Dr. Donovan's Daily Hair Loss Blog (2011-2017)


20 PrincipLES of PRACTICE



I have been honoured to have helped many patients with hair loss. The following are my personal views and opinions and provide insight into how I practice as a hair loss physician. 


A. My General Principles about Diagnosis & Evaluation of Hair Loss

Principle 1: The most important question an individual with hair loss can ask is "What is my actual diagnosis or reason for my hair loss? Is there more than one reason?"  In fact, the failure to identify the correct diagnosis is the most common mistakes people make about their hair loss.

Principle 2: There are countless numbers of different hair loss conditions and a person can have one, two three, four or rarely five conditions at the same time. It is true that you may have the same hair loss condition that your mother, father, or friend has - but you might not. 

Principle 3: Scarring hair loss conditions (also called the 'cicatricial alopecias') are much more common that we currently recognize. They are under diagnosed. 

Principle 4: A careful history of a patient's hair loss, a full evaluation of the scalp using trichoscopy and review of any necessary blood tests are how one reaches a diagnosis of hair loss.  All of these steps are important, but a detailed story of the patent's hair loss and health is probably the most important. 

Principle 5: All women with hair loss require blood tests. The exact blood tests the physician should order will differ from patient to patient according to their history of hair loss. However, one can rarely be completely confident of a diagnosis until blood test results have returned.

Principle 6: There are far more health conditions associated with hair loss than we currently recognize in conventional practice. As just one example  - the relationship between early male balding and heart disease, blood pressure problems and cholesterol problems.

Principle 7: One of the most helpful ways to evaluate the success of treatment is a simple camera. If a camera shows improvement - there is likely improvement. If a camera shows that there is less hair on the scalp after 9 months of treatment, the treatment is likely not helping to regrow hair.

Principle 8. Scalp biopsies are under-utilized. They are not needed in every patient with hair loss - and less than 5 % of patients who come to see us have biopsies. However, many patients would receive the correct diagnosis - and get started on the right treatment sooner -  if a biopsy was done.

Principle 9: There are far more hair loss conditions and patterns of hair loss than are recognized in textbooks. What we have now gives us a framework  - but it is incomplete.

Principle 10: The internet can potentially be very, very wonderful to anyone with hair loss but the internet can also be very, very harmful to an individual with hair loss.


B. My General Principles About the Treatment of Hair Loss. 


Principle 11: One can not even begin to discuss treatment until a diagnosis has been given. Every effort must be made to determine the diagnosis of an individual's hair loss.   

Principle 12: The early diagnosis of hair loss and early treatment generally leads to better long term outcomes.

Principle 13: When deciding on a particular treatment, one must ask "Have clinical research studies have been done on this treatment - and if so, how many studies have been published in the medical journals and how good are these studies?" These simple questions are not asked enough and this leads to many patients wasting time with ineffective treatments. 

Principle 14:  Recommendations for treatment must be made according to what I have termed the S.A.F.E Principle. Treatments must be safe, affordable, feasible and effective.  A new treatment that is very expensive and not very effective should never win out over an effective treatment that has long been used and is inexpensive. 

Principle 15: Scalp inflammation likely plays a more important role in many types of hair loss than we currently realize. 

Principle 16: A high proportion of women with androgenetic alopecia are not good candidates for hair transplantation. Some are candidates for the procedure of course - but this requires expertise to select those who in fact are good candidates. Far fewer women than men are good candidates for surgery.

Principle 17: Hair transplantation can be a good option for many men - but only after age 25. In discussing hair transplant options, the long term hair loss pattern of the patient must never be ignored. A young man appears to have endless hair for surgery. If we could fast forward to his 50s or 60s we would often see that in fact there is little donor hair there.

Principle 18: No drug is free of potential side effects. However, one must understand whether the potential side effect is 'very rare', 'rare' 'common' or 'very common.' 

Principle 19: Natural, holistic, and traditional treatments are wonderful and always welcome - provided they help.

Principle 20: Not pursuing treatment for one's hair loss is always an option. This should always be remembered.  




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