On BEING A HAIR LOSS PHYSICIAN

"I stopped swimming completely because I was worried about the chlorine. I didn't know if it was good or bad, so I stopped swimming. I told nobody why, but never showed up again."                                                    "My head feels like I am lying on SOS pads, I knew this wasn't normal. But all tests seemed OK"                                                 "With more and more hair loss, it's becoming difficult for my stylist to know what to do with my hair"                                                  "I am obviously freaked out by my hair loss and keep going to higher and higher grade shampoos. What else can I do now?"                                                   "I didn't notice hair on my pillow or hair in the sink, so where was it being lost from?"                                                   "My friends have been so supportive and amazing. They tell me I look the same as I always did. Would you believe that I've lost three-quarters of my hair? If anyone knew I was worried about my hair, they'd think I'm crazy"                                                   "For the first time in my life, I could actually feel the rays of sun on my head."                                                   "I'm at a point in my life where I now eat healthy, I'm in peak physical shape, I'm where I want to be... and then I start losing my hair. It's disheartening to say the least."                                                                " I dye my hair blonde to make it look thicker but I think this really damages it further. It's a viscious cycle."                                                                "I once had thick hair - the kind the hairdresser hates."

  

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Someone once said that if you do what you love, you'll never work a day in your life.  I like this quote because it helps me understand how I feel nearly every day.

I am drawn to a unique field of medicine that addresses the diagnosis and treatment of hair loss. I am a physician.  The individuals who step into my office are cared for as my patients - not as my clients and not as customers of our clinic. The stories and descriptions of how people feel when they discover they are losing hair has stuck with me since I first became a doctor.  Hair loss matters to everyone. And it matters to quite a significant degree in quite a large proportion of people. Losing hair speaks to the very essence of what it means to be a human.  Many individuals who experience hair loss feel self-conscious. Some lose that feeling of self consciousness with time, but others do not. Some feel anxious. Some feel sickened & paralyzed by the whole experience.

As a physician, I need to understand many aspects of the patient's experience with his or her hair loss to understand how best to treat their hair loss. It is not uncommon for two patients with the exact same hair loss condition to leave the office with different treatment plans. In my practice, there are no templates for treating hair loss. There is no rubber stamp protocol for treating genetic hair loss. There is no rubber stamp protocol for treating scarring alopecia or alopecia areata. There are no rubber stamps for anything. No two patients that visit my office are the same, and it follows that the treatment plan that they walk out the door with will likely differ as well.

Second, I am a dermatologist sub-specializing in the field of hair loss. The science behind hair growth is very interesting. The molecular and cellular mechanisms governing how a hair grows and how it sheds is both fascinating and bizarre. The growth of hair on the beard vs eyebrow, ear hair vs nose hair. Grey vs. black, blonde hair vs. red hair. Hair is interesting. My eyes have seen many strands of hair, yet I often pause with a  "hmmm" at the simplest finding on a patient's scalp.  

I started my career with the basic premise that if I could help patients with their hair loss I would have accomplished something worthwhile and good. Some patients would hopefully feel more confident and proceed to take on new goals in their personal life, work life or social life. Some would at least be less anxious. And some would stop feeling sick about it.  I hoped that some of my patients would be very happy.  Of course, we achieve these goals a good amount of the time, albeit not as frequently as we really need to. 

My practice has evolved to what I believe offers patients comprehensive care.  My previous experiences in both the academic medicine and private practice settings have shaped my current day hair clinic. One of the greatest concerns of my patients has been that modern medicine has become far too focused and some even might say narrow-minded. A heart specialist treats the heart but not the liver. A liver specialist treats the liver but not the heart. Clearly, there is a tremendous need for this level of expertise - and without it we would not have come very far.   But who looks at the big picture?  Abraham Kaplan is his 1964 book, "The Conduct of Inquiry: Methodology for Behavioural Science" stated the problems that exist when we become too specialized. 'Give a small boy a hammer, and he will find that everything he encounters needs pounding.'

In a similar thinking, consider these fictional examples I have created. Suppose one's goal is to get to and fro from work over a distance of 10 km, but at the same time get some exercise each working day. If one finds themselves in a car dealership, will that individual be advised that what he or she really needs to address the stated goals is to purchase is a bicycle ... and not a car. Or consider the man who is searching for simple options for emergency lighting for his house whenever the power & electricity go out.  A search online for emergency lighting directs him to a nearby store specializing in lighting options. Will he be given the option to consider a buying a flashlight or even buying a candle, or will that individual see the only option being the purchase of a complicated emergency lighting system for the home.

My practice evolved with a deeper understanding that individuals with hair loss want to first and foremost understand their diagnosis and prognosis. What is causing the hair loss... and what is going to happen over the next 5, 10 and 25 years? Second, individuals with hair loss want to know all their options for addressing their hair loss and they want to know just how realistic these options are as solutions.  Many current hair centres and clinics are extremely focused on one aspect of treating hair loss.  They do it well, but the options presented to the patient are often limited. A reminder of Abraham Kaplan's reference to the quote 'Give a small boy a hammer, and he will find that everything he encounters needs pounding.'

Consider then, the patient with hair loss with the diagnosis of lichen planopilaris that finds himself or herself in a hair transplant office. The particular condition is quiet and strictly speaking the patient is a candidate for surgery.  Is it a good option? Well for this patient,  yes. It's a great option.  But consider the next patient with the diagnosis of lichen planopilaris finds himself or herself in a hair transplant office. Is it a good option? For this particular patient, a hair transplant is not really a good option even though technically speaking it's one of the possible options. A far more satisfying option for camouflaging hair loss would be consideration of a wig or even scalp micro pigmentation. We can't really address the specific patient's goals with hair transplant surgery. 

Consider too, the 28 year old female with the diagnosis of androgenetic alopecia who finds herself in a wig salon.  She's devastated by the hair loss and wants full thick hair again.  Is a wig a good option? For this patient, yes. A well designed hairpiece is a great option.  But consider the next  28 year old female with the diagnosis of androgenetic alopecia who finds herself in a wig salon.  Is a wig a good option? For this particular patient, it is a good option, but a far better option would have been first to see a physician about the hair loss. Further work up by a physician would have revealed that the cause of her androgenetic alopecia is in part due to a hormonal abnormality known as polycystic ovarian syndrome (PCOS). Her diagnosis of PCOS has implications for her health, her risk for diabetes and heart disease and even her chances of becoming pregnant in the future should she want to in the future.  A wig is a good way to camouflage her hair loss but it did not address an important underlying issue she has. 

And so, my practice has evolved with an entirely different line of thinking. In 2017, I made a decision to stop my hair transplant surgery practice and modify my existing non-surgical practice to allow me greater flexibility to focus on the much 'bigger picture' for my patients.  If a patient comes to my office for a consult and hair transplant surgery is the best option for them, I refer them to a trusted colleague specializing in hair transplantation.  If a patient comes to my office for a consultant and a wig or scalp prosthesis is the best option for them, I refer them to a trusted colleague who focuses on wigs, hairpieces, toppers and hair systems.   If the patient requires non-surgical management, and close follow up for any one of a number of hair loss conditions, they remain a patient under my care in the Vancouver office.

My practice is focused on caring for the patient and his or her hair regardless of what the option for treatment may be.

 

My practice is based on three promises to my patients.

1) The first promise is that we will provide patients with diagnostic and treatment advice that is based on the most up-to-date scientific and medical research. If some aspect of hair loss research has been published in a medical journal, we've likely read it.  And if we've read it, we've already carefully considered how (and if) it should be worked into our treatment plans for our patients. We offer treatments based on science, safety and sensical thinking. We don't start JAK inhibitors (tofacitnib/ruxolitinib) in patients with alopecia areata who haven't tried other treatments first. We don't recommend PRP in patients with androgenetic alopecia who haven't carefully considered other treatments first.  The same type of common sense applies to how we approach scarring alopecia and hair shedding issues.

2) The second promise is that we will provide patients with care that is respectful, compassionate and rooted in trust. Whether a patient is coming for a second opinion and will likely never be seen again or a patient is coming back for their 15th or 100th appointment, we treat our patients like we too want to be treated as fellow human beings: with a respectful and non-judgemental approach.  

3) Our third promise is that we will never promise results. I can't state this enough. We will never promise results - but will will do everything we possibly can that is within the reaches of current biomedical science to get hair growing or stop it from being lost. We can not be so bold as to think humans can 'fully' control and navigate how hair follicles grow and don't grow. This approach is simply wrong. It is a wonderful goal for the future, but not a goal that is with us yet.  We will never promise results. I can confidently and respectfully say that our clinic sees some of the most complex presentations of hair loss. I achieve success in a good proportion of patients. I fail too.  In 2017, the field of hair medicine has a rudimentary understanding of hair growth mechanisms. This actually which gets us pretty far - but not far enough. There are no such things as guarantees for any hair loss condition. Period.  

 

THE FUTURE

In recent years, I have come to see that the bigger picture has some very lofty goals. We have a lot of work to do to train more physicians to recognize the importance of hair loss and to provide appropriate care for all types of hair loss. I continue to teach other doctors with the hopes that new doctors might also consider this field of medicine to be interesting and consider pursuing it as a career.  We have a lot of work to do to help insurance companies and health care providers understand not only the impact of hair loss but also the impact of helping people achieve hair growth.  We have a lot of work to do to bring safer, more effective treatments to our patients. We have a lot of work to do to support and fund high-quality research. We have a lot of work to do to remove from the world those ineffective products & services that prey on the vulnerability of those with hair loss. The goals are lofty but achievable.  

My sincere thanks for visiting our website.   I hope you'll find it informative and helpful in your personal quest to find information and answers. If you have a question, type in in the link here: MY QUESTION.  There's a good chance something helpful will pop up from one of the many hundreds of articles and blogs I have written. I also enjoy answering patient questions on my blog posts, as well as websites like Realself.com. My Instagram posts are a great way to learn about hair loss and also provide a means for individuals to ask questions. 

 

Thank you again,

 

Jeff Donovan

Vancouver.

 

 




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