Alessa Avec Fashion

Doctor Alan Bauman, who did my hair transplant, commented on my recent post about hair loss and it brings up an interesting issue:

Countless patients come through our doors each year after being shunned or even ridiculed by their dermatologist for wanting to do something about their hair loss. The most help any of them ever got from their Derm was a bottle of rogaine as they were sent out the door. Seek the advice of a trained medical professional who SPECIALIZES in hair restoration.

It's true that the majority of primary-care and dermatologists aren't interested in hair loss treatment, and find it a distraction. It's not covered by insurance, and a typical PCP or dermatologist won't profit from treating hairloss. More importantly, they often lack insight into a simple fact: if the patient had the courage to ask a physician, he likely is highly concerned about his hair-loss even if he appears otherwise. So when he's dismissed or ignored, he probably loses some trust for the physician.

That trust can undermine the doctor-patient relationship in ways the doctor never sees. Kinda sad, so here are some tips:

1. See a specialist if you can. Even if you're not interested in a hair transplant, a physician who specializes in hair is ideal (if your dermatologist or PCP has hair-loss informational resources in the front office, you're probably safe).
2. If you talk to your primary-care physician (or some derms), you're likely to do so at the end of an appointment discussing another medical issue... so don't wait until the doctor is reaching for the door handle.
3. Educate yourself before going, and let the physician know what you've tried already. This will help him/her know you're concerned. Trust me: unless he's treating his own hairloss, he's not going to know you're concerned about yours if you're subtle.
   
4. Ask for a recommendation and not options. Many physicians feel they're serving the patient if they list a variety of treatment approaches. While this demonstrates the physicians knowledge, the patient wants the doctor's advice.
5. If all else fails, go to another doctor. It's a lot easier to find another doctor than to try to change your doctor's personality or methods.

The Baltimore Sun did a piece Friday about hair loss and remedies, and ended with a nice quote:

Aside from the psychological implications, pattern hair loss has no negative health consequences. What you choose to do about it -- which may be absolutely nothing -- is a personal decision, best made after talking over the options with a dermatologist, family, and maybe some fairly objective friends.

The piece outlines the two FDA-approved remedies (Propecia and Rogaine), and offers some information about transplants. There's also some tips in regards to being "gentle" on hair, but I'm not sure I've seen enough reliable information about hairloss caused by scratching or towel drying. I think this is overstated because it's when we notice hair falling out.

When you get a normal hair transplant, you have a big ol' scar on the back of my head. Check out this photo of my head the next day. Pretty clean, thanks to FUE (follicular unit extraction) and we did nearly 2,000 grafts.

I never paid much attention to the Dutasteride (Avodart) vs. Finasteride (Propecia) when I worked on Propecia. Avodart isn't approved by the FDA for hairloss treatment. But I do remember the conferences where some physician always seemed to have an agenda to prove Dutasteride was better (I assumed they were part of the Avodart studies, or trying to get selected as paid "thought leaders" by GSK, which markets Avodart).

Turns out there was a study on it, but I don't know much more than I've read here.

Seems .1 mg of dutasteride had similar hair improvement at 24 weeks to finasteride 5 mg. But I'm kinda perplexed as why they didn't use finasteride 1 mg (which is the dosage of Propecia) and why they jacked up the dutasteride in one group to friggin' 2.5 mg, which gave 9 of the poor study participants a lowered libido.

Why study the extreme, when most of the hairloss benefits (and lower side effects) is realized at lower dosages? The incremental benefit in hair growth (or reduced loss) seems to be offset by the side effects... of either drug. So I'm glad I'm taking Propecia not Proscar (5 mg).

That said, it would appear that too much of these medications can drop your libido, which is always something I thought preciously was overstated. But this generally resolves after you stop (and many side effects of pharma drugs resolve after your body adjusts to it).

The thing about sexual side effects is that if you're told you'll get them, your odds of getting them increase significantly. It shows the power of expectations. Remember that, in early clinical trials, Propecia saw one group of men who dropped treatment more often, citing adverse reactions. That group, it turns out, was the one taking the placebo (sugar pill). See the Propecia Q&A for more information. It took me months, but I finally promoted that little-known fact from its hiding-place in the PI (prescribing information) to the Q&A... because I found it charmingly interesting. Of course now I can't find it, but here's the Q&A.

Here's another website (http://famewatcher.com/category/celebrity-hair-transplants) that "outs" some of the celebrities with alleged hair transplants.

Again- tough to tell without seeing a really close before/after picture, and even those can be deceptive. We've all seen old and new photos where our hair looks good and bad... lighting, growth and moisture can alter appearances.

My favorite rumor... Kevin Costner made the director use computer-generated imagery (CGI) to give him a better hairline. Kevin, a hair transplant would have kept Waterworld's budget in a better place.

Well we've started a fad. Seems Italian Prime Minster Silvio Berlusconi has "come out of the closet" with his hair transplant, and has become "the poster boy for male hair transplants and their age-defying benefit." (Source: Financial Times).

This excerpt is interesting. It puts the technology progress in layman terms, and gives you some insight on what guys go through before getting a transplant, which Beacon (see below) calls "no less painful than going to the dentist." I beg to disagree. It's a hell of a lot easier than going to the dentist. For starters, hair-transplant physicians are slightly less socially awkward.

But today’s hair transplant technology is as far removed from yesterday’s as the iPhone is from the clunky 1980s car phone. Brian Beacom, a 53-year-old journalist and author of Diary of a Hair Transplant: A Journalist’s Search for David Cassidy Hair (Phantom), waited more than two decades before going ahead with the procedure, watching the technology develop until it had been perfected. Beacom says: “Going bald really highlights the ageing process. You look 10 years older if you haven’t got hair, and you can look 10 years younger if you have it. Now people react to me differently, especially bald men who don’t know I have had a transplant; they look at me with a certain amount of envy.”

Alex asked in recent comments about Propecia being on the list of drugs that exclude you from donating blood. I was always bothered by that when I worked on Propecia, because it made it sound toxic.

The issue is simply that women can't take Propecia (no studies on women, and potential for birth defects). They can't even handle them (even though they're coated). They can't even smell Propecia, or be within 10 miles of the pills (mkay I'm having fun now). I didn't take Propecia when I was having kids, even though no research has shown that finasteride can travel to the women via the sperm. I've heard indirectly that scientists say it would take about 7 gallons of seamen for this to be a risk, but not a risk I wanted to take. Then again- I was probably passing along far more toxic things than finasteride. Like martini olives.

Why can't they identify the blood donoations as "for men only"? I dunno. Then again, I used to have blood-donor cards with multiple listings of my blood type. So I guess the system isn't perfect.

And as a Propecia user, I see this as a benefit. I can guilt-free avoid giving blood, which I despise (see proof in this, one of my least-viewed videos).

So ladies (especially those in child-raring years) are gonna have to stick with the rogaine/minoxidil (there's even a ladies dose of that for reasons I don't quite now). Or you could try some folk remedies. Here's a recent StopAgingNow article on what women can do.

Here's a great example of why managing patient expectations is really important. Per this picture, I'm seeing my regular hair growing out pretty fast. But the transplant area (and other thin areas) aren't growing out as fast or as dense.

Some people are saying, "dude your transplant didn't work." But Dr. B explained that post-transplant you don't see immediate results. In fact, even in 6 months I'll only see half the benefit.

But in a year, we'll see most of the improvement. As they say, "it takes a while to lose hair, so growing it back isn't overnight." They also say "I wish martini glasses had higher edges so they didn't spill in the bus." I think the latter is more funny.

Yeah, it's called "site retargeting." You do a web search for hairloss, balding or something related. Or maybe you buy a hair-loss book or visit a Bosley website.

Suddenly days and weeks and months later, everywhere you go on the web you get reminders of your sad fate. Here's a Bosley ad that appeared while I was searching Super Mario Galaxy 1 (hint: you don't need the 1).

Coincidence? I think not. Embarassing? Maybe for some, but not for a guy who did hair transplant live on the web. Smart marketing? I'd say yes.

Of course super smart marketing would be excluding guys that are already "hearting" their current surgeon... surgeonofnalts.

Not familiar with JimmerSD's term "Squirrel bomb"? It's kinda like getting rickrolled I guess.

Here's a couple "after" photos to show my new hair. It's kinda hard to see because they aren't next to "before" photos that match. The first was taken August. 26 and the second on August 30 (my surgery was August 18). Whatya think?

Most people think the hair-transplant procedure results are immediate, but it takes about 6 months to see 50% of the benefit, and a year to see 90% of the benefit. So I'm taking my Propecia and dabbing on my minoxidil (what Bauman calls the "sugar and caffeine).

Let it grow, let it grow, let it grow!

Hey, if I'm going to broadcast my hair transplant live, why not the follow-up? In my first real live-broadcast (I've done 800 plus videos online, but the live thing always terrifies me), I conduct a live & public follow-up consult via Stickam with someone from Bauman Medical. And I try to stay focused as I read the myriad of insults so common on Stickam. :)

In an unusual publicity campaign, Bosley is offering free hair transplants to 19 lucky war veterans. Time to lose the buzz cut?

Aztarnet.com reports: