This is a question that Dr. Nakatsui would love to find an answer to. When injection of platelet-rich plasma (PRP) first came out as a treatment several years ago, he was very interested and tried using
it to improve the quality of the skin but was not impressed with the results. As a result, he put this on hold until he could determine if it was truly effective or not. It sounds like a great idea but does it truly work? He is waiting to be convinced because if it works, he would gladly offer it to his patients in Edmonton again. There is evidence of effectiveness for wound and joint healing but does this extend to skin and hair?
Is there a good study on PRP?
In 2016, there was a double blind, multi-centre, placebo controlled study (the best kind of study) done that compared injection of PRP and placebo (saline) (Dermatol Surg 2016; 42:1243-1247). Investigators looked at hair counts and hair mass index along with patient-opinion survey responses. Examination of hair counts and hair mass index showed there was no significant difference between the treatment group and the placebo group 26 weeks after injection. Interestingly, however, when asked about the results of the treatment, 13% of the treatment group felt that they experienced improvements in hair loss and hair thickness, and 26.7% felt their hair felt coarser or heavier after the treatment. The hair was examined objectively by someone who had no idea which patients were injected with PRP or saline, so there was no potential for bias. In this study, about 1 out every 4 patients thought their hair improved when it actually did not.
Wouldn’t it be great if we had a test that simply and reliably told you whether or not you had a genetic cause for your hair loss? If we did, then you could walk into a doctor’s office or lab and find an answer in no time at all. This would also benefit doctors as we wouldn’t have to rely on using our eyes and ears to get a good history and physical. There is a test that came out about 10 years ago to do just this called HairDX. It involved a simple swab taken from your cheek and its claim was that it could reliably tell if a patient was suffering from androgenetic hair loss and thus tell the patient if he or she would benefit from hair loss medications like minoxidil and finasteride.
It is still used by some doctors today but unfortunately, this test is not as accurate as we first hoped. In fact, HairDX might only be about 70% accurate. That’s a large number of cases that are incorrectly classified.
Minoxidil (Rogaine ®) is a commonly used topical agent for male pattern balding and female pattern hair loss. Clinical studies have proven that it is effective for some patients (unlike most other topicals, for which virtually all have no real proof). However, it is not effective for everyone and it would be great if we had a test that could determine if the effort involved in applying Rogaine ® twice daily was worth it. At present, the only way to determine if it works is to try it for at least 6-9 months.
The importance of sulfotransferase for minoxidil responsiveness
It seems that there is an enzyme that may be involved in the efficacy of Rogaine ® and several studies have analyzed this enzyme in responders and non-responders. The enzyme is called sulfotransferase and the activity of this enzyme in plucked hair follicles appears to predict the responsiveness of patients to Rogaine ®.
According to an analysis of current and ongoing minoxidil response testing, this assay is able to successfully rule out 95.9% of non-responders. Not 100% but pretty close. If this test becomes commercially available, it could save some people a lot of time and effort. (more…)
We will occasionally request blood tests in women suffering from hair loss if the diagnosis is unclear. One of the tests we do is a testosterone (T) level as elevated levels of testosterone can be associated with hair loss and we want to rule out this possibility. Many times, however, the test result will reveal that the level is actually low. The question that arises is whether or not anything should be done about this. Dr. Nakatsui usually requests that the patient discuss this with her family physician to see if testosterone supplementation is reasonable. Over the years, some of the patients who went on supplementation have reported to us that their hair loss actually improved!
Should a woman with low T go on supplementation?
Whether or not to go on supplementation depends on a number of factors. Firstly, does the patient have any other symptoms of low testosterone, such as insomnia, fatigue, depressed mood, hot flashes, and vaginal dryness? If so, perhaps a case could be made to go on supplementation.
The other issue is that of side effects as one of the possible side effects is increased facial hair. Is the patient willing to deal with this?
The last question is whether or not supplementation will actually improve the hair loss. (more…)
For many years, we have used finasteride (Propecia) for male pattern hair loss and for many men, it has worked very well. However, in those men who are non-responders, another option may be dutasteride, a cousin to finasteride. Whereas finasteride is approved by the FDA for hair loss, dutasteride is not but has been used off-label for several years.
Both of these medications are 5-alpha-reductase inhibitors, which help improve hair loss by preventing the formation of dihydrotestosterone (DHT). The difference between them is that finasteride (FIN) inhibits 5-alpha reductase type 2, whereas dutasteride (DUT) inhibits 5-alpha reductase type 2 and type 1.
Which is stronger?
DUT is more potent and decreases DHT to a greater extent than FIN (90% versus 70%). However, the flip side is that side effects are potentially greater so many patients are reluctant to go on this medication for this reason. (more…)
Hair transplant surgeries have become one of the most popular cosmetic procedures for men and a large number of women. Much of what happens before, during, and after a hair transplant surgery is uncertain for many curious people. Here is what the typical process for hair restoration surgeries look like from consultation to 1 year after the surgery with Dr. Nakatsui.
Complimentary Comprehensive Consultation
A prospective patient will come in to our clinic for a complimentary consultation with Dr. Nakatsui. During this consultation, Dr. Nakatsui will obtain a thorough history of the individual. When did the hair loss begin, what types of treatments they have tried in the past, and what is their family history for hair loss are among a few of the typical questions asked.
Dr. Nakatsui then performs a thorough examination of the scalp to determine if there are any other medical factors that may contribute to the hair loss such as Alopecia Areata or Lichen Planopilaris. These are conditions in which the body attacks its own hair and because of that, hair transplantation into these areas is not recommended. Dr. Nakatsui then assesses the patient’s situation and expectations and determines if the individual is a good candidate for hair restoration surgery. (more…)