I recently had the opportunity to sit down with Dr. Robert Bernstein, an internationally recognized hair restoration and transplant expert in NYC, where we recorded an episode about hair loss on my “Beauty Doc” podcast. I got great insight about the causes for male and female hair loss as well as non-surgical therapies for preventing and treating hair loss. Here are some of the big “take aways” from our recording.

Hair loss is inherited by several genes. One of the genes control the release of androgens (“male hormones”) that produce “DHT” (a by-product of testosterone) which contributes to the miniaturization of hair follicles. What is important to stress is that hair loss is not primarily due to hair falling out but also due to miniaturization of the hair follicle.

Major Causes Of Hair Loss In Men And Women

Now let’s focus first on male pattern hair loss. Balding of hair follicles usually occurs at the top and front of your scalp because those locations are most sensitive to DHT (AKA male hormone derivative). Hair follicles found at the back and sides of the scalp are less sensitive to DHT and that explains why there is a “horse-shoe” pattern of hair loss in most men. Unlike men, women typically present with a diffuse loss of hair which may be due to changes in another molecule called aromatase (aka the female hormone) but there may be many underlying causes of hair loss in women.

Besides genes and hormones there are many medications and medical conditions that can cause hair loss. Examples include stress, anemia, pregnancy, thyroid disease and inflammatory diseases. That is why when someone presents with hair loss it is important to do a work-up that will include blood tests and sometimes biopsies.

It is vital to understand that almost any drug can cause hair loss including accutane (for acne), allupurinol (anti-gout), anti-hypertensives anti-thyroids, anti-psychotics, anti-estrogens(tamoxifen, arimidex), and anti-cancer drugs. Now what I found to be a surprisingly amazing fact is that there is a possibility for seasonal changes to have an impact on your hair growth. For instance women have more hair in the spring and summer and loss hair in the fall and winter which might have some evolutionary explanation so that the female might look more attractive or be protected from the sun during the warm months.

In Dr. Bernstein’s experience people generally tend to seek out treatment for the loss of hair too late. He believes that if patients go to a hair restoration specialist earlier then non-surgical approaches can be implemented before there is permanent loss of hair follicles. Early medical intervention to prevent male pattern hair loss should be considered especially if there is a family history of baldness. Women usually experience a diffuse pattern of hair loss and is found to different degrees in up to 50% percent of women. They too can benefit from seeking out a hair expert sooner than later.

According to Dr. Bernstein the decisions to seek hair restoration in men and women are commonly related to loss of sexual attractiveness and the perception that the loss of hair makes them appear older than their actual chronologic age which may impact them socially and professionally.

Non-Surgical Treatments for Hair Loss

After spending time exploring with Dr. Bernstein some of the major reasons for losing hair in men and women, we then discussed different preventative measures people could take to address this irksome problem.

Some of the non-surgical therapies men can choose between are Propecia and Rogaine. It was interesting to hear that Propecia (finasteride) happens to be more effective than Rogaine (minoxidil) foam if used once per day. Additionally Propecia has found to have sexual side-effects that some men find unacceptable where they can lose the ability to maintain an erection.

Hair loss prevention in women

Now females do not have the option of being able to use Propecia as it has been proven to ineffective for women. Women though do have other hair non-surgical therapeutic options that include Rogaine or PRP. These hair treatments seem to be more effective in women compared to men. One down side of Rogaine though is that it can feel greasy and therefore women generally have to wash their hair on a daily basis.

Women do not tend to wash their hair everyday so this can be an annoyance. There is also some evidence to support that it can also drop your blood pressure and cause facial hair to increase which is not necessarily the effect women want!

Spironolactone is another effective treatment option for women.

It is great because it works by blocking androgens which increase hair on the scalp and reduce body hair. Spironolactone is particularly effective for women that have polycystic ovaries so it has a dual benefit. Lastly, it has been proven that birth control pills also have a positive impact on increasing scalp hair which many women will be happy to hear.

Now if none of those medical options satisfy you there is also the option of PRP (plasma rich plasma) injections. But according to Dr. Bernstein, “PRP is not magic dust”. The PRP procedure includes having your blood drawn and then spun down in a centrifuge to concentrate the platelets which have growth factors.

Growth Factors in PRP

These growth factors found in platelets have the potential to help with regrowth of hair by stimulating stem cells in your scalp. The platelet rich plasma (PRP) that is concentrated is then injected into the scalp but I want to stress that there is a lack of scientific agreement and controversies regarding the number and frequency of injections as well as the depth of the scalp injections.

There still has not been a double blinded study to help prove the efficacy of the treatment though many clinicians have reported positive results in some of their patients who have had treatments. Dr. Bernstein’s protocol is to repeat the first PRP treatment after six weeks, three months, six months and then make an assessment to see if there has been any improvement.

I hope everyone reading this found the insights I had with Dr. Robert Bernstein to be informative. I have really learned a lot about hair loss and non-surgical treatment options and I hope to pick up the second segment about his surgical approaches to hair restoration in the near future. So stayed tuned!