, everything works fine, I'm really worried about my hair loss. Then you might consider one of the pharmaceutical ones. There's so much noise around phenasteride, yeah. And it inhibits just one isoform of the fibalpha reductase to use to do tasteride is sometimes a little bit less complicated. It's not on label, right, because it's not labeled as a men's hair loss drug. Yeah. But it actually inhibits both types of the fibalpha reductase, so maybe more efficacious.
SPEAKER_02Right. That's what I had heard as well. Well, oh my gosh, Michelle, I I thought I knew a fair amount about alopecia, but you have taught me so much today. And I wanted to, in our closing moments, do some rapid fire speed round questions.
SPEAKER_00I love this.
SPEAKER_02I know. Just to kind of get you, get to know you better, the audience gets to know you better. Okay, number one, if you weren't a dermatologist, what would you do?
SPEAKER_00I would be a musical theater actress. Uh because I love doing that. It's one of the things I do for fun. I've gotten to play Val McKelly. I've gotten to be in Young Frankenstein, Elizabeth Benning. I've gotten to be Dotsie Mei in the best little whorehouse in Texas because I could not be a whore in that. I see way too many people in this in this town as patients. You know, there's been so many. Oh, we got to be Morticia in the Adams family. I would, I would do that. I would be a musical theater actress. I would starve to death, but I would enjoy myself.
SPEAKER_02Yeah. Oh my gosh. You would be so great at it too, Michelle. Oh my gosh, that would be great. Maybe in your retirement from dermatology, maybe I'll go on paper calendar or a calendar on your phone?
SPEAKER_00Paper calendar. Like I can't, I can't do it. I have like a little date book bullet journal thing. I have to have it on paper. It's not real unless it's on paper.
SPEAKER_02I know. I am I am the same way. I'm the same way. Favorite reality TV show.
SPEAKER_00Ooh. That's a tough one.
SPEAKER_02Mm-hmm. If you could if you were gonna binge something tonight, it was the new season of whatever your favorite is. Okay, because I like the tea when the tea is hot.
SPEAKER_00I like um couples therapy. Oh yes. Yeah.
SPEAKER_02I heard about this. I haven't watched this. It's on like Showtime or something. I don't know.
SPEAKER_00I I watch it through one of my internet subscription things. I think it's through Hulu or Netflix or something. I don't remember which platform, but it's just kind of, you know, we like to eavesdrop as humans. It's a normal thing. These people have been paid in signed consent forms, so I feel comfortable doing this. Yeah. But it's just, you know, it's spicy tea. It's fun. It's nice nonsense background noise to have on when you're doing something like boring, like holding laundry or something like that. Or you can listen to Dermosphere and learn something that would also be good.
SPEAKER_02Yeah, also true. Also true. Um, if you won the lottery, what would be your first purchase?
SPEAKER_00Ooh, wow. That's a good question, too. Um, I would probably like just finish paying off our house so I didn't have to worry about that anymore.
SPEAKER_02Yep, yeah, so that's done.
SPEAKER_00And then, you know, most likely the the next like big thing would be a nice trip somewhere because travel is one of my favorite things to do. Yes. You know, I'm so lucky that my sister is so successful in her opera career that I get to travel to go see her perform sometimes. She's performed in Monaco, she's performed in Paris, she's performed in Japan. Like I'm just super proud of her.
SPEAKER_02So glamorous.
unknownI know.
SPEAKER_02Um, ideal dinner time, 5 p.m. or 8 p.m.
SPEAKER_00Ooh, that's a good question, too. See, I don't think I could do it at five, but by eight, I might be like hungry. So can I can I cheat and go halfway between say seven?
SPEAKER_02Sure. I'll let you. I'll let you. I guess I'm like an early dinner, like I love an early dinner. Like I love an early dinner. That's my favorite. Last rapid fire question, and perhaps most important. You work at Texas Tech, which is where Patrick Mahomes went to college.
SPEAKER_00Yes, it is.
SPEAKER_02So, where and when are Taylor and Travis getting married? Oh my goodness.
SPEAKER_00Well, I've got to call up my good friend. Yes, yes. So I I I full disclosure, I have no idea when the big wedding is gonna happen, but I will tell you, Pat is a great person. So, like when I was an assistant dean for our medical school, he was in college here, and he was gonna be the guest of honor for High Point Village's fundraiser, which is the special athletes village that we have here. Yeah, and it's where they train and they learn their new sports and all sorts of things, and it's a very supportive environment. So we were raising money for them, and I went the day ahead to make sure everything was ready and I was, you know, checking off things with my little clipboard. Yeah. And the ladies who ran everything at High Point Village said, Come here, Michelle, we need to tell you something. Like, you need to know that Pat has been here every single day this week. He's been doing drills with the special athletes, he's been talking about motivation and teamwork, and he's given so much time he publicized none of it. The cameras weren't there, he was just doing the right thing. And when he won this first Super Bowl, he sent a game ball back to um High Point Village. And he actually also puts like several kids all the way through college every year. And he doesn't make a fuss about it, he doesn't publicize it. He just does good work because he can. And it's I I've been very happy to see him succeed because you know, when people that are good people are successful, they change the world. And you know, I'm just really, really proud of him. And I, of course, have deep ties with the Texas Tech thing. Everybody in Lubbock loves the Chiefs, also. Lubbock's actually, I think, the second largest consumer of Chiefs merchandise, secondary in Kansas City.
SPEAKER_02I bet it is. Well, it's it's so good to know that he's truly one of the good ones. That is good. That's great. Yeah, he's a good guy. Well, Michelle, thank you so much for doing this. I know this took up a lot of your time. I think the audience will love this episode and get a lot from it. I think you're a good person being successful and doing a lot of good as well. And so thank you so much for joining us today.
SPEAKER_00Thank you so much for having me on. I really enjoyed it.
SPEAKER_02Thank you, Skin Credible Audience. Please keep listening, keep subscribing, keep liking, tell your friends, tell your family, tell everybody about the podcast so that everybody can know more about their skin. Thanks so much, everybody. Bye bye.