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Filtering by Category: Male pattern balding


Using Dutasteride in Male Pattern Balding.

Use of Dutasteride in Previous Finasteride users. 

Currently used 5 alpha reductase inhibitors include finasteride and dutasteride. Finasteride is FDA approved for hair loss at 1 mg. Dutasteride is not formally FDA approved for treating balding. However, the medication can can be used off label. 

Finasateride is an inhibitor of the enzyme 5 alpha reductase type 2  and dutasteride is an inhibitor of both 5 alpha reductease type 1 and type 2. Dutasteride is more potent and leads to greater reductions of dihydrotestosterone (DHT). Studies from 2004 showed that dutasteride lowers serum DHT by up to 90% whereas finasteride lowers it by about 70 %. Side effects are also potentially greater with dutasteride than finasteride.

Options for Using Dutasteride

Patients using finasteride who find that the medication has not given them the growth they hoped for or who feel that their hair loss has progressed slowly over time should speak to their physicians about options. There are several points to discuss with your health care provider. Many individuals who have a “partial” response to finasteride often wonder if they should switch to dutaseteride or add dutasteride to thr finasteride they are already taking.

1. Adding dutasteride on weekends.

Adding a very small dose of dutasteride on the weekends can often be an option for some men.  An Australian study in 2013 reported a male who was initially treated with finasteride for androgenetic alopecia (male balding). Despite good compliance with the medication, the patient noted his hair density was not as good as previous years, and low-dose dutasteride at 0.5 mg once per week was added to the finasteride therapy. Interestingly, this treatment plan resulted in a dramatic increase in his hair density, demonstrating that combined therapy with finasteride and dutasteride can improve hair density in patients already taking finasteride.

 

2. Switching to dutasteride altogether

Another option that patients may wish to discuss with their physicians is whether to stop finasteride altogether and start dutasteride.  In 2014, Jung and colleagues from South Korea studied 31 men with male balding who took dutasteride after finasteride did not help them. Well over three quarters of these men  (77 %) improved their hair density by making the switch (17 improved slightly, 6 moderately, 1 markedly).

 

Conclusion

The use of dutasteride is among the treatment options for men with incomplete responses to finasteride. 

 

 

Reference:

 

Jung et al. Effect of dutasteride 0.5 mg/d in men with androgenetic alopecia recalcitrant to finasteride. Int J Dermatol. 2014 Nov;53(11):1351-7

 

Boyapati A and Sinclair R. Combination therapy with finasteride and low-dose dutasteride in the treatment of androgenetic alopecia. Australasian J Dermatol 2013


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Classic studies from the Past: A Look at the Early Dutasteride Studies

Dutasteride vs Finasteride: Suppression of DHT

In the world of hair loss, we often quote numbers and statistics. We frequently throw around information without a good idea of where that information actually came from. An important study is a 2004 study by Dr. Clark and colleagues. It is one of the the classic studies examining how DHT changes with use of finasteride and dutasateride. 

The researchers studied 399 men with prostate enlargement (BPH) and randomized them to once-daily dosing for dutasteride (0.01, 0.05, 0.5, 2.5, or 5.0 mg), or 5 mg finasteride, or placebo for a total of 24 weeks. The percent decrease in DHT was 98% with 5.0 mg dutasteride and 95% with 0.5 mg dutasteride. This was found to be significantly lower than the 71% suppression observed with 5 mg finasteride.  Moreover there was less variability in DHT changes with dutasteride than finasteride. 

Clark et al. Marked suppression of dihydrotestosterone in men with benign prostatic hyperplasia by dutasteride, a dual 5alpha-reductase inhibitor. J Clin Endocrinol Metab. 2004

Clark et al. Marked suppression of dihydrotestosterone in men with benign prostatic hyperplasia by dutasteride, a dual 5alpha-reductase inhibitor. J Clin Endocrinol Metab. 2004

 

The other important part of their studies was the increased in DHT that follows stopping the medication. The graph above shows that DHT levels rise much more slowly when dutasteride is stopped than when finasteride is stopped. This is on account of the long half life of dutasteride compared to finasteride (6 hours for finasteride and 4-5 weeks for dutasteride).

 

 

Reference

Clark RV, et al. Marked suppression of dihydrotestosterone in men with benign prostatic hyperplasia by dutasteride, a dual 5alpha-reductase inhibitor. Randomized controlled trial. J Clin Endocrinol Metab. 2004.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Hair Transplants in Young Men

Are hair transplants an option under 25?

Hair transplantation is rarely a good option in men under 25 and it's generally never an option for men in the early 20s (i.e. before age 23). I completely understand that hair transplants are performed around the world in young men age 18-22. However, I don't think it's a good idea.

 

Why hair transplants in young men is not advisable

In an effort to look better and do something positive, many men rush into hair transplants. Not a day goes by that I don't see it or hear it.  There are a number of things that all young men should keep in mind.

 

1. Hair loss does not stop - it continues forever

Too many young men forget that hair loss will continue forever. If a patient is developing genetic hair loss at a young age, one thing is for sure: they will continue to slowly bald unless medication treatment is considered.  Having a hair transplant does not stop the balding process - it only delays the appearance.

 

2. Males who start balding in the early 20s are likely to develop advanced balding patterns in their 30s and 40s. 

It is critically important to understand that once genetic hair loss starts, it will continue forever. If balding starts at a young age, there is a very high chance that male will develop more significant hair loss in the 30s, 40s or 50s.  

 

3. Males who have hair transplants in the early 20s must be prepared for more surgeries throughout their lifetime

If a hair transplant is performed in the frontal hairline at too young of an age, the hairs that are moved into the frontal hairline may last a long time. However, the hairs 'behind' this frontal area could potentially disappear as normal balding continues along its course. At hair transplant performed at too young of an age often leads to placement of place hairs in an area which could look unnatural in the future. A good example would be the placement of too low of a hairline or a hairline with not enough curve to it.  In order for the patient to continue to look good and not have a 'gap' develop between the transplanted hairs and the continually receding hairline, the patient must return to the surgery centre from time to time for more transplants. In other words, if needs to be prepared for a lifetime of hair transplants. Therefore, a hair transplant is not a one time thing.

 

4. It's nearly impossible to predict prior to the mid 20s how many donor hairs a patient actually has. 

If humans had an infinite number of hairs in the “donor” area to move through hair transplants, I would be more likely to advise that more young men move forward and have hair transplants. However, hair in the donor area at the back of the scalp is present in limited supply. A young male with balding may have anywhere from 0 hairs to move (if they have diffuse unpatterned alopecia or DUPA) to up to 8000 folllicular units to move in his lifetime. It may not be clear until the mid to late 20s whether the number is closer to zero or closer to 8000.

Before the mid 20s, one needs to keep in mind that it is just a 'guess' as to how best to use hair transplant grafts from the back of the scalp.  As one ages, it becomes much clearer as to where it is best to place these grafts.  

 

Conclusion

It's rarely a good idea for a young man to have a hair transplant before the mid 20s. There are exceptions whereby a hair transplant in a 23 or 24 year old can be life altering - but these are rare exceptions. In most cases, I recommend these young patients strongly consider non surgical treatments to try to stop their hair loss before considering hair transplantation.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Hair loss is not a guessing game.

Guessing is easiest for men's hair loss

If you had to "guess" the reason for someone's hair loss, you'd likely guess correctly if the patient was male and you chose male balding (androgenetic alopecia). By far that's the most common cause of balding in men.  Dozens of other causes are possible, but they are not common. 

 

Hair loss in women is more complex.

For women, there's a very good chance you'd be wrong if you guessed androgenetic alopecia as the sole cause. Female hair loss is far more complex - and hair shedding issues and even scarring conditions are not uncommon. Hair loss of course, is not a guessing game and a diagnosis can usually be made by the patient's history, examining the scalp and sometimes examining blood test results or (rarely) performing a scalp biopsy.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Is it okay to use more minoxidil?

Using more minoxidil is not advised

The dosings of medications have been carefully worked out to balance efficacy with safety. If a patient feels he or she needs more, they should speak to their physician or pharmacist regarding how to apply minoxidil efficiently. If one feels this dose does not work, they might consider a variety of off label means... but only under supervision. This could include using a bit more than 1 mL, or using oral minoxidil at low doses.

 

Side effects of using too much minoxidil

The side effects of overdosing on minoxidil include worsening headaches, dizzininess, low blood pressure, heart palpitations, heart rhythm disturbances, ankle swelling, hair growth on the body. Rarely patients end up in the emergency department every year because they feel so unwell after using too much minoxidil. 

Minoxidil is a drug and use must be respected.

 


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Minoxidil: Does age really matter?

Minoxidil and age-related hair loss

Minoxidil is a topical medication used to treat many forms of hair loss including androgenetic alopecia (for which it is FDA approved). Minoxidil can be helpful for treating androgenetic alopecia at any age but becomes even more important to consider with advancing age. 

 

Senescent alopecia: A type of hair loss often forgotten

Hair thinning as one approaches the 60s and 70s is often less truly androgen driven. The diagnosis of senescent alopecia (SA) needs to be considered in these particular age groups and it can often respond to minoxidil. Senescent or age related alopecia is often forgotten by physicians. It mimics genetic hair loss almost perfectly so is easily misdiagnosed as genetic hair loss. The genes driving it are very different. The key point is that if one recognizes senescent alopecia could be a possibility - the use of treatments like minoxidil become more important rather than other traditional AGA-type treatments like finasteride.

Androgenetic alopecia tends to start somewhere between age 8 and age 50. Hair thinning that occurs later has a high likelihood of representing senescent alopecia. (Of course other types of hair loss may also occur after age 60 and genetic hair loss and senescent alopecia can overlap). A study by Karnik and colleagues in 2013 confirmed that these two conditions (AGA and SA) are truly unique. The authors studies 1200 genes in AGA and 1360 in SA and compared these to controls. Of these, 442 genes were unique to AGA, 602 genes were unique to SA and 758 genes were common to both AGA and SA. The genes that were unique to AGA included those that contribute to hair follicle development, morphology and cycling. In contrast to androgenetic alopecia, many of the genes expressed in senescent alopecia have a role in skin and epidermal development, keratinocyte proliferation, differentiation and cell cycle regulation. In addition, the authors showed that a number of transcription factors and growth factors are significantly decreased in SA. The concept of senescent alopecia is still open to some debate amongst experts. The studies by Karnik give credence to the unique position of these two conditions. But studies by Whiting suggested that it is not so simple as to say anyone with new thinning after age 60 has SA - many of these are also more in keeping with androgenetic alopecia. As one ages into the 70's, 80's and 90's - hair loss in the form of true senescent alopecia becomes more likely.

 

Reference

Karnik et al. Microarray analysis of androgenetic and senescent alopecia: comparison of gene expression shows two distinct profiles. J Dermatol Sci. 2013.

 

 


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Differentiating DUPA from CTE

How do we distinguish DUPA from CTE?

Diffuse unpatterned alopecia (DUPA) can generally be differentiated from chronic telogen effluvium (CTE) by careful review of the patient's history, and examination of the scalp using dermoscopy. Rarely a biopsy can be confirmatory but usually this is not needed.

 

DUPA

On history, patients with DUPA report diffuse thinning. They usually don't have all that much in terms of increased shedding. Typically, the hair loss is first noticed between age 15-24. Examination of the scalp shows variation in the sizes of follicles. We call this 'anisotrichosis'. Some hairs are thick and some are thin. The miniaturization occurs all over the scalp. A biopsy shows a terminal to vellus ratio of much less than 4:1.

 

CTE

In contrast to DUPA, patients with true CTE are usually a bit older when they first notice hair loss, often 35-60. Their stories are markes by concerns about massive shedding that comes and goes, some weeks good and some weeks bad. Patients with CTE don't usually look like they have hair loss to others whereas patients with DUPA often do look like they have hair loss. In CTE, examination shows terminal thick hairs. The temples may or may not show recession but often do in the setting of CTE. A biopsy shows T: V ratios that are high - and ratios 8:1 or higher are suggestive of CTE (compared to less than 4:1 for DUPA).

 

In summary, DUPA and CTE can usually be easily differentiated with careful examination and review of the patient's story.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Androgenetic Alopecia and Height

Height, AGA and Genetics

Recent research has shown that many of these genes that control balding also affect how tall an individual may become. 

height


Heilman-Heimbach and colleagues from the University of Bonn recently performed an extensive study of over 20,000 men (10,000 with hair loss compared to 10,000 without hair loss). The researchers uncovered 63 genetic changes that increase a man's risk of developing early onset balding. These same genetic changes were associated with an increased likelihood of being shorter. They concluded that many of the genes controlling male balding are also linked to being shorter in height.

A second study from the UK by Hagenaars and colleagues identified 287 genetic regions linked to male pattern baldness. This large study examined data from over 52,000 men. This study confirmed a similar finding as the Heilman-Heimbach et al. study above namely that many of the genes regulating hair loss in men also give an increased chance for shorter height.


Reference


Heilman-Heimbach et al. Meta-analysis identifies novel risk loci and yields systematic insights into the biology of male-pattern baldness. Nature Communications, 2017.

Hagenaars SP et al.  Genetic prediction of male pattern baldness. PLoS Genet 13(2): e1006594. 2017.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Hair Loss in Androgenetic Alopecia: Why can't anyone notice my hair loss?

ON the Three Stages of Hair Loss in Androgenetic Alopecia

threestagesAGA

Hair loss in patients with androgenetic alopecia (AGA) starts well before the affected individual actual becomes "aware" that his or her hair is thinning. I often think of AGA in three "stages" - labelled 1, 2 and 3 in the diagram. These are not to be confused with the 3 Ludwig stages of hair loss.

 

Stage 1

In stage 1, hair density is slowly reducing but the patient is unaware. There may be a slight increase in hair being shed in the shower or coming out daily in the brush. However, this generally goes by unnoticed by the patient. A biopsy can sometimes (but not always) capture a T:V ratio below 4:1 and some degree of miniaturization (and anisotrichosis) may be present. Much of the time it's challenging to confidently diagnose AGA in this stage. Some stay in stage 1 for a very long time; others just a matter of months.

 

Stage 2

In stage 2, the patient first becomes aware that something is not quite right. They may see a bit more scalp showing when they look in the mirror. They may feel the hair does not feels as thick when they run their fingers through the hair. Under bright lights they may feel a bit more aware of these changes. When the hair is wet, the thinning is evident.

Nevertheless, in this second stage everyone else tells the patient they look fine. Some patients are told they are "crazy". Even some physicians will tell the patient they "look fine" and need not worry. Patients often feel isolated in this stage because nobody believes them when they say they are losing hair! A biopsy definitely shows a T:V ratio less than 4:1 and miniaturization is clearly seen in more than 20 % of hairs. Many never progress to stage 3 especially those with onset of AGA later in life.

 

Stage 3

In stage 3, the hair loss has progressed to a stage where hair loss may become evident not only to the patient but also to others. Of course with use of various hairstyles, products, camouflaging agents it may still be possible to hide one's hair loss from others. As stage 3 progresses it becomes more and more difficult to hide hair loss.

 

Comment

As a physician, I try to understand the goal of my patients. Some patients in stage 2 want help to simply stop their hair loss so that they can "stay" in stage 2 and not move on to stage 3. Other patients want treatment advice to get them back into stage 1 (if possible). Some patients in stage 3 want to improve their density such that they can get a bit more hair back to hide their hair thinning more easily. The patient in such an example may not be looking to move from stage 3 to stage 2 but may be looking to improve their density.

Consider the 31 year old female with early thinning who is worried about her hair. Her friends and family think she's crazy worrying about her hair. After listening to the patients story and examining her scalp, I can reassure her that even without treatment she will stay in stage 2 for 5-10 years (and her friends and family will likely keep telling her she's crazy for many more years to come). However, my concern for her is that if nothing is done she will move on to stage 3 in her 40s, 50s and 60s. The goal of treatment is to prevent this.

I find this chart helpful for many of my patients and when teaching physicians about hair loss. 

 

 

 

 

 


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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How Many Genes Are Involved in Male Pattern Balding?

How many genes control whether an individual develops balding?

DNA.png

Studies by Hagenaars et al in 2017 showed that male balding is actually more complex than we ever imagined. The researchers identified 287 genetic regions that are linked to male pattern balding (androgenetic alopecia). This data came from studies of over 52,000 men.

 

Reference

Hagenaars et al. PLoS Genetics 2017
 


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Do all males bald in the same way? 

Do all males bald in the same way? 

male balding.jpg

The answer to that is no. Most men whonare going to bald first notice changes in the temples and/or crown and then ultimately bald according to the so called "Hamilton Norwood" scale. However this male shown in the photo has a pattern of balding that does not match up to any of the Hamilton Norwood patterns. He has what is known as a "female" pattern of male balding where the central scalp is involved first and the frontal hairline is relatively unaffected. This pattern of androgenetic hair loss is common in women and affects about 10-13 % of males.
 


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Treatment of Male Balding: A closer look at the three tiers of options

Treatment of Male Balding

A variety of treatment options exist for males with balding, also known as androgenetic alopecia. I like to think of the options in terms of three tiers or categories of treatments. Tier 1 treatments have the best evidence and are consistently the most effective. Tier 3 treatments have the least evidence.

 

Tier 1 Treatments

Minoxidil and Finasteride are the two FDA approved treatments. Dutasteride is off label in North America but is also not uncommonly prescribed as well. These are among the most effective treatments and what I would term "tier 1" treatments. 

 

Tier 2 Treatments

Other treatments can also be considered including low level laser and platelet rich plasma. Meta-analyses support a benefit of these over placebo or sham treatments so they are not without at least potential benefit. These are what I term "tier 2" treatments. Other tier 2 treatments with less evidence but still reasonable likelihood of benefit include oral minoxidil and topical finasteride. These are not FDA approved and off label.

 

Tier 3 Treatments

Then we come to "tier 3" treatments. Some treatments in this group might help some males but not all and tesults may be inconsistent. Some tier 3 treatments could be helpful, it's just that not enough studies have been done. The public loves many "tier 3" treatments as they wrongly assume some are completely safe. Many tier 3 treatments simply have not been studied to any significant degree to render conclusions about safety. Lack of studies does not equate to them being safe.

This tier 3 group includes a variety of treatments purported to have a DHT blocking and anti-androgen type effect. There is biochemical evidence of this effect for some of the treatments and even a hint of clinical benefit for others. There is far less study of this group of agents which includes saw palmetto, pumpkin seed oil, ketoconazole shampoo, topical androgen receptor blockers. In the last category are many agents that can be bought on the internet and that I see in my office at least once per week. The evidence for a clinical benefit from these agents is weak at best.

This summarizes the three tiers of non surgical treatments that can be considered in males with balding. A number of exciting options are on the horizon and only careful study will determine if we ever see them in the clinical setting. This includes topical prostaglandin F2 analogues (bimatoprost), prostaglandin D2 inhibitors, Wnt pathway activators, JAK inhibitors and a variety of cell based therapies.

 

 


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Bimatoprost for Androgenetic Alopecia: An intensely researched area

Bimatoprost for Male Balding

Bimatoprost is a prostaglandin F2 alpha analogue that stimulates hair growth. Bimatoprost at 0.03 % is a well known eyelash growth stimulatory compound and marketed under the name Latisse. 

bimatoprost-aga


Bimatoprost has been studied for use in androgenetic alopecia. At low concentrations, it is not particularly effective. Allergan is currently studying higher concentrations (1 and 3%). Data released by Allergan and available to the public online suggest that these higher concentrations may be beneficial in treating hair loss. This is an exciting area to watch out for in the near future.

The graph shows how bimatoprost compares to minoxidil in these Allergan led studies. In their preliminary results, higher concentrations of bimatoprost was similarly or even slightly more effective that minoxidil (the gold standard FDA approved topical treatment for androgenetic alopecia).


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Androgenetic Alopecia and Height

Baldness Associated with Shorter Height

Is there a link between the height of a man and his chances of developing androgenetic hair loss (male pattern balding)? 

Recent studies have suggested that answer is yes. Researchers at the University of Bonn performed an extensive study of over 20,000 men (10,000 with hair loss compared to 10,000 without hair loss) and concluded that many of the genes controlling male balding are also linked to being shorter in height.

The researchers discovered 63 genetic changes that increase a man’s risk of developing early onset balding. These same genetic changes were linked with a greater likelihood of being shorter.

This study confirms that hair loss is not an isolated phenomenon but rather controlled by genes that also determine one’s height and various aspects of health.

 

Reference

Heilman-Heimbach et al. Meta-analysis identifies novel risk loci and yields systematic insights into the biology of male-pattern baldness. Nature Communications, 2017; 8: 14694 DOI


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Valproate and Hair Loss: Does valproate cause hair loss through an androgen mediated mechanism?

There are many different types of drugs used as mood stabilizers is women with bipolar disorder. Many of these drugs can cause hair loss, albeit with different mechanisms. Common medications used in treating bipolar disorder include lithium, valproate, lamotrigine, topiramate, gabapentin, carbamazepine, oxcarbazepine.

 

Vaproate and Hyperandrogenism

There is increasing evidence suggests that valproate is associated with isolated features of polycystic ovarian syndrome (PCOS). To study this further, researchers studied three hundred women 18 to 45 years old with bipolar disorder. A comparison was made between the incidence of hyperandrogenism (including hirsutism, acne, male-pattern alopecia, elevated androgens) with oligoamenorrhea that developed while taking valproate versus other types of anticonvulsants drugs (like lamotrigine, topiramate, gabapentin, carbamazepine, oxcarbazepine) and lithium. 

 

What were the results?

It was interesting that among 230 women who could be evaluated, oligoamenorrhea with hyperandrogenism developed in 9 (10.5%) of 86 women on valproate compared to just 2 (1.4%) of 144 women on nonvalproate anticonvulsants or lithium. This translated into a nearly 8 fold risk of these hyperandrogenism and menstrual cycle changes with valproate. Oligomenorrhea happened within 12 months with valproic acid users.

 

Conclusion

Once needs to be aware of a possible PCOS like clinical phenomenon and for hair specialists - the development of hyperandrogenism and accelerated AGA in women using valproate for bipolar disorder. More studies are needed to confirm these findings.

Reference

Valproate is associated with new-onset oligoamenorrhea with hyperandrogenism in women with bipolar disorder.

Joffe H, et al. Biol Psychiatry. 2006.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Oral minoxidil for hair loss

Oral Minoxidil

Topical minoxidil was FDA approved in 1987 and we now have 30 years of experience with the drug. 

I'm increasingly asked about oral minoxidil. Does it work? Is it safe? What dose? 

Oral minoxidil is not FDA approved for treating hair loss. It was used in the 1980s for treating high blood pressure. When used at doses typical for treating blood pressure problems (5 mg twice daily), it can be associated with side effects - some quite serious. These include dizziness, low blood pressure, weight gain from fluid retention, high heart rate, heart rhythm problems. And of course hair growth can occur all over the body.

Lower doses of oral minoxidil may be safer and may still provide benefit. Doses ranging from 0.25 mg daily to up to 1 mg daily are generally well tolerated without a significantly increased risk of side effects. One does need to be closely monitored for blood pressure, weight changes, heart rate and excess hair growth on the body. For women, low dose minoxidil can be combined with spironolactone. In men low dose minoxidil can be combined with lower doses of finasteride.

 

Conclusion

Oral minoxidil is increasingly popular as men and women look for safer options for treating hair loss. Side effects of oral minoxidil must be respected and use of the medication must only be done in conjunction with a physician experienced in the use of oral minoxidil. Close monitoring is essential.

DOWNLOAD ORAL MINOXIDIL HANDOUT


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Who said miniaturization only happens in AGA?

Miniaturization  

It is often said that miniaturization of hairs (progressive thinning of hairs) is a main feature specific to men and women with androgenetic alopecia. This is not entirely accurate.

Miniaturization can be seen in many conditions including traction alopecia (shown here), alopecia areata as well as androgenetic alopecia.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Miniaturized Hairs

Do they grow the same length as originial hairs?

In the early stages of androgenetic alopecia (first few years), miniaturized hairs grow almost the same length as original hairs (not quite but close). 

As time passes, and if androgenetic alopecia progresses, them miniaturized hairs grow in the scalp for shorter and shorter periods. In advanced cases, hairs affected by androgenetic alopecia grow for only a 2-3 months - and are very, very short and very, very thin. We call these "vellus-like" hairs rather than miniaturized hairs but they are a type of miniaturized hair.  Over time, vellus like hairs just don't grow any more.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Scalp Elasticity: The Mayer Paul Formula

The flexibility or "elasticity" of the scalp is an important consideration for hair transplant surgeons performing follicular unit strip surgery (FUSS also called FUT). In general terms, the more elastic an individual's scalp is, the greater the number of grafts that can be taken ...  and the better the final hair density that can be created for the patient undergoing surgery.

 

A number of formulas and methods have been proposed to help surgeons calculate elasticity. There are even a number of commercial available instruments and tools that can also be bought to help calculate scalp elasticity.

 

The Mayer Paul Formula

The Mayer - Paul Formula is a well established method for calculating the elasticity of the scalp. To calculate elasticity on the scalp, two lines are initially drawn 5 cm (50 mm) apart. Then the two lines are compressed together (ideally with the two thumbs). Then, one records how far apart the two lines are after being squished together.

Scalp Elasticity is calculated as

[(50 mm - new position in mm)/50] multiplied by 100 %

 

VIDEO EXAMPLE: DEMONSTRATION FO THE MAYER PAUL

In this video example, the lines have been squeezed from 5 cm apart to 2.5 cm apart (X = 2.5 for the formula in this example). The elasticity is calculated as 50 %. According to the Mayer Paul formula elasticity of 30 % or more means that a strip of at least 2.2 cm can be taken (if needed) on a first FUT surgery. In contrast, 10 % elasticity means that the strip should be kept less that 1 cm in width


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Focal atrichia: A worrisome sign of AGA

Focal atrichia: What is it?

Focal trichina is a term which  refers to a specific observation seen on the scalp of patients with androgenetic alopecia. Those with focal atrichia have small circular areas devoid of hair.

This is a feature of advanced male balding (androgenetic alopecia) and also female pattern androgenetic alopecia. The finding is very important to recognize. Focal atrichia occurring in patients under 30 is worrisome for me as it is associated with a higher risk for progression to more extensive balding.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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