This AmA has ended.

Great questions today, thanks to the Reddit Community! We look forward to our next AmA with you all.

With extensive patient experience and over 60 combined years practicing Clinical Dermatology focusing on hair loss and regrowth treatments, we are Clinical Dermatologists Steven D. Shapiro M.D. and Michael T. Borenstein M.D. Ph.D.

We operate Gardens Dermatology in Southern Florida as our practice and founded Shapiro MD to bring safe and effective products for treating hair-loss through eCommerce and telemedicine distribution.

More information can be found at:

http://www.gardensdermatology.com/hair-loss.html

https://shapiromd.com/main/AMA

edit: thanks for the silver and gold!

Comments: 2289 • Responses: 36  • Date: 

HPSteakcraft2266 karma

How's the future looking in terms of a cure for male pattern baldness (reversing, not just preventing)?

OIlberger5070 karma

If the richest man in the world is bald, we’re not close yet.

BAjdmguy1071 karma

What about Elon Musk?

NeverEnoughMuppets519 karma

Or even Joel McHale

OIlberger681 karma

Musk got hair transplants, which is different than “plugs”. Transplants nowadays can be pretty damn effective (if you can afford a good one), lots of celebs have had them. Steve Carrel, Matthew McConaughey, look at their “before” pictures, they definitely had transplants. McHale either got transplant or he’s wearing a “system” (elaborate hairpiece).

I’ve read that hair cloning is the next technology (basically, you can only get a transplant if you have enough hair in the back of your head, cloning will let you have unlimited “donor” hair, but it’ll be really expensive). Plus you can keep balding after the transplant, requiring another transplant for maintenance. And it leaves scars. And it’s a painful procedure, But it’s pretty much the only “cure” on the horizon (besides Rogaine and Propecia, and there’s plenty of case studies to see how effective those are), there’s no pill or procedure in the works that’ll reverse it or stop it entirely.

ShapiroMD-HairLoss605 karma

Cloning makes sense as the person will only have new hairs placed, without the need for the painful donor areas. New hairs placed typically do not cause pain. There will be an unlimited supply but there will be costs for cloning and storage, not to mention placement of the new hairs.

ShapiroMD-HairLoss731 karma

I think the ultimate goal of treating male pattern hair loss is to stop the loss so the person can retain their own hair. We will see that in our lifetime, most likely through stem cell or gene therapy.

ShapiroMD-HairLoss469 karma

I think that improvement in current DHT blockers will occur. Stem cells and exosome technology will become more specific for hair loss. Cloning of hair will become FDA approved in 2 to 3 years as well.

ShapiroMD-HairLoss136 karma

Stem cells and exosome therapy will be improved. Cloning will be FDA approved in the next few years. DHT blockers will be used in combination with other products.

ShapiroMD-HairLoss0 karma

Much research is being done to work on more effective treatments for male pattern hair loss. The currently available treatments in many situations can be very helpful. Each person's situation is unique and needs to be addressed specifically based on their physiology.

lavenderpebbles590 karma

I am a hairstylist and one of the most common things I see in my female clients is loss of density around the hair line and temples. I have assumed this is due to hormones but I've never really understood why. Could you explain why this is so common in woman? And can it be prevented ?

ShapiroMD-HairLoss580 karma

Women tend to preserve their front hairline and thin on top of the head in female pattern hair loss. If you see loss of the front hairline, then some other cause may be occurring beside the Ludwig phases of female pattern hair loss. Most often, it can be a Traction Alopecia or hair loss, caused by many previous years of pulling hair into a tight style which weakens hair. The weakened hairs would be the first to fall out.

ShapiroMD-HairLoss174 karma

Female pattern alopecia is the medical name for common type hair loss in women.

Some studies have shown that 40% of women have some hair loss by the age of 50 and fewer than 45% of women reach 80 years old with a full head of hair. It is common that hair loss of this type in women starts at the hair line and thins in the center as time passes. Genetics play a significant role in women's hair loss, but there is no specific test at this time to show if a woman will have this type of hair loss or how it will progress if it happens. Circulating hormone levels have not been shown to have an obvious connection to female pattern alopecia. Most women with female pattern alopecia have been shown to have normal hormone levels, so it is still unclear as to the true pathway for women's hair loss, but it is definitely specific to women.

Healthy balanced diet, exercise, lowering stress levels are the basics for prevention. Over the counter shampoos with naturally occurring anti-hair loss ingredients and minoxidil are beneficial for women with hair loss, however, the oral treatments (finasteride and dutasteride) are NOT to be used in pregnancy capable women and have NOT been shown to be effective for women with pattern hair loss.

onesadlittleboy494 karma

Is minoxidil actually working? If so, is it true that it cannot be used 4 hours before and after the hair was washed?

Also, is washing hair daily damaging them in the long run?

ShapiroMD-HairLoss745 karma

Minoxidil is thought to increase blood supply to hairs, bringing much needed nutrients to maintain hair, and in some cases grow hair. It takes a few hours to be absorbed, that is why waiting 4 to 6 hours after applications, is of benefit to allow complete absorption. Daily or every other day hair washing is of benefit to keep hair clean and remove the normal cycle of Telogen, or resting, hairs. If you wash less often than daily, you will still lose the same amount of hairs (normal is 150 hairs per day), so you can add the days together to realize the catch up hair loss will end up being the same. This means if you wash every third day, then expect to lose 450 hairs in a normal hair loss cycle.

diagas443 karma

Is biotin a fad or worth it? I used to do supplements and currently use a shampoo. I'd consider my intentions more proactive than reactive, so any course correcting info would be appreciated. 29 y/o M here.

ShapiroMD-HairLoss1023 karma

For many years, biotin has been considered beneficial for hair growth. Many people were taking biotin as a supplement with the hope that it would help the hair grow more effectively. More recent studies have demonstrated that the best way to get biotin is through dietary sources (i.e. eating it in food) as opposed to a supplement. It turns out that simply adding a biotin supplement is not as useful as eating it regular food sources, such as common foods rich in biotin - eggs, almonds, cauliflower, some cheeses, mushrooms among others.

Martholomeow397 karma

So eat a lot of mushroom and cheese omelettes?

ShapiroMD-HairLoss305 karma

BRB, This hair-loss AmA "brought to you by Denny's."

goz88430 karma

How come they didn’t answer anything?

ShapiroMD-HairLoss146 karma

I just stepped in to answer questions and am also going through older, less common, questions. Feel free to repeat an important question as I step in.

TacoDoc372 karma

Can you shed some light on what sort of treatments celebrities are getting that makes their hair fuller? I feel like they are paying for some top level procedures because the results are not half bad. Are they just well done hair transplants? I’m thinking of people like Gordon Ramsey, Elon Musk, lesser known but definitely had something done was Daniel Tosh. What exactly are these people doing?

ShapiroMD-HairLoss677 karma

I cannot say what people I do not know use. However, I know a person who sells glue for hair pieces and he says 80% of Hollywood has hair pieces for what that information is worth.

Elon_Muskmelon159 karma

Also see Deion Sanders, Brian Urlacher, and in-progress Lebron James. Its plugs. They're just getting pretty good at it these days.

ShapiroMD-HairLoss338 karma

As a Miami Heat fan, I watched Lebron lose hair through the years and stress of his daily grind. I noticed more recently that he had more hair. I believe he has had hair transplants but cannot say for sure as I do not know him. The procedures are relatively quick healing, so even with his short off seasons (from so many trips to the NBA finals), he could manage the healing time.

MisterTatoHead98 karma

u/ShapiroMD-HairLoss do you think Lebron and the Lakers will outlast the Clippers this year?

ShapiroMD-HairLoss133 karma

It should be a great battle in the Western Division! Don't discredit the Heat in the East, I think they might have a shot this year! (no pun intended)

TacoDoc21 karma

Username checks out.

Follow up question - does the transplanted hair grow?

ShapiroMD-HairLoss77 karma

Transplanted hair typically falls out as it is pushed out by the new hair growing underneath. It is highly successful with final results 9 to 12 months later.

EbenHSHD182 karma

What are the early signs of hair loss and is there anything that can be done to slow/stop it?

ShapiroMD-HairLoss565 karma

The earliest sign of male pattern baldness is called "bitemporal recession". This means that the top corner of the forehead on each side has the hair pull back and fade away. As time passes, this hair loss continues to move back and the hair starts thinning on the crown (top of the back) of the scalp.

The best way to help slow/stop it is:

  1. Healthy diet,

  2. Exercise consistently,

  3. Attempt to lower your stress level

  4. Start with over the counter shampoos/conditioner/leave in products that are supportive of fighting the DHT (dihydrotestestosterone) effects on the hair. There are great choices to help, especially early on. The sooner you start fighting hair loss, the more likely it is that you will be able to help stop and even improve your hairline.

  5. If these choices don't help, then make an appointment with a Board Certified Dermatologist who can further evaluate the situation and make formal recommendations for you.

MiddleEiffel135 karma

What is considered normal hair loss? As a female, it feels like I am losing a lot of hair, but I can't tell if it is thinning. I don't want to catch it when it is too late.

ShapiroMD-HairLoss153 karma

Great question!
It is normal to lose approximately 100 hairs per day. This is an average as some people will lose more and others less for their typical average.
Therefore, you should expect to see some hair on the brush/comb/shower drain as you manage your hair on a daily basis.

In addition, the length of the hair lost can make it seem like more or less hair that is falling out. If your hair is long, then one hair coming out will seem like a lot more than someone with very short hair. This is a common sense idea but many of my patients have felt better after talking about this point because they just see these long hairs rolled up and it seems like such a large amount.

As long as you do not see any bald spots and you feel that your hair is growing, then you should not worry too much about seeing some hair come out when you brush or shower as this is normal.

If that changes or you have bald spots or are concerned about your hair growth, then you should make an appointment to see a board certified dermatologist for further evaluation.

MrsMeeSeeks43580 karma

Thank you for doing this AMA. I am a 29F who had a baby just over a year and a half ago. I breastfed up until a few months ago. Around 6 months ago my already baby fine, thin hair started falling out and thinning even more to where I feel like I look horrible and look bald/ing. I have been to the doctor and my thyroid is normal, antibodies are all normal. Trying to eat right and live healthy. Any tips or tricks on getting my hair back? Or is it just a baby thing and I've got to wait until my hormones regulate?

ShapiroMD-HairLoss142 karma

I start examining hair by performing a hair pull test. I look to see the stage, i.e Telogen effluvium (stress aggravated hair loss like after having a baby and understandably a new sleep cycle for the child and Mom both). Then, I perform a full hair loss panel of blood tests. I perform a CBC with diff, Platelet count, SMAC-20, ANA, RPR (diagnostic), TSH, T4, DHEA-S, and Total Testosterone. I look at medications and over the counter supplements as well as they can cause hair loss as well (like too much Vitamin A or birth control pills). If all of this is negative, then I perform a biopsy of the skin at the edge of the hair loss. Please make sure all of this was done.

tAL_GOREan50 karma

[deleted]

ShapiroMD-HairLoss80 karma

A healthy lifestyle is essential to maintaining your physical well being, which, obviously, includes your hair as well. High stress levels negatively affect an individual's health and can be part of hair loss issues. A balanced diet with the proper recommended amounts of nutrients is critical to giving your hair the building blocks necessary to grow properly.

ShapiroMD-HairLoss46 karma

Thank you all for your excellent questions.

Dr Steven Shapiro will be taking over the AMA moving forward.

Best regards,

Michael Borenstein, MD, PhD

sekerzitski45 karma

What are your thoughts on taking Dutasteride to prevent hair loss?

ShapiroMD-HairLoss113 karma

Dutasteride is a medication that has been used for fighting hair loss in men. In a recent published meta-analysis, Dutasteride (which works in a similar way to Finasteride - by blocking 5-alpha reductase, which is the hormone that changes Testosterone to DHT) was highly effective for male pattern alopecia. This means that it helped male pattern baldness in a beneficial way as a prescription pill treatment from a physician.

Typically, a person will start taking dutasteride or finasteride once there are signs of hair loss (bitemporal recession/thinning on the top). When I discuss the use of oral medications, I will commonly discuss the use of these medications, even in the early stages of hair loss. This is because once hair loss becomes visibly noticeable, we don't have any true way to predict how much hair someone will lose. Thus, it makes sense to discuss all the options - from over the counter to prescription medications.

liftedup_sky27 karma

What are some options for women with thinning hair? I'm only in my 20s and already notice my hair thinning out.

ShapiroMD-HairLoss37 karma

Use gentle shampoos and conditioners, like DHS or Free & Clear Shampoo. Limit blow drying and teasing of the hair. Coloring can weaken hair in some patients. Make sure your sleep habits and diet are healthy. Have annual routine blood tests to check hormones and look for anemia.

Trafago25 karma

Hello Doctors, I have a question regarding seborrheic dermatitis and its affect on hair loss. I have this condition both on my scalp and my face (more mild on the scalp but worse on the face)

I also have genetic hair loss, I have noticed that my beard hair is getting thinner, can seborrheic dermatitis cause hair loss on the scalp and of the beard?

I've been prescribed to use ketoconzaole 2% for both my scalp and my face- can that actually worsen the hair and beard loss?

ShapiroMD-HairLoss25 karma

Great questions. Some work was done a long time ago showing that inflammation was the first step in hair loss. Seborrheic dermatitis is a form of inflammation. If it becomes severe, then hair loss can follow. Keeping Seborrheic dermatitis under control is very important to reduce it's damage to hair. Ketoconazole is an antifungal which has been used to treat Seborrheic dermatitis. Ketoconazole is also a weak DHT blocker so it can benefit male pattern hair loss, but keep in mind it is weak for male pattern hair loss.

TheSchnipe21 karma

Are you related to Ben Shapiro?

ShapiroMD-HairLoss40 karma

My cousin's son is Ben Shapiro, not sure if it is the same one.

ShapiroMD-HairLoss12 karma

Welcome to the Hair Loss AMA. I am Michael Borenstein, MD, PhD. I will be responding to your questions until 3 pm when Dr Steven Shapiro will take over.

orders1-6510 karma

How much research has been done on PRP? I've had it recommended as a female in the early stages of hair loss but it seems closer to ancient bloodletting then modern science. They're promising to inject blood platelets into my scalp that causes it to begin regrowing hair and I was quoted an 80% success rate. Nobody can tell me how success is defined and that everyone is different so I'll have to pay for 4-6 sessions before finding out if it works at all.

ShapiroMD-HairLoss20 karma

I tried it for patients a few years ago and found a 50% success rate at that time. More recently, a study out of NYU (a different Dr. Shapiro) showed a 70% success rate. I believe you have to do more treatments in a series to have some success as not each treatment will be successful. The biggest risk is the cost as it is not typically unsafe in the right hands, just not as successful as each patient would want.

ducklingugly18 karma

does minoxidil give a long lasting solution to the typical hairloss problem in men?

ShapiroMD-HairLoss22 karma

Like all products, including toothpaste, minoxidil only works while using it. I found it grew and maintained hair in 80% of patients, with most of those being maintenance.

ShapiroMD-HairLoss7 karma

Thanks so much for all the great questions today! I wish we could have answered each one, but we will plan to do a follow-up AmA later this year - hopefully many of you will be able to reply with great results by then. Please check out shapiromd.com for more information on treatments available for order or prescription online. If you have any other questions email [[email protected]](mailto:[email protected]) and we will do our best to get back to you.

Sloopsinker5 karma

What causes hair loss? And why are most bald people only bald on top?

ShapiroMD-HairLoss16 karma

Thank you for participating. There are many causes of hair loss, including the most common - androgenic alopecia (also known as male pattern hair loss in men and female pattern alopecia in women), which is typically a genetically programmed process in which the person's hair is following the body's process of telling the hair to shrink and disappear in response to hormones; there are dietary causes of hair loss (especially in people with a limited diet or problems absorbing typical nutrients); infections can cause hair loss (bacterial and fungal infections most commonly); stress can cause hair loss (in response to physical stress - surgery/sickness/injury - or emotional stress) where the hair changes its method of growing and shifts into a falling out pattern.

These are just a broad overview of the many causes of hair loss and does not cover all the causes of hair loss, but I listed some of the most common ones.

In response to the question regarding the location of the baldness, it turns out that the method of hair loss - which is believed to be the hormone - DHT (dihydrotestosterone) causing the hairs to shrink and fade away in the typical balding pattern in the center and top of the scalp, the hairs on the sides and back of the head on the lower part, do not have the receptors to respond to that hormone. This is the reason that even people who have lost the hair on the top, still keep the lower part of the hair. The lower hair doesn't respond to the hormone, so that hair stays.

LemmeSmashMyHead4 karma

Are there any "Natural" methods to prevent/slow hairloss that actually work? Or are they all a farce?

ShapiroMD-HairLoss17 karma

There are definitely naturally occurring ingredients that are helpful for hair loss. Saw palmetto berry extract has been specifically shown in published studies to interfere with the method of pattern hair loss. Caffeine at proper concentrations in a topical (applied directly to the scalp) preparations has also been shown to be benefical for hair loss and block the effects of DHT in published studies as well. In addition, extracts of Green Tea (a common drinking tea worldwide) have been shown in published studies to be beneficial in blocking the effects of DHT.

These ingredients, individually or in combination, are naturally occurring substances that have been shown to be beneficial for fighting hair loss. You can find over the counter versions of these ingredients in commonly available shampoo/conditioner/leave in products.

ShutupPussy3 karma

Do you have any comment on the terrifying condition some men get called PFS (Post Finesteride Syndrome)?

ShapiroMD-HairLoss8 karma

I am not familiar from my patients. I have prescribed Finasteride for many years without seeing it in any of my patients. I have read up on it and it sounds horrible.

faydgetspyner3 karma

How does wearing cap/hats all days every dat effect the hair on men?

ShapiroMD-HairLoss5 karma

If tight, they can reduce the blood supply to hairs, aggravating hair loss.

Hijinx_MacGillicuddy3 karma

What are your thoughts on PRP? Does it work? Is it the best option?

ShapiroMD-HairLoss6 karma

I answered PRP to another person saying that the highest success I have seen is 70% from a different Dr. Shapiro at NYU. This means it does not work in everyone but may need multiple treatments. It is very safe so I think the biggest risk is the cost, meaning you pay for something but may not get the result you want.