#316 – AMA #63: A guide for hair loss: causes, treatments, transplants, and sex-specific considerations

In this “Ask Me Anything” (AMA) episode, Peter dives deep into the topic of hair loss, exploring its relationship with aging and its impact on quality of life. The conversation focuses on androgenic alopecia, the most common form of hair loss in both men and women, and covers the differences in patterns and causes between the sexes. Peter delves into the right timing for treatment, breaking down various options such as minoxidil and finasteride, low-level laser therapy, platelet-rich plasma injections, and more. Additionally, Peter outlines the pros and cons of the two primary hair transplantation methods and concludes with practical advice on selecting the right specialist or treatment team for those facing hair loss.

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We discuss:

• The impact of hair loss on emotional health [2:15];
• The prevalence, patterns, and causes of hair loss in men and women [5:15];
• The genetic and hormonal causes of hair loss, and the role of dihydrotestosterone (DHT) in androgenic alopecia [8:45];
• The visual differences in hair loss patterns between men and women, and the importance of consulting a specialist to rule out non-genetic causes of hair loss [13:30];
• How genetic predisposition influences the risk of androgenic alopecia, and how early detection through diagnostic tools and blood tests can help manage the risk more effectively [16:45];
• Ideal timing for starting treatment: why early treatment is crucial for effectively managing hair loss [19:30];
• The various FDA-approved treatments for androgenic alopecia, their mechanisms, and additional off-label treatments commonly used to manage hair loss [24:30];
• Topical minoxidil—the most commonly recommended starting treatment for hair loss [30:15];
• Oral vs. topical minoxidil: efficacy, ease of use, and potential side effects that must be considered [33:45];
• Finasteride for treating hair loss: efficacy, potential side effects on libido, and the need for careful PSA monitoring in men to avoid missing early signs of prostate cancer [37:15];
• Other effective hair loss treatments for women: boosting hair density with spironolactone gel and ketoconazole shampoo as part of a comprehensive strategy [41:30];
• Low-level laser therapy: effectiveness, costs, practicality, and a comparison of in-office treatments with at-home devices [49:00];
• Platelet-rich plasma (PRP) as an off-label treatment for hair loss: potential effectiveness, varying protocols, and significant costs [53:45];
• Hair transplant for advanced hair loss: criteria and considerations [58:00];
• Types of hair transplants: follicular unit transplantation (FUT) vs. follicular unit extraction (FUE) [1:02:00];
• The financial cost of hair transplant surgery, and what to consider when seeking affordable options [1:06:15];
• The potential risks and downsides of the various hair transplant procedures [1:09:30];
• Post-procedure care for hair transplants and whether the procedure must be repeated periodically [1:16:30];
• Combining different hair loss treatments: benefits, risks, and considerations [1:18:30];
• Emerging hair loss treatments with limited data [1:21:00];
• Key considerations for selecting the right treatment plan for hair loss [1:22:00];
• A summary of the different considerations for men and women facing hair loss [1:24:30];
• Practical advice on selecting the right specialist or treatment team [1:26:15]; and
• More.

The impact of hair loss on emotional health [2:15]

General Podcast Focus:

• Most podcast episodes and AMA sessions focus on lifespan and healthspan topics.
• Today’s topic is hair loss, which doesn’t directly relate to lifespan or healthspan but is a common question from both podcast listeners and patients.

The conversation will address:

• Causes of hair loss.
• Options to slow down hair loss or treat it once it has occurred.
• Summary of available treatments and guidance on choosing the right approach.
• How hair loss affects both men and women differently.
• How to find a good specialist if treatment is necessary.

For most people, hair loss is noticed in different ways:

• Visually, through the thinning of hair density.
• Noticing fallen hairs on pillows or in drains.

Relationship Between Hair Loss and Healthspan

• Although hair loss may not directly affect lifespan or traditional healthspan factors (physical or cognitive performance), it can still impact quality of life.
• But it can cause emotional distress, which ties it to emotional health and, indirectly, to healthspan.

The prevalence, patterns, and causes of hair loss in men and women [5:15]

Prevalence of Hair Loss Across Genders:

• Hair loss is common for both men and women, but many people are surprised by how frequently women experience it.
• The focus of this discussion is androgenic alopecia (AGA), which accounts for about 95% of male hair loss and at least half of female hair loss cases.

Male vs. Female Hair Loss:

• Androgenic alopecia is the primary cause of hair loss in men and often in women, but women have other common causes of hair thinning that must be ruled out.
• Men: Androgenic alopecia is responsible for almost all cases of hair loss in men.
• Women: While androgenic alopecia can cause thinning, other factors, such as pregnancy, menopause, autoimmune conditions, stress, vitamin deficiencies, and medications, play a larger role in women.
  • Temporary hair loss during and after pregnancy is common, but its inclusion in statistics depends on the context.

Causes of Hair Loss (other than AGA)

• Autoimmune conditions.
• Psychological stress.
• Hormonal changes (e.g., pregnancy, menopause).
• Vitamin/mineral deficiencies: Iron, Vitamin D, B12.
• Medications: Rare cases linked to statins, antidepressants, antihypertensives.

*NOTE: For most of this episode of the podcast, we’re going to be referring to androgenic alopecia

Prevalence and Age-Related Hair Loss

• Prevalence in Men:
  • Male pattern hair loss (AGA) affects 30-50% of men by age 50.
  • Virtually all cases are manifest by age 40, though some men can begin experiencing hair loss as early as their late teens or early 20s.
• Prevalence in Women:
  • Female pattern hair loss is surprisingly common, affecting 20-50% of women across their lifespan.
  • It can begin as early as age 40, but in some cases, it may not start until age 60.

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