Male Hair Loss

WebMD Live Events Transcript

Guys, are you wondering where your hair went? More importantly, are you wondering what you can do about it? Hair restoration expert Craig L. Ziering, DO, answered questions about male hair loss on July 6, 2005.  

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

MODERATOR:
Welcome to WebMD Live, Dr. Ziering. Thank you for joining us today. What are the primary causes for hair loss in men?

ZIERING:
The primary cause of hair loss is genetics. That's inherited or androgenic hair loss and makes up the majority. There are some medical reasons as well, and that can be related to thyroid conditions, anemia or skin disorders such as Lupus. Another common cause is alopecia areata, which is like an autoimmune condition -- the body recognizes its own hair as foreign and causes the hair to fall out.

By far the greatest reason is the genetic cause and it's inherited from either the mother or fathers' side, and that's where the DHT that comes from testosterone attacks the hair follicles, which results in miniaturization of hair follicles and hair loss. It's important to understand that this hair loss is progressive. So if you have it, it's best to treat it earlier than later.

MEMBER QUESTION:
If a man takes testosterone, will that speed up the hair loss?

ZIERING:
Hair loss is not so much a factor of the amount of testosterone but the fact that testosterone is present and gets converted to DHT -- that's the bad actor.

If you take certain steroids, such as in body building, you can increase the rate of loss or potentiate or initiate an inherited form of hair loss that is waiting to take place -- you can advance it or initiate it.

MODERATOR:
Once the process of hair loss starts, can it be stopped?

ZIERING:
Hair loss itself, by nature, is progressive, which means it continues. To stop it we can use medications. There are two FDA-approved medications for men. Rogaine, or minoxidil, which is a topical product, liquid, which is applied directly to the scalp twice a day, and Propecia or finasteride, which is an oral pill taken once a day.

These medications work alone or even better, in conjunction to stop the progressive nature of hair loss and in many patients, are able to reverse some of the miniaturization of the hair follicles. However, only hair transplantation is the permanent solution to hair loss.

"Some confusion comes from the fact there are hair "thickeners" which add moisture to the hair shaft and seal in moisture and therefore create the appearance of thicker, fuller hair, which is beneficial but does not grow new hair."

MEMBER QUESTION:
Do topical sprays which purport to bring blood to the surface of the scalp work to regrow hair?

ZIERING:
Many over-the-counter preparations claim to restore hair or regrow hair. However only the two that we mentioned have been approved by the FDA and have been studied in double blind clinical trials with proven benefits.

Some products contain the topical preparation minoxidil in them; if they do --as an ingredient -- they will get the benefit of that ingredient as if it was used alone.

MEMBER QUESTION:
What about shampoo treatments?

ZIERING:
Shampoos are important for general hair care in that they remove dirt and oils from the hair which cause the hair to be flat and lay in clumps. Therefore shampoos can restore moisture to the hair shafts and give it a healthier and shinier experience, but will not grow new hair.

MEMBER QUESTION:
Are certain shampoos better to use when your hair is thinning?

ZIERING:
People have different types of hair, oily versus dry, and should match their shampoo with the production of their oil. Some shampoos that are mild are good to use so there's no damage to the hair shaft. However none of them can grow back hair. So in general it's a personal preference.

Some confusion comes from the fact there are hair "thickeners" which add moisture to the hair shaft and seal in moisture and therefore create the appearance of thicker, fuller hair, which is beneficial but does not grow new hair.

Hair cuts and styles such as cutting your hair shorter will also give your hair the appearance of fuller, thicker hair.

MEMBER QUESTION:
I'd like the doctor's opinion of Nizoral.

ZIERING:
Nizoral is a medicated shampoo used to treat "dandruff" and also has been shown to have some antiandrogen properties, so it may be beneficial in preventing additional hair loss. It is often recommended in conjunction with the other two FDA-approved medications.

MEMBER QUESTION:
Are there any vitamins/mineral/supplements that can help?

ZIERING:
The best thing to do is eat a healthy, well-balanced diet. And unless you're deficient because of a medical condition you don't need to take vitamins or supplements. However the B supplement vitamin helps with skin, hair and nails, so if you're going to take one, that's the one to take -- the B vitamin complex.

MEMBER QUESTION:
I will be going through chemo and may lose hair. Will it come back when I'm done with treatment?

ZIERING:
Chemotherapy can cause hair to fall out, but it's generally temporary and most hair will grow back, although it may be thinner or curlier at first.

Good luck with your treatment. There are plenty of experts that can deal with your hair loss afterwards, if it does not grow back as expected.

"We are capable of doing three thousand or more follicular unit grafts at one time, moving over 7,500 hairs at a time, and most patients require only one or two surgeries to get the look they want to achieve."

MODERATOR:
If medical, noninvasive treatments aren't satisfactory, what options does a man have?

ZIERING:
The first is to do absolutely nothing and let the progressive nature of hair loss continue and accept the hair loss. The only permanent solution to restore your hair is to have a microscopic follicular hair transplant. A third option is to use a hair system or toupee. But today's hair transplants are virtually undetectable and look extremely natural and allow the patient to have complete freedom with regard to activities.

MODERATOR:
What is involved in a hair transplant?

ZIERING:
We take the hair from the back and sides of the head, which are not programmed genetically to be lost, and therefore are not sensitive to the DHT. We remove a strip of tissue with the hair follicles and divide them up under the microscope into one, two, and three haired follicular unit grafts, which are then artistically transplanted to the front and top of the head into the thinning or bald spots. The incisions are made with very fine small instruments at the appropriate angle, direction, and orientation to recreate a natural look. So basically hair transplant surgeons like myself are in the moving business.

MODERATOR:
How long does this take? Does it require procedures?

ZIERING:
We are capable of doing three thousand or more follicular unit grafts at one time, moving over 7,500 hairs at a time, and most patients require only one or two surgeries to get the look they want to achieve.

MEMBER QUESTION:
My husband has lost all of the hair from the top of his head. He just has some on the sides and back. Is it too late for him to get a hair transplant? It is a really large bald area.

ZIERING:
No, it is probably not too late for him to get a transplant. You can look at our web site to see patients who have perhaps similar amounts of loss. You can also seek out a hair-loss expert in your area and have a personal consultation so that he can be evaluated by a trained professional and have a treatment plan recommended and designed just for him.

MODERATOR:
What is recovery like? How long does it take? What kind of restrictions are there while recovering?

ZIERING:
The procedure is done in the office while the patient is watching movies and TV. They have local anesthetic like they would get in the dentist's office and a medication to relax them. They go home that day at the end of the procedure.

The time is dependent upon the number of grafts received, and they often can go back to work the next day or within a few days and can return to full activities, including sports, after about 10 days.

The grafting procedure is so refined today that if you have a little bit of hair in the area we're transplanting into it often can be covered and hidden from others that very day. If you're bald on top, the healing will take place in most instances within a week.

MODERATOR:
How natural does it look?

ZIERING:
It looks extremely natural. Most of my work goes unnoticed. The days of the plug, doll hair and corn rows are gone. Today's transplants are extremely natural.

MEMBER QUESTION:
Will it last?

ZIERING:
These transplants are permanent because the hairs that are moved do not have the genetic tendency to be lost, nor are they susceptible to the DHT. Evidence of the lasting effect of transplants can be seen every day when you see someone with plugs or doll's hair.

"The current techniques enable us to move hair more naturally than ever before."

QUESTION

Testosterone is a chemical found only in men. See Answer

MODERATOR:
So how does a man choose a hair restoration doctor?

ZIERING:
First of all they should look at a specialist and someone who only does hair restoration procedures. They should find a board certified physician, preferably one that is certified by the American Board of Hair Restoration Surgeons -- someone who has experience.

They need to make sure they are using the current state-of-the art technology, which is microscopic follicular unit grafting. They must meet the physician in consultation and have the opportunity to look at and talk with other patients.

Finally, they must choose someone they feel comfortable with who understands their aesthetic desires and can meet their expectations.

MODERATOR:
If balding has begun, say at the temples, and a hair transplant is done now, what happens with the rest of the head? Will it look funny?

ZIERING:
A skilled and experienced hair restoration surgeon will account for present and future loss in designing your hair restoration procedure and in evaluating the donor area of hair that you have to transplant today and for the future. The current techniques enable us to move hair more naturally than ever before. So this should not be a concern if you choose the appropriate surgeon.

MEMBER QUESTION:
Do you have a recommendation for a physician in Allentown, Pa?

ZIERING:
The most widely recognized of international hair loss experts is the International Society of Hair Restoration Surgeons. Their web site is www.ishrs.org. They have a "Find a Doctor" section.

Of course, you can Google and Yahoo! and find someone in your area. You have to do your own research and due diligence.

MEMBER QUESTION:
What can one who has very limited financial resources do to help with hair loss? There is no way I can afford a transplant.

ZIERING:
Most hair restoration surgeons offer a "no charge" consultation for patients to be evaluated as to what treatment options they have. A good physician will present all the options for the patient and help them evaluate them based on efficacy and the patient's financial means. So the best thing is to find someone in your area.

MEMBER QUESTION:
If you had the old hair plugs, can they be fixed?

ZIERING:
Approximately 30% of the work that I do is correcting the old plug technique. We can get extremely good results that appear natural by combining a new technology with the older plug results.

MEMBER QUESTION:
I'm a body builder and worry that lying on the bench is rubbing the hair off of the back of my head.

ZIERING:
While wearing a hat is a myth as far as hair loss is concerned, so too is lying on a bench. However, if you cause physical traction and trauma to the hair, it can break, and if done repeatedly, can cause some permanent hair damage and hair loss, like that scene with people who braid their hair too tightly over a long period of time. This is called specifically traction alopecia.

You should be evaluated to see if the hair loss is due to breaking and damage or genetic male pattern hair loss and baldness.

"The sooner you begin treatment with medications approved by the FDA, the better the patient's response - this is also true with thinning."

MODERATOR:
What are the barriers to treatment for hair loss in men?

ZIERING:

• They often don't want to admit they have a problem with hair loss.
• They are in denial with regard to how advanced their hair loss actually is.
• They don't believe there's anything out there that will work for them or will look natural.

These are all important because since hair loss is progressive, the sooner that a patient takes action the better the ultimate result. This goes for both medical and surgical intervention.

MODERATOR:
Is there anything designed specifically to help with the bald spot on the back of the head?

ZIERING:
In combination with the medication of minoxidil and finasteride, there is the Ziering Whorl, a classification system and a reconstructive process to surgically restore the hair on the back of the head or bald spot into its natural pattern and direction.

MODERATOR:
So it really looks natural?

ZIERING:
There are certain patterns in the back of the head bald spot which I've classified as either an S-shaped pattern or Z-shaped pattern or a combination of the two, and if you recreate the transplant in this whorl pattern it will give you the most natural appearance with a fuller look.

MEMBER QUESTION:
Can anything be done for hair that is thinning but doesn't have a "bald" area?

ZIERING:
The sooner you begin treatment with medications approved by the FDA, the better the patient's response - this is also true with thinning.

If you start to transplant into those areas, you can replace this hair with strong permanent hair without anyone knowing what you're doing.

MODERATOR:
For what other areas can hair transplantation be helpful?

ZIERING:
Hair transplantation to the scalp for genetic or male pattern hair loss is the most common but not the only area for this treatment process. We can also transplant into areas that were burned or scars from other surgical procedures. Hair transplantation can also be done to restore eyebrows, eyelashes, mustaches, and beards. We are also able to restore sideburns and recreate the temple peaks.

MEMBER QUESTION:
What are the risks associated with this procedure (hair transplant)?

ZIERING:
Hair transplants are a very safe outpatient procedure with minimal risks, similar to having a mole removed from the skin.

There will be a small scar in the back of the head where the hair is removed, however that is covered up easily by existing hair. And really no marks will be seen on the top of the head.

One complication can be that you'll be forced to get rid of most of your hats.

"It's also important for people to know hair restoration works equally well for women as it does for men. They are a growing segment of my patient population."

MEMBER QUESTION:
Will transplanted hair gray with the rest of my hair?

ZIERING:
The hair follows the same pattern and propensity from where it comes. So it will gray over time, but it maintains its genetic instructions from where it came from.

MODERATOR:
Dr. Ziering, we are almost out of time. Before we wrap things up for today, do you have any final comments for us?

ZIERING:
The main reason people don't have hair transplants today is it won't look natural. But with today's state-of-the-art techniques and skilled surgeons, patients owe it to themselves to be evaluated by a hair restoration expert in their area, or to travel to a national expert, because there's no reason to suffer with their hair loss any longer.

We've transplanted patients from as young as 8 years old because of trauma and an 87-year-old patient. It's also important for people to know hair restoration works equally well for women as it does for men. They are a growing segment of my patient population.

If you go to our web site you can do a virtual consultation. You ask the questions and we'll answer them. You can also see before and after pictures and get more information.

MODERATOR:
Our thanks to Craig Ziering, DO, for joining us today. For more information, please visit Dr. Ziering online at www.zieringmedical.com.

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