December 11, 2017

Keep Your Hair On!

Concerned about side effects from baldness meds? Fight hair loss the smart way ….

By Dr. Julie T. Chen, M.D.

Yes, yes—Vin Diesel and Jason Statham make baldness sexy. But that look doesn’t work for anyone, and plenty of men out there would just as soon keep their locks flowing, thank you very much. I understand that, and the topic comes up frequently with my male patients, who find themselves battling what seems to be an unstoppable slide toward chrome domes.

Male pattern baldness is responsible for about 95 percent of baldness in men, with approximately two-thirds of American men experiencing some level of thinning hair by age 35. This can be devastating and can affect many aspects of a man’s life, from their interpersonal relationships to their own perception of life, happiness, and satisfaction. It can also impact their professional lives—their confidence wanes, baldness jokes may zing around the office, etc.

When the subject comes up, men are mostly interested in prevention. On any given day, I have at least one male patient in my clinic asking about hair loss medications such as Propecia or Avodart and wanting to know whether it is a good idea and if so, are their side effects they need to watch out for. While acknowledging the potentially devastating impact of thinning hair, as a doctor, I still caution guys about safety issues, as long-term negative effects are a real concern. We see and hear about men who use these medications and have been able to maintain their hairline despite a strong family predisposition for hair loss, but we hear much less frequently  about the risks. Face it: if a man has developed more breast tissue or sexual dysfunction because of the medication, he is less likely to talk about that with his friends and more likely to discuss the positive effect of maintaining hair.

So let’s discuss some pros and cons of these medications, and shed some light on how to stay healthy while on your quest for a full head of hair. Ultimately, you may find these healthier options as even sexier than the quick-fix medications that come with problematic side effects … because the side effects definitely are not sexy. And if something is touted as a “quick fix” and seems too good to be true, there usually is some level of a downside to it. So let’s take a look at the downside of these ‘magic bullet’ medications.

We’ll start with DHT. This is a natural hormone in the body found at higher levels in men than women, and it plays a significant role in hair loss, The more there is of DHT, the more potential for hair loss. So it makes sense that hair loss medications will target this hormone to block it so that the rate of hair loss is slowed. However, as you can imagine, if you block a natural male hormone, the potential side effects probably aren’t going to be that appealing. These ‘magic bullets’ may lead to breast tissue enlargement, decreased ability to build muscle mass or increased muscle weakness, altered ability for us to monitor the prostate cancer blood marker called PSA, decreased sexual desire, erectile dysfunction, decreased semen production, and decreased sensation with sexual intercourse. It may also lead to depression and low mood, as well as increased fatigue.

The reason for all these potential side effects is because there are DHT and testosterone receptors in our brain, sexual organs, muscles, and almost everywhere in our body to varying degrees. When you start to mess around with a hormone that is naturally meant to be at certain levels in our body but you artificially block it, it doesn’t just affect your hair line…it also affects many other organs. There are concerns that even after men come off the hair loss medications that these effects may persist to some degree or another.

There is also growing concern that prostate cancers found in men who are on hair loss medications seem to be more advanced and aggressive in its staging. This could be because of the medication altering our ability to monitor the PSA level or it may affect the male hormonal balance thus leading to changes in prostate cancer risks.

Regardless of the reason, all of these concerns are real and problematic; not just for the doctors caring for men who are on these medications, but for the men themselves. Many of the side effects can be devastating to interpersonal relationships, self-perception and professional life—just like hair loss would.

So, if you are a man battling male pattern baldness or worried about potential thinning hair because of your family history, but now you are worried about the side effects of hair loss medications, what can you do? There are natural ways to help prevent hair loss. Smoking and alcohol can impede healthy hair growth, so avoiding these would help. An assortment of vitamins and nutrients also help to support hair growth. These include B vitamins, protein, iron, vitamin E, vitamin A, vitamin C, healthy fats, curcumin, and water. In a study from the Archives of Dermatology, curcumin was seen to inhibit TGF Beta One, which plays a role in the death of hair follicles. Interestingly, this ingredient is starting to show up in some shampoos, but I have my patients take it in supplement form and in their food because it has anti-cancer anti-inflammatory properties as well.

When you look at shampoos, it’s important to look for ones that are sulfate-free and organic. Many of the preservatives and chemicals in shampoos may not be beneficial in promoting healthy hair follicles. Similarly, heavy metals in our water may be damaging as well so installing a filter on your shower head would be a good idea if you are trying to create the healthiest environment for your scalp and hair as possible.

Lastly, good scalp circulation is important for hair growth, so massage your scalp during your shower and make sure you are getting a broad gamut of nutrients, like circulation-boosting B3 from your foods to help maximize blood flow to your hair follicles. Other options to help with increasing scalp circulation include scalp acupuncture and cranio-sacral therapy. You can check with your doctor about reputable practitioners in your area.

However, if all else fails with these natural methods of preventing hair loss and you feel that you have to try the hair-loss medications, make sure your doctor is monitoring your hormone levels and your thyroid levels. You should make sure you are not anemic, do not have an autoimmune disease, and that your thyroid is performing optimally, because various diseases can predispose you to greater hair loss.

If your labs are normal, then you should get a baseline DHT and monitor your estrogen, testosterone, DHEA-s, and DHT levels regularly while on the medication. Monitoring is key if you are going the medication route in order to ensure maximum benefit with minimal side effects.

If your baseline DHT is “low-normal,” using a DHT-blocking medication may just lead to side effects and not much benefit. If you do use the medication, make sure it isn’t blocking so much of the DHT that your hormone pathway is being shunted towards increased estrogen levels. That may lead to breast tissue issues, decreased muscular functioning, and sexual dysfunction.

Despite this being an understandingly difficult situation, keep in mind that the sexiest way to prevent the negative effects of hair loss is to embrace what you have and to remember that you being comfortable with yourself is undoubtedly the sexiest version of you that anyone can ask for.

Dr. Julie T. Chen, M.D., an integrative medicine physician who is board-certified in internal medicine and is also fellowship-trained and board-certified in integrative medicine. She has her own medical practice in San Jose, CA, is the medical director of corporation wellness at several Silicon Valley-based companies, and has been featured in radio, TV, newspaper, and magazine interviews. Her website is www.makinghealthyez.com.


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