November 23, 2025 • 26 mins
11/23/25
The Healthy Matters Podcast
S05_E04 - Hair Today, Gone Tomorrow! All About Hair Loss.
With Special Guest: Dr. Audrey Jacobsen
Everyone loses a few hairs every day (about 50-100 on average). But ever wonder why some people lose some or even all of their hair entirely? Or why things like stress or Chemotherapy can have have an effect on our manes? Hair loss is something that will make you gray at an early age - if you're lucky! But the who, when and why is something that almost always leaves us with more questions than answers.
It turns out, hair loss falls under the field of dermatology, so thankfully on episode 4 of our show, we'll be joined by the Chair of Dermatology at Hennepin Healthcare, Dr. Audrey Jacobsen (MD, MPH), to help us get to the root of the matter (apologies - hair puns are low-hangin fruit...). We'll go over why hair loss can happen, who's most at risk, and best yet, what can be done to treat or even prevent it. This is an obvious stressor for a lot of people, so thankfully we've got an expert to walk us through it, and hopefully keep the grays at bay. Join us!
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
SPEAKER_00 (00:01):
Welcome to the Healthy Matters Podcast with Dr.
David Hilden, primary carephysician and acute care
hospitalist at HennepinHealthcare in downtown
Minneapolis, where we cover thelatest in health, health care,
and what matters to you.
And now here's our host, Dr.
David Hilden.
SPEAKER_03 (00:18):
Hey everybody, and welcome to episode four of the
Healthy Matters Podcast.
I'm your host, David Hilden.
Today we're going to be talkingabout hair loss.
Have you ever noticed that yourshower drain is starting to look
like it needs its own hairbrush?
If so, you are not alone.
Hair loss happens to millions ofpeople, men and women, and it's
one of the most common reasonspeople see a dermatologist.
(00:40):
Today, we're getting to theroot, and that pun was fully
intended, of why hair losshappens, what's normal, what's
not, and what you can actuallydo about it.
So joining me today is Dr.
Audrey Jacobson.
She is the chair of dermatologyhere at Heneman Healthcare in
Minneapolis, and she is someonewho helps patients understand,
prevent, and treat hair loss allthe time.
Audrey, thanks for being hereand welcome to the show.
SPEAKER_01 (01:02):
Thank you for having me.
I'm excited to talk about hairloss.
SPEAKER_03 (01:04):
Okay, start with the basics then about hair loss.
We all know what it is, yourhair falls out, but what is it
from a medical perspective?
What is actually happening?
SPEAKER_01 (01:12):
Yeah, so really what's happening is that your
hair is coming out from theroot, right?
And there's different causes forthat.
So it's really important toknow, you know, what is really,
like you said, the root cause ofyour hair loss.
So either there's some damagegoing on underneath the scalp,
or your hair is justtransitioning to a phase where
it naturally wants to fall out.
SPEAKER_03 (01:32):
So let's talk about that second half first.
So some people lose a ton ofhair and some people don't lose
much at all.
Is that just in the normalpopulation that you lose your
hair?
Is that supposed to happen?
SPEAKER_01 (01:45):
Yeah.
So I mean, I think that thatactually gets to the two most
common causes of hair loss thatI see in clinical practice.
So that's gonna be your hormoneor age-related hair loss.
Sometimes that's called male orfemale pattern baldness.
I don't like to call it baldnessbecause you you might not go
bald from that, and that tendsto scare patients.
SPEAKER_03 (02:02):
Right, right.
But people know what you'retalking about.
They do.
The receding hairline and allthat.
SPEAKER_01 (02:07):
Exactly.
And then there's that other typeof hair loss, which is that
sudden shedding of hair lossthat people say have after like
a very stressful event, andthat's called telogen effluvium.
Those are the two most commontypes of hair loss that I see.
SPEAKER_03 (02:19):
So let's do the male or female pattern hair loss,
because that's what I think alot of people think of.
There's a lot of, there'sprobably a lot of men out there
that says, yeah, my hair startedleak leaving when I was 30, and
others are 85 years old andthey're still got a full head of
hair.
But it's both men and women,right?
Correct.
Why does it happen?
SPEAKER_01 (02:36):
So that is all related to, I would say,
genetics and hormones, right?
So I see men and women withthis.
Men, it's more common.
You've got that classic recedinghairline around the temples, and
then that top of the scalpthere.
Women also get it too, but ithappens to tend to be more in
that top of the scalp, thatcrown.
But what people don't understandis that it's really genetics,
(02:58):
right?
So when I see patients withthis, I go, tell me about your
family members.
Did anyone else in your familyhave thinning hair or any males
in your family kind of go baldat an early age?
That's really important.
And when we also talk abouthormones related with this, I
encourage patients, I say, it'snot that your hormones are out
of whack.
There's nothing wrong with them.
It's just that those hairfollicles are more sensitive to
(03:19):
the normal hormones in yourbody, and that is related to
genetics.
And that's why you might havethat early hair thinning.
SPEAKER_03 (03:24):
What's a hair follicle?
SPEAKER_01 (03:26):
So, hair follicle is like the little tube that your
hair grows out of from thescalp.
And that hair follicle is reallyimportant for the health of that
hair.
SPEAKER_03 (03:34):
So, in this hormonal type of hair loss, is that
follicle okay?
It's just that the hairs are, Idon't even know, they're leaving
the follicle in their entirety.
SPEAKER_01 (03:43):
This might get a little too nitty-gritty there.
No, but I'm curious.
We actually talk aboutminiaturization of hairs in
androgenetic alopecia.
Androgenetic is that geneticrelated and hormonal.
SPEAKER_03 (03:56):
Miniaturization of hairs?
Okay, you've got to tell me whatthat is.
SPEAKER_01 (04:00):
So when I do a hair exam, I am looking at someone's
scalp like with a microscope,right?
I am like all up in their scalp,and I see hairs with a normal
diameter, and then I also seehairs that look really skinny.
And when I see a lot of hairsthat look really skinny, I say,
hey, there must be somehormone-related changes going on
to these hair follicles that isresulting in these like thinner
(04:20):
hairs, and that can also leadhair to look thinner.
SPEAKER_03 (04:23):
Wow.
I never even thought of that.
And I did actually graduate frommed school, Audrey.
So I do have to say, I do haveto say, when you decided what
you want, what you wanted asspecialty, here's what I want to
do.
I want to be a dermatologist soI can get all up in people's
scalps.
Is that what you were thinking?
SPEAKER_01 (04:39):
I don't, I don't actually know if I knew that
that was involved at the time,but here I am.
SPEAKER_03 (04:44):
Yeah, I don't think a lot of people know that.
Your specialist for hair loss,folks, is your dermatologist.
I can do a few things as yourprimary care doctor, but I
digress.
Okay, so the hairs fall out inuh both men and women.
How common is this?
SPEAKER_01 (04:59):
It's really common.
I I I don't have an exactpercentage for you, but I
sometimes quote like 50% forwomen, and maybe even more
common for men.
It's super common.
It may be just your hair isslightly thinner, but you're not
gonna go bald, right?
Or it's it's to the point wheremen will go bald at an early
age.
It just really depends.
There's a huge variety.
SPEAKER_03 (05:19):
And there's a variety of when it starts too.
SPEAKER_01 (05:22):
Exactly, yeah.
So especially for men, they maystart noticing it in their 20s,
even you know, when they're ateenager, if they have a really
strong family history of it.
But for others, it might not betill their 30s, 40s, 50s, even.
SPEAKER_03 (05:33):
Is it all genetic, or are there things we do in our
lives that might make your hairloss worse?
SPEAKER_01 (05:39):
I think for that androgenetic or that male
pattern or female pattern, thatis typically just genetics, kind
of luck of the draw.
That being said, I see mixedhair loss too, right?
Where you might just have yeah,living a really stressful life,
have a stressful event, surgery,COVID.
That leads to some like suddenhair shedding, and then it might
(06:00):
unmask this hormone-related hairloss that you might not have
known you had.
So there's definitely a mixedcomponent, and we always want to
treat both if we can.
SPEAKER_03 (06:07):
That's super interesting.
So you mentioned earlier a bigword teluvium, something or
other.
That was that what you said canbe more sudden.
Could you say more about firstof all, what was the word you
used?
SPEAKER_01 (06:17):
Telogen effluvium.
Telogen effluvium.
SPEAKER_03 (06:19):
Okay, listeners, get that into a cocktail party
sentence.
I dare you.
Telogen effluvium.
What is that?
SPEAKER_01 (06:25):
So I'll break down that crazy Latin term for you,
right?
So telogen is that phase of hairthat is gonna shed, right?
A lot of your hair is already inthat phase.
Like you're gonna shed hair.
Normal shedding is 50 to 100hairs a day, right?
So I see it's kind of like alot, right?
SPEAKER_03 (06:42):
It does seem kind of like a lot.
SPEAKER_01 (06:43):
Yeah.
Effluvium is kind of the suddenshedding, right?
The most common classic exampleI give that is you had a baby,
four months later, you're like,why is my hair falling out?
Right?
Or you had a surgery or you hadCOVID, a few months later, your
hair just sheds.
It will come back though.
It just takes a long time.
SPEAKER_03 (07:01):
So stressful things in your life can lead to an
acceleration of hair loss.
SPEAKER_01 (07:05):
Totally.
Finals.
I see it in college kids uhcoming in, they're really
stressed out.
They just had finals, and thenthey're like, my hair shedding,
right?
So it can be an emotionalstressor, a physical stressor,
really anything.
SPEAKER_03 (07:16):
So let's go to the other causes that might be under
your scalp that are causing hairloss.
What are they?
SPEAKER_01 (07:22):
So that I think is a more niche area of hair loss,
and one that you definitely wantto be seeing a board-certified
dermatologist for.
So those are gonna be yourautoimmune or inflammatory type
of hair loss.
And that's where that hairfollicle we talked about, that
little kind of uh cylinder orsheath that the hair grows out
of in the scalp is somehow beingdamaged or attacked by your own
(07:46):
body.
I think alopecia areata is thebest example of that.
SPEAKER_03 (07:50):
Many people I think have heard of alopecia areata.
And alopecia simply means hairloss, right?
True.
SPEAKER_01 (07:55):
Yes, alopecia just means hair loss.
SPEAKER_03 (07:57):
So it's something being destroying your hair
follicles.
Do they come back?
SPEAKER_01 (08:00):
Yeah, so alopecia areata is a really interesting
one in that your hair can comeback.
So it's that hair follicle iskind of temporarily being
attacked by your own body.
And then if we treat it with theright medications to kind of
calm down your immune system,say, hey, don't attack to your
own hair.
You don't need to attack yourown hair, it's yours, right?
Um, we can get that hair to growback.
SPEAKER_03 (08:21):
What other kinds are there?
SPEAKER_01 (08:22):
Yeah, so there's these inflammatory types of hair
loss, and those are actually, Iwould say, more serious medical
conditions where there's actualdamage happening to the hair
follicle.
And that can actually lead inwhat we call scarring alopecia
or scarring hair loss, where thehair follicle gets so damaged
that it gets scarred and youcannot grow hair out of that
hair follicle again.
(08:43):
So it can lead to more permanenthair loss or hair thinning.
Those are the ones that we needto catch as early as possible.
SPEAKER_03 (08:49):
So, on any of these, how does your daily stress or
your nutrition or your othermedical conditions affect hair
loss?
SPEAKER_01 (08:57):
So I think when I talk to patients about hair
loss, I like to take a wholebody approach, right?
I might ask about mental health,depression, anxiety, other
things that might beexacerbating their hair loss.
We know that skin health, hairhealth is all linked, and I am a
huge proponent of gettingpatients mental health care if
they need.
So we'll address that if we needto.
(09:19):
You did talk about nutrition.
There are a few labs that Imight check on a patient if I'm
worried about any type of hairloss because I just want to
promote a healthy environmentfor hair growth.
It may not be the main cause oftheir hair loss, but we might
check things like iron, yourthyroid, maybe your zinc, maybe
your vitamin D, just to makesure we've really optimized a
(09:39):
good environment for hairgrowth.
SPEAKER_03 (09:41):
What about medications people take or
supplements or chemotherapy?
Oh, I suppose chemotherapycauses hair loss.
Let's put that aside for asecond.
What about other medications?
Do you see much effect on thenormal, usual stuff people are
taking?
SPEAKER_01 (09:54):
Not the normal, usual stuff, I would say.
Um, I will say I have a lot ofpatients come in with biotin.
They're taking biotin.
It's, you know, supposedly magicfor, you know, hair, skin, and
nails, right?
That's not actually the case.
We don't actually think biotinworks that well, and it can
actually mess up some labvalues.
So say a patient's on biotin,they come to see you to get
(10:14):
their thyroid checked.
It can actually mess up thosethyroid values, or they might go
to the emergency room for somechest pain.
It can actually mess up thosevalues we might check in the
emergency department, like yourtroponin for heart health.
So we actually encouragepatients not to take biotin.
SPEAKER_03 (10:29):
Oh, that's a good tip.
So there's probably nothing youneed to be doing other than
getting a good diet, a balanceddiet.
I'm gonna say don't smokebecause you're never supposed to
smoke, folks, if you haven'tfigured that one out yet.
Um, uh, you don't need to takeextra supplements, things like
that.
And if you are experiencing somehair loss, you know, go see a
specialist.
Which brings me to thisquestion: what patterns might
(10:51):
people notice in their own headthat would cause them to come
see you?
SPEAKER_01 (10:55):
I mean, I definitely want to see a patient if they're
experiencing a sudden loss ofhair, sudden bald spots on their
hair, or if they're experiencingany scalp pain, burning,
itching, those are signs that,you know, I want to see you as
soon as possible.
Um, if you've noticed thatgradual hair thinning over time,
oh, for sure I still want to seeyou, but it may not be as urgent
(11:16):
as some of these other types ofhair loss where we're gonna need
to start some pretty intensetreatments right away to prevent
more loss.
SPEAKER_03 (11:23):
So before you go see your dermatologist and that more
gradual stuff, go buy a linttrap for your shower.
SPEAKER_00 (11:27):
Maybe that's what you need to do.
SPEAKER_03 (11:30):
I'm gonna go back to chemotherapy.
Just um this, we're not gonnaget in a lot of detail about
cancer treatments inchemotherapy, but why does it
cause hair loss?
Or some of the chemotherapiescause such substantial hair
loss.
SPEAKER_01 (11:40):
Yeah.
So remember how we talked aboutthat hair follicle.
So that's kind of that cylinder,that sheath that the hair grows
out of.
Chemotherapy targets that hairfollicle because it has really
rapidly dividing cells.
If you think about cancer,cancer cells are rapidly
dividing, they're growing.
Hair follicles do the samething.
So chemotherapy doesn't know,right?
And so it just attacks thosehair follicles as well.
(12:01):
And that can cause that hair tofall out because it's no longer
in that nice healthy environmentfor growth.
SPEAKER_03 (12:07):
When it does come back, does it come back just
like your previous hair?
Because I've heard some peoplesay it came back curlier or
fuzzy or something.
SPEAKER_01 (12:14):
So the hair follicle shape and orientation affects
how your hair grows.
So if that's been damaged bychemotherapy, your hair might
grow back a little bit differentwhen it comes back.
SPEAKER_03 (12:23):
So we are talking about hair loss with
dermatologist Dr.
Audrey Jacobson.
She is the chair of dermatologyat Hennepin Healthcare here in
downtown Minneapolis.
We're gonna take a short break,and when we come back, we're
gonna discuss the diagnosis ofhair loss, available treatment
options, and we'll find out ifthere are ways to prevent or
reverse it.
So stick around, we'll be rightback.
SPEAKER_02 (12:43):
When Hennepin Healthcare says, we're here for
life, they mean here for you,your life, and all that it
brings.
Hennepin Healthcare has ahospital, HCMC, a network of
clinics in the metro area, andan integrative health clinic in
downtown Minneapolis.
They provide all of the primaryand specialty care you'd expect
to find, as well as serviceslike acupuncture and
(13:06):
chiropractic care.
Learn more athennepinhealthcare.org.
Hennepin Healthcare is here foryou and here for life.
SPEAKER_03 (13:21):
And we're back talking about hair loss with Dr.
Audrey Jacobson.
So I see people all the time inprimary care with hair loss, and
I gotta be really honest withyou.
I know precious little abouthair loss.
I really do.
I don't know very much about it.
So, folks, you can call yourprimary care doctor, but this is
a specialty thing.
Um, you might have your firstvisit with your primary doctor.
(13:41):
If you don't know who to call,go see them.
They can look at it and see ifit's anything to be worried
about.
Um, but they'll probably do thisas well.
Make sure you see adermatologist who does this.
So they come see you.
They're in your clinic.
What do you do?
Do you do tests?
Do you look at it real close?
What do you do?
SPEAKER_01 (13:57):
Yeah.
So, first of all, I'm gonna talkto my patient, right?
We're gonna ask a whole history.
I know we talk to our patientsin dermatology too.
Um, we're gonna ask a lot ofquestions about their family
history, their personal history,stressors in their life, other
medical conditions.
And then we're also gonna do areally good hair and scalp exam,
right?
So I'm gonna get at mydermatoscope.
That's kind of like mymicroscope.
SPEAKER_03 (14:17):
So I'm gonna be looking at the Sherlock Holmes
spyglass kind of thing.
SPEAKER_01 (14:21):
I totally feel like Sherlock Holmes every day in
clinic.
Except you call it adermatoscope.
It's a dermatoscope, yep.
And then after I look at thescalp, at that point I'm gonna
have a good idea of what type ofhair loss is going on.
I'll oftentimes get some bloodwork.
We talked about some of thosekind of vitamins and minerals we
might get.
Rarely I'll do a biopsy if I'mnot really sure, or it's I'm
(14:43):
like, is this a scarring type ofhair loss, or is this just
regular hormone genetic, youknow, that androgenetic hair
loss?
We might do a biopsy.
I don't do biopsies as much onthe scalp, but it's definitely
something we can do.
SPEAKER_03 (14:55):
Can you usually just kind of tell the scalp looks
okay, everything's looking okaydown underneath your hair?
SPEAKER_01 (15:02):
Yeah, so there's a lot of clues, especially if I'm
using my fancy dermatoscope,that can tell me how are the
hair follicles doing?
Is there inflammation?
Is there no inflammation?
You know, do we need a biopsy ornot?
SPEAKER_03 (15:14):
Because just underneath the hair is on your
scalp is skin.
So you can kind of get downthere and look at it.
SPEAKER_01 (15:19):
Yeah, but if we do need to do a biopsy, it's about
a five-minute in-officeprocedure that we can do that
same day.
SPEAKER_03 (15:25):
Oh, that's good to know.
Yeah, so it's not some massivething where you're going to an
operating room or anything likethat.
Would you just take a littlepiece of the skin?
SPEAKER_01 (15:32):
Yeah, we numb up the skin with an injection of
anesthesia, then we take just, Icall it a tiny cookie cutter
kind of cylinder of the scalp,and then we put in one or two
stitches, and then we're done.
SPEAKER_03 (15:41):
Oh, okay.
So that's not a very big deal ifyou do need that, folks.
Okay, so let's say they have theandrogenetic, the
hormone-related, thegenetic-related hair loss.
What treatment options areavailable?
SPEAKER_01 (15:52):
Really good question.
So I like to break thosetreatment options into two
categories.
So I talk about hair growth.
We want to help grow the hair.
And then for some patients, wewant to say, hey, we kind of
want to block that hormonethat's causing that hair loss in
the first place.
And there's differentmedications, topically or oral,
that we can combine to kind oftreat both of those areas.
So promoting hair growth andthen also blocking that male
(16:14):
hormone that causes the hairloss.
SPEAKER_03 (16:17):
So start with the topicals.
Do they work?
SPEAKER_01 (16:19):
They do.
So that's gonna be your topicalmonoxidil.
A lot of people know it asrogaine, but minoxidil is the
generic version, and studies doshow that it is effective when
used regularly.
SPEAKER_03 (16:29):
So the what people have told me, especially women,
oh boy, I'm gonna get this thingthat grows hair.
Um, it's gonna, I'm gonna, I'mgonna look like a hairy gorilla,
uh, you know, when it's alldone.
I take it it's not like that.
SPEAKER_01 (16:41):
Definitely not the topical version of minoxidel,
because that's just gonna treatlocally wherever you put it.
The oral version of monoxidil,right, which you may know is a
blood pressure medication, weuse in low doses for hair
growth.
One of the most common sideeffects is hair growth.
And women that could wean someextra chin hairs that they might
have to pluck.
SPEAKER_03 (17:01):
Okay, so that is a thing when you because it
doesn't really know which hairfollicles to go after.
And if you have a hair follicleon your face, even women, yep,
exactly.
You could have some hairsgrowing where you didn't really
want them.
SPEAKER_01 (17:14):
Exactly.
SPEAKER_03 (17:15):
Do you use systemic or oral monoxidyl on women
though?
SPEAKER_01 (17:19):
I do.
I use systemic monoxidal really,it's so common now, actually,
it's getting extremely popular.
And it's it's nice for peoplewho don't want to have to put
kind of a greasy or messysolution in their hair every
single day who prefer a pill.
SPEAKER_03 (17:32):
So you take this thing every day.
Does it make the hairs you havegrow better or does it grow new
ones?
What does it do?
SPEAKER_01 (17:39):
Um so ideally, it would make the hairs you grow
grow a little bit moreeffectively or thicker, right?
And then that can lead to, youknow, a thicker overall head of
hair.
SPEAKER_03 (17:49):
Okay.
What other treatments?
I take it, those are the ones tomake your hair grow better.
SPEAKER_01 (17:52):
Yes.
SPEAKER_03 (17:53):
What are the ones to block the hormones?
What do you do?
SPEAKER_01 (17:56):
So you're gonna know a lot of these medications from
internal medicine, right?
So we can use sphenasteride.
SPEAKER_03 (18:01):
Which I use for prostates.
SPEAKER_01 (18:03):
Exactly.
So phenasteride I can use formen or women actually to block
that male hormone that causesthat hormone-related hair loss.
Um, and then for women, I canuse another pill called
spironolactone as well that alsohelps block that male hormone.
But both of those do come withsome potential side effects that
is makes it important to see,you know, your dermatologist to
(18:25):
talk about those before youstart.
SPEAKER_03 (18:26):
Right, because they are altering your hormones in
your body.
They're blocking androgens,they're anti-androgenergic.
Oh, that's a that's a mouthful.
We're recording this on themorning.
Yes.
Um, yeah, so they block liketestosterone and hormones that
tend to make you lose your hair.
SPEAKER_01 (18:44):
Exactly.
SPEAKER_03 (18:44):
Is it common to do just one of those, the the
monoxidil, or is it common to dojust the hormone blockers, or is
it usually both?
What do you do?
SPEAKER_01 (18:52):
You know, I talk with my patients about what they
want to do.
If they're a little nervousabout pills and side effects, we
might say, hey, let's just startwith some topical monoxidil and
see how that goes.
If they're coming in reallymotivated and they're okay with
some of the potential sideeffects of some of the pills,
they say I want it all, we'lldefinitely do combined
treatment.
SPEAKER_03 (19:08):
It sounds like there's some decent treatments
out there if you're having thistype of hair loss.
That's my take home from that,is that some things can there's
there's some relief for you foryou out there, listeners.
Okay, what about procedures orlasers or implants or
transplants or I don't know, allthe stuff you hear about.
SPEAKER_01 (19:24):
There's a lot out there.
Um, a lot of these otherprocedures are not covered by
insurance, unfortunately.
So they get to be quite pricey.
I think we're starting to getmore and more studies that show
in certain populations theymight be effective.
So things like platelet-richplasma injections, right?
Oh, or microneedling.
(19:44):
There's people who specialize inthose procedures.
I don't specialize in thoseprocedures, um, but I can get
you to the right person who doesdo them if you have the extra
dollars in your bank account toafford it.
SPEAKER_03 (19:54):
Okay.
So and is that hair transplantstoo?
I never, frankly, I neverunderstood this.
I've been practicing 25 years.
I never quite got the hairtransplant thing that well, you
take a hair follicle fromsomewhere else, or what do you
do?
SPEAKER_01 (20:06):
So there's certain hair follicles on your head that
are more sensitive to thosehormones.
So what you do in a hairtransplant is you take hair
follicles from areas that arenot sensitive to the hormones,
and then you put them in theareas where you're having hair
loss.
SPEAKER_03 (20:20):
Well, I know.
That sounds like a not somethingI do.
That sounds like quite theprocedure.
unknown (20:25):
Okay.
SPEAKER_01 (20:26):
I will say none of those procedures are magic,
right?
They're gonna be an add-ontreatment to whatever medical
therapy that you're on.
So I don't want patients tothink, wow, I can't afford this
treatment.
I'm so sad I can't get it.
It would make my hair so muchbetter.
Like, no, they're really just anadd-on to kind of our big
hitters, which are gonna be themonoxidyl or the finasteride.
SPEAKER_03 (20:46):
Okay, that's actually good to know.
You don't you don't have to gofirst to those things.
Exactly.
Okay.
What about over-the-counterstuff?
People, I bet are just inundatedwith things that claim to help
hair growth, shampoos or pills,or supplements.
Is there anything to those?
SPEAKER_01 (21:02):
There's so much out there.
Um, there's maybe a couple ofsupplements that have some small
amount of data that show thatthey're effective, but those
studies are also sponsored bythe manufacturer.
So I'm always skeptical of that.
I really think it comes down toseeing a dermatologist, getting
those high-value labs checked,like we talked about,
(21:23):
determining the cause of hairloss before wasting a bunch of
money on theseover-the-counters.
SPEAKER_03 (21:28):
Yeah, one thing it will do is it will uh it'll
cause your wallet to be thinner.
I don't know if it'll cause yourhair to be thicker, but it those
things will cause your wallet tobe thinner.
SPEAKER_01 (21:36):
Very expensive.
There's one that's over$80 amonth, right?
That's a lot of money forsomething that may or may not
help.
SPEAKER_03 (21:42):
Yeah, exactly.
So when you do these treatments,um, what kind of uh time frame
are people talking about?
And next week, do you suddenlyhave a big head of hair?
Is it something you notice amonth later, a year later, and
do you do it forever?
How does it work?
SPEAKER_01 (21:56):
So I tell patients that this is really slow and
really frustrating.
I do a six-month follow-up asthe first follow-up for the
first one.
And that depends on the type ofhair loss.
Six months is general for that,you know, female or male pattern
baldness that we've been talkingabout.
If it's something like aninflammatory or alopecia areata,
we're gonna do a much soonerfollow-up.
(22:16):
But for that most common type ofhair loss, I do six months
because that is how long it'sreally gonna take for me to see
if these treatments are working.
And one other thing I counselabout is that monoxidil, when
you first start using it, it cancause some hair shedding.
So patients often come back andthey'll say, This made it worse.
I stopped it after a month.
And I'm like, oh no, like whatit's doing is we're getting rid
(22:36):
of the hairs that are gonna shedanyways.
We're making room for those newhairs that are gonna grow.
So it can be frustrating,especially at the start.
SPEAKER_03 (22:43):
Patience in this one sounds like you really it is uh
probably frustratingly long forpeople.
Okay, before I let you go,Audrey, let's play a little game
here on the last segment of thepodcast.
You up for it?
SPEAKER_02 (22:54):
Mm-hmm.
SPEAKER_03 (22:55):
Okay, we're gonna call it what's my hairline.
I'm kidding, you I'm kiddingyou.
It's simple.
I'm gonna read you a fewstatements.
You tell us if it's fact orfiction and maybe shed some
light behind it.
Sound good?
SPEAKER_01 (23:07):
Sounds good.
SPEAKER_03 (23:07):
Okay, first one wearing hats causes hair loss.
True or not?
SPEAKER_01 (23:12):
I'm gonna go with not true.
SPEAKER_03 (23:13):
Yeah, I you know, so a lot of people say this.
I've never even really heardthis myself, but I mean,
baseball hats or your basiccowboy hat that I wear every
day.
Um, that doesn't do it.
SPEAKER_01 (23:23):
I'm gonna say no.
SPEAKER_03 (23:25):
All right, that's a myth.
That's a myth.
Okay, number two, frequentwashing and brushing your hair
makes it worse.
SPEAKER_01 (23:31):
I'm gonna say also not true to that one.
The hair that's gonna fall outis gonna fall out.
So what you're seeing when youwash or brush your hair is not
necessarily making it worse.
SPEAKER_03 (23:40):
Okay, so you're just noticing it because it's in the
shower drain, that kind ofthing.
Okay, number three, celebritieshave some hair loss secrets that
the rest of us don't know about.
SPEAKER_01 (23:49):
I wish that was true.
They're probably just doing allthe same things we're doing, but
not uh not talking about it.
SPEAKER_03 (23:55):
Or maybe they have a really good wig and you just
don't know it.
SPEAKER_01 (23:58):
I think that they have some really good
hairstylists.
SPEAKER_03 (24:00):
Yeah, I think that's probably what they have.
That's probably what they have.
Okay, lastly, in case peoplemissed this earlier, hair loss
is only a men's issue.
SPEAKER_01 (24:07):
Definitely false.
Men and women both experiencehair loss.
I would actually say I see morewomen with hair loss in my
clinic than men.
SPEAKER_03 (24:14):
I wonder why that is.
Is that just because men kind ofexpect it?
SPEAKER_01 (24:16):
Probably.
I think there's also a lot ofsocial expectations around hair
for women as well.
And it's uh it's a huge part ofidentity for a lot of women.
SPEAKER_03 (24:24):
Okay.
All right.
Well, thanks.
I liked that little lightninground game.
That was fun.
Now let's get back to one or twomore questions before I let you
go.
You know, so it can be, you justkind of touched on it, it can be
emotionally draining for people.
Maybe, maybe people identify aswomen more than men.
Um, but for everybody aboutlosing your hair, how can we
help people cope with thatconfidence or that emotional
(24:44):
side of hair loss?
SPEAKER_01 (24:46):
Yeah, for sure.
I mean, I think seeing yourdermatologist so you can start
treatments and have that supportis really important.
For different types of hairloss, there's even support
groups out there.
So there's a support group forpatients with alopecia area.
There's a support group forpatients with scarring alopecia.
So all those nationwide supportgroups are out there for
patients.
So we try to hook patients intothose if we feel like it would
(25:07):
be helpful.
SPEAKER_03 (25:08):
That's really helpful.
You are not alone.
It is very common, is it not?
It's really common.
Yes.
So, okay, Dr.
Jacobson, before I let you go,is there anything you'd like to
leave our audience about thesubject of hair loss?
SPEAKER_01 (25:19):
Gosh, I mean, I think you just said it in that
you're not alone.
There's treatments available,and there are dermatologists
more than willing and excited tohelp you with your hair loss.
SPEAKER_03 (25:28):
Yeah, really good tip.
Um, listeners, if you arenoticing changes in your hair,
talk to your dermatologist, yourboard-certified dermatologist.
They are your experts when itcomes to your skin, hair, and
nails.
Thanks for being here, Dr.
Jacobson.
SPEAKER_01 (25:40):
Thank you so much for having me.
This was a lot of fun.
SPEAKER_03 (25:42):
It has been a lot of fun and informative.
Listeners, I hope you agree withthat.
If you want to find moreepisodes of the Healthy Matters
Podcast, go tohealthymatters.org or wherever
you get your podcast.
Thank you for listening to thisepisode, and we will be back in
two weeks' time with anotherepisode.
And in the meantime, be healthyand be well.
SPEAKER_00 (26:02):
Thanks for listening to the Healthy Matters Podcast
with Dr.
David Hilden.
To find out more about theHealthy Matters Podcast or
browse the archive, visithealthymatters.org.
Got a question or a comment forthe show?
Email us at healthymatters athmed.org.
Or call 612-873-TALK.
There's also a link in the shownotes.
(26:23):
The Healthy Matters Podcast ismade possible by Hennepin
Healthcare in Minneapolis,Minnesota, and engineered and
produced by John Lucas atHighball.
Executive producers are JonathanComito and Christine Hill.
Please remember we can only givegeneral medical advice during
this program.
And every case is unique.
We urge you to consult with yourphysician if you have a more
serious or pressing healthconcern.
(26:45):
Until next time, be healthy andbe well.
Welcome to the Healthy Matters Podcast with Dr.
David Hilden, primary carephysician and acute care
hospitalist at HennepinHealthcare in downtown
Minneapolis, where we cover thelatest in health, health care,
and what matters to you.
And now here's our host, Dr.
David Hilden.
SPEAKER_03 (00:18):
Hey everybody, and welcome to episode four of the
Healthy Matters Podcast.
I'm your host, David Hilden.
Today we're going to be talkingabout hair loss.
Have you ever noticed that yourshower drain is starting to look
like it needs its own hairbrush?
If so, you are not alone.
Hair loss happens to millions ofpeople, men and women, and it's
one of the most common reasonspeople see a dermatologist.
(00:40):
Today, we're getting to theroot, and that pun was fully
intended, of why hair losshappens, what's normal, what's
not, and what you can actuallydo about it.
So joining me today is Dr.
Audrey Jacobson.
She is the chair of dermatologyhere at Heneman Healthcare in
Minneapolis, and she is someonewho helps patients understand,
prevent, and treat hair loss allthe time.
Audrey, thanks for being hereand welcome to the show.
SPEAKER_01 (01:02):
Thank you for having me.
I'm excited to talk about hairloss.
SPEAKER_03 (01:04):
Okay, start with the basics then about hair loss.
We all know what it is, yourhair falls out, but what is it
from a medical perspective?
What is actually happening?
SPEAKER_01 (01:12):
Yeah, so really what's happening is that your
hair is coming out from theroot, right?
And there's different causes forthat.
So it's really important toknow, you know, what is really,
like you said, the root cause ofyour hair loss.
So either there's some damagegoing on underneath the scalp,
or your hair is justtransitioning to a phase where
it naturally wants to fall out.
SPEAKER_03 (01:32):
So let's talk about that second half first.
So some people lose a ton ofhair and some people don't lose
much at all.
Is that just in the normalpopulation that you lose your
hair?
Is that supposed to happen?
SPEAKER_01 (01:45):
Yeah.
So I mean, I think that thatactually gets to the two most
common causes of hair loss thatI see in clinical practice.
So that's gonna be your hormoneor age-related hair loss.
Sometimes that's called male orfemale pattern baldness.
I don't like to call it baldnessbecause you you might not go
bald from that, and that tendsto scare patients.
SPEAKER_03 (02:02):
Right, right.
But people know what you'retalking about.
They do.
The receding hairline and allthat.
SPEAKER_01 (02:07):
Exactly.
And then there's that other typeof hair loss, which is that
sudden shedding of hair lossthat people say have after like
a very stressful event, andthat's called telogen effluvium.
Those are the two most commontypes of hair loss that I see.
SPEAKER_03 (02:19):
So let's do the male or female pattern hair loss,
because that's what I think alot of people think of.
There's a lot of, there'sprobably a lot of men out there
that says, yeah, my hair startedleak leaving when I was 30, and
others are 85 years old andthey're still got a full head of
hair.
But it's both men and women,right?
Correct.
Why does it happen?
SPEAKER_01 (02:36):
So that is all related to, I would say,
genetics and hormones, right?
So I see men and women withthis.
Men, it's more common.
You've got that classic recedinghairline around the temples, and
then that top of the scalpthere.
Women also get it too, but ithappens to tend to be more in
that top of the scalp, thatcrown.
But what people don't understandis that it's really genetics,
(02:58):
right?
So when I see patients withthis, I go, tell me about your
family members.
Did anyone else in your familyhave thinning hair or any males
in your family kind of go baldat an early age?
That's really important.
And when we also talk abouthormones related with this, I
encourage patients, I say, it'snot that your hormones are out
of whack.
There's nothing wrong with them.
It's just that those hairfollicles are more sensitive to
(03:19):
the normal hormones in yourbody, and that is related to
genetics.
And that's why you might havethat early hair thinning.
SPEAKER_03 (03:24):
What's a hair follicle?
SPEAKER_01 (03:26):
So, hair follicle is like the little tube that your
hair grows out of from thescalp.
And that hair follicle is reallyimportant for the health of that
hair.
SPEAKER_03 (03:34):
So, in this hormonal type of hair loss, is that
follicle okay?
It's just that the hairs are, Idon't even know, they're leaving
the follicle in their entirety.
SPEAKER_01 (03:43):
This might get a little too nitty-gritty there.
No, but I'm curious.
We actually talk aboutminiaturization of hairs in
androgenetic alopecia.
Androgenetic is that geneticrelated and hormonal.
SPEAKER_03 (03:56):
Miniaturization of hairs?
Okay, you've got to tell me whatthat is.
SPEAKER_01 (04:00):
So when I do a hair exam, I am looking at someone's
scalp like with a microscope,right?
I am like all up in their scalp,and I see hairs with a normal
diameter, and then I also seehairs that look really skinny.
And when I see a lot of hairsthat look really skinny, I say,
hey, there must be somehormone-related changes going on
to these hair follicles that isresulting in these like thinner
(04:20):
hairs, and that can also leadhair to look thinner.
SPEAKER_03 (04:23):
Wow.
I never even thought of that.
And I did actually graduate frommed school, Audrey.
So I do have to say, I do haveto say, when you decided what
you want, what you wanted asspecialty, here's what I want to
do.
I want to be a dermatologist soI can get all up in people's
scalps.
Is that what you were thinking?
SPEAKER_01 (04:39):
I don't, I don't actually know if I knew that
that was involved at the time,but here I am.
SPEAKER_03 (04:44):
Yeah, I don't think a lot of people know that.
Your specialist for hair loss,folks, is your dermatologist.
I can do a few things as yourprimary care doctor, but I
digress.
Okay, so the hairs fall out inuh both men and women.
How common is this?
SPEAKER_01 (04:59):
It's really common.
I I I don't have an exactpercentage for you, but I
sometimes quote like 50% forwomen, and maybe even more
common for men.
It's super common.
It may be just your hair isslightly thinner, but you're not
gonna go bald, right?
Or it's it's to the point wheremen will go bald at an early
age.
It just really depends.
There's a huge variety.
SPEAKER_03 (05:19):
And there's a variety of when it starts too.
SPEAKER_01 (05:22):
Exactly, yeah.
So especially for men, they maystart noticing it in their 20s,
even you know, when they're ateenager, if they have a really
strong family history of it.
But for others, it might not betill their 30s, 40s, 50s, even.
SPEAKER_03 (05:33):
Is it all genetic, or are there things we do in our
lives that might make your hairloss worse?
SPEAKER_01 (05:39):
I think for that androgenetic or that male
pattern or female pattern, thatis typically just genetics, kind
of luck of the draw.
That being said, I see mixedhair loss too, right?
Where you might just have yeah,living a really stressful life,
have a stressful event, surgery,COVID.
That leads to some like suddenhair shedding, and then it might
(06:00):
unmask this hormone-related hairloss that you might not have
known you had.
So there's definitely a mixedcomponent, and we always want to
treat both if we can.
SPEAKER_03 (06:07):
That's super interesting.
So you mentioned earlier a bigword teluvium, something or
other.
That was that what you said canbe more sudden.
Could you say more about firstof all, what was the word you
used?
SPEAKER_01 (06:17):
Telogen effluvium.
Telogen effluvium.
SPEAKER_03 (06:19):
Okay, listeners, get that into a cocktail party
sentence.
I dare you.
Telogen effluvium.
What is that?
SPEAKER_01 (06:25):
So I'll break down that crazy Latin term for you,
right?
So telogen is that phase of hairthat is gonna shed, right?
A lot of your hair is already inthat phase.
Like you're gonna shed hair.
Normal shedding is 50 to 100hairs a day, right?
So I see it's kind of like alot, right?
SPEAKER_03 (06:42):
It does seem kind of like a lot.
SPEAKER_01 (06:43):
Yeah.
Effluvium is kind of the suddenshedding, right?
The most common classic exampleI give that is you had a baby,
four months later, you're like,why is my hair falling out?
Right?
Or you had a surgery or you hadCOVID, a few months later, your
hair just sheds.
It will come back though.
It just takes a long time.
SPEAKER_03 (07:01):
So stressful things in your life can lead to an
acceleration of hair loss.
SPEAKER_01 (07:05):
Totally.
Finals.
I see it in college kids uhcoming in, they're really
stressed out.
They just had finals, and thenthey're like, my hair shedding,
right?
So it can be an emotionalstressor, a physical stressor,
really anything.
SPEAKER_03 (07:16):
So let's go to the other causes that might be under
your scalp that are causing hairloss.
What are they?
SPEAKER_01 (07:22):
So that I think is a more niche area of hair loss,
and one that you definitely wantto be seeing a board-certified
dermatologist for.
So those are gonna be yourautoimmune or inflammatory type
of hair loss.
And that's where that hairfollicle we talked about, that
little kind of uh cylinder orsheath that the hair grows out
of in the scalp is somehow beingdamaged or attacked by your own
(07:46):
body.
I think alopecia areata is thebest example of that.
SPEAKER_03 (07:50):
Many people I think have heard of alopecia areata.
And alopecia simply means hairloss, right?
True.
SPEAKER_01 (07:55):
Yes, alopecia just means hair loss.
SPEAKER_03 (07:57):
So it's something being destroying your hair
follicles.
Do they come back?
SPEAKER_01 (08:00):
Yeah, so alopecia areata is a really interesting
one in that your hair can comeback.
So it's that hair follicle iskind of temporarily being
attacked by your own body.
And then if we treat it with theright medications to kind of
calm down your immune system,say, hey, don't attack to your
own hair.
You don't need to attack yourown hair, it's yours, right?
Um, we can get that hair to growback.
SPEAKER_03 (08:21):
What other kinds are there?
SPEAKER_01 (08:22):
Yeah, so there's these inflammatory types of hair
loss, and those are actually, Iwould say, more serious medical
conditions where there's actualdamage happening to the hair
follicle.
And that can actually lead inwhat we call scarring alopecia
or scarring hair loss, where thehair follicle gets so damaged
that it gets scarred and youcannot grow hair out of that
hair follicle again.
(08:43):
So it can lead to more permanenthair loss or hair thinning.
Those are the ones that we needto catch as early as possible.
SPEAKER_03 (08:49):
So, on any of these, how does your daily stress or
your nutrition or your othermedical conditions affect hair
loss?
SPEAKER_01 (08:57):
So I think when I talk to patients about hair
loss, I like to take a wholebody approach, right?
I might ask about mental health,depression, anxiety, other
things that might beexacerbating their hair loss.
We know that skin health, hairhealth is all linked, and I am a
huge proponent of gettingpatients mental health care if
they need.
So we'll address that if we needto.
(09:19):
You did talk about nutrition.
There are a few labs that Imight check on a patient if I'm
worried about any type of hairloss because I just want to
promote a healthy environmentfor hair growth.
It may not be the main cause oftheir hair loss, but we might
check things like iron, yourthyroid, maybe your zinc, maybe
your vitamin D, just to makesure we've really optimized a
(09:39):
good environment for hairgrowth.
SPEAKER_03 (09:41):
What about medications people take or
supplements or chemotherapy?
Oh, I suppose chemotherapycauses hair loss.
Let's put that aside for asecond.
What about other medications?
Do you see much effect on thenormal, usual stuff people are
taking?
SPEAKER_01 (09:54):
Not the normal, usual stuff, I would say.
Um, I will say I have a lot ofpatients come in with biotin.
They're taking biotin.
It's, you know, supposedly magicfor, you know, hair, skin, and
nails, right?
That's not actually the case.
We don't actually think biotinworks that well, and it can
actually mess up some labvalues.
So say a patient's on biotin,they come to see you to get
(10:14):
their thyroid checked.
It can actually mess up thosethyroid values, or they might go
to the emergency room for somechest pain.
It can actually mess up thosevalues we might check in the
emergency department, like yourtroponin for heart health.
So we actually encouragepatients not to take biotin.
SPEAKER_03 (10:29):
Oh, that's a good tip.
So there's probably nothing youneed to be doing other than
getting a good diet, a balanceddiet.
I'm gonna say don't smokebecause you're never supposed to
smoke, folks, if you haven'tfigured that one out yet.
Um, uh, you don't need to takeextra supplements, things like
that.
And if you are experiencing somehair loss, you know, go see a
specialist.
Which brings me to thisquestion: what patterns might
(10:51):
people notice in their own headthat would cause them to come
see you?
SPEAKER_01 (10:55):
I mean, I definitely want to see a patient if they're
experiencing a sudden loss ofhair, sudden bald spots on their
hair, or if they're experiencingany scalp pain, burning,
itching, those are signs that,you know, I want to see you as
soon as possible.
Um, if you've noticed thatgradual hair thinning over time,
oh, for sure I still want to seeyou, but it may not be as urgent
(11:16):
as some of these other types ofhair loss where we're gonna need
to start some pretty intensetreatments right away to prevent
more loss.
SPEAKER_03 (11:23):
So before you go see your dermatologist and that more
gradual stuff, go buy a linttrap for your shower.
SPEAKER_00 (11:27):
Maybe that's what you need to do.
SPEAKER_03 (11:30):
I'm gonna go back to chemotherapy.
Just um this, we're not gonnaget in a lot of detail about
cancer treatments inchemotherapy, but why does it
cause hair loss?
Or some of the chemotherapiescause such substantial hair
loss.
SPEAKER_01 (11:40):
Yeah.
So remember how we talked aboutthat hair follicle.
So that's kind of that cylinder,that sheath that the hair grows
out of.
Chemotherapy targets that hairfollicle because it has really
rapidly dividing cells.
If you think about cancer,cancer cells are rapidly
dividing, they're growing.
Hair follicles do the samething.
So chemotherapy doesn't know,right?
And so it just attacks thosehair follicles as well.
(12:01):
And that can cause that hair tofall out because it's no longer
in that nice healthy environmentfor growth.
SPEAKER_03 (12:07):
When it does come back, does it come back just
like your previous hair?
Because I've heard some peoplesay it came back curlier or
fuzzy or something.
SPEAKER_01 (12:14):
So the hair follicle shape and orientation affects
how your hair grows.
So if that's been damaged bychemotherapy, your hair might
grow back a little bit differentwhen it comes back.
SPEAKER_03 (12:23):
So we are talking about hair loss with
dermatologist Dr.
Audrey Jacobson.
She is the chair of dermatologyat Hennepin Healthcare here in
downtown Minneapolis.
We're gonna take a short break,and when we come back, we're
gonna discuss the diagnosis ofhair loss, available treatment
options, and we'll find out ifthere are ways to prevent or
reverse it.
So stick around, we'll be rightback.
SPEAKER_02 (12:43):
When Hennepin Healthcare says, we're here for
life, they mean here for you,your life, and all that it
brings.
Hennepin Healthcare has ahospital, HCMC, a network of
clinics in the metro area, andan integrative health clinic in
downtown Minneapolis.
They provide all of the primaryand specialty care you'd expect
to find, as well as serviceslike acupuncture and
(13:06):
chiropractic care.
Learn more athennepinhealthcare.org.
Hennepin Healthcare is here foryou and here for life.
SPEAKER_03 (13:21):
And we're back talking about hair loss with Dr.
Audrey Jacobson.
So I see people all the time inprimary care with hair loss, and
I gotta be really honest withyou.
I know precious little abouthair loss.
I really do.
I don't know very much about it.
So, folks, you can call yourprimary care doctor, but this is
a specialty thing.
Um, you might have your firstvisit with your primary doctor.
(13:41):
If you don't know who to call,go see them.
They can look at it and see ifit's anything to be worried
about.
Um, but they'll probably do thisas well.
Make sure you see adermatologist who does this.
So they come see you.
They're in your clinic.
What do you do?
Do you do tests?
Do you look at it real close?
What do you do?
SPEAKER_01 (13:57):
Yeah.
So, first of all, I'm gonna talkto my patient, right?
We're gonna ask a whole history.
I know we talk to our patientsin dermatology too.
Um, we're gonna ask a lot ofquestions about their family
history, their personal history,stressors in their life, other
medical conditions.
And then we're also gonna do areally good hair and scalp exam,
right?
So I'm gonna get at mydermatoscope.
That's kind of like mymicroscope.
SPEAKER_03 (14:17):
So I'm gonna be looking at the Sherlock Holmes
spyglass kind of thing.
SPEAKER_01 (14:21):
I totally feel like Sherlock Holmes every day in
clinic.
Except you call it adermatoscope.
It's a dermatoscope, yep.
And then after I look at thescalp, at that point I'm gonna
have a good idea of what type ofhair loss is going on.
I'll oftentimes get some bloodwork.
We talked about some of thosekind of vitamins and minerals we
might get.
Rarely I'll do a biopsy if I'mnot really sure, or it's I'm
(14:43):
like, is this a scarring type ofhair loss, or is this just
regular hormone genetic, youknow, that androgenetic hair
loss?
We might do a biopsy.
I don't do biopsies as much onthe scalp, but it's definitely
something we can do.
SPEAKER_03 (14:55):
Can you usually just kind of tell the scalp looks
okay, everything's looking okaydown underneath your hair?
SPEAKER_01 (15:02):
Yeah, so there's a lot of clues, especially if I'm
using my fancy dermatoscope,that can tell me how are the
hair follicles doing?
Is there inflammation?
Is there no inflammation?
You know, do we need a biopsy ornot?
SPEAKER_03 (15:14):
Because just underneath the hair is on your
scalp is skin.
So you can kind of get downthere and look at it.
SPEAKER_01 (15:19):
Yeah, but if we do need to do a biopsy, it's about
a five-minute in-officeprocedure that we can do that
same day.
SPEAKER_03 (15:25):
Oh, that's good to know.
Yeah, so it's not some massivething where you're going to an
operating room or anything likethat.
Would you just take a littlepiece of the skin?
SPEAKER_01 (15:32):
Yeah, we numb up the skin with an injection of
anesthesia, then we take just, Icall it a tiny cookie cutter
kind of cylinder of the scalp,and then we put in one or two
stitches, and then we're done.
SPEAKER_03 (15:41):
Oh, okay.
So that's not a very big deal ifyou do need that, folks.
Okay, so let's say they have theandrogenetic, the
hormone-related, thegenetic-related hair loss.
What treatment options areavailable?
SPEAKER_01 (15:52):
Really good question.
So I like to break thosetreatment options into two
categories.
So I talk about hair growth.
We want to help grow the hair.
And then for some patients, wewant to say, hey, we kind of
want to block that hormonethat's causing that hair loss in
the first place.
And there's differentmedications, topically or oral,
that we can combine to kind oftreat both of those areas.
So promoting hair growth andthen also blocking that male
(16:14):
hormone that causes the hairloss.
SPEAKER_03 (16:17):
So start with the topicals.
Do they work?
SPEAKER_01 (16:19):
They do.
So that's gonna be your topicalmonoxidil.
A lot of people know it asrogaine, but minoxidil is the
generic version, and studies doshow that it is effective when
used regularly.
SPEAKER_03 (16:29):
So the what people have told me, especially women,
oh boy, I'm gonna get this thingthat grows hair.
Um, it's gonna, I'm gonna, I'mgonna look like a hairy gorilla,
uh, you know, when it's alldone.
I take it it's not like that.
SPEAKER_01 (16:41):
Definitely not the topical version of minoxidel,
because that's just gonna treatlocally wherever you put it.
The oral version of monoxidil,right, which you may know is a
blood pressure medication, weuse in low doses for hair
growth.
One of the most common sideeffects is hair growth.
And women that could wean someextra chin hairs that they might
have to pluck.
SPEAKER_03 (17:01):
Okay, so that is a thing when you because it
doesn't really know which hairfollicles to go after.
And if you have a hair follicleon your face, even women, yep,
exactly.
You could have some hairsgrowing where you didn't really
want them.
SPEAKER_01 (17:14):
Exactly.
SPEAKER_03 (17:15):
Do you use systemic or oral monoxidyl on women
though?
SPEAKER_01 (17:19):
I do.
I use systemic monoxidal really,it's so common now, actually,
it's getting extremely popular.
And it's it's nice for peoplewho don't want to have to put
kind of a greasy or messysolution in their hair every
single day who prefer a pill.
SPEAKER_03 (17:32):
So you take this thing every day.
Does it make the hairs you havegrow better or does it grow new
ones?
What does it do?
SPEAKER_01 (17:39):
Um so ideally, it would make the hairs you grow
grow a little bit moreeffectively or thicker, right?
And then that can lead to, youknow, a thicker overall head of
hair.
SPEAKER_03 (17:49):
Okay.
What other treatments?
I take it, those are the ones tomake your hair grow better.
SPEAKER_01 (17:52):
Yes.
SPEAKER_03 (17:53):
What are the ones to block the hormones?
What do you do?
SPEAKER_01 (17:56):
So you're gonna know a lot of these medications from
internal medicine, right?
So we can use sphenasteride.
SPEAKER_03 (18:01):
Which I use for prostates.
SPEAKER_01 (18:03):
Exactly.
So phenasteride I can use formen or women actually to block
that male hormone that causesthat hormone-related hair loss.
Um, and then for women, I canuse another pill called
spironolactone as well that alsohelps block that male hormone.
But both of those do come withsome potential side effects that
is makes it important to see,you know, your dermatologist to
(18:25):
talk about those before youstart.
SPEAKER_03 (18:26):
Right, because they are altering your hormones in
your body.
They're blocking androgens,they're anti-androgenergic.
Oh, that's a that's a mouthful.
We're recording this on themorning.
Yes.
Um, yeah, so they block liketestosterone and hormones that
tend to make you lose your hair.
SPEAKER_01 (18:44):
Exactly.
SPEAKER_03 (18:44):
Is it common to do just one of those, the the
monoxidil, or is it common to dojust the hormone blockers, or is
it usually both?
What do you do?
SPEAKER_01 (18:52):
You know, I talk with my patients about what they
want to do.
If they're a little nervousabout pills and side effects, we
might say, hey, let's just startwith some topical monoxidil and
see how that goes.
If they're coming in reallymotivated and they're okay with
some of the potential sideeffects of some of the pills,
they say I want it all, we'lldefinitely do combined
treatment.
SPEAKER_03 (19:08):
It sounds like there's some decent treatments
out there if you're having thistype of hair loss.
That's my take home from that,is that some things can there's
there's some relief for you foryou out there, listeners.
Okay, what about procedures orlasers or implants or
transplants or I don't know, allthe stuff you hear about.
SPEAKER_01 (19:24):
There's a lot out there.
Um, a lot of these otherprocedures are not covered by
insurance, unfortunately.
So they get to be quite pricey.
I think we're starting to getmore and more studies that show
in certain populations theymight be effective.
So things like platelet-richplasma injections, right?
Oh, or microneedling.
(19:44):
There's people who specialize inthose procedures.
I don't specialize in thoseprocedures, um, but I can get
you to the right person who doesdo them if you have the extra
dollars in your bank account toafford it.
SPEAKER_03 (19:54):
Okay.
So and is that hair transplantstoo?
I never, frankly, I neverunderstood this.
I've been practicing 25 years.
I never quite got the hairtransplant thing that well, you
take a hair follicle fromsomewhere else, or what do you
do?
SPEAKER_01 (20:06):
So there's certain hair follicles on your head that
are more sensitive to thosehormones.
So what you do in a hairtransplant is you take hair
follicles from areas that arenot sensitive to the hormones,
and then you put them in theareas where you're having hair
loss.
SPEAKER_03 (20:20):
Well, I know.
That sounds like a not somethingI do.
That sounds like quite theprocedure.
unknown (20:25):
Okay.
SPEAKER_01 (20:26):
I will say none of those procedures are magic,
right?
They're gonna be an add-ontreatment to whatever medical
therapy that you're on.
So I don't want patients tothink, wow, I can't afford this
treatment.
I'm so sad I can't get it.
It would make my hair so muchbetter.
Like, no, they're really just anadd-on to kind of our big
hitters, which are gonna be themonoxidyl or the finasteride.
SPEAKER_03 (20:46):
Okay, that's actually good to know.
You don't you don't have to gofirst to those things.
Exactly.
Okay.
What about over-the-counterstuff?
People, I bet are just inundatedwith things that claim to help
hair growth, shampoos or pills,or supplements.
Is there anything to those?
SPEAKER_01 (21:02):
There's so much out there.
Um, there's maybe a couple ofsupplements that have some small
amount of data that show thatthey're effective, but those
studies are also sponsored bythe manufacturer.
So I'm always skeptical of that.
I really think it comes down toseeing a dermatologist, getting
those high-value labs checked,like we talked about,
(21:23):
determining the cause of hairloss before wasting a bunch of
money on theseover-the-counters.
SPEAKER_03 (21:28):
Yeah, one thing it will do is it will uh it'll
cause your wallet to be thinner.
I don't know if it'll cause yourhair to be thicker, but it those
things will cause your wallet tobe thinner.
SPEAKER_01 (21:36):
Very expensive.
There's one that's over$80 amonth, right?
That's a lot of money forsomething that may or may not
help.
SPEAKER_03 (21:42):
Yeah, exactly.
So when you do these treatments,um, what kind of uh time frame
are people talking about?
And next week, do you suddenlyhave a big head of hair?
Is it something you notice amonth later, a year later, and
do you do it forever?
How does it work?
SPEAKER_01 (21:56):
So I tell patients that this is really slow and
really frustrating.
I do a six-month follow-up asthe first follow-up for the
first one.
And that depends on the type ofhair loss.
Six months is general for that,you know, female or male pattern
baldness that we've been talkingabout.
If it's something like aninflammatory or alopecia areata,
we're gonna do a much soonerfollow-up.
(22:16):
But for that most common type ofhair loss, I do six months
because that is how long it'sreally gonna take for me to see
if these treatments are working.
And one other thing I counselabout is that monoxidil, when
you first start using it, it cancause some hair shedding.
So patients often come back andthey'll say, This made it worse.
I stopped it after a month.
And I'm like, oh no, like whatit's doing is we're getting rid
(22:36):
of the hairs that are gonna shedanyways.
We're making room for those newhairs that are gonna grow.
So it can be frustrating,especially at the start.
SPEAKER_03 (22:43):
Patience in this one sounds like you really it is uh
probably frustratingly long forpeople.
Okay, before I let you go,Audrey, let's play a little game
here on the last segment of thepodcast.
You up for it?
SPEAKER_02 (22:54):
Mm-hmm.
SPEAKER_03 (22:55):
Okay, we're gonna call it what's my hairline.
I'm kidding, you I'm kiddingyou.
It's simple.
I'm gonna read you a fewstatements.
You tell us if it's fact orfiction and maybe shed some
light behind it.
Sound good?
SPEAKER_01 (23:07):
Sounds good.
SPEAKER_03 (23:07):
Okay, first one wearing hats causes hair loss.
True or not?
SPEAKER_01 (23:12):
I'm gonna go with not true.
SPEAKER_03 (23:13):
Yeah, I you know, so a lot of people say this.
I've never even really heardthis myself, but I mean,
baseball hats or your basiccowboy hat that I wear every
day.
Um, that doesn't do it.
SPEAKER_01 (23:23):
I'm gonna say no.
SPEAKER_03 (23:25):
All right, that's a myth.
That's a myth.
Okay, number two, frequentwashing and brushing your hair
makes it worse.
SPEAKER_01 (23:31):
I'm gonna say also not true to that one.
The hair that's gonna fall outis gonna fall out.
So what you're seeing when youwash or brush your hair is not
necessarily making it worse.
SPEAKER_03 (23:40):
Okay, so you're just noticing it because it's in the
shower drain, that kind ofthing.
Okay, number three, celebritieshave some hair loss secrets that
the rest of us don't know about.
SPEAKER_01 (23:49):
I wish that was true.
They're probably just doing allthe same things we're doing, but
not uh not talking about it.
SPEAKER_03 (23:55):
Or maybe they have a really good wig and you just
don't know it.
SPEAKER_01 (23:58):
I think that they have some really good
hairstylists.
SPEAKER_03 (24:00):
Yeah, I think that's probably what they have.
That's probably what they have.
Okay, lastly, in case peoplemissed this earlier, hair loss
is only a men's issue.
SPEAKER_01 (24:07):
Definitely false.
Men and women both experiencehair loss.
I would actually say I see morewomen with hair loss in my
clinic than men.
SPEAKER_03 (24:14):
I wonder why that is.
Is that just because men kind ofexpect it?
SPEAKER_01 (24:16):
Probably.
I think there's also a lot ofsocial expectations around hair
for women as well.
And it's uh it's a huge part ofidentity for a lot of women.
SPEAKER_03 (24:24):
Okay.
All right.
Well, thanks.
I liked that little lightninground game.
That was fun.
Now let's get back to one or twomore questions before I let you
go.
You know, so it can be, you justkind of touched on it, it can be
emotionally draining for people.
Maybe, maybe people identify aswomen more than men.
Um, but for everybody aboutlosing your hair, how can we
help people cope with thatconfidence or that emotional
(24:44):
side of hair loss?
SPEAKER_01 (24:46):
Yeah, for sure.
I mean, I think seeing yourdermatologist so you can start
treatments and have that supportis really important.
For different types of hairloss, there's even support
groups out there.
So there's a support group forpatients with alopecia area.
There's a support group forpatients with scarring alopecia.
So all those nationwide supportgroups are out there for
patients.
So we try to hook patients intothose if we feel like it would
(25:07):
be helpful.
SPEAKER_03 (25:08):
That's really helpful.
You are not alone.
It is very common, is it not?
It's really common.
Yes.
So, okay, Dr.
Jacobson, before I let you go,is there anything you'd like to
leave our audience about thesubject of hair loss?
SPEAKER_01 (25:19):
Gosh, I mean, I think you just said it in that
you're not alone.
There's treatments available,and there are dermatologists
more than willing and excited tohelp you with your hair loss.
SPEAKER_03 (25:28):
Yeah, really good tip.
Um, listeners, if you arenoticing changes in your hair,
talk to your dermatologist, yourboard-certified dermatologist.
They are your experts when itcomes to your skin, hair, and
nails.
Thanks for being here, Dr.
Jacobson.
SPEAKER_01 (25:40):
Thank you so much for having me.
This was a lot of fun.
SPEAKER_03 (25:42):
It has been a lot of fun and informative.
Listeners, I hope you agree withthat.
If you want to find moreepisodes of the Healthy Matters
Podcast, go tohealthymatters.org or wherever
you get your podcast.
Thank you for listening to thisepisode, and we will be back in
two weeks' time with anotherepisode.
And in the meantime, be healthyand be well.
SPEAKER_00 (26:02):
Thanks for listening to the Healthy Matters Podcast
with Dr.
David Hilden.
To find out more about theHealthy Matters Podcast or
browse the archive, visithealthymatters.org.
Got a question or a comment forthe show?
Email us at healthymatters athmed.org.
Or call 612-873-TALK.
There's also a link in the shownotes.
(26:23):
The Healthy Matters Podcast ismade possible by Hennepin
Healthcare in Minneapolis,Minnesota, and engineered and
produced by John Lucas atHighball.
Executive producers are JonathanComito and Christine Hill.
Please remember we can only givegeneral medical advice during
this program.
And every case is unique.
We urge you to consult with yourphysician if you have a more
serious or pressing healthconcern.
(26:45):
Until next time, be healthy andbe well.
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