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Thanks for watching!

thanks. For what condition are we talking?

@ not even hair loss. I just want thicker eyebrows and at least a connected subtle. I currently have no facial hair

Not everyone responds to finasteride and minoxidil with new growth. That's the first thing to point out. Maybe 30-50% do, depending on the stage they start out with. But not everyone does. So, it's a bit of myth that everyone gets improvement. Some find that their condition is paused - but not improved. Second, it's rare to have HN7 at age 21. So be sure to get a professional opinion on your stage. Most males who think they have HN7 aren't actually in this stage. Remember- one needs to bald in these areas to call it HN7. If there is some fine hair or some thinning in these areas, then no- this is not the correct stage. It's almost impossible to be a true HN7 at age 21. Yes, it can look thin, but no, it's not common to have HN7. Usually, males who tell me they are HN7 are actually somewhere between HN3-5. HN7 means very little to no hair in these areas and a small fringe of hair around the back.

@ thank you for your response. I have sent in my question of the week to you 3 or 4 times. I uploaded all my pictures from when I was a NW2 at 15 up to when I was at a high NW scale at 20 years old, along with being extremely thinned out on the sides and back. I uploaded my bloodwork and family history details. I have gone to multiple dermatologists and they don’t do much of anything. My endocrinologist i saw asked me more questions than the derms I saw. I know it is about impossible to see you, if there is any way you can look at my question of the week, it would be much appreciated. Also, is there any said reason why some people don’t get regrowth and others do? Thank you for all do

@@HIMYM123456789 one needs to be careful about interpreting data for large groups vs single patients. yes, as a group patients in oral minoxidil are not expected to have much of an increase in heart rate or reduced blood pressure compared to those not using this drug. But don’t think for a moment that there is not an occasional patient that is quite sensitive. There is! There are occasional patients that even feel unwell on topical minoxidil too! Fortunately all this is rare. As for your issues, you’re going to want to review all this really carefully with your doctor so he or she can ask you good questions and figure out how best to assist. Some patients do improve their cardiovascular responses but not everyone.

@@donovanmedical9780 Thanks for the response Dr. I'll share my experience in case you were interested professionally. I was taking .625 and later 1.25mg for a month experimenting with doses and timing and some baroreceptor resetting did seem to take place eventually where my reflexive heart rate and contractility response was lowered in intensity, but did still get an increase around 8-10bpm (pulse-ox measurement) for around 1:40-2hrs after a dose. Overall did not feel well along with occasional dyspnea, even with normal range BP and cardiovascular health. I was just not a good candidate. Another interesting side effect I noticed (went off and on the drug 2 times to confirm this) was slight reflux-like symptoms or an occasional globus sensation in the throat. Especially after a big meal, which is expected but was amplified while taking minoxidil. I'm not sure if minoxidil can affect the LES a little initially as it also has potassium channels which can be hyper polarized (albeit not the same type) but the LES is regulated by several other major systems so its effect might not be as pronounced. But probably not to the extent of endothelial smooth muscle since it's not its pharmacological target. Overall, these symptoms might have been tolerable for a drug that needs to be taken temporarily. I was wondering if rubbing a little bit of topical minoxidil at the temples (I seem to still have some miniaturized hair there that may be viable since I'm in the very early stages) would cause any adverse effects around other parts of the scalp? It's my main problem area and using it over my scalp also makes me feel unwell, though not to the extend as the oral form.

@@donovanmedical9780 Thanks for the response Dr. I'll share my experience in case you were interested professionally. I was taking .625 and later 1.25mg for a month experimenting with doses and timing and some baroreceptor resetting did seem to take place eventually where my reflexive heart rate and contractility response was lowered in intensity, but did still get an increase around 8-10bpm (pulse-ox measurement) for around 1:40-2hrs after a dose. Overall did not feel well along with occasional dyspnea, even with normal range BP and cardiovascular health. I was just not a good candidate. Another interesting side effect I noticed (went off and on the drug 2 times to confirm this) was slight reflux-like symptoms or an occasional globus sensation in the throat. Especially after a big meal, which is expected but was amplified while taking minoxidil. I'm not sure if minoxidil can affect the LES a little initially as it also has potassium channels which can be hyper polarized (albeit not the same type) but the LES is regulated by several other major systems so its effect might not be as pronounced. But probably not to the extent of endothelial smooth muscle since it's not its pharmacological target. Overall, these symptoms might have been tolerable for a drug that needs to be taken temporarily. I was wondering if rubbing a little bit of topical minoxidil at the temples (I seem to still have some miniaturized hair there that may be viable since I'm in the very early stages) would cause any adverse effects around other parts of the scalp? It's my main problem area and using it over my scalp also makes me feel unwell, though not to the extend as the oral form.

Good luck

@@hollaz2 Alopecia areata is an autoimmune disease. From the day you were born you has a chance to develop this. in the present day, we don’t understand everything about alopecia areata but we know some have a form that comes and goes meaning hair falls and then grows back again. Some have a form that sticks around and only goes dormant with ongoing use of drugs. Triggers like covid do cause it to appear in some patients. Alopecia is never cured or fixed - there is always the possibility of it returning. You are on some really good treatments but you might want to speak to your dermatologist about all the treatments that exist and when and how they are used. Alopecia does not spread like an infection but simply starts up at other areas.There are 25 treatments so be sure to sit down with your dermatologist if things aren’t improving how you imagine.

@@donovanmedical9780 A sincere thank you for the reply. I forgot to ask, the patches have been random on my face and scalp, but, they are symmetrical for the most part on both legs - does this mean anything at all?

@@hollaz2 Not really, That's quite typical. But like all hair issues, I would need to see your skin and hair up close with trichoscopy (magnification) and know everything about your health history from day 1 of life up to today. But the short answer is not really.

@@donovanmedical9780 Ah okay, I was under the wrong assumption that symmetrical alopecia areata carries a greater likelihood of developing alopecia universalis. Even though the lesions on my scalp and face have improved because of the steroid injections, the hair loss on my legs continue to get bigger because of no intervention; will it eventually result in losing all my leg hair? I'm praying everyday for my alopecia to go into remission so that I can move on from this. Thank you for answering my questions.

Please doc I need to know. Nothing is helping my hair loss

Following for info..please reply here

@@nathan87 these hairs carry little significance here. if you have concerns about a condition post hair transplant, then you need a few properly done scalp biopsies

@@donovanmedical9780 thanks so much for the reply, it is good to hear that you seem to be in agreement with my dermatologist. Regarding biopsy - yes indeed. The problem is that the issues are only in the transplanted area right on the hairline. The symptoms are mild and have not yet resulted in any obvious loss, so at this stage I am not keen to take multiple biopsies from that area. This is why I am currently trying to use other clues to determine whether there is anything worth proactively treating.

@@nathan87 please see a dermatologist or hair specialist who really understands trichoscopy. Looking at pulled hairs like you are mentioning will not get you anywhere. We diagnose hair loss by taking really good histories (stories from patients) and examining the scalp and trichoscopy and looking a biopsies (if needed). These pulled hairs in a post transplant patient will not yield conclusive information in 99% of the cases.

@@donovanmedical9780 again, thanks for the advice, I really appreciate it. I feel I should clarify that this is indeed just one aspect I had been considering amongst many with my dermatologist. I have a feeling he would meet your criteria - in fact, he was a co-contributor to a recent publication alongside yourself! Nevertheless, was just interested to hear your thoughts given that this had been covered in the podcast.

thanks so much. I try to get to as many as I can. We appreciate your interest. The program gets a lot of great questions every day so it's always challenging to get to all of them. But I always try to get to as many as I can.

sounds like a good plan. You'll need a really good examination and a series of blood tests. For someone in the 20s, the ability to determine if a patient has TE or AGA or both is really important. Good luck.

yes, it can. Remember that there may be 40,000 to 75,000 follicles on the scalp in situations like this and just because a biopsy shows scarring or destruction of a hair does not been that all hairs are similarly affected or at a similar stage of destruction. Not at all. One group of hairs on the left side of the crown might be terminally damaged and sebaceous glands completely loss and bulge destroyed but hairs over on the right side might be less affected. A biopsy is a sample of a given area and one must be careful about implicating the entire scalp with the same finding. As far as the hair follicle opening being 'closed' - yet that is not always a perfect predictor of success of treatments. It can be tricky to perfeclty correlate "closed pores" with drug loss of regrowth potential.

@donovanmedical9780 thank you, This is good news to hear!

So, to diagnose hair loss, I need two things: 1) I need to know a person's life story from birth until the present day 2) I need to examine the scalp up close, including the use of trichoscopy. None of these are possible here so I can't say. But be sure to see your dermatologist if you are wondering about the link between your hair texture and AGA.

You'll want to see a hair loss specialist in your area. You may want to see your general practitioner or internist for appropriate referrals. I can't suggest treatment without seeing your scalp up close. The treatments for hair loss are all different depending on the diagnosis, and most women with a diagnosis of CTE don't actually have CTE. So be sure to see a specialist for a proper evaluation.

Thanks for your comment. This is not something that I generally will do as I need to see your scalp up close and know way more about your story. However, you may want to check out our question of the week program. we do answers large numbers of general questions there. Thanks

@@donovanmedical9780 I also just got some bloodwork back and my hemoglobin read 21.5 g/dL. My HCT level 64.3% and my total RBC was 6.79 Mil/uL. All fasted. My Glucose was in the pre diabetes range and I always have a clean diet. My blood pressure was stage 1 hypertension. I am a student athlete in college and my lifestyle is very healthy. I’ll fly into Whistler if I have to. I’m losing hope

Thank you for your kind comment and thanks for stopping by!

Success rates of the oral JAK inhibitors is fairly similar. so what’s way way more important for you to discuss with your doctors is cost and side effects. These are generally lifelong treatments. Have a thorough discussion about short and long term side effects with your doctor.

10 years ago, a brilliant doctor and I studied the use of isotretinoin in LPP. Sure it is an option but no it does not help everyone. Be sure to speak to your own doctor as I have no idea if this is a good and safe choice for you or not (as I don’t know your story). Yes, pioglitazone is an option but I don’t like this drug all that much for reasons again you’re going to need to chat with your doctor about (bladder cancer and heart effects). pubmed.ncbi.nlm.nih.gov/25437967/

Do you see my answer below? @copetillirope178

@@donovanmedical9780 i can see this comments yeah but i don't see the one with the linked study . thank you very much

You are not alone

Did it recover ?

Not mesotherapy, no. Adalimumab with SC injection yes, not mesotherapy. There is no good evidence yet to support adalimumab mesotherapy as a useful strategy

Pentoxyfylline has not been well studied. i would guess it might be better than useless, yes, but I don’t see it as revolutionary. That said, that’s my opinion in the face of poor evidence. As far as question 2, yes, dutasteride is the most effective treatment for FFA. Nothing is more effective. as far as LPP goes, it has less benefit (except in clear cut cases of FAPD).

You'll find this helpful. AGA has largely lymphocytic inflammation. donovanmedical.com/hair-blog/aga-inflammation-2

@@donovanmedical9780 thank you! You also mentioned that he normal scalp can have some inflammation. What type of inflammation would that be?

@@donovanmedical9780 if AGA has similar inflammation surrounding the hair follicle compared to AA, why don’t AA treatments work on AGA as well? In theory, could those treatments help regrowth if one is on a 5-ar inhibitor?

@@ct123-t2l No, the inflammation is not the same. It's a completely different type of inflammation and pattern of inflammation and immune system disruption. They are not similar at all.

@@donovanmedical9780 has anyone tried to treat AGA by inhibiting that specific inflammation like they do in AA? How do they differ? Are there any articles you can link explaining it the difference? Thanks

if there is hair regrowth of any kind, there are stem cells alive. Now there are vast numbers of stem cells to begin with, but these diseases rapidly deplete them. SSRI are all that helpful. you'll want to see posts on the website about evidence based treatments for these diseases. As far as contraindications, you'll want to speak to your doctor and check a drug interaction checker online (free) to see if there are interactions. We have no good evidence yet for Regenera in these diseases but ongoing research will point us in new directions with many treatments.

@@donovanmedical9780 thankyou very much for the answer doctor.

Lots of possibilities actually and I would need to know a lot more information. A scalp biopsy (or two) will be important in many such cases. Be sure to see a patch testing expert if you think ACD is in the equation. There are many many causes of what you describe.

@donovanmedical9780 I had patch testing in Dec 2023 which found 5 allergens and a biopsy in March that said AGA and seb derm. Have been reacting to all meds, topicals etc w hair loss which is how I got to an immunologist since addressing the patch test and biopsy results made things worse. Now this diagnosis seems to overrule everything else so he wants to put me on a mast cell stabilizer. I had AA in 2017 so he thinks it could have reactivated the scalp issue.

@@pamedwards6522 Thanks so much for sharing. This is a complex situation and I would need to ask you another 77 questions in order to know where to go next! Be sure to keep close follow up with your doctors.

@donovanmedical9780 I actually think at this stage w all of the inflammation I've had I may now have something scarring. I know alot of loss has been from demodex as I also now have blepharitis, roasacea and eyelash/brow loss and I know it's worse on my scalp. He's looking at chromolyn sodium but I am wondering what else could help (Jak inhibitor, etc).

@@pamedwards6522thanks so much. the “what else” would require me to review all the details and ask you lots of questions and likely see the scalp up close. otherwise, it’s impossible for me to add much at this point. These sorts of situations require a really good trichoscopic assessment and thorough review of all the facts from the last few years. This requires digging and digging and good detective work.

Thanks and welcome! See you again sometime.

it depends on which of the 195 countries one lives in an which insurance policy a patient has and what the indication is for.

​@@donovanmedical9780I live in California and I want to use it on some bald spots I have due to lichen Planopilaris

@@soije4440 oh, I would need to know a lot more information and the opportunity to see your scalp up close. You are assuming that hair loss is quite straightforward! In addition to seeing your scalp, I would need to understand why really you made this switch. What really are the motivations to undertake this change? I would need to rule out other hair conditions that are present including any recent factors or triggers that might be driving a telogen effluvium. Blood work could be useful. I can’t say which ones you need without knowing your whole story. Of course, we would need to completely remove exclude comorbid or coexisting seborrheic dermatitis, alopecia areata, scarring alopecia which might be present - as well as any recent stress or recent COVID infections. We would also need to review the source of oral minoxidil and where exactly it’s coming from. We would also need to review any other prescription medications or supplements started or stopped in the last 2 years. Yes, it’s certainly possible that a shed like you describe is perfectly normal and part of a good growth response to oral minoxidil. But no, it’s not possible to assess hair loss without amassing all the facts and seeing the scalp up close. Be sure to follow up with your dermatologist or hair specialist.

thank you! We've have another session in the future.

Thank you so much. We're so glad you to have you with us!

Thank you for sharing. You may want to review this with a dermatologist and consider a 4 mm punch biopsy. These issues can arise from many potential causes. Often a biopsy is helpful - but first and foremost a good history and examination is needed.

@donovanmedical9780 Thank you so much for responding. I just saw a dermatologist at Johns Hopkins last week and she wasn't concerned saying everyone has scalp irregularities but this is not normal for me. She said I had AGA and seb derm but my concern was an emerging FFA. I also have some eyelash and eyebrow loss. She would not do a biopsy saying it would only cause additional inflammation. Is it possible to send you the images from that visit? I know you can't make a diagnosis but if you were concerned I would seek a second opinion near me. Thanks again!

@@pamedwards6522 thanks. You might want to check out our volunteer program at the Donovan Hair Academy. We answer tough questions every week and use the questions to train the next generation of top hair specialists in the world. www.donovanhairacademy.com/qow

@donovanmedical9780 I will definitely do that. I have had alopecia areata in the past and was concerned about diffuse areata at first but then started to lose my frontal hairline. lThank you so much!

Thank you