August 26, 2025 • 48 mins
Is your shower drain trying to tell you something?
Hair loss is one of the most common and emotionally devastating issues women face in midlife, yet it’s often met with silence—or endless product promises that rarely deliver.
In this episode of Asking for a Friend, board-certified internist Dr. Mary Wendel—a physician who has dedicated over 20 years exclusively to women’s hair loss—joins Michele Folan to break the stigma and share the science. After witnessing her grandmother’s struggles and facing her own perimenopausal thinning, Dr. Wendel transformed her career to focus solely on helping women reclaim their confidence and their hair.
What you’ll learn in this episode:
- Why 80–85% of female hair loss is caused by genetics and hormones
- How testosterone therapy and hormone pellets can speed up thinning
- The role of stress, weight loss, menopause, and GLP-1 medications in sudden shedding
- Which diagnostic tests actually matter (and which don’t)
- The truth about PRP therapy, red light, and laser treatments
- Why washing your hair less may be making it worse
- Simple, science-backed steps you can take now for healthier, thicker hair
Whether you’ve noticed extra strands in your shower drain, are worried about thinning at your part, or simply want to understand what’s happening to your hair in midlife, this conversation is packed with evidence-based answers and hope.
👉 Listen now to uncover the real causes of women’s hair loss, the treatments that actually work, and how you can take back control. Subscribe, share with a friend, and join us in removing the stigma around female hair loss.
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💌 Have questions about 1:1 health and nutrition coaching or Faster Way? Reach me anytime at mfolanfasterway@gmail.com
✨ For more tips, science-backed strategies, and midlife health inspiration, sign up for my weekly newsletter:
👉 https://michelefolanfasterway.myflodesk.com/i6i44jw4fq
🎤 In addition to coaching, I speak to women’s groups, moderate health panel discussions, and bring experts together for real, evidence-based conversations about midlife health. If you’d like me at your next event, let’s connect!
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Transcripts are created with AI and may not be perfectly accurate.
Disclaimer: This podcast is for general informational purposes only and does not constitute the practice of medicine, nursing, or other professional healthcare services. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your qualified healthcare provider with any questions regarding a medical condition.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Michele Folan (00:00):
Hey friends, Michele here, I bring over 25
years of health industryexperience to everything I do as
a certified fitness andnutrition coach and host of a
top 2% global women's health andwellness podcast.
And I don't just share theseconversations on the mic, I
bring them to live audiences.
I've moderated women's healthpanels, interviewed top experts
(00:21):
on stage, and spoken to women'sgroups about thriving in midlife
through metabolic health,strength, and longevity.
My mission is to help womenfeel strong, capable, and in
control of their long-termhealth.
If you're planning an event onwomen's health, midlife wellness
or personal growth, I'd love tobe part of it.
Reach out through LinkedIn orthe link in the show notes.
(00:44):
Let's make your next eventunforgettable and meaningful.
Health, wellness, fitness, andeverything in between.
We're removing the taboo fromwhat really matters in midlife.
I'm your host, Michele Folan,and this is Asking for a Friend.
(01:09):
If you've strategically movedyour part to hide thinning, or
if your ponytail feelssuspiciously skinnier than it
used to, or if you're like me,you've held a wad of hair in
your hand after showering andthought what the hell is going
on, this is a great episode foryou.
Hair thinning and hair loss inmidlife is incredibly common,
(01:30):
but it's also incrediblyfrustrating, emotional and often
brushed off as just aging thetruth.
There's always a root cause andthere are actual solutions
beyond buying yet anothershampoo that overpromises and
underdelivers.
My guest today is Dr MaryWendel, founder and chief
medical officer of Meditress, amedical practice dedicated
(01:52):
solely to treating hair loss inwomen.
She's a board certifiedinternist who took her own
experience with hair loss andturned it into a mission to help
other women get real answersand real results.
We're talking hormones, haircycles, hrt, prp, red light,
nutrition, stress, and why weneed to stop Googling and get
(02:13):
serious about the rightdiagnosis.
Dr Mary Wendel, thank you forbeing here today.
Mary Wendel, MD (02:18):
Well, thank you for having me.
I'm always happy to talk aboutthis subject.
It's near and dear to my heartfor many reasons, so thank you.
Michele Folan (02:27):
Yeah, and we're going to dig into that, but I
love to start with your storyand really, what inspired you to
dedicate your medical career towomen's hair loss, because
that's not where you started,it's not where I started.
Mary Wendel, MD (02:41):
It is where I'm ending, but I am a board
certified internist and I didprimary care medicine for over
30 years and during that time myhusband, who was an emergency
room physician, transitionedinto hair and has been doing
hair transplants for about 35years.
(03:01):
And towards the end of mymedical career we started to see
more and more women walkingthrough the door asking about
hair transplants and what theycould do.
It took a lot of courage forthem to come through a door that
was primarily very maleoriented, and so my husband said
can you help me here?
And so I started splitting mytime between my general medical
(03:22):
practice and the hair practice.
And you know you mentioned theemotional component.
I will say that's the thing thatsurprised me the most, and I
shouldn't have been surprised.
But these, the women, came in.
Many of them had seen manyother providers before me for
their hair and just feltdiscouraged and dismissed.
(03:43):
There wasn't as much to offerinitially, but I really felt for
them and had a lot ofcompassion.
My own family history isunfortunately fraught with
female hair loss.
My grandmother wore a wig.
My parents' hair was prettygood, but I have several female
cousins who are also struggling.
(04:03):
My own hair loss started tobecome noticeable to me just
perimenopausally, which isfairly typical.
But it was interesting that Iwas surprised when I looked in
the mirror and saw it happening.
I'm like, oh no not me.
I'm sorry this can't behappening, but so it became a
personal mission as well and asmy medical practice, I started
(04:25):
to move away from that.
I spent more and more time heredoing the hair, and now we have
a whole lot more to offer and alot more guidance to give Okay.
Michele Folan (04:33):
So what kind of extra education did you have to
get to get where you are now?
Mary Wendel, MD (04:39):
Yeah, actually that's a good question.
That I'm asked a lot because Iam, you know, a highly trained
internist and you know that tooka long question.
That I'm asked a lot because Iam, you know, a highly trained
internist and you know that tooka long time and a lot of you
know, many years.
But actually, hair loss,although it can be complicated,
it's a fairly narrow field.
I did take a lot of classes, Idid a lot of courses, both in
(05:01):
person and online.
I worked with a lot ofdermatologists who, you know,
specialize in hair loss and ithas become its own specialty
within the dermatology world.
So it it, you know, I wasinterested enough and and always
interested in learningsomething new, and it's
constantly changing.
Even since I started this youknow we were doing the math just
(05:22):
last night I've been doing thisfor over 20 years.
A lot has changed, wow.
So you have to keep up.
Either way.
Michele Folan (05:29):
Oh, yeah, for sure.
You know, when I got close tomenopause, my husband would make
jokes like God, it looks like asquirrel was run over by a
lawnmower in the shower, youknow, because there would be
hair all over the place.
Right, and I know I'm not alone.
Other women deal with this.
But I think it'd be good tojust start with the basics, mary
(05:51):
, and like what are the mostcommon types of hair loss you
see in women, particularlymidlife and postmenopausal women
?
Mary Wendel, MD (06:01):
By far the most common cause of hair loss is
androgenic alopecia Fancy termfor you've inherited these
tendencies.
Your hormones are playing intothis and that's why we see it
accelerate perimenopausally,premenopausally, and really
that's the vast majority.
That's probably 80 to 85% ofthe women that we see, and it's
(06:25):
the most common.
It's actually what causes mento lose their hair as well, and
women don't really appreciatethe fact that they're inheriting
this.
I often say you know who'ssitting around the dinner table
on Thanksgiving and take a lookat everybody's hair, because the
women are not excluded fromthat and it's a bit of a shock
(06:46):
when it happens, but it is byfar the most common and most you
know truly most women by thetime they hit in their mid-50s
will say, oh, I don't havenearly as much hair as I used to
when they're really pressed.
But it's when it starts tonotice the spaces between the
hair Suddenly your scalp is abit more noticeable.
That's when women start topanic.
(07:07):
So that is by far the mostcommon and hormones play a huge
role Hormones and aging andgenetics.
We also see a lot of what'scalled telogen effluvium, which
is a term that just meansexcessive shedding brought about
by a long list of potentialproblems.
Stress plays a huge role there.
Some of the worst hair sheddingI've ever seen has been as a
(07:30):
result of extreme stress, and itcan be physical stress, like
illness, can be emotional stressfor which there's nothing.
You know, there's no number totest to see how bad it really is
, but the hair will tell you,your outsides, will tell you
what's going on to your insides,and it is also very common.
But the most common is theandrogenic.
Michele Folan (07:51):
All right, Two questions On average.
How many hairs would we expectto lose in a day?
Mary Wendel, MD (07:59):
Yeah, that's a great question and it's
something that creates a lot ofanxiety for a lot of women.
It's extremely variable.
You know, women who have morehair are going to shed more.
The statistics claim thatanywhere up to a hundred hairs a
day is considered normal.
Well, if I lost a hundred a day, I'd be in shock because that's
just not my pattern.
(08:20):
I'd be like running for thehills.
But like young women, like mygrand, my 16-old granddaughter,
her hair's everywhere and she'snot losing it excessively.
It's just she's got a lot ofhair so she's going to lose more
.
But when you have less hair tostart with, you're going to shed
much less than that 100.
It's going to be more like 40or so, and once you start
(08:42):
reaching that 100 point, it'sgoing to feel abnormal.
Ethnicity plays a role as well.
There's some types of hair thattends to shed more than others.
That's more brittle, that'smore likely to break.
So a lot of things play into itand that's why it's a little
deceiving when you read thearticles that say well, you can
lose up to 100 a day and thenthat would be considered normal.
(09:02):
But that's not true.
If you're normally hitting, youknow, 30 to 40 a day and
suddenly you're hitting ahundred.
That's going to look veryexcessive.
It's going to look you're goingto know something's up.
It's a change in your pattern.
Michele Folan (09:15):
There'd be a difference between losing your
hair at the root and then losingyour hair due to breakage,
correct, okay, then the otherquestion would be do we, at
certain times of the year, losemore hair than other times of
the year?
Mary Wendel, MD (09:33):
Yes, we do More .
Women tend to have a little bitof a shed in the fall and
there's a physiologic reason forthat.
Our growth cycle prolongsduring the summer months with
the heat or the sun.
I think it's a lot has to dowith vitamin D from the sunlight
.
Vitamin D is good for hair, butnot everybody sheds in the fall
.
Some women never shedseasonally, but of women who do
(09:55):
shed seasonally, more commonlyit's the fall.
I always shed a little bit inthe fall.
There are some women that shedin the springtime, which is sort
of what you'd expect if youwere a bear living in winter.
You know you're hibernating,it's cold, you come out of the
hole and suddenly you don't needthat thick fur anymore and
you're going to shed it.
But that doesn't work forpeople.
We don't need to lose a lotcome springtime, so we tend to
(10:16):
shed more in the fall.
All right, we're not bears.
Michele Folan (10:19):
Then I guess my other question now these are
popping into my head as we'respeaking what about eyelashes
and eyebrows?
Mary Wendel, MD (10:26):
Not usually cyclical, like scalp hair, but
if you have a medical illnessthat's causing you to shed,
there are certainly hair lossdiseases that you can lose
eyebrows and eyelashes, but themost common cause of androgenic
alopecia generally doesn't causeexcessive shedding and a
telogen effluvium, which isagain due to illness or stress,
(10:49):
doesn't usually affect eyebrowsor eyelashes.
Michele Folan (10:52):
So then, what are some of the biggest
misconceptions you hear fromwomen about hair loss, and what
do you wish women would knowearlier?
Mary Wendel, MD (11:03):
Yeah, I think the biggest misconception is
that all the answers are on theinternet, because they're not.
But I also think that peoplewomen are surprised when they
find out that they've inheritedthis.
You know, I see we see a fairnumber of younger women in their
mid-20s or so who have sort ofadvanced hair loss for their age
(11:26):
, and I will always ask thoseyoung women what does dad look
like?
Well, dad's bald.
I mean not just thinning, butdad's bald, so you can inherit
that from your dad.
It's both sides of the family.
The genetics is very complex.
Once in a while someone willcome in and say there's nobody,
but when you really get down tobrass tacks, the genetics is
very complex.
Once in a while someone willcome in and say there's nobody,
(11:49):
but when you really get down tobrass tacks, the genetics is
fairly complicated.
So really people don'tunderstand that the genetics can
be that strong for women aswell as for men.
Okay, that's interesting.
Yeah, and it's almost universal.
When I see a young woman, yeah,and it's almost universal when
I see a young woman, I see evenwomen as young as 18 or 19
coming in with already you knowadvanced loss and sometimes dads
(12:12):
will bring the girls in anddad's bald or dad has had a hair
transplant, and you know theycome in and when they find out
that their daughter hasinherited from them, they're
heartbroken and I feel badly forthem because they know how it
affects their daughters, theiryoung daughters.
But it's very strongly geneticfor women as well as men.
Michele Folan (12:32):
All right.
So how about for male patternhair loss?
I used to always be told thatit's the maternal grandfather
that predicted no, okay.
Mary Wendel, MD (12:46):
No, no and yes, that is also a big
misunderstanding.
It's both sides equally.
And they now know with studies,recent studies, that a man, a
young man, of his dad's fall,he's got a more than 50% chance
of losing his hair as well.
So it's not you know thematernal grandfather, it's, it's
(13:07):
both sides coming at youequally.
And the more history of it, thegreater likelihood that both
men and women will will losetheir hair.
You know women are not expectedto lose their hair.
You know men are not, may notbe happy about it, but they're
probably not surprised,especially if you know dad's
bald.
But for women and that's thehard part is that they don't
(13:28):
understand that and and they'rethey don't expect it.
And suddenly you know they're45 years old and their hair is
thinning and they didn't expectit.
So yeah, it's, it's hard.
Michele Folan (13:40):
It's hard.
Yeah, it is very emotional, butnow you mentioned stress, yep,
are there any other lifestylefactors alone that can cause
significant hair loss?
Mary Wendel, MD (13:53):
Diet nutrition is huge.
We've done a lot of researchhere on diet, rapid weight loss.
You know so many women are onthe GLP-1s and you can lose
weight slowly and carefully andwith good nutrition and not
necessarily shed.
But if you've lost a lot ofweight rapidly and you're not
being careful about your proteinintake, your vitamins, you're
(14:15):
not taking any supplements,those women will shed a lot.
So diet nutrition plays a hugerole.
It does.
Michele Folan (14:26):
We've heard about ozempic face, so now we get
ozempic hair.
Mary Wendel, MD (14:31):
Absolutely yeah .
Michele Folan (14:32):
Yeah, I guess that doesn't surprise me.
Mary Wendel, MD (14:36):
No, when bariatric surgery was more
popular.
We don't see it much anymorewith these medications now.
Firstly, everybody who hadbariatric surgery shed a lot of
hair.
It was expected.
We knew it was coming and wewould warn them.
But nobody's warning thesewomen, and so they're coming in,
having lost 50 pounds in fivemonths, which is too fast, and
they're not eating any protein.
(14:57):
They're barely eating one meala day, no supplements, nothing.
You know they're not checkingtheir nutrition.
And suddenly, you know they'refistfuls of hair everywhere.
And so, again, doesn't surpriseme.
Michele Folan (15:09):
Dr Wendell, we're going to take a quick break and
when we come back I want totalk about hormones, hrt and
hair loss.
So how's that nightly wineo'clock working out for you?
Or those 3 pm carb crashes thatmake you want to face plant on
your desk?
And let's not even talk aboutthe look your doctor gave you at
(15:29):
your last checkup yeah, thatlook.
Listen, midlife isn't a freepass to let your health slide.
You can't just hope your genesstill fit and call it good.
If you don't take charge now,your body's going to send you a
bill later and, trust me, it'sexpensive.
That's where the faster way tofat loss comes in.
(15:50):
We're talking real strategies,fueling with the right macros,
strength training that actuallyworks and habits that keep you
out of the nursing home and onthe dance floor.
So what's it going to be?
More excuses or more muscle?
Your move, the link's in the tobe More excuses or more muscle,
your move, the links in theshow notes.
Come join me.
All right, we are back.
(16:11):
I would like to addresshormones.
What role do estrogen andtestosterone play in the health
of women's hair?
Mary Wendel, MD (16:20):
It plays a huge role pretty much across the
board in terms of age, butparticularly peri and
postmenopausally.
You know, our hormones changedramatically for that 10 year
period.
We all feel it, we all know it.
Our estrogen levels sort ofdrop slowly over time.
Testosterone drops as well, andso estrogen plays a very
(16:42):
positive role in hair health.
We see that in pregnant women.
You know, hair tends to getfull and lush and beautiful and
shiny during pregnancy.
Of course, afterwards it tendsto fall out, which is very
disturbing.
But hormones play a huge role.
So estrogen, yes, very positive.
Even progesterone.
Again, those levels have to bein balance, though, and that's
(17:03):
the tricky part about women whoare on HRT.
You know how well are thesehormones being monitored?
Is it a balanced, compoundedprogram that they're on?
Are they being checkedperiodically?
The big issue for us is thetestosterone, and it's a hard
thing for some of these women tohear, but testosterone will
(17:25):
drive androgenetic alopecia, andthere are a lot of different
ways to get these hormones.
And again, if you're on alittle bit of testosterone and
your levels have been checkedand they're considered what
would be a therapeutic level,that's less of an issue.
But there are a lot of women onmegadose testosterone, and I
will tell you and warn womenthat pellets have no place in
(17:49):
good hormone management.
The pellets give you a veryhigh dose and then it slowly
trickles down and then theyreplace it and then it's really
high again and those changescause shedding, even if you're
not on testosterone.
Sometimes just the big swingsin the estrogen will cause
shedding, even if you're not ontestosterone.
Sometimes just the big swingsand the estrogen will cause
shedding.
But mega dosing of oftestosterone with those pellets.
(18:11):
Women come in all the time withaccelerated loss over the
course of a year because they'vebeen on these pellets and we
tell them it's probably thatthey're very concerned.
I know that there are somehormone specialists that will
tell their patients thattestosterone is good for their
hair, but there's not one bit ofscience to prove that or back
(18:31):
it.
The science is all showing thattestosterone drives hair loss.
We know it drives hair loss inmen.
That's why they're put onmedications to block it, but it
also drives it in women.
Michele Folan (18:41):
I wanted to ask you about testosterone, because
I'm on testosterone, I'm veryopen about that, and so I've
been watching very closelybecause that would be a concern
of mine.
I'm just doing a topicalcompounded.
You may not be able to tell methis, but is there a certain
level that you would see In theblood that you would say, ooh,
(19:05):
that's getting too high, that'sgoing to put you at risk for
androgenic alopecia.
Mary Wendel, MD (19:11):
Our hormones are very it's a very complicated
system but there are levelsthat are considered normal and
they vary by age.
A normal level for apostmenopausal woman for
testosterone would be very low.
If you want to supplement, youcan still supplement and keep
yourself in what would beconsidered a normal therapeutic
(19:31):
range, sort of like what maybe a40-year-old woman would have
instead of a 55-year-old woman.
So you're above what usuallywould exist at 55, but you're
not wildly elevated.
So if you can keep yourselfwithin what is considered that
normal level, that normal range,it's not going to have the same
effect on your hair as it wouldif it were really high.
(19:55):
Now, having said that, there's alot of variability of people's
sensitivities to these hormones.
There are some women that comein and they've already got
advanced androgenic alopecia andthey're considering going on
testosterone and I would cautionthem to do that If they already
have advanced hair loss.
You don't want to.
You know you really want to doeverything to maintain your hair
(20:16):
and try to get some regrowth,and testosterone is probably not
something that I would add tothat mix.
But again, if they're beingmonitored carefully and their
levels are, you know, sort of onthe lower side of normal,
that's probably okay.
I've changed my view on all ofthis because we just saw so many
women come in with huge dosesand high levels and various bad
(20:38):
hair loss and I just we wouldsay actually for a few years
I've told everybody they're ontestosterone.
I can't fix it, but that's notexactly true.
If they're well-managed andtheir levels are therapeutic,
it's probably okay.
Michele Folan (20:50):
All right, I would say.
Based on guests on my podcastand the reading I've done, it
seems like pellets are startingto fall out of favor.
Mary Wendel, MD (21:02):
I think you're right.
But every so often somebodystill walks in the door and they
said, oh I a new pellet put in,and I'm like oh, no, yeah
because you have to wait threemonths for it to drop.
You can't, you can't doanything.
I think it's been a big moneymaker.
Michele Folan (21:15):
It is a big money maker for some of these doctors
and I I think it's.
Mary Wendel, MD (21:19):
It's not ethical no, and and some of the
med spas are doing it as wellthey do have a doctor or a nurse
practitioner doing it, but theydon't have the training and the
expertise to manage it properly.
And a lot of women have themand then they never get their
levels checked.
They have no idea where they'reat and that's dangerous.
You know, like any medication,you know it needs to be
(21:42):
monitored carefully and thedoses need to be appropriate for
the reasons you're taking it.
So that's the problem is it'sthere's a lot of
misunderstanding.
And yeah, I'm just.
We just had a couple of peoplewomen come in last week.
Oh, I just had my pellet put inand I'm like, oh no, I don't
know.
There are actually medicationsfor postmenopausal women that do
(22:04):
help block the testosterone.
We sometimes would considerthat, but it has to be
postmenopausal.
These meds aren't safe forpremenopausal women, got it?
Michele Folan (22:13):
All right.
Well, just so you know, I amgetting my testosterone.
I get blood work twice a year,so I keep very close tabs on it.
Mary Wendel, MD (22:21):
That's you know , and that's safe and that's
fine, and yeah, that's I meanthere's a lot of good reasons to
take HRT.
You know, I was a physicianwhen we were doing a lot of
hormone replacement and thensuddenly we were not, because
there was all this bad studiesthat actually just confused the
whole situation.
(22:41):
So we took everybody off themfor about 10 years and then
gradually we started puttingthem back on.
So there's no question, thereare physiologic benefits to HRT
if managed well.
Michele Folan (22:51):
All right.
Well, we've talked abouthormones and kind of your
approach, but when I come to youas a patient, what are you
going to test me for?
Mary Wendel, MD (23:02):
Okay, we pretty much do blood work on everybody
or we get a copy of their mostrecent blood work from their
physician.
If they're on hormones, wewould like to see the levels
within the last six months.
We do test for certainnutrients like iron, zinc.
Vitamin D is very important forhair health.
The hormone levels again ifthey're on HRT, we will check
(23:25):
the estrogen progesterone.
The hormone levels again ifthey're on HRT, we will check
the estrogen, progesterone andthe testosterone.
We always check thyroid levelsbecause, again, very common in
women postmenopausally, thyroiddysfunction is actually on the
rise and can affect hair healthsignificantly In young women
under the age of 40, who wewouldn't expect them to be going
through menopause quite yet.
We do check testosterone ifthey have advanced hair loss,
(23:49):
because we want to look for PCOS, polycystic ovary syndrome
because those women haveelevated testosterone and it can
drive their hair loss.
So it's age-dependent and it'salso medical, history-dependent.
But we do check, like I said,basically CBC, blood count, iron
, vitamin D, zinc, all thosehormones.
(24:10):
Sometimes we check a cortisollevel which is sort of a rough
estimate of how much stress yourbody's feeling.
It's not a great, you know.
It's one of those tests that Ilike to do sometimes and just to
sort of remind me that thesepatients are really stressed out
because you know some womenjust shed chronically and we
(24:31):
can't find a reason for it.
And those are the women.
I'll check a cortisol and, youknow, get a good stress history
on them and you know theircortisol levels are usually
normal but they're on the veryhigh side of normal.
So they're always running at avery stressful level and we
believe that stress plays a bigrole in chronic shedding.
So I will check that in somepatients.
Michele Folan (24:54):
What other diagnostic processes would you
put a patient through?
And the reason I'm asking thisis I would love to know how much
scalp health plays into this.
Mary Wendel, MD (25:07):
Yes, it's a great question.
We have a machine that's calleda trichoscopy machine and where
it magnifies the scalp so thatwe can get a great view of the
scalp.
It's the health how muchinflammation is there?
Is there buildup of product?
Is there scaling?
We also can see the hairfollicle.
(25:27):
So what kind of situation thefollicle is in?
Is there inflammation there?
We can sometimes see evidence ofautoimmune disorders from the
scalp.
Yeah, so it's a very importantpart of the evaluation.
We do it on everybody and youreally cannot make a clear
diagnosis of a cause of hairloss without doing tricoscopy.
(25:49):
And that's something that notevery, even not every
dermatologist, does, but they'regetting to it more, but we've
been doing it for years.
So without that you reallycan't make the diagnosis.
We rarely do a scalp biopsy andwe probably did more.
We never did a lot of them, butthere were doctors that did
more of them, probably 10 years.
Lot of them, but there weredoctors that did more of them,
probably 10 years ago.
(26:09):
But there's really, unless yousee evidence of some significant
underlying autoimmune skindisease, there's really no need
to do it.
You can make the diagnosiswithout it.
But it's important to do.
It's really important.
We check the strength of thehair.
It's so interesting it'sbeginning to change.
But for the last five years orso there's been this trend
(26:31):
towards shampooing less, and Imean significantly less.
Women come in oh, I haven'tshampooed in two weeks or I just
rinse my hair out, even thoughI go to the gym every other day,
and it's really interesting tosee how unhealthy these scalps
are, how much debris and buildupthere is, and we actually do a
scalp cleanse here where weclean it all off to take a good
(26:53):
look.
Sometimes you can't see enoughof the scalp until you do that,
oh Lord.
So there's this trend with dryshampoos and all of this, and so
there's been a bit of fearabout using certain products and
I think you know you need torespect them, but the scalp
needs to be cleaned at leastevery two to three days.
I mean, you don't have to use aharsh shampoo to do that.
(27:14):
But there are scalp uh detoxprograms.
We do offer it here with thecleanse as well as with some
product, but that probably formost women who shampoo you know
what a couple times a week, theyprobably only need to do that
maybe once a month, but somewomen they build up seborrhea or
dandruff, and we're just seeingmore and more of it.
(27:35):
I think some of it is lifestyle, it's diet related, but again
there's this fear.
You know, don't shampoo toomuch and again, that varies from
ethnicity.
Different types of hair need tobe cleaned at different points
and the curlier the hair is, themore fragile it is and the
drier it is.
So you need to be careful toadd back moisture to really
(27:59):
curly, tight, curly hair.
Straight hair tends to be lessfragile, believe it or not, and
tends to be greasier.
So it's interesting, it'svariable.
But again, our recommendationfor more straight hair is at
least twice a week.
Women who have tight curls, I'dsay at least once a week.
But they're not doing that.
(28:21):
They're coming in.
You know I haven't shampooed intwo weeks and we're always
afraid to look at the tricoscopyand you know we're going to
find it's just not pretty.
And then you know you can'tgrow a good strand of hair
unless your scalp is clean.
So it's it's important to haveto do that and and once in a
while we, a lot of our patients,will come in every couple of
months and just just get a goodcleanse, a good scalp cleanse
(28:44):
and and that's it feels great.
Your scalp is healthy.
It takes away all the debris.
Michele Folan (28:54):
So it's a good idea, all right.
That was definitely one of myquestions because this comes up
all the time about how oftenshould I wash my hair.
And I wash my hair two or threetimes a week.
It's a pain, but I don't know.
My hair just feels better and Iwork out, I go to the gym, I I
can't, I just can't just yeah,okay, and that's, that's the
appropriate amount.
Mary Wendel, MD (29:11):
It really is okay PRP.
Michele Folan (29:14):
PRP.
I do want to talk about PRP,but I if you could kind of back
up and talk about the PRPprocess a little bit.
And also, is it painful, andwho's a good candidate?
Mary Wendel, MD (29:27):
okay, prp.
It's one of those treatmentsthat is like, who thought to do
this?
Prp was being used for manyother purposes before the hair
industry decided to give it a go.
But PRP stands forplatelet-rich plasma.
So what we do is we take ablood sample and it gets spun
down in a centrifuge and theblood gets separated and the
(29:49):
platelets are a certain type ofcell that normally helps prevent
bleeding and helps stopbleeding.
But amazingly, hanging aroundthose platelets are all these
beautiful growth factors andproteins and things that
stimulate healing and growth,things that stimulate healing
(30:09):
and growth, which, when youthink about it, it's a beautiful
system because if you have aninjury, that area needs to heal
and grow back.
So with the platelets, whenthey go there to stop the
bleeding, they bring all thatrich blood with them and the
healing starts immediately andhealing usually means regrowth
of cells.
So somebody figured out let'stry it on hair, let's see if it
(30:29):
will help the hair grow better.
And so I'm going to say,probably about 20 years ago,
people started experimentingwith it and again, the blood is
drawn, it's spun down.
The layers of the platelets area very specific layer.
They're pulled out and they'reinjected into the areas of the
scalp that to grow, and so therehave been various modifications
(30:55):
of how to do this over the last10 to 15 years, which is good,
because we know much more aboutthe science, we know the best
way to do it, we know how muchfluid we need, what's the
concentration that works best,and through all of that research
and there's been thousands ofstudies done, which is a good
thing we know that the best wayto do this is to have a series
(31:17):
of PRP.
It's three treatments, three tofour treatments one month apart
.
Then you wait until about sixto seven months, reevaluate, see
what kind of growth you'regetting, and if you're getting a
benefit and it seems to behelping, then you really need to
get boosters.
It's not something that causesa permanent change.
It only works while you'redoing it.
So most boosters now are aboutevery six months.
(31:40):
Initially we were doing it oncea year, and there's some women
who can get away with once ayear boosters, but most people
it's about every six months, andso it's an understanding that
we're not curing this, we'retreating it, and that's true of
everything.
For the most part, you're notreally curing it, you're
treating it.
Now the different ways of doingit and there are still many
different ways of doing it.
(32:00):
The needle way most people aredoing they're numbing up the
scalp so that it's not aspainful.
You know, getting the numbingis a little discomfort.
There's some discomfort, butyou really need the scalp to be
numbed in order to get thenumber of injections that are
required to get a good benefit.
We are starting to do somethingthat's called painless PRP.
(32:20):
It's a different method ofinjecting.
It is an injection but there'sno needle.
It's called a jet peel.
There's a high-intensity flowthat is actually able to make a
canal through the skin to getthat PRP solution down to the
hair follicle.
So that's a nice alternative.
I can't tell people with 100%honesty that it works equally
(32:44):
well as the needle PRP, but Iwill tell you that it works.
I know that it works.
I've seen it work in patientsthat didn't do well with the
other methods.
And so for women who have, youknow, they're afraid of the
needles, and there are a lot ofpatients that have been, you
know, gone through someillnesses, chemotherapy they're
not going to let us inject theirhead, and so this has been a
(33:05):
nice alternative for them and itworks very, very well.
So that's been a nice addedbenefit.
So who is a good candidate?
I'm going to tell you prettymuch anybody Virtually all the
types of hair loss that we knowabout can get some benefit from
PRP.
We know that androgenic alopeciait works the best for that.
(33:28):
That's been the majority of theresearch, and some women get
wonderful responses within sixto nine months.
It's noticeable, and so when wesee that, it's great.
We do know that PRP worksbetter when you have other
treatments added to it, and sothings like laser therapy which
I know you asked, you know youput on your questionnaire we
(33:50):
certainly can talk about thatbut also medications like
minoxidil and spironolactone andyoung women, sometimes hormonal
therapy, will be beneficial.
So those things all worktogether.
They're additive.
One plus one does make three inthis particular instance.
So we do know they work bettertogether than they do
(34:11):
individually better togetherthan they do individually.
Michele Folan (34:19):
Okay With PRP.
As we get older, is ourplatelet-rich plasma as
effective as it would have beenwhen we were younger?
Mary Wendel, MD (34:24):
Yeah, I mean the answer to that question is
yes, and it's interesting.
The only people that it mightbe a problem for is someone that
might have chronically lowplatelet count, because you need
a certain concentration inorder to get those growth
factors to do their job.
And so there are some people asthey age, their counts drop a
little bit Not dangerously so,but it makes it a little bit
(34:47):
more challenging.
But we're always a littlesurprised when we see a person
in their 80s, for instance,coming in.
They want to try the treatmentand we know that research has
shown that it works best inwomen who are a little bit
younger, but also who starttheir treatment before their
(35:07):
hair loss is really aggressive.
It's easier to maintain hairthan it is to regrow.
You can regrow it, there's noquestion.
But PRP works better on womenthan men for some reason, and it
seems to work better on youngerwomen.
Now that doesn't mean if you'reolder it's not going to work
for you.
One of my nurse practitionershas a patient who's in her 80s.
(35:30):
Her hair loss is profound andshe's getting the most
remarkable result and I'm justin awe of that fact.
But again, we are less I'm notgoing to say enthusiastic, but
we know that it doesn't workquite as well in the elderly
population.
Doesn't mean we won't try, justmeans they need to understand
that and they usually come inunderstanding that.
Michele Folan (35:51):
What about minoxidil?
Where do you stand on that?
Right now, come inunderstanding that.
Mary Wendel, MD (35:55):
What about minoxidil?
Where do you stand on thatright now?
Minoxidil has a real place here.
There are thousands of studiesto show benefit.
It doesn't give you that bigwow.
That's the problem is that whenwell, particularly the topical,
you know you're puttingsomething on your scalp, women
don't tend to like it.
It leaves a bit of a residue.
You know, virtually 100% of thestudies done on minoxidil in
six months show that you havemore hair than you did when you
started it.
(36:15):
But it's not like you look inthe mirror and go, oh, my hair
is so much better and so a lotof women will give up on it,
which is unfortunate because itdoes help maintain hair.
With the reinvention of oralminoxidil very low-dose oral
minoxidil that seems to have abit of a better response to it.
(36:35):
You don't have to put anythingon your scalp.
It is a medication you takeorally, but in very low doses.
The likelihood of potentialside effects is pretty low.
So I think that women shouldconsider it.
If you don't want to put it inyour body, then you need to put
it on the scalp.
If you're not concerned about,you know, have any risk factors,
which would include, you know,cardiac disease.
(36:55):
If someone who was elderly, wewouldn't give them low-dose
minoxidil, and if they had aheart disease, we wouldn't
either.
As long as it's well, you know,you ask all the right questions
and we screen for the properpatient, it can be done safely.
So I think it should beconsidered.
I really do.
Michele Folan (37:12):
Are there any other drugs or therapies that
are kind of on the horizon thathave you excited?
Mary Wendel, MD (37:18):
There actually is a lot of research being done,
which is exciting.
For the longest time,particularly for women, there
was nothing happening.
It was just until PRP camealong.
It was just very, very hard.
Laser therapy was a niceaddition, but, yes, there are
hormonal treatments beingresearched, particularly for
(37:38):
younger women.
There are new types of lasertherapy which is being
considered, and there are.
It's funny because there aremedications.
They don't give them a name yet.
You know, it's like QX200 isstill being studied, but yes,
fortunately, there's a lot ofresearch being done now, and so
it's interesting that themedication that a lot of women
(37:59):
know about is Latisse, whichactually helps your eyelashes
and eyebrows grow.
That can be compounded into asolution on the scalp which can
help stimulate some growth.
It can be compounded with orwithout minoxidil and that can
have some benefit.
And so, yes, there are somenewer things that people are
working on, and that'sreassuring actually.
Michele Folan (38:19):
You know, I don't know who told me this, and
maybe it's something that I sawon the internet Using Rogaine on
your eyebrows.
Mary Wendel, MD (38:28):
Oh, yeah, yeah, yeah, you just don't want to
get in your eye.
A lot of minoxidil solutionshave alcohol in the base, so,
yeah, just have to be careful.
But yes, it will stimulategrowth.
Michele Folan (38:38):
Your husband still does the hair
transplantation?
Yes, will he do eyelash andeyebrow transplants?
Yes, all right.
How common is that these days?
Mary Wendel, MD (38:49):
You know it's it's as women feel more
comfortable coming in.
We're seeing more and more ofit.
You know, from my generation weover plucked our eyebrows for
decades until they were gone.
And then, you know, a lot ofwomen are getting, you know,
microblading done, which is ingood hands, looks great, but you
have to have it touched up.
Um the the the eyebrowtransplants are permanent but
(39:12):
you do have to groom them causethey'll grow, which is so
interesting.
But it's easily managed.
Eyelashes are a little trickier.
There aren't a lot of surgeonsthat do them.
He does do them and he actuallylikes to do them.
But again, they grow fasterthan your normal eyelashes.
So you have to train them togrow a certain way.
They have to put them in verycarefully.
They place them in a veryspecific manner so that they'll
(39:32):
grow properly.
But we see more and more of it.
We've done a few eyebrows on men, which is interesting.
There was a gentleman that camein.
He has a very unusual type ofhair loss and he lost his
eyebrows 10 years ago and hesaid, yes, he didn't like the
fact that he lost the top of hishair, the scalp hair, but he
said, because he lost hiseyebrows, everybody thought he
had cancer and was undergoingchemo.
(39:53):
And he said he got tired ofanswering those questions.
And so he came in and we gavehim a little bit of hair on the
top and they transplanted theeyebrows.
And he came in and his wifesaid he's so happy with the
eyebrows.
That's what really made himhappy.
So it's you know, whatevermakes you happy, it's okay.
Michele Folan (40:10):
Yeah, I think hair in men is overrated.
I'm totally cool with a baldman.
Mary Wendel, MD (40:15):
You know I hate to say this, but I agree with
you.
You know I you know and I willnever say that in my husband's
office and you know he doesn't.
He doesn't need a hairtransplant, so he's fortunate.
But you know, under my breathI'll say you know, real men
don't need hair.
Michele Folan (40:31):
I'm like what do you need hair on your head for?
I kind of think it's sexy thatyou know if they're losing their
hair a little bit.
I'm okay with that.
Yeah, it's okay.
Mary Wendel, MD (40:42):
And you know hair transplants are variable.
My husband's been doing them along time and he's surgically
very good at it, and so his hairtransplants look very natural.
But I mean there are some outthere that look awful and I'm
like, oh, you should have justleft it off.
You know, it's just, you know.
But his, you know, I have tosay his look great, but, um,
that's not the case all the time.
Michele Folan (41:02):
Oh yeah, and, and you know, with all these women
doing these fake eyelashes, oureyelash extensions, it has to be
a boon for you all, because Ihave seen some horrendous
results of women losing, like,all their eyelashes with those
(41:24):
things.
Mary Wendel, MD (41:24):
Yes, yes, unfortunately that's.
We're seeing that more and more.
You know, the more that womendo it, the more we're going to
see it.
And, yes, the eyelash situationis not a great one.
And, yes, the eyelash situationis not a great one.
Michele Folan (41:33):
Yeah, yeah, my, my optometrist, she, she's like,
uh, no, um, you are not notdoing it because I have dry eye.
You know, she doesn't even likeyou using any kind of eyelash
serum because because of theprostaglandin.
So I've been very obedient whenit comes to that.
Mary Wendel, MD (41:50):
I just depend on cover girl to give me some
eyelashes?
Michele Folan (41:52):
Yeah, exactly, exactly.
When it comes to that, I justdepend on CoverGirl to give me
some eyelashes.
Mary Wendel, MD (41:55):
Yeah, exactly, exactly.
Michele Folan (41:56):
So we talked a little bit about sleep and
stress, maybe, over styling ofour hair.
There was one more that Iwanted to ask about Does alcohol
play a role in hair quality?
Mary Wendel, MD (42:19):
I'll be honest with you.
I haven't seen any research onthat.
I haven't heard anybody talkabout it at conferences.
I really believe everything inmoderation.
I think that a little bit ofalcohol is fine.
The effects that it has on yournutrition it's always dependent
on how much you enjoy.
You know, enjoy it.
So I don't think it's a it's abig issue.
Michele Folan (42:38):
I really don't All right.
And then I forgot to ask youred light therapy.
Oh yeah, so I have a red lightmask that I wear.
And then I was like I'm goingto just pop this thing on my
head, so I'll just put it on myhead, and you should see my
husband.
He just looks at me sometimesand he's like you are just out
(42:59):
of control.
But will that work if I wearthat on my head enough?
Mary Wendel, MD (43:05):
Yeah, it's a great question and laser therapy
is not the same as red lighttherapy.
Red light therapy are LEDs andthere's been a little bit of
research on LED and hair growthand there seems to be some
minimal benefit to it.
But when they compare it to thetrue laser light therapies, the
(43:28):
low level light therapies,there's a huge difference.
Light therapies there's a hugedifference.
True laser diodes have a muchmore beneficial result for hair
growth than just the red lightand we're seeing some of these
newer.
I mean, we recommend a lot oflow-level laser here, but we
(43:52):
recommend the apparatuses thathave complete laser.
It's more expensive, there's noquestion.
The caps and the bands thathave just lasers are more
expensive than the ones thathave just red light.
There are some companies thatare sort of mixing it up a
little bit.
They'll throw a few red lightsin with the lasers to make it
less expensive, but they're notgoing to work quite as well,
(44:14):
they're just not.
So there has been some researchto decide.
You know, is that equivalentand it's not?
Probably a little bit ofbenefit, Okay, but not like
laser therapy.
Michele Folan (44:27):
I would love to know for the women listening
who's feeling defeated bythinning hair or shedding, what
would be your message for her?
What would be the first stepshe should take If someone's
experiencing a lot of shedding,a lot of loss.
Mary Wendel, MD (44:49):
I think that they really should, first of all
, get a good physical.
They can talk to their primarycare physician.
When I did primary care,patients would come in.
Of course, I was a bit moreopen to it than maybe a lot of
people.
But a good set of blood work,making sure nutritionally
they're in good shape.
But you really want to seesomebody who knows about hair
loss and dermatologists aretrained in it.
They have varying degrees ofinterest in it, but that's a
(45:09):
place to start.
I mean, we have offices inMassachusetts and New York and
there are good people all overthe country, but you never know
quite what you're getting whenyou walk through the door and a
lot of women have been dismissedas, oh, your hair's fine, don't
worry about it.
Or the other side of it.
They're told oh, you're goingto need a wig in 10 years.
None of which is true.
You know, neither side is true,so don't get discouraged.
(45:30):
If I would just say you know,get a good physical, get your
blood work checked and then seea specialist.
Don't wait.
Don't wait and don't go on theinternet, because it's scary.
There's a lot of misinformationthere.
Michele Folan (45:43):
Oh, that's great advice.
And then one kind of a personalquestion what is something that
you do for yourself every day?
What's one of your core pillarsof self-care?
Mary Wendel, MD (45:55):
Oh, I, always I take before I start my day.
I've become an early riser,which I never used to be.
I think that comes with aging.
I take about 30 minutes in mychair with my coffee, do a
little meditation, a littlemessaging for the day, a little
bit of journaling, just to sortof settle me, and that's
(46:16):
important.
Otherwise you jump out of bedand you're running 100 miles an
hour and you don't give yourbrain a rest and you don't give
your spirit a rest.
So I think it's so important,just take that 30 minutes If you
have to get up a little earlier, just try to fit that into your
routine.
And I think it's so important.
And I have, you know, I haveseveral apps that help me to
(46:38):
meditate a little bit.
Or you know just messaging, youknow things to help you feel
stronger and more ready for yourday.
I mean, it's tough, things arevery stressful, and you know the
pandemic did a number on ourhair, I will tell you that for
sure, and so we're still much inrecovery of that.
But there's still a lot ofstress and whatever you can do
(47:00):
to minimize it.
I don't do yoga every day, butI do it a few times a week and
again it's a very meditativeslow yoga, appropriate for my
age.
But I think those 30 minutes Ilove those 30 minutes.
Michele Folan (47:12):
I love that.
That's a good one.
Mary Wendel, MD (47:16):
I need to do that you know something I've
just started to do, I thinkreally since COVID, you know I
was home.
What am I going to do all day?
So I just kind of started thatand I've kept it up, and when I
miss a day here or there, I feelit it's like oh, I want my
chair.
Michele Folan (47:32):
I got to run home and sit in my chair for 30
minutes.
Oh, that's great.
It's a good reminder for all ofus.
Dr Mary Wendel, this wasincredibly informative.
I appreciate you being heretoday and I will let you know if
I need you at some point.
Mary Wendel, MD (47:49):
Okay, I'm here.
I'm here.
Thank you for inviting me.
You've been, you're obviouslyvery informed and that's a nice
thing to share.
I really appreciate it.
Michele Folan (48:00):
Well, thank you.
Thank you for listening.
Please rate and review thepodcast where you listen and if
you'd like to join the Askingfor a Friend community, click on
the link in the show notes tosign up for my weekly newsletter
, where I share midlife wellnessand fitness tips, insights, my
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Hey friends, Michele here, I bring over 25
years of health industryexperience to everything I do as
a certified fitness andnutrition coach and host of a
top 2% global women's health andwellness podcast.
And I don't just share theseconversations on the mic, I
bring them to live audiences.
I've moderated women's healthpanels, interviewed top experts
(00:21):
on stage, and spoken to women'sgroups about thriving in midlife
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My mission is to help womenfeel strong, capable, and in
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If you're planning an event onwomen's health, midlife wellness
or personal growth, I'd love tobe part of it.
Reach out through LinkedIn orthe link in the show notes.
(00:44):
Let's make your next eventunforgettable and meaningful.
Health, wellness, fitness, andeverything in between.
We're removing the taboo fromwhat really matters in midlife.
I'm your host, Michele Folan,and this is Asking for a Friend.
(01:09):
If you've strategically movedyour part to hide thinning, or
if your ponytail feelssuspiciously skinnier than it
used to, or if you're like me,you've held a wad of hair in
your hand after showering andthought what the hell is going
on, this is a great episode foryou.
Hair thinning and hair loss inmidlife is incredibly common,
(01:30):
but it's also incrediblyfrustrating, emotional and often
brushed off as just aging thetruth.
There's always a root cause andthere are actual solutions
beyond buying yet anothershampoo that overpromises and
underdelivers.
My guest today is Dr MaryWendel, founder and chief
medical officer of Meditress, amedical practice dedicated
(01:52):
solely to treating hair loss inwomen.
She's a board certifiedinternist who took her own
experience with hair loss andturned it into a mission to help
other women get real answersand real results.
We're talking hormones, haircycles, hrt, prp, red light,
nutrition, stress, and why weneed to stop Googling and get
(02:13):
serious about the rightdiagnosis.
Dr Mary Wendel, thank you forbeing here today.
Mary Wendel, MD (02:18):
Well, thank you for having me.
I'm always happy to talk aboutthis subject.
It's near and dear to my heartfor many reasons, so thank you.
Michele Folan (02:27):
Yeah, and we're going to dig into that, but I
love to start with your storyand really, what inspired you to
dedicate your medical career towomen's hair loss, because
that's not where you started,it's not where I started.
Mary Wendel, MD (02:41):
It is where I'm ending, but I am a board
certified internist and I didprimary care medicine for over
30 years and during that time myhusband, who was an emergency
room physician, transitionedinto hair and has been doing
hair transplants for about 35years.
(03:01):
And towards the end of mymedical career we started to see
more and more women walkingthrough the door asking about
hair transplants and what theycould do.
It took a lot of courage forthem to come through a door that
was primarily very maleoriented, and so my husband said
can you help me here?
And so I started splitting mytime between my general medical
(03:22):
practice and the hair practice.
And you know you mentioned theemotional component.
I will say that's the thing thatsurprised me the most, and I
shouldn't have been surprised.
But these, the women, came in.
Many of them had seen manyother providers before me for
their hair and just feltdiscouraged and dismissed.
(03:43):
There wasn't as much to offerinitially, but I really felt for
them and had a lot ofcompassion.
My own family history isunfortunately fraught with
female hair loss.
My grandmother wore a wig.
My parents' hair was prettygood, but I have several female
cousins who are also struggling.
(04:03):
My own hair loss started tobecome noticeable to me just
perimenopausally, which isfairly typical.
But it was interesting that Iwas surprised when I looked in
the mirror and saw it happening.
I'm like, oh no not me.
I'm sorry this can't behappening, but so it became a
personal mission as well and asmy medical practice, I started
(04:25):
to move away from that.
I spent more and more time heredoing the hair, and now we have
a whole lot more to offer and alot more guidance to give Okay.
Michele Folan (04:33):
So what kind of extra education did you have to
get to get where you are now?
Mary Wendel, MD (04:39):
Yeah, actually that's a good question.
That I'm asked a lot because Iam, you know, a highly trained
internist and you know that tooka long question.
That I'm asked a lot because Iam, you know, a highly trained
internist and you know that tooka long time and a lot of you
know, many years.
But actually, hair loss,although it can be complicated,
it's a fairly narrow field.
I did take a lot of classes, Idid a lot of courses, both in
(05:01):
person and online.
I worked with a lot ofdermatologists who, you know,
specialize in hair loss and ithas become its own specialty
within the dermatology world.
So it it, you know, I wasinterested enough and and always
interested in learningsomething new, and it's
constantly changing.
Even since I started this youknow we were doing the math just
(05:22):
last night I've been doing thisfor over 20 years.
A lot has changed, wow.
So you have to keep up.
Either way.
Michele Folan (05:29):
Oh, yeah, for sure.
You know, when I got close tomenopause, my husband would make
jokes like God, it looks like asquirrel was run over by a
lawnmower in the shower, youknow, because there would be
hair all over the place.
Right, and I know I'm not alone.
Other women deal with this.
But I think it'd be good tojust start with the basics, mary
(05:51):
, and like what are the mostcommon types of hair loss you
see in women, particularlymidlife and postmenopausal women
?
Mary Wendel, MD (06:01):
By far the most common cause of hair loss is
androgenic alopecia Fancy termfor you've inherited these
tendencies.
Your hormones are playing intothis and that's why we see it
accelerate perimenopausally,premenopausally, and really
that's the vast majority.
That's probably 80 to 85% ofthe women that we see, and it's
(06:25):
the most common.
It's actually what causes mento lose their hair as well, and
women don't really appreciatethe fact that they're inheriting
this.
I often say you know who'ssitting around the dinner table
on Thanksgiving and take a lookat everybody's hair, because the
women are not excluded fromthat and it's a bit of a shock
(06:46):
when it happens, but it is byfar the most common and most you
know truly most women by thetime they hit in their mid-50s
will say, oh, I don't havenearly as much hair as I used to
when they're really pressed.
But it's when it starts tonotice the spaces between the
hair Suddenly your scalp is abit more noticeable.
That's when women start topanic.
(07:07):
So that is by far the mostcommon and hormones play a huge
role Hormones and aging andgenetics.
We also see a lot of what'scalled telogen effluvium, which
is a term that just meansexcessive shedding brought about
by a long list of potentialproblems.
Stress plays a huge role there.
Some of the worst hair sheddingI've ever seen has been as a
(07:30):
result of extreme stress, and itcan be physical stress, like
illness, can be emotional stressfor which there's nothing.
You know, there's no number totest to see how bad it really is
, but the hair will tell you,your outsides, will tell you
what's going on to your insides,and it is also very common.
But the most common is theandrogenic.
Michele Folan (07:51):
All right, Two questions On average.
How many hairs would we expectto lose in a day?
Mary Wendel, MD (07:59):
Yeah, that's a great question and it's
something that creates a lot ofanxiety for a lot of women.
It's extremely variable.
You know, women who have morehair are going to shed more.
The statistics claim thatanywhere up to a hundred hairs a
day is considered normal.
Well, if I lost a hundred a day, I'd be in shock because that's
just not my pattern.
(08:20):
I'd be like running for thehills.
But like young women, like mygrand, my 16-old granddaughter,
her hair's everywhere and she'snot losing it excessively.
It's just she's got a lot ofhair so she's going to lose more
.
But when you have less hair tostart with, you're going to shed
much less than that 100.
It's going to be more like 40or so, and once you start
(08:42):
reaching that 100 point, it'sgoing to feel abnormal.
Ethnicity plays a role as well.
There's some types of hair thattends to shed more than others.
That's more brittle, that'smore likely to break.
So a lot of things play into itand that's why it's a little
deceiving when you read thearticles that say well, you can
lose up to 100 a day and thenthat would be considered normal.
(09:02):
But that's not true.
If you're normally hitting, youknow, 30 to 40 a day and
suddenly you're hitting ahundred.
That's going to look veryexcessive.
It's going to look you're goingto know something's up.
It's a change in your pattern.
Michele Folan (09:15):
There'd be a difference between losing your
hair at the root and then losingyour hair due to breakage,
correct, okay, then the otherquestion would be do we, at
certain times of the year, losemore hair than other times of
the year?
Mary Wendel, MD (09:33):
Yes, we do More .
Women tend to have a little bitof a shed in the fall and
there's a physiologic reason forthat.
Our growth cycle prolongsduring the summer months with
the heat or the sun.
I think it's a lot has to dowith vitamin D from the sunlight
.
Vitamin D is good for hair, butnot everybody sheds in the fall
.
Some women never shedseasonally, but of women who do
(09:55):
shed seasonally, more commonlyit's the fall.
I always shed a little bit inthe fall.
There are some women that shedin the springtime, which is sort
of what you'd expect if youwere a bear living in winter.
You know you're hibernating,it's cold, you come out of the
hole and suddenly you don't needthat thick fur anymore and
you're going to shed it.
But that doesn't work forpeople.
We don't need to lose a lotcome springtime, so we tend to
(10:16):
shed more in the fall.
All right, we're not bears.
Michele Folan (10:19):
Then I guess my other question now these are
popping into my head as we'respeaking what about eyelashes
and eyebrows?
Mary Wendel, MD (10:26):
Not usually cyclical, like scalp hair, but
if you have a medical illnessthat's causing you to shed,
there are certainly hair lossdiseases that you can lose
eyebrows and eyelashes, but themost common cause of androgenic
alopecia generally doesn't causeexcessive shedding and a
telogen effluvium, which isagain due to illness or stress,
(10:49):
doesn't usually affect eyebrowsor eyelashes.
Michele Folan (10:52):
So then, what are some of the biggest
misconceptions you hear fromwomen about hair loss, and what
do you wish women would knowearlier?
Mary Wendel, MD (11:03):
Yeah, I think the biggest misconception is
that all the answers are on theinternet, because they're not.
But I also think that peoplewomen are surprised when they
find out that they've inheritedthis.
You know, I see we see a fairnumber of younger women in their
mid-20s or so who have sort ofadvanced hair loss for their age
(11:26):
, and I will always ask thoseyoung women what does dad look
like?
Well, dad's bald.
I mean not just thinning, butdad's bald, so you can inherit
that from your dad.
It's both sides of the family.
The genetics is very complex.
Once in a while someone willcome in and say there's nobody,
but when you really get down tobrass tacks, the genetics is
very complex.
Once in a while someone willcome in and say there's nobody,
(11:49):
but when you really get down tobrass tacks, the genetics is
fairly complicated.
So really people don'tunderstand that the genetics can
be that strong for women aswell as for men.
Okay, that's interesting.
Yeah, and it's almost universal.
When I see a young woman, yeah,and it's almost universal when
I see a young woman, I see evenwomen as young as 18 or 19
coming in with already you knowadvanced loss and sometimes dads
(12:12):
will bring the girls in anddad's bald or dad has had a hair
transplant, and you know theycome in and when they find out
that their daughter hasinherited from them, they're
heartbroken and I feel badly forthem because they know how it
affects their daughters, theiryoung daughters.
But it's very strongly geneticfor women as well as men.
Michele Folan (12:32):
All right.
So how about for male patternhair loss?
I used to always be told thatit's the maternal grandfather
that predicted no, okay.
Mary Wendel, MD (12:46):
No, no and yes, that is also a big
misunderstanding.
It's both sides equally.
And they now know with studies,recent studies, that a man, a
young man, of his dad's fall,he's got a more than 50% chance
of losing his hair as well.
So it's not you know thematernal grandfather, it's, it's
(13:07):
both sides coming at youequally.
And the more history of it, thegreater likelihood that both
men and women will will losetheir hair.
You know women are not expectedto lose their hair.
You know men are not, may notbe happy about it, but they're
probably not surprised,especially if you know dad's
bald.
But for women and that's thehard part is that they don't
(13:28):
understand that and and they'rethey don't expect it.
And suddenly you know they're45 years old and their hair is
thinning and they didn't expectit.
So yeah, it's, it's hard.
Michele Folan (13:40):
It's hard.
Yeah, it is very emotional, butnow you mentioned stress, yep,
are there any other lifestylefactors alone that can cause
significant hair loss?
Mary Wendel, MD (13:53):
Diet nutrition is huge.
We've done a lot of researchhere on diet, rapid weight loss.
You know so many women are onthe GLP-1s and you can lose
weight slowly and carefully andwith good nutrition and not
necessarily shed.
But if you've lost a lot ofweight rapidly and you're not
being careful about your proteinintake, your vitamins, you're
(14:15):
not taking any supplements,those women will shed a lot.
So diet nutrition plays a hugerole.
It does.
Michele Folan (14:26):
We've heard about ozempic face, so now we get
ozempic hair.
Mary Wendel, MD (14:31):
Absolutely yeah .
Michele Folan (14:32):
Yeah, I guess that doesn't surprise me.
Mary Wendel, MD (14:36):
No, when bariatric surgery was more
popular.
We don't see it much anymorewith these medications now.
Firstly, everybody who hadbariatric surgery shed a lot of
hair.
It was expected.
We knew it was coming and wewould warn them.
But nobody's warning thesewomen, and so they're coming in,
having lost 50 pounds in fivemonths, which is too fast, and
they're not eating any protein.
(14:57):
They're barely eating one meala day, no supplements, nothing.
You know they're not checkingtheir nutrition.
And suddenly, you know they'refistfuls of hair everywhere.
And so, again, doesn't surpriseme.
Michele Folan (15:09):
Dr Wendell, we're going to take a quick break and
when we come back I want totalk about hormones, hrt and
hair loss.
So how's that nightly wineo'clock working out for you?
Or those 3 pm carb crashes thatmake you want to face plant on
your desk?
And let's not even talk aboutthe look your doctor gave you at
(15:29):
your last checkup yeah, thatlook.
Listen, midlife isn't a freepass to let your health slide.
You can't just hope your genesstill fit and call it good.
If you don't take charge now,your body's going to send you a
bill later and, trust me, it'sexpensive.
That's where the faster way tofat loss comes in.
(15:50):
We're talking real strategies,fueling with the right macros,
strength training that actuallyworks and habits that keep you
out of the nursing home and onthe dance floor.
So what's it going to be?
More excuses or more muscle?
Your move, the link's in the tobe More excuses or more muscle,
your move, the links in theshow notes.
Come join me.
All right, we are back.
(16:11):
I would like to addresshormones.
What role do estrogen andtestosterone play in the health
of women's hair?
Mary Wendel, MD (16:20):
It plays a huge role pretty much across the
board in terms of age, butparticularly peri and
postmenopausally.
You know, our hormones changedramatically for that 10 year
period.
We all feel it, we all know it.
Our estrogen levels sort ofdrop slowly over time.
Testosterone drops as well, andso estrogen plays a very
(16:42):
positive role in hair health.
We see that in pregnant women.
You know, hair tends to getfull and lush and beautiful and
shiny during pregnancy.
Of course, afterwards it tendsto fall out, which is very
disturbing.
But hormones play a huge role.
So estrogen, yes, very positive.
Even progesterone.
Again, those levels have to bein balance, though, and that's
(17:03):
the tricky part about women whoare on HRT.
You know how well are thesehormones being monitored?
Is it a balanced, compoundedprogram that they're on?
Are they being checkedperiodically?
The big issue for us is thetestosterone, and it's a hard
thing for some of these women tohear, but testosterone will
(17:25):
drive androgenetic alopecia, andthere are a lot of different
ways to get these hormones.
And again, if you're on alittle bit of testosterone and
your levels have been checkedand they're considered what
would be a therapeutic level,that's less of an issue.
But there are a lot of women onmegadose testosterone, and I
will tell you and warn womenthat pellets have no place in
(17:49):
good hormone management.
The pellets give you a veryhigh dose and then it slowly
trickles down and then theyreplace it and then it's really
high again and those changescause shedding, even if you're
not on testosterone.
Sometimes just the big swingsin the estrogen will cause
shedding, even if you're not ontestosterone.
Sometimes just the big swingsand the estrogen will cause
shedding.
But mega dosing of oftestosterone with those pellets.
(18:11):
Women come in all the time withaccelerated loss over the
course of a year because they'vebeen on these pellets and we
tell them it's probably thatthey're very concerned.
I know that there are somehormone specialists that will
tell their patients thattestosterone is good for their
hair, but there's not one bit ofscience to prove that or back
(18:31):
it.
The science is all showing thattestosterone drives hair loss.
We know it drives hair loss inmen.
That's why they're put onmedications to block it, but it
also drives it in women.
Michele Folan (18:41):
I wanted to ask you about testosterone, because
I'm on testosterone, I'm veryopen about that, and so I've
been watching very closelybecause that would be a concern
of mine.
I'm just doing a topicalcompounded.
You may not be able to tell methis, but is there a certain
level that you would see In theblood that you would say, ooh,
(19:05):
that's getting too high, that'sgoing to put you at risk for
androgenic alopecia.
Mary Wendel, MD (19:11):
Our hormones are very it's a very complicated
system but there are levelsthat are considered normal and
they vary by age.
A normal level for apostmenopausal woman for
testosterone would be very low.
If you want to supplement, youcan still supplement and keep
yourself in what would beconsidered a normal therapeutic
(19:31):
range, sort of like what maybe a40-year-old woman would have
instead of a 55-year-old woman.
So you're above what usuallywould exist at 55, but you're
not wildly elevated.
So if you can keep yourselfwithin what is considered that
normal level, that normal range,it's not going to have the same
effect on your hair as it wouldif it were really high.
(19:55):
Now, having said that, there's alot of variability of people's
sensitivities to these hormones.
There are some women that comein and they've already got
advanced androgenic alopecia andthey're considering going on
testosterone and I would cautionthem to do that If they already
have advanced hair loss.
You don't want to.
You know you really want to doeverything to maintain your hair
(20:16):
and try to get some regrowth,and testosterone is probably not
something that I would add tothat mix.
But again, if they're beingmonitored carefully and their
levels are, you know, sort of onthe lower side of normal,
that's probably okay.
I've changed my view on all ofthis because we just saw so many
women come in with huge dosesand high levels and various bad
(20:38):
hair loss and I just we wouldsay actually for a few years
I've told everybody they're ontestosterone.
I can't fix it, but that's notexactly true.
If they're well-managed andtheir levels are therapeutic,
it's probably okay.
Michele Folan (20:50):
All right, I would say.
Based on guests on my podcastand the reading I've done, it
seems like pellets are startingto fall out of favor.
Mary Wendel, MD (21:02):
I think you're right.
But every so often somebodystill walks in the door and they
said, oh I a new pellet put in,and I'm like oh, no, yeah
because you have to wait threemonths for it to drop.
You can't, you can't doanything.
I think it's been a big moneymaker.
Michele Folan (21:15):
It is a big money maker for some of these doctors
and I I think it's.
Mary Wendel, MD (21:19):
It's not ethical no, and and some of the
med spas are doing it as wellthey do have a doctor or a nurse
practitioner doing it, but theydon't have the training and the
expertise to manage it properly.
And a lot of women have themand then they never get their
levels checked.
They have no idea where they'reat and that's dangerous.
You know, like any medication,you know it needs to be
(21:42):
monitored carefully and thedoses need to be appropriate for
the reasons you're taking it.
So that's the problem is it'sthere's a lot of
misunderstanding.
And yeah, I'm just.
We just had a couple of peoplewomen come in last week.
Oh, I just had my pellet put inand I'm like, oh no, I don't
know.
There are actually medicationsfor postmenopausal women that do
(22:04):
help block the testosterone.
We sometimes would considerthat, but it has to be
postmenopausal.
These meds aren't safe forpremenopausal women, got it?
Michele Folan (22:13):
All right.
Well, just so you know, I amgetting my testosterone.
I get blood work twice a year,so I keep very close tabs on it.
Mary Wendel, MD (22:21):
That's you know , and that's safe and that's
fine, and yeah, that's I meanthere's a lot of good reasons to
take HRT.
You know, I was a physicianwhen we were doing a lot of
hormone replacement and thensuddenly we were not, because
there was all this bad studiesthat actually just confused the
whole situation.
(22:41):
So we took everybody off themfor about 10 years and then
gradually we started puttingthem back on.
So there's no question, thereare physiologic benefits to HRT
if managed well.
Michele Folan (22:51):
All right.
Well, we've talked abouthormones and kind of your
approach, but when I come to youas a patient, what are you
going to test me for?
Mary Wendel, MD (23:02):
Okay, we pretty much do blood work on everybody
or we get a copy of their mostrecent blood work from their
physician.
If they're on hormones, wewould like to see the levels
within the last six months.
We do test for certainnutrients like iron, zinc.
Vitamin D is very important forhair health.
The hormone levels again ifthey're on HRT, we will check
(23:25):
the estrogen progesterone.
The hormone levels again ifthey're on HRT, we will check
the estrogen, progesterone andthe testosterone.
We always check thyroid levelsbecause, again, very common in
women postmenopausally, thyroiddysfunction is actually on the
rise and can affect hair healthsignificantly In young women
under the age of 40, who wewouldn't expect them to be going
through menopause quite yet.
We do check testosterone ifthey have advanced hair loss,
(23:49):
because we want to look for PCOS, polycystic ovary syndrome
because those women haveelevated testosterone and it can
drive their hair loss.
So it's age-dependent and it'salso medical, history-dependent.
But we do check, like I said,basically CBC, blood count, iron
, vitamin D, zinc, all thosehormones.
(24:10):
Sometimes we check a cortisollevel which is sort of a rough
estimate of how much stress yourbody's feeling.
It's not a great, you know.
It's one of those tests that Ilike to do sometimes and just to
sort of remind me that thesepatients are really stressed out
because you know some womenjust shed chronically and we
(24:31):
can't find a reason for it.
And those are the women.
I'll check a cortisol and, youknow, get a good stress history
on them and you know theircortisol levels are usually
normal but they're on the veryhigh side of normal.
So they're always running at avery stressful level and we
believe that stress plays a bigrole in chronic shedding.
So I will check that in somepatients.
Michele Folan (24:54):
What other diagnostic processes would you
put a patient through?
And the reason I'm asking thisis I would love to know how much
scalp health plays into this.
Mary Wendel, MD (25:07):
Yes, it's a great question.
We have a machine that's calleda trichoscopy machine and where
it magnifies the scalp so thatwe can get a great view of the
scalp.
It's the health how muchinflammation is there?
Is there buildup of product?
Is there scaling?
We also can see the hairfollicle.
(25:27):
So what kind of situation thefollicle is in?
Is there inflammation there?
We can sometimes see evidence ofautoimmune disorders from the
scalp.
Yeah, so it's a very importantpart of the evaluation.
We do it on everybody and youreally cannot make a clear
diagnosis of a cause of hairloss without doing tricoscopy.
(25:49):
And that's something that notevery, even not every
dermatologist, does, but they'regetting to it more, but we've
been doing it for years.
So without that you reallycan't make the diagnosis.
We rarely do a scalp biopsy andwe probably did more.
We never did a lot of them, butthere were doctors that did
more of them, probably 10 years.
Lot of them, but there weredoctors that did more of them,
probably 10 years ago.
(26:09):
But there's really, unless yousee evidence of some significant
underlying autoimmune skindisease, there's really no need
to do it.
You can make the diagnosiswithout it.
But it's important to do.
It's really important.
We check the strength of thehair.
It's so interesting it'sbeginning to change.
But for the last five years orso there's been this trend
(26:31):
towards shampooing less, and Imean significantly less.
Women come in oh, I haven'tshampooed in two weeks or I just
rinse my hair out, even thoughI go to the gym every other day,
and it's really interesting tosee how unhealthy these scalps
are, how much debris and buildupthere is, and we actually do a
scalp cleanse here where weclean it all off to take a good
(26:53):
look.
Sometimes you can't see enoughof the scalp until you do that,
oh Lord.
So there's this trend with dryshampoos and all of this, and so
there's been a bit of fearabout using certain products and
I think you know you need torespect them, but the scalp
needs to be cleaned at leastevery two to three days.
I mean, you don't have to use aharsh shampoo to do that.
(27:14):
But there are scalp uh detoxprograms.
We do offer it here with thecleanse as well as with some
product, but that probably formost women who shampoo you know
what a couple times a week, theyprobably only need to do that
maybe once a month, but somewomen they build up seborrhea or
dandruff, and we're just seeingmore and more of it.
(27:35):
I think some of it is lifestyle, it's diet related, but again
there's this fear.
You know, don't shampoo toomuch and again, that varies from
ethnicity.
Different types of hair need tobe cleaned at different points
and the curlier the hair is, themore fragile it is and the
drier it is.
So you need to be careful toadd back moisture to really
(27:59):
curly, tight, curly hair.
Straight hair tends to be lessfragile, believe it or not, and
tends to be greasier.
So it's interesting, it'svariable.
But again, our recommendationfor more straight hair is at
least twice a week.
Women who have tight curls, I'dsay at least once a week.
But they're not doing that.
(28:21):
They're coming in.
You know I haven't shampooed intwo weeks and we're always
afraid to look at the tricoscopyand you know we're going to
find it's just not pretty.
And then you know you can'tgrow a good strand of hair
unless your scalp is clean.
So it's it's important to haveto do that and and once in a
while we, a lot of our patients,will come in every couple of
months and just just get a goodcleanse, a good scalp cleanse
(28:44):
and and that's it feels great.
Your scalp is healthy.
It takes away all the debris.
Michele Folan (28:54):
So it's a good idea, all right.
That was definitely one of myquestions because this comes up
all the time about how oftenshould I wash my hair.
And I wash my hair two or threetimes a week.
It's a pain, but I don't know.
My hair just feels better and Iwork out, I go to the gym, I I
can't, I just can't just yeah,okay, and that's, that's the
appropriate amount.
Mary Wendel, MD (29:11):
It really is okay PRP.
Michele Folan (29:14):
PRP.
I do want to talk about PRP,but I if you could kind of back
up and talk about the PRPprocess a little bit.
And also, is it painful, andwho's a good candidate?
Mary Wendel, MD (29:27):
okay, prp.
It's one of those treatmentsthat is like, who thought to do
this?
Prp was being used for manyother purposes before the hair
industry decided to give it a go.
But PRP stands forplatelet-rich plasma.
So what we do is we take ablood sample and it gets spun
down in a centrifuge and theblood gets separated and the
(29:49):
platelets are a certain type ofcell that normally helps prevent
bleeding and helps stopbleeding.
But amazingly, hanging aroundthose platelets are all these
beautiful growth factors andproteins and things that
stimulate healing and growth,things that stimulate healing
(30:09):
and growth, which, when youthink about it, it's a beautiful
system because if you have aninjury, that area needs to heal
and grow back.
So with the platelets, whenthey go there to stop the
bleeding, they bring all thatrich blood with them and the
healing starts immediately andhealing usually means regrowth
of cells.
So somebody figured out let'stry it on hair, let's see if it
(30:29):
will help the hair grow better.
And so I'm going to say,probably about 20 years ago,
people started experimentingwith it and again, the blood is
drawn, it's spun down.
The layers of the platelets area very specific layer.
They're pulled out and they'reinjected into the areas of the
scalp that to grow, and so therehave been various modifications
(30:55):
of how to do this over the last10 to 15 years, which is good,
because we know much more aboutthe science, we know the best
way to do it, we know how muchfluid we need, what's the
concentration that works best,and through all of that research
and there's been thousands ofstudies done, which is a good
thing we know that the best wayto do this is to have a series
(31:17):
of PRP.
It's three treatments, three tofour treatments one month apart
.
Then you wait until about sixto seven months, reevaluate, see
what kind of growth you'regetting, and if you're getting a
benefit and it seems to behelping, then you really need to
get boosters.
It's not something that causesa permanent change.
It only works while you'redoing it.
So most boosters now are aboutevery six months.
(31:40):
Initially we were doing it oncea year, and there's some women
who can get away with once ayear boosters, but most people
it's about every six months, andso it's an understanding that
we're not curing this, we'retreating it, and that's true of
everything.
For the most part, you're notreally curing it, you're
treating it.
Now the different ways of doingit and there are still many
different ways of doing it.
(32:00):
The needle way most people aredoing they're numbing up the
scalp so that it's not aspainful.
You know, getting the numbingis a little discomfort.
There's some discomfort, butyou really need the scalp to be
numbed in order to get thenumber of injections that are
required to get a good benefit.
We are starting to do somethingthat's called painless PRP.
(32:20):
It's a different method ofinjecting.
It is an injection but there'sno needle.
It's called a jet peel.
There's a high-intensity flowthat is actually able to make a
canal through the skin to getthat PRP solution down to the
hair follicle.
So that's a nice alternative.
I can't tell people with 100%honesty that it works equally
(32:44):
well as the needle PRP, but Iwill tell you that it works.
I know that it works.
I've seen it work in patientsthat didn't do well with the
other methods.
And so for women who have, youknow, they're afraid of the
needles, and there are a lot ofpatients that have been, you
know, gone through someillnesses, chemotherapy they're
not going to let us inject theirhead, and so this has been a
(33:05):
nice alternative for them and itworks very, very well.
So that's been a nice addedbenefit.
So who is a good candidate?
I'm going to tell you prettymuch anybody Virtually all the
types of hair loss that we knowabout can get some benefit from
PRP.
We know that androgenic alopeciait works the best for that.
(33:28):
That's been the majority of theresearch, and some women get
wonderful responses within sixto nine months.
It's noticeable, and so when wesee that, it's great.
We do know that PRP worksbetter when you have other
treatments added to it, and sothings like laser therapy which
I know you asked, you know youput on your questionnaire we
(33:50):
certainly can talk about thatbut also medications like
minoxidil and spironolactone andyoung women, sometimes hormonal
therapy, will be beneficial.
So those things all worktogether.
They're additive.
One plus one does make three inthis particular instance.
So we do know they work bettertogether than they do
(34:11):
individually better togetherthan they do individually.
Michele Folan (34:19):
Okay With PRP.
As we get older, is ourplatelet-rich plasma as
effective as it would have beenwhen we were younger?
Mary Wendel, MD (34:24):
Yeah, I mean the answer to that question is
yes, and it's interesting.
The only people that it mightbe a problem for is someone that
might have chronically lowplatelet count, because you need
a certain concentration inorder to get those growth
factors to do their job.
And so there are some people asthey age, their counts drop a
little bit Not dangerously so,but it makes it a little bit
(34:47):
more challenging.
But we're always a littlesurprised when we see a person
in their 80s, for instance,coming in.
They want to try the treatmentand we know that research has
shown that it works best inwomen who are a little bit
younger, but also who starttheir treatment before their
(35:07):
hair loss is really aggressive.
It's easier to maintain hairthan it is to regrow.
You can regrow it, there's noquestion.
But PRP works better on womenthan men for some reason, and it
seems to work better on youngerwomen.
Now that doesn't mean if you'reolder it's not going to work
for you.
One of my nurse practitionershas a patient who's in her 80s.
(35:30):
Her hair loss is profound andshe's getting the most
remarkable result and I'm justin awe of that fact.
But again, we are less I'm notgoing to say enthusiastic, but
we know that it doesn't workquite as well in the elderly
population.
Doesn't mean we won't try, justmeans they need to understand
that and they usually come inunderstanding that.
Michele Folan (35:51):
What about minoxidil?
Where do you stand on that?
Right now, come inunderstanding that.
Mary Wendel, MD (35:55):
What about minoxidil?
Where do you stand on thatright now?
Minoxidil has a real place here.
There are thousands of studiesto show benefit.
It doesn't give you that bigwow.
That's the problem is that whenwell, particularly the topical,
you know you're puttingsomething on your scalp, women
don't tend to like it.
It leaves a bit of a residue.
You know, virtually 100% of thestudies done on minoxidil in
six months show that you havemore hair than you did when you
started it.
(36:15):
But it's not like you look inthe mirror and go, oh, my hair
is so much better and so a lotof women will give up on it,
which is unfortunate because itdoes help maintain hair.
With the reinvention of oralminoxidil very low-dose oral
minoxidil that seems to have abit of a better response to it.
(36:35):
You don't have to put anythingon your scalp.
It is a medication you takeorally, but in very low doses.
The likelihood of potentialside effects is pretty low.
So I think that women shouldconsider it.
If you don't want to put it inyour body, then you need to put
it on the scalp.
If you're not concerned about,you know, have any risk factors,
which would include, you know,cardiac disease.
(36:55):
If someone who was elderly, wewouldn't give them low-dose
minoxidil, and if they had aheart disease, we wouldn't
either.
As long as it's well, you know,you ask all the right questions
and we screen for the properpatient, it can be done safely.
So I think it should beconsidered.
I really do.
Michele Folan (37:12):
Are there any other drugs or therapies that
are kind of on the horizon thathave you excited?
Mary Wendel, MD (37:18):
There actually is a lot of research being done,
which is exciting.
For the longest time,particularly for women, there
was nothing happening.
It was just until PRP camealong.
It was just very, very hard.
Laser therapy was a niceaddition, but, yes, there are
hormonal treatments beingresearched, particularly for
(37:38):
younger women.
There are new types of lasertherapy which is being
considered, and there are.
It's funny because there aremedications.
They don't give them a name yet.
You know, it's like QX200 isstill being studied, but yes,
fortunately, there's a lot ofresearch being done now, and so
it's interesting that themedication that a lot of women
(37:59):
know about is Latisse, whichactually helps your eyelashes
and eyebrows grow.
That can be compounded into asolution on the scalp which can
help stimulate some growth.
It can be compounded with orwithout minoxidil and that can
have some benefit.
And so, yes, there are somenewer things that people are
working on, and that'sreassuring actually.
Michele Folan (38:19):
You know, I don't know who told me this, and
maybe it's something that I sawon the internet Using Rogaine on
your eyebrows.
Mary Wendel, MD (38:28):
Oh, yeah, yeah, yeah, you just don't want to
get in your eye.
A lot of minoxidil solutionshave alcohol in the base, so,
yeah, just have to be careful.
But yes, it will stimulategrowth.
Michele Folan (38:38):
Your husband still does the hair
transplantation?
Yes, will he do eyelash andeyebrow transplants?
Yes, all right.
How common is that these days?
Mary Wendel, MD (38:49):
You know it's it's as women feel more
comfortable coming in.
We're seeing more and more ofit.
You know, from my generation weover plucked our eyebrows for
decades until they were gone.
And then, you know, a lot ofwomen are getting, you know,
microblading done, which is ingood hands, looks great, but you
have to have it touched up.
Um the the the eyebrowtransplants are permanent but
(39:12):
you do have to groom them causethey'll grow, which is so
interesting.
But it's easily managed.
Eyelashes are a little trickier.
There aren't a lot of surgeonsthat do them.
He does do them and he actuallylikes to do them.
But again, they grow fasterthan your normal eyelashes.
So you have to train them togrow a certain way.
They have to put them in verycarefully.
They place them in a veryspecific manner so that they'll
(39:32):
grow properly.
But we see more and more of it.
We've done a few eyebrows on men, which is interesting.
There was a gentleman that camein.
He has a very unusual type ofhair loss and he lost his
eyebrows 10 years ago and hesaid, yes, he didn't like the
fact that he lost the top of hishair, the scalp hair, but he
said, because he lost hiseyebrows, everybody thought he
had cancer and was undergoingchemo.
(39:53):
And he said he got tired ofanswering those questions.
And so he came in and we gavehim a little bit of hair on the
top and they transplanted theeyebrows.
And he came in and his wifesaid he's so happy with the
eyebrows.
That's what really made himhappy.
So it's you know, whatevermakes you happy, it's okay.
Michele Folan (40:10):
Yeah, I think hair in men is overrated.
I'm totally cool with a baldman.
Mary Wendel, MD (40:15):
You know I hate to say this, but I agree with
you.
You know I you know and I willnever say that in my husband's
office and you know he doesn't.
He doesn't need a hairtransplant, so he's fortunate.
But you know, under my breathI'll say you know, real men
don't need hair.
Michele Folan (40:31):
I'm like what do you need hair on your head for?
I kind of think it's sexy thatyou know if they're losing their
hair a little bit.
I'm okay with that.
Yeah, it's okay.
Mary Wendel, MD (40:42):
And you know hair transplants are variable.
My husband's been doing them along time and he's surgically
very good at it, and so his hairtransplants look very natural.
But I mean there are some outthere that look awful and I'm
like, oh, you should have justleft it off.
You know, it's just, you know.
But his, you know, I have tosay his look great, but, um,
that's not the case all the time.
Michele Folan (41:02):
Oh yeah, and, and you know, with all these women
doing these fake eyelashes, oureyelash extensions, it has to be
a boon for you all, because Ihave seen some horrendous
results of women losing, like,all their eyelashes with those
(41:24):
things.
Mary Wendel, MD (41:24):
Yes, yes, unfortunately that's.
We're seeing that more and more.
You know, the more that womendo it, the more we're going to
see it.
And, yes, the eyelash situationis not a great one.
And, yes, the eyelash situationis not a great one.
Michele Folan (41:33):
Yeah, yeah, my, my optometrist, she, she's like,
uh, no, um, you are not notdoing it because I have dry eye.
You know, she doesn't even likeyou using any kind of eyelash
serum because because of theprostaglandin.
So I've been very obedient whenit comes to that.
Mary Wendel, MD (41:50):
I just depend on cover girl to give me some
eyelashes?
Michele Folan (41:52):
Yeah, exactly, exactly.
When it comes to that, I justdepend on CoverGirl to give me
some eyelashes.
Mary Wendel, MD (41:55):
Yeah, exactly, exactly.
Michele Folan (41:56):
So we talked a little bit about sleep and
stress, maybe, over styling ofour hair.
There was one more that Iwanted to ask about Does alcohol
play a role in hair quality?
Mary Wendel, MD (42:19):
I'll be honest with you.
I haven't seen any research onthat.
I haven't heard anybody talkabout it at conferences.
I really believe everything inmoderation.
I think that a little bit ofalcohol is fine.
The effects that it has on yournutrition it's always dependent
on how much you enjoy.
You know, enjoy it.
So I don't think it's a it's abig issue.
Michele Folan (42:38):
I really don't All right.
And then I forgot to ask youred light therapy.
Oh yeah, so I have a red lightmask that I wear.
And then I was like I'm goingto just pop this thing on my
head, so I'll just put it on myhead, and you should see my
husband.
He just looks at me sometimesand he's like you are just out
(42:59):
of control.
But will that work if I wearthat on my head enough?
Mary Wendel, MD (43:05):
Yeah, it's a great question and laser therapy
is not the same as red lighttherapy.
Red light therapy are LEDs andthere's been a little bit of
research on LED and hair growthand there seems to be some
minimal benefit to it.
But when they compare it to thetrue laser light therapies, the
(43:28):
low level light therapies,there's a huge difference.
Light therapies there's a hugedifference.
True laser diodes have a muchmore beneficial result for hair
growth than just the red lightand we're seeing some of these
newer.
I mean, we recommend a lot oflow-level laser here, but we
(43:52):
recommend the apparatuses thathave complete laser.
It's more expensive, there's noquestion.
The caps and the bands thathave just lasers are more
expensive than the ones thathave just red light.
There are some companies thatare sort of mixing it up a
little bit.
They'll throw a few red lightsin with the lasers to make it
less expensive, but they're notgoing to work quite as well,
(44:14):
they're just not.
So there has been some researchto decide.
You know, is that equivalentand it's not?
Probably a little bit ofbenefit, Okay, but not like
laser therapy.
Michele Folan (44:27):
I would love to know for the women listening
who's feeling defeated bythinning hair or shedding, what
would be your message for her?
What would be the first stepshe should take If someone's
experiencing a lot of shedding,a lot of loss.
Mary Wendel, MD (44:49):
I think that they really should, first of all
, get a good physical.
They can talk to their primarycare physician.
When I did primary care,patients would come in.
Of course, I was a bit moreopen to it than maybe a lot of
people.
But a good set of blood work,making sure nutritionally
they're in good shape.
But you really want to seesomebody who knows about hair
loss and dermatologists aretrained in it.
They have varying degrees ofinterest in it, but that's a
(45:09):
place to start.
I mean, we have offices inMassachusetts and New York and
there are good people all overthe country, but you never know
quite what you're getting whenyou walk through the door and a
lot of women have been dismissedas, oh, your hair's fine, don't
worry about it.
Or the other side of it.
They're told oh, you're goingto need a wig in 10 years.
None of which is true.
You know, neither side is true,so don't get discouraged.
(45:30):
If I would just say you know,get a good physical, get your
blood work checked and then seea specialist.
Don't wait.
Don't wait and don't go on theinternet, because it's scary.
There's a lot of misinformationthere.
Michele Folan (45:43):
Oh, that's great advice.
And then one kind of a personalquestion what is something that
you do for yourself every day?
What's one of your core pillarsof self-care?
Mary Wendel, MD (45:55):
Oh, I, always I take before I start my day.
I've become an early riser,which I never used to be.
I think that comes with aging.
I take about 30 minutes in mychair with my coffee, do a
little meditation, a littlemessaging for the day, a little
bit of journaling, just to sortof settle me, and that's
(46:16):
important.
Otherwise you jump out of bedand you're running 100 miles an
hour and you don't give yourbrain a rest and you don't give
your spirit a rest.
So I think it's so important,just take that 30 minutes If you
have to get up a little earlier, just try to fit that into your
routine.
And I think it's so important.
And I have, you know, I haveseveral apps that help me to
(46:38):
meditate a little bit.
Or you know just messaging, youknow things to help you feel
stronger and more ready for yourday.
I mean, it's tough, things arevery stressful, and you know the
pandemic did a number on ourhair, I will tell you that for
sure, and so we're still much inrecovery of that.
But there's still a lot ofstress and whatever you can do
(47:00):
to minimize it.
I don't do yoga every day, butI do it a few times a week and
again it's a very meditativeslow yoga, appropriate for my
age.
But I think those 30 minutes Ilove those 30 minutes.
Michele Folan (47:12):
I love that.
That's a good one.
Mary Wendel, MD (47:16):
I need to do that you know something I've
just started to do, I thinkreally since COVID, you know I
was home.
What am I going to do all day?
So I just kind of started thatand I've kept it up, and when I
miss a day here or there, I feelit it's like oh, I want my
chair.
Michele Folan (47:32):
I got to run home and sit in my chair for 30
minutes.
Oh, that's great.
It's a good reminder for all ofus.
Dr Mary Wendel, this wasincredibly informative.
I appreciate you being heretoday and I will let you know if
I need you at some point.
Mary Wendel, MD (47:49):
Okay, I'm here.
I'm here.
Thank you for inviting me.
You've been, you're obviouslyvery informed and that's a nice
thing to share.
I really appreciate it.
Michele Folan (48:00):
Well, thank you.
Thank you for listening.
Please rate and review thepodcast where you listen and if
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