Chapter 15: Ask The Expert


 

Question from a 32-Year-Old Male:

I have a mustache and a goatee, and they are quite thick, I guess. But the hairs on the sides of my face are not that thick. Moreover, on one side of my face, there is hardly any hair for stubble for a side burn. What can be done to correct this? Is there something genetically wrong with me? Some people mistake me for a woman on the phone, so I guess there is something wrong with my voice. I’ve tried applying Rogaine on my face, but I don’t think it helped much. I know this is probably silly and making me seem vain, but being able to grow a beard is as important to me as a woman being able to give birth to a baby. I feel insufficient as a man because of this. Can you please help me?

Answer:

Facial hair, as well as all other hair distribution on the body, is determined by your genetics. There are no vitamins or medications that are safe and effective at stimulating facial hair growth.

Some men have had hair transplants to enhance a mustache or beard. The problem is, we cannot be sure that if the patient shaves there will be no marks or scars showing where the transplanted hairs are growing. I had one patient, a twenty-five-year-old clerk, who came to me because he wanted a full mustache. We did 300 grafts and he was tickled pink with the result. Later, he joined a more conservative firm that required a clean-shaven look. Fortunately, in his case, the transplants were not obvious when he shaved his mustache, but this is not always so.

Question from a 33-Year-Old Male:

This is going to sound like a really weird question, but for about five years now I have been noticing that I seem to be losing a lot of hair (sink, shower, brush) but still have a full head of hair and no thinning spots. Am I just being paranoid because I’m at that age? Is there a reason I’m losing so much hair but it doesn’t ever show?

Answer:

Everyone is born with about 100,000 hairs on his or her head, and about half of them can be lost before the hair begins to looks thin. Each hair is shed eventually, and after a resting period, a new hair begins to grow from the same hair follicle where the old hair was shed. An average of fifty to 100 hairs are shed every day, and approximately the same number of new hairs start growing each day. Since you still have a full head of hair with no thinning spots, you are most likely experiencing normal shedding.

Question from a 33-Year-Old Male:

I’ve been losing a tremendous amount of hair every day but show no signs of thinning anywhere. I went to see my Dermatologist, and he told me I have “normal hair density” and that I am probably one of the few people with very short shedding cycle” and that I would probably never be able to grow long hair (which I haven’t). Could you please tell me what all this means?

Answer:

We all start out with about 100,000 active hair follicles. On average about fifty to 100 hairs are shed every day, and fifty to 100 new hairs begin growing each day as well. Typically a new hair grows about a half inch a month for about five years, which would allow a hair to grow about thirty inches long if it was not cut during that time. After an average of five years, the hair follicle goes into regression and resting phases for a few months, during which the hair is usually shed. After a few more months, a new hair again begins to grow from the same hair follicle, and the growth cycle starts over. Typically about ninety percent of the hair follicles are growing hair, while the other ten percent are shedding or resting. Some people have a genetic program for a shorter average growing cycle, perhaps only two or three years, while others have longer average growing cycles. A shorter average growing cycle would result in hairs being shed before they could grow as long as thirty inches. It would also result in greater hair shedding, as a higher percentage of the 100,000 hair follicles would be in the shedding phase, when compared to a person with a longer growth cycle. The person with the shorter growing cycle would also have a higher percentage of new hairs starting to grow each day, but this would be a lot less noticeable than seeing the shed hairs in the sink and shower drain.

Question from a 39-Year-Old Male:

My mom’s dad had a head full of hair. My dad’s dad went bald, and my dad is bald himself. Do I have the chance of going bald? I used to have really thick hair but it seems to be thinning. I do use hair styling products. What should I use? What can I do to prevent hair loss?

Answer:

The genetic predisposition to have hair loss can be passed on by either or both parents. If your father is bald and his father also became bald, then you have a good chance of also suffering pattern baldness. Hair styling products are cosmetic, meaning they only affect appearance and will have no effect on your hair loss. The best way to address your hair loss is to see a dermatologist, and if an exam determines that your thinning hair is due to genetics, a prescription for Propecia can help to stop and possibly reverse the hair loss you are experiencing.

Question from a 39-Year-Old Male:

I heard that men lose hair because hair follicles either become dead or dormant. My question is what determines whether they become dead or just dormant?

Answer:

Over time, a naturally-occurring hormone in the blood of both men and women called dihydrotestosterone, usually abbreviated DHT, signals certain hair follicles that have been genetically programmed for hair loss to slowly stop producing new hairs. So the answer to your question is that a combination of DHT and genetics and time all determine which hair follicles stop growing hairs. DHT in the blood gets to all the hair follicles on the body. Only the ones that are genetically programmed to be sensitive to the DHT message stop growing hairs. In men with pattern hair loss, these follicles are usually located at the hairline and on the top of the head. In women, the DHT-sensitive hair follicles are distributed more generally over the top of the head.

Initially, most hair follicles affected by DHT seem to be “dormant,” and if the DHT message is quickly blocked by medication such as Propecia, or a competing message to grow occurs, such as with the medication Rogaine, some of the dormant follicles will awaken and begin to grow new hairs again. However, if the DHT message is allowed to continue, over time the “dormant” follicles cannot be awakened and may be considered “dead.” The exact biochemical changes that occur when a hair follicle goes from being productive, to dormant, to unproductive, are not completely understood. But we do know that medical treatment at the early stages of hair loss is more effective than treatment at later stages.

Question from a 41-Year-Old Male:

I have three children and a wife, and have what I consider to be a lot of premature wrinkling spots below my lower lip off to the sides. This coincides with areas where I have bald spots in my beard area. I grew a goatee beard, except that it did not look good due to these bald spots. I was wondering if you have ever done hair transplants on facial areas such as this. Is there scarring? Is this a nutty idea?

Answer:

Certainly some people consider facial hair transplants to be a nutty idea, however they have been performed in Japan since the 1930s, and on occasion in this country since that time to correct injuries from burns and accidents. I receive a surprising number of inquiries about enhancing facial hair growth from men in their twenties and thirties who believe that if only they had a thicker mustache or beard, their lives would be different. I do not advise transplants for these young men.

Facial hair transplants involve the same theory of donor dominance that scalp hair transplants are based upon. Donor hair follicles are taken from the back of the head, and moved in this instance to the face, rather than to the scalp. The transplanted hair follicles will continue to grow hairs at the new location, based upon their genetic program. I perform mustache and beard enhancing facial hair transplants on occasion for mature men who have a good understanding of the benefits and risks of such a procedure. The procedure involves carefully placing hundreds of single-hair grafts between existing hair follicles in the mustache or beard area. The benefits, of course, are thicker facial hair. The risks include using up some of the limited supply of donor hairs, as well as the risk of small but visible scars at the recipient area. Also, the transplanted hairs may have a somewhat different texture than the existing facial hair, and may need to be trimmed more frequently. On my web site you can view photos of a man who received transplants to his mustache area, and was quite satisfied with the results. Some time after the transplant procedure, he got a job at a law firm that required a clean-shaven appearance of all employees, and he shaved off his enhanced mustache. He was fortunate in that his skin did not show visible scars from the tiny incisions that were made for the facial hair grafts. Others may have more visible scarring, should they choose to shave off their enhanced facial hair.

Question from a 48-Year-Old Male:

I am using both Proscar 5mg/day (tablets) and minoxidil (lotion) double strength twice a day. It seems that I am growing new hair with some gain in the back and somewhat less in the front. Has this combination been proven to be effective? Is one better than the other? Any dosage recommendations or other advice?

Answer:

Proscar is the brand name for the drug finasteride when it is prescribed as a pill for treating enlarged prostate glands. The same drug finasteride, in a lower dosage, is FDA approved in tablet form for treating hair loss under the brand name Propecia. Since you are taking Proscar, I would assume it was prescribed to treat a prostate gland condition, and you are enjoying the desirable side effect of reduced hair loss.

Minoxidil is the active ingredient drug in Rogaine, which in lotion form was originally available by prescription only, and is now FDA approved as an “over-the-counter” medicine for treating hair loss. Minoxidil lotion is not absorbed well into the skin, and excessive application can cause skin irritation. For treating hair loss, the combination of oral finasteride and topical minoxidil is more effective than either one used alone, and this combination has been used since 1993. A study of the effectiveness of the drug combination was published in a dermatology journal a year or two later. Simply put, finasteride works by stopping most of the DHT hormone message telling the hair follicles to stop growing. Minoxidil works by telling the follicles to keep growing hairs, even when they get the DHT hormone message. My advice would be to continue your present treatment. Between the two medications, it is the finasteride in your Proscar tablets which will help you most in the long run.

The following two questions have the same answer.

Question from a 59-Year-Old Male:

Although I use a dandruff shampoo, I still have a flaky itchy scalp. What can I do?

Question from a 41-Year-Old Male:

I am troubled by dandruff. Although I wash my hair frequently (four to five times a week), my dandruff tends to reoccur. Why does this happen? Is there a way to permanently cure dandruff? I’ve heard that some dandruff shampoos actually make dandruff worse in the long run. What causes dandruff? What can I do?

Answer:

Dandruff is a common condition, and surprisingly the cause is not well understood. First, let me state that dandruff does not cause hair loss, nor is it a symptom of hair loss. Also, there is no permanent cure for dandruff, but it can be controlled fairly easily. Dandruff is a condition characterized by excessive scaling and skin flake shedding on the scalp. Dandruff is sometimes accompanied by an itching sensation, and sometimes by excessive oiliness, but without visible redness or inflammation. Dermatologists call excessive oiliness on the skin seborrhea. Excessive scaling and skin flaking accompanied by visible redness and inflammation, usually occurring in areas where the skin is oily, is called seborrheic dermatitis. Flaking on the scalp, without redness, is dandruff.

Dead skin cells on the surface of scalp, just like skin cells on the surface everywhere else on the body, are eventually shed as new skin cells grow out from the underlying layers of skin. Normally a new skin cell grows from the innermost layer of skin, and as older skin cells are shed in an orderly manner, after about a month the new skin cell reaches the surface layers and eventually dies and is shed itself. And normally, the dead skin cells fall off a few layers at a time, in tiny clusters that are microscopic and not noticed.

With dandruff, there is a combination of an uneven rate of skin cell growth and abnormally sticky sebum (hair oil) that result in comparatively large flakes of skin twenty to forty layers thick being shed. These relatively large chunks of dead skin cells are visible as dandruff flakes.

Although the exact cause of dandruff is not completely understood, the condition is associated with an increase in the population of certain microorganisms that naturally occur on the scalp, including Pityrosporum ovale, a yeast-like fungus that lives in the oil glands and hair follicles on the scalp. The cause of the increase in the population of Pityrosporum ovale is not well understood, and dandruff conditions often change over time for an individual, even without treatment. Dermatologists have a range of prescription treatments for dandruff, including medications that control itching, reduce oiliness, slow the rate of skin cell growth, and kill the microorganisms associated with excessive scalp flaking.

The most effective non-prescription dandruff treatments are shampoos with ingredients that reduce the population of these microorganisms. After rinsing off the anti-dandruff shampoos, the active ingredients remain on the surface of the scalp. Furthermore, alternating each day between shampoos with different active ingredients has been shown to be more effective at controlling dandruff than using a single anti-dandruff shampoo product every day.

Before scheduling an appointment with a dermatologist to control your dandruff, try alternating between Nizoral one percent shampoo, containing ketoconazole and now available at drugstores without a prescription, and either a shampoo containing zinc pyrithione such as regular Head & Shoulders, or a shampoo containing selenium sulfide, such as Selsun Blue shampoo. Or try alternating among all three. If, after a few weeks, your dandruff condition does not seem to be improving, then consult with a dermatologist.

Question from 42-Year-Old Male:

I am a management consultant, in the hospital field, with considerable coursework in biology and chemistry. I also sold pharmaceuticals, and I have read extensively in all the sciences. I receive a “Longevity Journal” which this month is touting and selling “Testone Cream” and “Teston 6” capsules. These products contain DHEA and “andro” plus “pregnenolone.” I take high blood pressure pills, which depress testosterone, and I do have the genetic trait for male pattern baldness. I am not overly concerned about this, but if I could spend two or three bucks a day to correct my lack of vigor, and correct my increasing baldness, I would do it. But there is just so damn much hype and hucksterism going on that it seems impossible to make sound decisions. I’ll be damned if I can evaluate claims outside of the field of formal medicine. Would you share your thoughts on this?

Answer:

Worthless products and treatments alleged to cause permanent weight loss, improve sexual vigor, extend the lifespan, cure cancer or AIDS, and of course stop hair loss, cost consumers around the world billions of dollars each year. It is an extremely profitable business for the sellers, and there is very little regulatory control over performance claims.

These “miracle products” inevitably target our fears, hopes, and vanity. Their claims are supported by stories and testimonials, rather than reproducible scientific studies, although some sellers of these products fraudulently claim to have such studies as well. The products may have been “used for years in Europe,” or Asia, or somewhere else, and are only now available for purchase in this country. They often expla

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