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Topic Title: Dr Lee's Myths and Facts
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Created On: 02/17/2005 04:39 PM
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 02/17/2005 04:39 PM
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frontal_loss21
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Posts: 86
Joined: 04/09/2004

I just found this post on another site thought I would share. Good Luck!


A. Myths regarding hair loss that are Historical and Persistent
Myths regarding hair physiology
B. Myths regarding hair physiology
C. Myths regarding the business of Hair Restoration
D. Myths Specifically about MPB
E. Myths about MPB and Cosmetics
F. Myths Relating MPB and Other Skin Disorders
G. Myths regarding MPB and non-FDA approved treatments
Myths about Minoxidil and MPB
H. Myths about Minoxidil and MPB
I. Myths about finasteride and MPB
J. Myths regarding Hair Restoration Surgery


A. Myths regarding hair loss that are Historical and Persistent
A.1 Myth: Wearing hats cause hair loss
A.2 Myth: MPB is caused by plugged pores
A.3 Myth: Poor Blood Flow Causes Pattern Baldness
A.4 Myth: Male pattern baldness is caused by skin mites
A.5 Myth: MPB can be prevented or improved by good nutrition
A.6 Myth: Bald men are sexier
A.7 Myth: Oily skin causes hair loss
A.8 Myth: Sebum causes MPB
A.9 Myth: Hairs shed in the shower is an accurate measure of the degree of shedding

A.1 Myth: Wearing hats cause hair loss.

No. It doesn’t. This is probably one of the most persistent myths. Like many of the myths, it probably started with valid observations but with invalid conclusions. The idea that ‘wearing a hat causes hair loss’ probably originated in the military. Young men entering the service were required to wear hats and soon showed signs of thinning hair or going bald. But the two events are simply related to (due to) serendipitous timing. The ages that young men enter the military are also the same ages that male pattern hair loss becomes apparent.

A.2 Myth: MPB is caused by plugged pores

Wrong. The idea that plugged hair follicles cause hair loss is a long held myth perpetuated by the many companies exploiting hair loss myths in order to sell bogus hair products. The hair follicle is deep in the dermis of the scalp. Not even scrub brushes and abrasive cleansers will 'clean out the hair follicles'. So, if any company is claiming that their product unplugs follicles, you can be assured that the claims for the product are fraudulent. It's more likely that they're implying that their product will clear the opening on to the skin through which the hair shaft grows. Which is fine, but what they don't tell you is that the follicles don’t get obstructed and that ‘plugged pores’, whatever they define that to be, has nothing to do with MPB.

In regards to the "dirty scalp theory" of MPB, there is no credible rationale to it at all. If this 'theory' had any credibility, you would expect a decreasing incidence of MPB in today's population as compared to past centuries, since it has become routine for many people to bathe/shampoo on a daily basis as compared to earlier times, when bathing would be a weekly or even a monthly event. But, there is no evidence to suggest that the incidence of MPB is declining despite the fact that we are ‘unplugging our pores’.

A.3 Myth: Poor Blood Flow Causes Pattern Baldness

Wrong. This myth has been used to sell hair loss products as bizarre as devices that allow you to hang upside down to potions that ‘increase the blood flow to the scalp’. MPB is not caused by poor or decreased circulation.

If poor circulation caused MPB, there would be no explanation for the hair loss of MPB to occur in a symmetrical pattern. Instead, balding would occur in accordance to the areas of coverage of the various arteries to the scalp, which just doesn’t happen.

Furthermore, hair follicles would never be successfully transplanted, if MPB were due to decreased blood supply, since the transplants are used to fill in the balding areas affected by MPB.

All organs and tissues require proper circulation to maintain their health and all portions of the scalp receive large amounts of oxygenated blood. In fact, 20% of the output of the heart goes to the head, so the scalp is highly vascularized. Numerous studies have shown that the vascular supply to the balding scalp is just as good as the vascular supply to the non-balding scalp.

A.4 Myth: Male pattern baldness is caused by skin mites

There’s no relationship between MPB and mites of any kind. Skin mites are just as numerous in the scalps of men who aren't balding as in men affected with MPB.

Everyone has literally millions of skin mites on their bodies. They're as ubiquitous as dust mites are. Under a high power microscope they appear very menacing, in fact, not unlike Godzilla. But they’re harmless. The truth is they have formed a symbiotic relationship with humans ever since there were humans

A.5 Myth: MPB can be prevented or improved by good nutrition

That’d be nice, but it’s just not true. There is no known connection between nutrition and MPB. Poor nutrition neither causes nor exacerbates MPB. Subsequently, there is no scientific evidence that there are any specific nutrients and/or vitamins that will prevent or reverse MPB. Preventing or reversing MPB is much more complicated and much more difficult than correcting a nutritional deficiency due to faulty dietary intake.

Which is not to say that nutritional deficiencies can’t cause hair loss or poor hair growth. The cells that comprise the hair follicles in the scalp are some of the most active in the entire human body. Those active follicles require a constant supply of nutrients, vitamins and minerals. So, it only stands to reason that there are many causes for poor hair growth or even hair loss due to dietary reasons. For example, patients who have protein deficiencies, either because of malabsorption or because of lack of intake, can present with poor hair growth and even hair loss. Patients with iodine deficiency can have the coarse hair and hair loss of hypothyroidism. Biotin deficiency can cause poor hair growth. Iron deficiencies are often overlooked as a cause of hair loss, especially in women. Etc.

A.6 Myth: Bald men are sexier.

The belief that baldness makes you more virile than a man with a full head of hair is without scientific foundation.

In fact, many well-designed studies show that a good head of hair rates high on the list of ‘physically attractive’ features for men and women. An article entitled Psychologic and Sociologic Dimensions of Hair: An Aspect of the Physical Attractiveness Phenomenon (Patzer, PhD, Clinics in Dermatology, vol 6 no 4; pp 93-101) concludes ”Since hair is one determinant of physical attractiveness, the importance of hair can be expected to increase in our society for two reasons: (1) it’s importance is consistently and frequently promulgated through powerful forms of marketing and mass media and (2) there is growing emphasis to increase physical attractiveness through a younger appearance.”

A.7 Myth: Oily skin causes hair loss.

Not really. Some people just have more active sebaceous glands than others do, so the skin on their faces and on their scalps is more ‘oily’. But there is no relationship between an oily scalp and MPB. Whereas, it is true that DHT will concentrate in the sebaceous secretions, because DHT is fat soluble, the DHT in the sebaceous secretions is not the cause of MPB. The sebaceous glands are superficial to the hair follicles, and the DHT in the sebum does not affect the hair follicles, which are deep in the dermis.

A.8 Myth: Sebum causes MPB

There is a relationship between sebum and DHT, but not between sebum and MPB. DHT is found in the sebum in a high concentration because DHT is soluble in fatty substances such as sebum. But the sebaceous glands are superficial to the hair follicles and the DHT in the sebum does not affect the hair follicle. Damage due to DHT occurs at the base of the hair follicles, where testosterone is converted into DHT via types 1 and 2, 5 alpha- reductase enzymes. Routine shampooing or otherwise removing sebum will not prevent or reverse MPB.

A.9 Myth: Hairs shed in the shower is an accurate measure of the degree of shedding.

Wrong. There are a number of reasons why the number of hairs shed in the shower is not an accurate measure of shedding. Normal shedding of scalp hair is 50 to 100 strands per day. You will lose some of these on your pillow at night, some into the air as you perform your daily routine, and, of course, when you shampoo your hair. When the end-telogen hair shaft become wet and soapy, they also become more adhesive to your fingers and are easily extracted from the scalp. Since the hairs accumulate at the drain, the total number of hairs appears exaggeratedly increased. The less frequently you shampoo the greater the total number of telogen hairs that will accumulate and shed when you do shampoo again.

In the normal scalp, approximately 10% of the hair follicles are in various stages of the telogen phase. During the telogen phase, the hairs are easily extracted with a quick tug, of the hair shaft. Only about 1% of the telogen hairs will fall out with no encouragement. That's because the telogen phase lasts ~100 days and only those at the end of the phase fall out without any assistance. The other 90% of the hairs not in the telogen phase are mostly in the anagen phase and are strongly anchored in the dermis of the scalp. Anagen hairs cannot be pulled out of the scalp with a simple tug.



B. Myths regarding hair physiology
B.1 Myth: Dandruff is an indication of the activity of MPB
B.2 Myth: Hair that is shed always has a bulb on the scalp end
B.3 Myth: If left uncut, my hair will just keep growing and growing
B.4 Myth: Shaving your head will make the hair grow faster and/or thicker



B.1 Myth: Dandruff is an indication of the activity of MPB

Actually, there's no association between dandruff and MPB.

Dandruff is not a cause of hair loss. Dandruff is a chronic, non-inflammatory scalp condition that results in excessive scaling of the scalp epidermis (the most superficial of the skin layers) and is clinically visible in approximately 20% of the population. The severity of dandruff declines in the summer and, despite popular misconceptions is not proved to be aggravated by emotional stress.

Although it is normal for epidermal cells on the scalp to continually slough off (just as they do elsewhere on the body), in patients with dandruff the turnover rate of epidermal cells on the scalp is about twice that of those on the normal scalp. Dandruff scales often appear around a hair shaft because of the epithelial growth at the base of the hair, but there is no association with hair loss.

Routine washing with a non-prescription shampoo is usually sufficient to control dandruff. The active ingredients in dandruff shampoos include selenium, coal tar, salicylic acid, ketoconazole, pyrithium zinc, etc. Use whichever product works most effectively for you.

B.2 Myth: Hair that is shed always has a bulb on the scalp end

True, but you don’t always see the bulb. The collection of dead cells and debris at the scalp end of a hair that has spontaneously shed is extremely friable and is easily abraded off.

B.3 Myth: If left uncut, my hair will just keep growing and growing

No such luck. The length to which the hair on your scalp will grow depends on your hair's natural cycle, which is unique to you. The longer the hair's growth phase (anagen), the longer the hair will grow. The length of the anagen phase of terminal scalp hair is generally in the range of 3 to 5 years. If you have a naturally long growth phase, you can grow your hair to well below your waist. Whereas, if you have a naturally shorter growth phase, your hair will shed before it grows to that length. The length of your particular growth phase is strictly based on heredity. The rate at which hair on the scalp will grow is 1/2 inch (1 cm)/month.

B.4 Myth: Shaving your head will make the hair grow faster and/or thicker

Wrong. Shaving the head has no effect on either hair growth or hair loss. The common misperception that shaving enhances growth is probably due to the appearance of all of the hair shafts from anagen follicles re-emerging at the same time. So, it looks optimistically like a synchronized, enhanced period of growth. But it’s an illusion. Hair on the scalp grows approximately one-half inch (1 cm) per month and there’s nothing we can do to change that.

Take note that men may shave their beards daily. If shaving enhanced growth, it would become impossible to shave after months of repeated shaving.



C. Myths regarding the business of Hair Restoration
C.1 Myth: MPB can be cured in a few days
C.2 Myth: Hair analysis is a reliable source in determining the causes of MPB
C.3 Myth: Money back guarantees improve the credibility of hair loss products
C.4 Myth: Massaging the scalp is effective in treating MPB
C.5 Myth: A large list of ingredients improves the effectiveness of a hair growth product
C.6 Myth: A ‘Brick and Mortar’ based business has nothing to do with the validity of hair loss products

C.1 Myth: MPB can be cured in a few days.

Never happens. MPB has no cure. Products that are effective in treating MPB require "the norm of 4 to 6 months" to see significant results, e.g. either a loss reversal or new hair growth. The reason is simple. What we are trying to do is to replace thin or fine hair shafts by thicker ones. In order for that to happen, the follicle producing the fine hair shaft has to shift into the telogen phase, which lasts ~100 days, shed the fine shaft, and start growing an observable thicker shaft. That requires 4 to 6 months.

C.2 Myth: Hair analysis is a reliable source in determining the causes of MPB

Big mistake. Here’s an excerpt from a TIME magazine article in 2001: “Each year a quarter of a million Americans shell out up to $70 a pop for a hair analysis, but reports show that the tests, which is supposed to diagnose nutritional problems, are, at best, unreliable. Six popular labs were asked to test hair samples, all from the same head, for 30 minerals and metals, including selenium, aluminum and lead. Result? Reported concentrations for the same hair differed wildly from lab to lab, often varying 10-fold. If that's not enough to make your hair curl, most of the labs also sell supplements to remedy the ills they purportedly find.”

Here’s another article: Hair Analysis Debunked by Dr. Isadore Rosenfeld

A study reported 15 years ago in the Journal of the American Medical Association found no scientific basis for using hair analysis to determine nutritional needs. Still proponents continue to offer it to patients. A new study, in the same journal, reports similar findings.

Hair samples from the same people were sent to six labs specializing in this technique. Results varied widely, and recommendations often were completely contradictory. For example, one lab said a patient was a 'fast metabolizer' and should avoid vitamin A. Another said the same individual was a 'slow metabolizer' and suggested vitamin A supplements. So, if advised to have a hair analysis to define your nutritional status, I suggest you use the $30-$70 instead for a new shirt or take your spouse to dinner.

C.3 Myth: Money back guarantees improve the credibility of hair loss products

Not so. In medicine there are no absolutes and there are no guarantees. Likewise, legitimate hair growth medicines cannot be guaranteed to reverse hair loss. If a product is guaranteed to reverse hair loss or your money will be refunded, then you should be wary of the product. Any marketing specialist will tell you that less than 1/3 of consumers will ever demand their money back from a product, regardless how egregious the product might have been. In medicine (as in life), there are no guarantees. A surgeon can never guarantee the result of an operation anymore than an internist can guarantee the result of any particular medication. You should feel uneasy when there is a ‘money-back guarantee’ on any 'medical' products.

C.4 Myth: Massaging the scalp is effective in treating MPB

It would be nice, if MPB could be so easily treated. In fact, it doesn’t work. There have always been advocates of scalp massages to improve circulation, but there is no proof that doing so is of any benefit in treating MPB.

All organs and tissues require proper circulation to maintain their health and function. 20% of the output of the heart goes to the head, so the scalp is highly vascularized. MPB is not caused by poor or decreased circulation. Numerous studies have shown that the vascular supply to the balding scalp is just as good as the non-balding scalp.

Common sense would tell you that if poor circulation were the cause of MPB, then hair loss would be in a pattern corresponding to the blood flow and it isn’t. Furthermore, if poor circulation were the cause of MPB, then hair transplants would never be successful, since hair is being placed into balding areas supposedly having decreased blood flow.

C.5 Myth: A large list of ingredients improves the effectiveness of a hair growth product

It’s just the opposite. First of all, take careful note of the active ingredients. Have the ingredients been proven to do whatever has been claimed in the advertisement? Are there references to studies in recognized scientific or medical journals? That’s going to be very unlikely. If the manufacturer makes it difficult for you to find the list of ingredients, you have reason to be wary of the product.

Here’s why you should have misgivings in regards to products that have multiple ‘active’ ingredients: each ingredient may be safe and effective, but there could not possibly be sufficient studies to prove that the ingredients are compatible together. Nor can you know whether or not they may have adverse reactions with one another, either while they are in solution or on the scalp. There are many substances that become ineffective when combined, although they may be effective when applied separately. Minoxidil and spironolactone is a good example of this type of incompatibility. Another example of medications used for the same purpose (antibiotics), but shouldn’t be used together because they become ineffective, would be tetracycline and penicillin.

C.6 Myth: A ‘Brick and Mortar’ based business has nothing to do with the validity of hair loss products

This should really speak for itself. Is there a business site other than the Internet? The development and production of products to treat MPB require a physical space for such activities. If the manufacturer does not give you a postal address and a telephone number, it should raise suspicions as to the legitimacy of the business. There should also be a way to contact the business by phone or email.



D. Myths Specifically about MPB
D.1 Myth: MPB and shedding are synonymous
D.2 Myth: There is a medical cure for MPB
D.3 Myth: An over active sex life will cause or exacerbate MPB
D.4 Myth: Only men experience pattern baldness
D.5 Myth: MPB is always a gradual process
D.6 Myth: Taking anabolic steroids exacerbates MPB
D.7 Myth: MPB can occur anywhere on the scalp
D.8 Myth: MPB can occur in infants and children
D.9 Myth: The causes of MPB in women are the same as in men
D.10 Myth: I should wait until my MPB gets worse before treating it
D.11 Myth: The frequency of shampooing has an effect on the rate of MPB
D.12 Myth: MPB is associated with pain or other scalp sensation
D.13 Myth: Pattern Baldness Comes from Your Mother's Side Only
D.14 Myth: MPB reduces the number of follicles on the scalp

D.1 Myth: MPB and shedding are synonymous

No, but shedding is a part of MPB. MPB and shedding should not be used interchangeably to describe a cause of hair loss. MPB, which entails miniaturization of the hair follicles, is the result of one's genetic predisposition and is the result of very complicated and incompletely understood biochemical reactions in the cells that comprise the hair follicle. This miniaturization results in progressively thinner hair in a symmetrical pattern typical of MPB. There is no loss in the number of hairs on the scalp, but there is a loss in the quality of the hair on the scalp. On the other hand, shedding is a part of the normal cycle of hair growth. The hair shafts on the scalp will spontaneously shed at the end of the telogen (resting) phase. If you shampoo, brush, or pull on hairs in the telogen phase, they will dislodge easily. The same is not true for hairs in the anagen (growing) phase. Hairs in the anagen phase are firmly rooted and are difficult to dislodge.

D.2 Myth: There is a medical cure for MPB

Unfortunately, this is not a myth. Hair transplants can nicely disguise MPB and medical treatment or the combination of surgical and medical treatments may be excellent temporizing measures. However, none of the treatments for MPB currently available offer a permanent cure for MPB. They can prevent and/or partially reverse the process of MPB, but we're only buying time. The five-year studies on the effects of finasteride and topical minoxidil on scalp hair show that there is a dramatic difference between patients continuing on these medications and patients who did not treat their MPB at all. Untreated patients almost invariably showed progressive thinning and/or recession of their hair, whereas patients on treatment kept most of their hair. However, as compared to their own results at the end of two years, the patients who remained on treatment had slightly less hair at the end of five years than they did at the two-year mark. These two and five year results were qualitative and represented self-assessments by the patients.

D.3 Myth: An over active sex life will cause or exacerbate MPB

Not true. There is no correlation between a hyperactive sex life or masturbation and hair loss, just as there is no direct correlation between the serum testosterone level and MPB. In the adult human male, there is a very wide 'normal range' for serum testosterone (300-1200 ng/dL), but there is no direct relationship between the testosterone level and MPB.

However, it is a long established fact that there is a correlation between MPB and DHT (dihydrotestosterone), which is why many of the treatments for MPB include decreasing the amount of DHT in the scalp that can affect the hair follicles. The rate-limiting factor in the production of DHT is primarily the amount of the enzyme 5 alpha reductase available to convert the testosterone to DHT. So, having more testosterone in the body does not necessarily mean there is also going to be more DHT.

D.4 Myth: Only men experience pattern baldness

Not true. In reality, pattern hair loss is just as common in women as it is in men, though the degree of loss, the age of onset, and the overall pattern usually differs in women as compared to men. Statistically, after the teenage years, the incidence of MPB is reflected by the decade in life, i.e. 20% of men in their 20’s are affected by MPB, 30% of men in their 30’s are affected by MPB, etc. By the age of 50, over 50 percent of men have significant hair loss. For women, about 25 percent have significant hair loss by the age of 50, though it may be less apparent because women are more conscientious about hiding it than men are.

The areas of pattern baldness are also different in men and women. While men have a tendency to first lose hair in the frontal, temporal and/or vertex of the scalp, pattern baldness produces thinning hair diffusely throughout the scalp with sparing of the frontal hairline.

D.5 Myth: MPB is always a gradual process

For most men, MPB is a gradual process, but it can occur with devastating suddenness as well.

The sudden massive shedding will cause the next generation of hair to have considerably less texture and body, sometimes to the point of appearing as vellus hairs. These hairs will have shortened anagen phases. The affected areas are confined to those areas of the scalp where the hair follicles have active and sensitive androgen receptor sites, i.e. the vertex, crown and frontal regions.

D.6 Myth: Taking anabolic steroids exacerbates MPB

If you do not have a genetic predisposition for MPB, then taking anabolic steroids will not cause hair loss. But, if you do have a genetic predisposition for MPB, then taking anabolic steroids can accelerate MPB. Even though anabolic steroids are not androgens per se, the body can convert them into androgens.

Here's an excerpt from an article by Dr. David Whiting, a widely acknowledged leading researcher/dermatologist: “Testosterone and dihydrotestosterone can circulate systemically to follicles, or be manufactured locally in the follicle from circulating weak androgens (dehydroepiandro-sterone and androstenediol) via complex enzyme-mediated processes involving specific dehydrogenase and reductase enzyme pathways. All of these enzyme reactions are dependent upon specific pyridine cofactors. It is clear that reductase, dehydrogenase, and probably aromatase enzymes are of major importance in hair growth as they mediate the complex interchange of sex hormones implicated in anagen activity."

D.7 Myth: MPB can occur anywhere on the scalp

Not true. If hair loss occurs on the back of your scalp, above the ears, in patches, or is brittle, then you have hair loss due to causes other than MPB.

MPB is not a matter of losing hair, i.e., shedding. Shedding 50-100 hairs/day is normal. MPB is a matter of atrophy or miniaturization of the hair follicle due to a combination of genetic predisposition of the hair follicles and the presence of DHT. Embryologically, skin in the frontal, temporal, crown and vertex of the scalp derives from a different set of germ cells than does the skin on the sides and back (occiput) of the scalp. The hair follicles in the sides and back of the head do not contain androgen receptors and consequently do not become affected by DHT or involved in the process of MPB.

D.8 Myth: MPB can occur in infants and children

MPB would never occur before puberty. Why? MPB is the common name for alopecia androgenetica, a name that emphasizes that the cause is related to androgens and genetics. Androgens are not produced in the body until puberty, so MPB can become noticeable as early as the onset of adolescence. Our youngest patient is 13 years old. Unfortunately, early onset portends an ultimately severe case of MPB.

D.9 Myth: The causes of MPB in women are the same as in men

This is a very controversial subject. Women normally have only 1/10 the levels of DHT as do men, yet women also suffer from MPB. The age of onset is later than in men. The pattern of involvement is diffuse as opposed to the typical MPB pattern in men. The frontal hairline is usually preserved. And finasteride has not proven to be helpful in treating post-menopausal female patients. But, the underlying pathophysiology is probably basically the same.

When you consider causes for hair loss other than MPB, there are more medical conditions causing hair loss in women than there are for men. These reasons include iron deficiency, menopause, post partum telogen effluviums, etc.

D.10 Myth: I should wait until my MPB gets worse before treating it

This is a difficult myth to refute because neither the age of onset of MPB, nor the rate at which the MPB will progress nor the final extent can ever be predicted. However, as a general rule, the earlier MPB is treated, the better the positive results will be.

A report from Moscow Medical University stated that there is some fibrotic encapsulation (irreversible hair loss) to the hair follicles 30 months from the onset of alopecia androgenetica occurred in some patients. Their conclusion was to prevent loss by treating alopecia androgenetica when the first signs of alopecia androgenetica appear.

Any of the medications for treating MPB work best if the hair loss has been within the past few years. For a patient with recent hair loss, the reversal of MPB is usually quite successful, if the patient uses a combination of a medication to promote hair growth (topical minoxidil) along with a medication or medications to inhibit the quantity of action of DHT in the scalp. Examples of such effective and safe medications include finasteride, azelaic acid, topical spironolactone and topical ketoconazole.

D.11 Myth: The frequency of shampooing has an effect on the rate of MPB

This is a qualified true and false statement. If you use a shampoo containing ketoconazole that can effect the biochemical environment around the follicles, then it is possible to reverse hair loss. Any other shampoo will remove DHT from the surface of the scalp, but they are of no benefit in preventing MPB because it is the DHT around the hair follicle that is causing the damage. These shampoos and conditioners cannot change the biochemical environment around the hair follicles, which is deep in the dermal layers of the scalp.

Otherwise, whether you never shampoo or shampoo daily will not affect the age of onset or the rate of progression of MPB.

Shampoos are designed to clean the hair and leave it manageable and looking good. If they do that for you, it's as much as you can ask for. Other than shampoos containing ketoconazole, which have been shown to reduce DHT in the scalp, shampoos really have no effect on hair growth or loss. See also A.2 Myth: MPB is caused by plugged pores.

D.12 Myth: MPB is associated with pain or other scalp sensation

No, but there is a cause of telogen effluvium associated with scalp pain.

The biochemical processes that result in MPB are not accompanied with any physical sensation. If you are experiencing scalp pain, it may be a good idea to have a dermatologist examine your scalp.

An article in the March 1998 issue of Archives of Dermatology describes "Scalp Dysesthesia". Some individuals who develop a telogen effluvium report painful burning sensations in association with excessive shedding of the hair. Until recently this problem was not officially identified by dermatologists. The syndrome has been called “scalp dysesthesia” or “burning scalp syndrome”. The cause of burning scalp syndrome is unknown. It has been successfully treated by some dermatologists with antidepressants such as doxepin or amytryptaline.

D.13 Myth: Pattern Baldness Comes from Your Mother's Side Only

Yes and no. It’s an enduring and common misconception among patients that MPB is ‘inherited from the mother’s side’. Well, that statement is neither right nor wrong. Pattern baldness can be inherited from the mother’s side. But it can also be inherited from the father’s side.

Despite the fact that the entire human genome, comprising approximately 30,000 genes in the human DNA, was completely mapped out as of April 2003, the gene or, more likely, genes responsible for MPB, have not been identified. What is known is that the age of onset, the rate of progression, and the pattern of follicular miniaturization are all influenced by heredity. Generally, the earlier the
 02/17/2005 06:54 PM
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Socks
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Great info! This is one of those posts that should be either stickied on the Open Forum or put in the FAQ
 02/17/2005 08:59 PM
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orangebanzai
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sOCKS! IT SAID NO SHEDDING ON PROPECIA..........I WOULD TRY IT IF I THOUGHT I WOULDNT HAVE TO ENDURE SHED FROM HELL!
 02/17/2005 09:08 PM
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JWM
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Yeah, the no shed thing is BS if you ask me.
 02/17/2005 10:19 PM
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poet
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I agree that is the one thing I don't agree with. I definitely had shedding on Dutasteride and it grew back nicely. Was idsconcerting as it occured. It's unfortunate that Minox appears to decline over time, but I still think in the long run you are better of staying on Minox than quitting it and going through a massive irreversible shed.
 02/17/2005 10:41 PM
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jack
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It's unfortunate that Minox appears to decline over time


this is considering tht the patient is not using a dht treatment is it not?
 02/17/2005 10:42 PM
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Socks
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I agree that there were certain areas I thought was not entirely accurate but overall it is a GREAT read for anyone; new or old
 02/17/2005 11:26 PM
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NYC Guy
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A great read. I for one have never experienced any shedding on Propecia in the almost 12 months I have been on it.
 02/18/2005 12:03 AM
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redfox
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I think it's excellent read, and should definetly be a sticky. There were several things I disagreed with or questioned, but still very much worth reading.
 02/18/2005 05:43 AM
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JWM
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I am experiecing a brutal shed from Dut at the moment, but like Poet said, I plan on riding it out in hopes for regrowth.
 02/18/2005 07:36 AM
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Peter Mac
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All organs and tissues require proper circulation to maintain their health and all portions of the scalp receive large amounts of oxygenated blood. In fact, 20% of the output of the heart goes to the head, so the scalp is highly vascularized. Numerous studies have shown that the vascular supply to the balding scalp is just as good as the vascular supply to the non-balding scalp.
I agree that any product claiming to increase blood flow to stop baldness is a complete and total scam. However, there is something that should be noted here. In a NW7 who has been balding for 20+ years there is absolutely a decreased blood flow in the scalp. A hair follicle demands a large supply of blood. In the absence of hair follicles, the blood supply does indeed diminish and this has been documented in studies. It is a mistake to perform dense packing on these individuals because many of the grafts will likely not grow due to decreased blood flow. However, if a light transplant is performed to help re-establish the blood supply, then larger sessions can be performed. Both Dr. Lee and Dr. Bernstein have made a similar argument concerning blood supply and I believe both of their texts should be updated with this minor correction.

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There are many substances that become ineffective when combined, although they may be effective when applied separately. Minoxidil and spironolactone is a good example of this type of incompatibility.
Dr. Proctor has said he is the only one who has ever successfully combined Minox and Spiro and it is his trade secret. The only product with spiro and minox combined in one solution is Prescription Proxiphen.

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D.7 Myth: MPB can occur anywhere on the scalp

Not true. If hair loss occurs on the back of your scalp, above the ears, in patches, or is brittle, then you have hair loss due to causes other than MPB.
true, but I think it should be noted that the donor area thins in some individuals, albeit more slowly than the rest of the head.

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It is not normal for Propecia to cause shedding at any time during its use. Binding the type 2 5-alpha reductase does not cause a shift from anagen to telogen, so no shedding would be expected to occur. If shedding does occur, it is not a sign that finasteride is working. There have been rare cases in which patients have reported a telogen effluvium months after initiating treatment with finasteride. Apparently, a drop in the systemic levels of DHT had been the inciting event in causing these cases of telogen effluvium. Although a telogen effluvium usually begins somewhere between 11 and 16 weeks after the inciting event, it can start as soon as 4 weeks thereafter.
I think quite a few derms and ht surgeons would disagree with this statement. I noticed my crown went slick bald after starting propecia, but grew back slightly thicker. I believe a little shedding is a good sign as it sheds vellous hair in a synchronous manner and the follicles grow back thicker and stronger.
 02/18/2005 02:25 PM
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JustinG20
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I am confused about what this is saying. . . . Is it saying tha Propecia can cause a shed but that this is not a good sign or that Propecia will not cause a shed at all?


Also I do have scalp pain. My scalp burns from time to time. Does this mean I have telogen effluvium and if so, when does this clear up if at all?

HELP please. I am really confused right now.

Edited: 02/18/2005 at 02:44 PM by JustinG20
 02/18/2005 02:40 PM
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Peter Mac
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Dr. Lee is a talented researcher and writer and I highly respect everything he does, but I do disagree on a couple of points.

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There have been rare cases in which patients have reported a telogen effluvium months after initiating treatment with finasteride.
In most of propecia's studies there were Norwood 3's and 4's that still have a lot of hair left. It goes without saying that a NW3 won't shed a lot of vellous hair. However, I believe a NW5 will go through more shedding just because there is more vellous hair. I also believe that a NW5 would continue to see progress on propecia longer than a NW3 just because more progress can be made if the hair is still salvageable. for example, on a scale of 1 to 100 if your hair is a 75 and mine is 25 in terms of thickness and tint I can continue making progress long after you've reached your max gains.
 02/18/2005 02:47 PM
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TheFittest
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All,

Minor quibbles aside, this is possibly the *single most useful text* ever posted on HLH. As ever, the good Dr. Lee remains a superb source of the most reliable current information on MPB and MPB related matters.

Farrel should make this a permanent part of the Open Topic forum.

TheFittest
 02/18/2005 04:51 PM
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Chemenger
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what are the chances that propecia induces an actual telogen effluvium? I am losing much more hair at the hairline since starting propecia and I also have some pain/tenderness on some parts of my scalp(mostly the hairline). I had this pain even before starting the propecia if I'm not mistaken. Also, why do people actually lose hair when taking propecia? My dermatologist also told me that there is no hairloss(or initial shed) associated with the use of propecia. There are hairs on my scalp that fall out so easily and this really concerns me. If the drug is working, then fine, but if its causing a deterioration of hair instead then I don't know what to say. Needles to say, I know that I have to wait a while to see if the drug will regrow hairs, but it just seems like its going the wrong way right now.
 02/18/2005 06:17 PM
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FreakyBallerGeek
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I agree with the fittest. Peter Mac didn't disagree with any of that--he just seemed to want to add some clarifications to a couple points. I think the information is sound and helpful.
 02/18/2005 07:23 PM
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TAGOHL
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Good summary, but a few corrections are in order:

> A.9 Myth: Hairs shed in the shower is an accurate measure of the degree of shedding

Tracking shower shedding is not an accurate count of the overall number of hairs shed per day, but it can be a useful (somewhat crude) way to track overall shedding. If you lose (on average) 50 hairs per day in the shower, and all of sudden you are noticing 150 hairs/day in the shower, you can likely conclude that you have increased overall shedding.

> A.4 Myth: Male pattern baldness is caused by skin mites
>
> There’s no relationship between MPB and mites of any kind.

Actually, there is a relationship -- it just hasn't been proven to be a causal relationship (i.e., that mites induce hair loss). Balding scalps do indeed have more mites than non-balding scalps (Int J Dermatol. 2001 Jul;40(7):475-6). Whether mites just find balding follicles a better home, or whether they actually do some damage, is open to debate. In dogs and other animals, mites can without a doubt cause alopecia. This is secondary to inflammation generated in response to the precense of the mites.

> Skin mites are just as numerous in the scalps of men who aren't balding as in men affected with MPB.

Not true. See:

Androgenetic alopecia: the role of inflammation and Demodex. Int J Dermatol. 2001 Jul;40(7):475-6.

> A.6 Myth: Bald men are sexier.

This is totally in the eye of the beholder. Some women may think this. Most probably don't.

> A.8 Myth: Sebum causes MPB

Sebum likely doesn't have a direct effect on MPB, but excess sebum can be a breeding ground for microorganisms, which in turn can generate inflammation, which then may exacerbate MPB. A pilot study has shown that the use of antimicrobials can be effective in MPB. See:

Improvement in the inflammatory aspect of androgenetic alopecia. A pilot study with an antimicrobial lotion. Journal of
Dermatological Treatment 7: 3 (SEP 1996): 153-157.

> D.12 Myth: MPB is associated with pain or other scalp sensation

In some men, hair and/or scalp pain is associated with MPB. This has been documented in the medical literature. For example, see:

The presence of trichodynia in patients with telogen effluvium and androgenetic alopecia. Int J Dermatol. 2003 Sep;42(9):691-3.

> F.2 Myth: Seborrheic dermatitis exacerbates MPB

Many derms believe that it can, as do I. Inflammation is bad for hair growth.

> inflammation that may occur with seborrheic dermatitis is thought to be due to the body's reaction to a yeast in the scalp (Pityrosporum)
> and to products that break down oil.

Unfortunately, the hair follicle gets caught in the crossfire.

> However, when the seborrheic dermatitis improves, the hair grows back again.

If you not suffering from MPB, this is true. There is no guarantee that follicles prone to MPB will grow back once lost to anything.

> It is not unusual to experience seborrheic dermatitis and MPB at the same time and neither condition exacerbates the other.

I disagree vehemently. Seb derm can generate inflammation. Inflammation, in turn, can induce hair loss (either scarring or non-scarring). You draw the conclusion.

> Sebum does contain concentrated levels of DHT, but since the sebum on the scalp is very superficial to the androgen receptors at the
> level of the hair follicles, which are deep in the dermis,

Sebaceous glands sit right next to the bulge region of the hair follicle, which is where the all-important stem cells are located. Histological studies have also shown a higher prevalence of inflammation in MPB-affected follicles, and that inflammation is localized to the area where the sebaceous gland sits.

> it plays no role in initiating the chain of events, which results in miniaturizing the hair follicle in the process of MPB.

No one is saying seb derm causes MPB. Just that it can make a bad situation worse.

> F.3 Myth: MPB is an inflammatory response and therefore can be cured by clearing up the infection

There is evidence that inflammation is present in MPB, at least in certain individuals. Since inflammation has known hair growth inhibiting effects, it isn't a huge leap to believe it plays at least a partial role in MPB (an exacerbating one, if nothing else).

Dr. Lee seems to have a hard time accepting that anything other than DHT can negatively effect hair growth. While DHT is a primary cause of pattern baldness in males, there are likely a number of other factors which can exacerbate hair loss and/or play a role in MPB.

TAGOHL



 02/18/2005 07:29 PM
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FreakyBallerGeek
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do you subscribe to the dermatology journal?
 02/19/2005 01:45 AM
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Pete
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When I've conversed with Dr. Lee he has spent considerble time and effort to help me - he's a great chap!
 02/19/2005 01:50 AM
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Dave001
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Quote

Originally posted by: TAGOHL
Good summary, but a few corrections are in order:


There is evidence that inflammation is present in MPB, at least in certain individuals. Since inflammation has known hair growth inhibiting effects, it isn't a huge leap to believe it plays at least a partial role in MPB (an exacerbating one, if nothing else).


Dr. Lee seems to have a hard time accepting that anything other than DHT can negatively effect hair growth. While DHT is a primary cause of pattern baldness in males, there are likely a number of other factors which can exacerbate hair loss and/or play a role in MPB.

TAGOHL


Kevin Davis? That you?

Hair Loss Help » Hair Loss Open Topic » Dr Lee's Myths and Facts

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