Scott Webb (Host): So-called miracle cures for baldness in men are big business, but do they work and are there better and more effective ways to deal with hair loss? My guest today is going to answer these questions and more. I'm joined today by Dr. Karl Saardi. He's a dermatologist with Valley Health.

 Welcome to Conversations Like No Other, presented by Valley Health System in Ridgewood, New Jersey. Our podcast goes beyond broad everyday health topics to discuss very real and very specific subjects impacting men, women, and children. We think you'll enjoy our fresh take. I'm Scott Webb.

Doctor, it's nice to have you here today we're going to talk about baldness and masculinity and how these things are tied together and what folks are doing, especially men are doing about baldness and so forth. So, let's just start there. Is baldness a medical issue or is it just some sort of cosmetic hustle, if you will?

Dr. Karl Saardi: That's a really good question. Like a lot of things in dermatology, you know, it's probably one of those conditions that straddles both medical problems and cosmetic issues. Another disease that would fall into that category would be something like acne where it's not medically harmful to people most of the time. But it does affect people's self-esteem. It can lead to long-term scarring in those areas that can be difficult to correct or another example would be like psoriasis if it's not really bothering the person. They're embarrassed to go to the pool and be seen with these scaly plaques on their skin.

So like a lot of conditions in dermatology, it's probably a little bit of both. In certain situations, it can be a sign of an underlying medical issue. But the typical male pattern hair loss or what we call androgenetic alopecia is usually just the standalone condition.

Host: Yeah. Yeah. It makes me wonder, Doctor, like why do some men lose their hair and others don't? Is there something we can do maybe at a younger age to prevent hair loss?

Dr. Karl Saardi: It's probably for the most part a combination of genetics. And it's not exactly like a one-to-one like eye color or hair color. It probably exists on a gradient where, you know, you're probably inheriting some good genes from mom and some bad genes from dad or vice versa. And it kind of exists along the spectrum. The cause of male pattern baldness or androgenetic alopecia is not really like a hormone problem. It's just a genetic sensitivity to normal levels of male sex hormones like testosterone. And gradually, the hair follicles, especially on the top of the scalp become a little bit more sensitive to it and don't grow or what we call miniaturize and turn into those little like white baby hairs that you can't quite see with the naked eye compared to the fully grown, like full thickness black or pigmented hairs that you can see.

Host: Sure. Yeah. So, staying with you and you're the expert here. If baldness is genetic, and it does sound like for the most part it is, so we know we can't really outrun our family history and genetics, unfortunately. Then, why, Doctor, are there so many, I'm using air quotes, but "miracle cures" on the market if there's nothing we can really do about it?

Dr. Karl Saardi: Yeah. A lot of miracle cures that are hawked as being like a quick fix for hair loss. I've never really seen amazing results with any of the over-the-counter products, with the exception of a topical minoxidil or the brand name Rogaine. There's not really much in the way of supplements. On the other side of things, there are some really effective ways to cover up hair loss with ways to pigment the scalp or some powders that you can apply to the scalp to make hair loss less noticeable or camouflage it a little. I think those are, you know, are underutilized a lot of times by then.

Host: Sure. Yeah, it's a huge marketplace. I don't need to tell you. It's a huge marketplace out there, and there's obviously a lot of demand. And I see all these things in the aisles, you know, at Target or whatever. And it just really makes me wonder, you know, as I used air quotes "miracle cures," are they really what's most effective? You gave us a sense there that maybe Rogaine, that kind of thing, could be effective for some. I'm wondering, Doctor, like the hair loss drugs, if you will, do they mess with our hormones, let's say more than they help?

Dr. Karl Saardi: Yeah. So, there's two main categories of medications we use for androgenetic alopecia. One category would be finasteride or related medications, commonly known as Propecia. Those do effect the conversion of testosterone to a less active form called dihydrotestosterone. And with some of the newer medications in that family, it is a little bit more targeted just to the prostate and the skin or hair follicles.

So, most of the time, hormone levels will stay pretty much normal. And it does have some other effects. The main side effect with that family of medications is reduced libido or sex drive, and sometimes like erectile dysfunction. And it is probably one of the more common reasons why people stop these medications.

Over the last couple years, one of the medications in this family, dutasteride, which was originally developed for benign prostatic hyperplasia, prostate enlargement became generic and is much, much more affordable now than it was before. In the two biggest studies we have, we didn't really see many of the sexual side effects compared to finasteride. The men who took the dutasteride had the same rates of sexual side effects as men who took placebo or sugar pill, which probably speaks to it being a little bit more targeted and more potent than the finasteride.

The other medication that we use prescription medication is minoxidil, which is the active ingredient in Rogaine, but we can also use it in a pill form. It was originally developed for blood pressure. And what people found was that it caused hair growth all over. And that's how you know Rogaine was originally developed. That doesn't usually affect hormones at all, even though it does cause increased body hair and facial hair, which some men find bothersome. It actually has really no effect on health. We don't fully understand how it actually works to regrow hair.

Host: Are transplants really a cure or are they more of a rich man's bandaid?

Dr. Karl Saardi: Transplants, I would say, are pretty close to a cure. What we know is that for whatever reason the hair follicles on the sides and the back of the scalp are less sensitive to the effects of testosterone. And that's why, you know, they'll typically harvest those hair follicles from like the back or the sides and move them up to the crown.

And for the most part, those hair follicles are immune to the effects of testosterone be gradually becoming more sensitive to testosterone over time. So, I'd say it's pretty close. The issue, you know, comes up when those hairs that were still on the crown that were not transplanted, when those kind of go through the normal process and do become more sensitive, the hair will still thin a little bit. But it shouldn't really have too much effect on the transplanted hairs. Most hair transplant, hair restoration, people I've worked with do want patients on some sort of a medical therapy in addition to the transplant to try to preserve those hairs. But yeah, the transplants are kind of the only thing where, you know, you may not have to take a medication long term.

Host: Okay. Wondering if this is just a locker room myth or not, but I've heard or some people believe anyway, that losing hair is actually like lowering your testosterone or your lower testosterone that's why you're losing your hair. Maybe you can just explain the connection there and is that just a locker room myth?

Dr. Karl Saardi: Yeah. Pretty much just the locker room myth. It's actually the opposite effect. One of the main side effects of misuse of testosterone to like bodybuilding and things like that is actually hair loss, because your normal levels of testosterone probably don't affect the hairs as much. But when you boosted up to levels that are towards the top end of normal, of normal or beyond. In other words, like more than your body needs or would make normally, that actually causes those hairs on the crown to start miniaturizing and falling out. Similar effect with acne or increased body hair. There's just too much testosterone in the system and that's what causes people to lose their hair when they're abusing testosterone supplements.

Host: I want to ask you about hair clinics, or I read this somewhere. So, I feel like at least what I read was that basically they're sort of like casinos, if you will. They're high stakes, low odds, and a lot of flashy promises. What are your thoughts about them?

Dr. Karl Saardi: I think there are, you know, a lot of clinics out there, a lot of doctors who, you know, do hair restoration that really do deliver amazing results. It is absolutely expensive. It doesn't work for everybody. But with the technology we have today, I'd say the success is much higher than it was before. And the results are a lot better. A lot of people looking into hair transplantation are worried about having that "pluggy look" from decades ago where we actually used to remove like little cylinders of skin from the back of the scalp and move it to the crown. And it resulted in like individual, like tufts of hair. Nowadays, with the technology we have, they actually remove individual hair follicles. You can, for the most part, avoid that pluggy look. And I think the odds of having a good result are much, much higher now with the latest technologies than they were even like 15 or 20 years ago.

I think, you know, if you are someone who is looking into this kind of treatment, you do want to vet the clinic that you're going to and Google reviews or Zocdoc reviews that they only tell us so much of the story. A lot of times, it will come down to word of mouth. And if you are working with the dermatologist, I think that's a really good place to start asking their opinion of the hair transplant, hair restoration places in your area that do good work, because odds are they probably have a small group of people that they like referring to, and I've seen good results from.

Host: Yeah, I think that's great advice from an expert, you know, reach out. Speak with your doctors, speak with your dermatologists, see who they recommend, Google reviews, other things like that. I want to finish up today and, just think about this maybe more broadly, does hair loss actually maybe signal deeper health issues or is it just vanity fuel?

Dr. Karl Saardi: Yeah. It can definitely be part of other medical issues. Generally, we can tell by examining the scalp both from far away and up close with a tool we call a dermatoscope to see what the actual growing hairs look like, things that would definitely make me want to look into underlying illnesses would be if the hair loss is like more patchy, like individual areas where there's hair loss rather than the typical thinning like receding hairline and thinning at the crown. If there's inflammation in the scalp, any redness, scaling, or symptoms like burning, itch, pain. If there are other medical issues going on, like if somebody's undergoing treatment for cancer or something like that, it could it be related to a medication, those would be some signs that it could be an underlying medical problem. At least in my own practice, my threshold to do like a small skin biopsy where we actually remove a small circle of skin to look at it under the microscope and get a better sense of if there is inflammation or if anything else is going on on the microscopic level, that will usually point us in a direction to look for other medical issues or even other causes of hair loss that are treated a little bit differently. And some of them, like alopecia areata, which is like an autoimmune type of hair loss have excellent treatments that are now available.

Host: Well, I appreciate your time today. I always like to dispel myths if I can, I like to do a little myth-busting. I feel like we did that today. Hopefully, we help folks, help men, you know, reach out get the advice of an expert. There's lots of help available. It could be genetic, it might be something else. All good stuff. Thank you so much.

Dr. Karl Saardi: Yeah, absolutely. Great to be on.

Host: And for more information about dermatology at Valley, please visit valley health.com/dermatology. And if you found this podcast helpful, please share on your socials and check out our entire podcast library for topics of interest to you. And thanks for listening to Conversations Like No Other, presented by Valley Health System in Ridgewood, New Jersey. For more information on today's topic or to be connected with today's guest, please call 201-689-2103 or email valleypodcast@valleyhealth.com. I'm Scott Webb. Stay well.