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157: Thinning Up Top

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157: Thinning Up Top

Sep 26, 2023

Losing a bit of hair? You're not alone. Hair loss is a concern many men grapple with, even if it isn't always a direct health risk. Dermatologist Dr. Luke Johnson explains the causes, misconceptions, and effective treatments surrounding male hair loss. Join the Who Cares guys for a deep dive into understanding hair loss and exploring preventive measures and treatments.

Episode Transcript

This content was originally created for audio. Some elements such as tone, sound effects, and music can be hard to translate to text. As such, the following is a summary of the episode and has been edited for clarity. For the full experience, we encourage you to subscribe and listen— it's more fun that way.



Scot: Hey, Troy, have you thought about what you'd do if you'd start losing your hair? I mean, how do you feel about that whole deal? Are you just going to let it happen, let it go quietly into the night? Are you going to fight?

Troy: I think I would let it go quietly into the night. I would go bald gracefully, I guess I would say. I don't know. I hadn't thought much about it, but it's funny we're talking about this because I did notice, as I was looking some pictures recently, maybe my hairline is receding a bit.

Scot: All right. Mitch, how about you? How's your hair?

Mitch: It's okay. I've been growing it out, but early on, as I started to grow it out and stuff like that, I had a hair loss scare and went and talked to the doc and everything. I'm actually on some medication, so hopefully we'll talk about that a little bit today.

Scot: Oh, so you're doing something about it?

Mitch: Oh, yeah. I'm not going into that still quiet night. I'm fighting for every strand on here.

Troy: Yeah, you're on it. I'm impressed.

Scot: As a kid, I remember my dad had male pattern baldness. That's where . . . I guess. We'll find out. But that's where you get that bald spot right in the center of your head. And he told me he had it since he was in his 20s. I've been luckier, but the other day the guy that's cut my hair for 25 years said, "You're starting to thin a bit on top there."

So I often joke because this is something I've thought about for a long time, because ever since I knew my dad, he had that baldness. It must have made an impact on me. It wasn't until I was just kind of reflecting just now that I realized it must have.

And I've often joked that if I start losing my hair, I'm just going to shave my head rather than have that bald spot. But now that I'm here, I'm rethinking about that. I don't know if that's what I want to do.

Troy: Remember that spray-on stuff they used to advertise? Were you thinking about using that, do you know?

Scot: No, never thought of using that. I mean, that's one of the things, is what's a scam? What's legit? I think I tend to think that nothing is really going to help it. So that's a big part of why we're here today with our guest.

Hair loss isn't really a health concern per se, but it is something that does concern a lot of men, and if you Google hair loss, there isn't any shortage of companies that want to sell you their products to either prevent your hair loss or restore the hair you no longer have. And if you're like me, you wonder if they're scams or they actually work.

So our goal today is if hair loss is something that concerns you, we want to make sure you get the best info you can so you're not wasting your money on products that don't work or you don't have unrealistic expectations about the products that have been shown to help.

This is "Who Cares About Men's Health," information, inspiration, and a different interpretation of men's health. My name is Scot Singpiel. I bring the BS. The MD to my BS, Dr. Troy Madsen.

Troy: Hey, Scot. And I am very interested in this now. Like I said, I've thought about it, excited to hear what Dr. Johnson has to say.

Scot: He's an "I care about men's health" convert, Producer Mitch Sears.

Mitch: You got me super self-conscious and looking in the webcam at my hair right now.

Scot: And our expert today is dermatologist Dr. Luke Johnson. Is hair loss something you've thought of personally?

Dr. Johnson: Hey, guys. It's good to be back. I indeed have thought a lot about hair loss, and spoilers, I am taking some medicine for my own hair.

Troy: Oh, wow.

Scot: Well, that's good news, right? If a doctor is doing it, then it must work.

First of all, I made a statement at the top of the show that hair loss isn't a health concern. First of all, I want to make sure is that even true?

Dr. Johnson: Well, it's not something that threatens people's lives or overall health, but there's no doubt that it can severely affect a lot of people's quality of life. We have various ways of measuring that, and some people can be seriously affected by it. You can probably imagine especially a teenager, vulnerable part of their lives, some other problem that causes them to have hair loss. Maybe they don't want to go outside. They wear hats all the time. It can be a big deal for some people.

Scot: Yeah, I guess I didn't think about younger people. I'm just talking about as you age. What are other ways that you see hair loss impact men of any age as far as their self-esteem or their emotional health or anything like that?

Dr. Johnson: It's quite variable, and I try to bring this up with my patients as well. I say some people are really, really bothered by it, and some people don't really care, and then there are other people who kind of like the way it looks, think it looks cool, and want to wear it loud and proud.

I try not to put my own personal bias into what they might be thinking, I just sort of lay that out. Usually, of course, by the time they come to our office they're somebody who wants to get treatment for it, but we shouldn't go in assuming that.

Scot: Yeah, sure. I guess I always assume that people that are going to make a big deal about it had great hair to begin with. I mean, all I ask of my hair at this point is not to embarrass me. That's all I really ask.

So what are some of the ways guys can lose their hair? I think male pattern baldness is the one maybe that we all traditionally think of, that bald spot in the center of the head. Talk about that and talk about other ways that hair loss can manifest itself.

Dr. Johnson: Yeah, there are lots of different ways of hair loss to a dermatologist. This is the kind of stuff we get excited about. We talk about why people are losing their hair and when it happens and why it happens. But you're right that male pattern baldness, and in women female pattern baldness, is probably the most common cause of hair loss in adults.

The medical term for this phenomenon is androgenetic alopecia. And it is just what you describe. That bald spot in the center of the scalp, or what we would call the vertex scalp, tends to be very characteristic. People also usually notice thinning in sort of the frontal corners of their scalp, what we would call the bilateral frontotemporal scalp, and then it kind of recedes backward.

That's how it usually shows up in men anyway. In women, it's a little bit different, but this isn't "Who Cares About Women's Health."

Scot: Is that widow's peaking? Is that what that's called, widow's peak?

Dr. Johnson: Well, people can have a widow's peak even if they don't have this phenomenon, but this is something that can cause it.

Scot: So male pattern baldness is one. What else do you have there?

Dr. Johnson: The second most common cause in adults is probably what's called telogen effluvium. So this is caused by stress, oftentimes stress physically on the body, like going through a surgery or having an illness, and this is when you see people actually can pull their hair out. So the old joke of people pulling their hair out because of stress, it's this thing.

Scot: All right. And it has nothing to do with how hard they're pulling. It's just the roots are weak so you can pull it out.


Dr. Johnson: Well, I guess some people it might depend on how hard they're pulling, but most of the time it just sort of comes out by accident in the shower or brushing their hair.

Troy: They're pulling their hair out, but I assume it's something that's a temporary thing, and maybe once they get through that stressful period, their hair fills back in?


Dr. Johnson: Yes. So that is the good news. Usually the hair doesn't fall out right away because it's still stuck to the scalp, but it usually falls out sort of one to three months after the stressful event, and in recent years COVID has been a big cause of this. And then the hair sheds for six months to a year and then it fully recovers.

Now, people can probably keep it going longer if they stress out about it, so the best thing you can do if you have hair loss like this is to just chillax. Your hair will come back.

Scot: All right. Easier said than done, though, when you're watching clumps of hair hit the drain, right?

Troy: Exactly.

Scot: All right. So you've got male pattern baldness. You have the kind of stress-related hair loss. Are there other types of hair loss we should be aware of before we get into which of these hair losses can you actually do something about, which can't you do something about, and what are those things?

Dr. Johnson: Yeah, one or two other things I'll mention. This telogen effluvium thing, usually I see it caused by stressful events, but there are some medications that can cause it as well. So if you listen to this and you're like, "Well, I've been waiting for kind of a while now," it might be worth talking to somebody because maybe one of your medications could be involved, especially some that are used to treat blood pressure can cause this kind of hair loss.

And then there's a type of hair loss called alopecia areata. This is often what I see in younger people, like the teenagers, and it shows up as circular bald spots that sort of come out of nowhere in the scalp. And sometimes it can affect the eyelashes and eyebrows and even the rest of the hair on the body as well.

It's treated completely differently, so if you think you've got that . . . Usually it just gets better on its own, but if it doesn't seem like it's going to, we can help.

Scot: All right. Wow. What causes that type of balding?


Dr. Johnson: That is an autoimmune disease. So the immune system decides it wants to attack the hair follicles. Why does it decide that? Nobody knows.

Scot: Before we get into some of the other stuff here, I've heard some myths, Dr. Johnson. Maybe you can clear some of this up. So I've heard myths that wearing a hat can cause hair loss. True or false?

Dr. Johnson: Mostly false, but if you wear the wrong kind of hat, I suppose it could happen. There is a type of hair loss we call traction alopecia where there's a lot of pressure on the hair. So people who have tight braided hairstyles for example, it can just put enough inflammation on those little hair roots that they get lost and sometimes it can become permanent. So don't wear a ridiculous hat. Otherwise, dermatologists love hats.

Scot: I've heard also that if you look at the men on your mother's side of the family, that'll indicate whether or not you'll have hair loss, which was what got me through most of my life because my grandpa on my mom's side actually had a decent head of hair. Is that true or false?

Dr. Johnson: It's partially true. It turns out that all your genes are important, so those that come from both sides of the family can play a role.

Troy: So it's really nothing more . . . Yeah, because I already looked at my mom's father, my grandfather, and he just had the most beautiful head of hair, and his hair was dark black well into his 90s. I said, "That's how my hair is going to be." But it sounds like that's not the case.

Dr. Johnson: Maybe he was dyeing it.

Troy: Maybe he was dyeing it. That was always the joke, that he put shoe polish in his hair. But he swears he didn't.

Scot: What I'm hearing Dr. Johnson say is that maybe.

Troy: Maybe, but it's just as likely my dad's dad, whatever his hair pattern. So it sounds like there's really nothing special about the maternal line that impacts your hair.

Dr. Johnson: I don't think so, though I have heard that as well. And also, you got a bunch of genes that might not have become obvious in your other ancestors as well. So just because somebody was bald doesn't mean you're going to be, but it does kind of increase the risk that you'll get it.

Scot: All right. And then I've also heard that washing your hair too much can lead to hair loss. Is that true?

Dr. Johnson: That is not true, though if you have this telogen effluvium thing, then washing your hair will dislodge the hairs that were going to come out.

Scot: Okay. Got it. Let's jump into what can be done. So first of all, I think it's worth saying are we generally talking about male pattern baldness when men are concerned about losing their hair and want to do something about it and start looking at options?

Dr. Johnson: Yes. When men and women come into my clinic for hair loss, that's usually what we're dealing with.

Scot: You said that twice now, so I guess it is a woman's concern as well. Why is it we think it's just men's concern? That's interesting, isn't it?

Dr. Johnson: I guess because we're chauvinists. Actually, I would say more women are concerned with it than men, and I blame society. That's where I blame all of our ills.


Troy: It's all society. But I'm assuming, though, it's something that affects more men than women, but like you said, maybe more women are concerned about it and come in for treatment than men.

Dr. Johnson: I believe that is accurate.

Scot: So talking about male pattern baldness then, which can start occurring at just about any age. Is that accurate?

Dr. Johnson: I've had 15-year-olds with it.

Scot: Wow.


Mitch: Wow.

Scot: What are some things that one could do? So, first, let's hit prevention strategies. What are some prevention strategies if you're concerned about male pattern baldness? And Mitch might even be able to jump in on this.

Mitch: So my experience was I was growing my hair out for the first time in decades since high school. It was starting to get longer and I started to notice when I was taking a shower there was hair in the drain. I kept track of it and it kept happening, and I started to see more in the drain and more in the drain. I wasn't sure if maybe it was breakage or maybe it was stress, because I had heard that would help me lose my hair or whatever.

But eventually spoke with John Smith actually, one of the guests we have all the time. I'm like, "Hey, I don't know if this is hair loss. I don't know if this is whatever," and he was like, "There's a pill that can prevent it and it's cheap and it has minimal side effects. If you want to try it and see if it improves things, go for it."

I started taking the pill and after a couple weeks, I stopped seeing the hair in the drain. So I guess I'm doing the first step of prevention. I don't know.

Troy: I was going to say it sounds like that's more jumping into the treatment phase of things. I'm just curious is there just stuff lifestyle-wise? We talked about stuff that maybe is kind of more myth in terms of stuff that causes it, but is there anything on just flat-out prevention? And I just want you to say diet and exercise, because I know everything comes back to that. But I'm just curious.

Dr. Johnson: In terms of androgenetic alopecia, or male pattern hair loss, I don't think there is anything that's been shown to help prevent it. Sometimes people get some of these other causes of hair loss like this telogen effluvium thing, and then their attention is drawn to their hair and they might notice some male pattern hair loss that they had just ignored before or not noticed.

So in that sense, trying to avoid stressful events in your life can be helpful. Diet and exercise I suppose could help make you feel more calm, as can meditation and stuff. But I think the short answer is there's really nothing to help prevent it.

Troy: So if I heard correctly, the Mediterranean diet does not prevent hair loss.

Dr. Johnson: But I'm sure it's great for other things.

Troy: It's going to prevent the heart attack, which would then lead to hair loss.

Mitch: So I guess that leads me to a question, because I was kind of pitched this pill as a preventative measure, and I guess is that just to prevent further loss? We can't grow it back once we lose it? Or what's going on with that?

Dr. Johnson: Yes, you're mostly right. So our treatments these days for hair loss are really pretty decent, but they would do a much better job at preventing further loss than it growing back stuff you've already lost. So if you're thinking you're starting to recede a little bit and you're not going to want to, then that's the time to start treatment right away.

Scot: And this pill that Mitch is taking, is this for male pattern baldness? This sounds like it's for the . . . what? Alomalopecia? What was the other . . .


Mitch: So I'm on a Finasteride, which I guess . . . Is that Propecia?

Dr. Johnson: Yes, Propecia is the brand name and that's the only pill that's FDA approved for this type of hair loss. And it's an oldie but a goodie. It is for androgenetic alopecia, or male or female pattern hair loss, and it works decently well at preventing further loss and not so much at re-growing stuff you've already lost. But sometimes, especially in combination with other treatments, you can regrow some.

Scot: And what are you on right now, if you don't mind me asking? You did bring it up, so I hope you feel comfortable talking about it.


Dr. Johnson: I am also taking Finasteride and I also take a pill called minoxidil.

Scot: And what does minoxidil do?

Dr. Johnson: So minoxidil has been used for many years, decades, as a topical treatment, so something you can rub on your scalp for hair loss. The brand name is Rogaine. Most people have heard of Rogaine.

Scot:That's a classic.

Dr. Johnson:And Minoxidil also shows up in an old "Simpsons" episode, as I recall, when Homer gets hair. But in more recent years, it's had a lot more interest in dermatology as a pill, because rubbing stuff in your hair twice a day is kind of annoying and the pill is quite safe and can be more effective than rubbing it on your scalp.

The main side effect is low blood pressure, which maybe a lot of our listeners are interested in achieving, but I tell people to watch out for lightheadedness. And it can also grow some hair in places where you don't necessarily want it, like face or legs. It tends to be more of an issue for our female patients. But it also does a pretty good job at preventing further loss, and if you, again, use multiple things together, it can help regrow some of the stuff you've lost.

Scot: Are there other preventative things that you turn to when you have a client come into your office?

Dr. Johnson: So in terms of prevention, there's nothing really you can do, but in terms of early treatment, these are some options. And there are a few others as well, but these are our go-tos in terms of medical treatments.

Scot: All right. So when we're talking about Rogaine or that other pill that Mitch and you are both on, you consider that more of a treatment than a prevention then?

Dr. Johnson: Yes, though it does prevent further loss.

Scot: Got it. So those are kind of the two things when it comes to treatment.


Dr. Johnson: Again, there are others, but if you're coming to the dermatologist's office, those are the main things we're going to break out. If you want to not bother with a dermatologist and think about just clicking through Amazon links and finding stuff, that's another story.

Scot: Okay. And how effective are those other stories?

Dr. Johnson: It's tough to say. There have been medical studies on some of them, and some of them look all right. But those studies are usually heavily biased by the companies that make the supplements, so it's tough to say for sure.

I would say the ones that I think have decent data . . . there are a couple of specific brands. Viviscal has decent data. So especially if people are really motivated, I usually recommend Finasteride and minoxidil and Viviscal.

And then there are a couple of natural products that kind of work similarly to some of these medicines, like saw palmetto and pumpkin seed oil. Again, I'm a little suspicious of them, though. I honestly would recommend that you just see a dermatologist and get on some medicine because, as we all know, some of these nutritional supplements and nutraceuticals can be impure or not as strong as they claim, and of course can have side effects or interactions with other medicines.

Mitch: So I guess one of the questions I have is that I have met men in my life that have receding hairlines, they're upset about it, etc., but they never went to a dermatologist. What are some of the reasons that you can think of that would prevent a guy from going?

I was shocked to find out that it's a cheap pill and I can just take it and I can prevent hair loss, but there are so many guys in my life that never did that. What do you see in your office, etc., that can stop a guy from going and getting treatment?

Dr. Johnson: Well, I see some curmudgeonly guys who just never want to see a doctor for anything, and I agree these are both inexpensive pills that have low side effects and work all right. There are some downsides to taking them. Probably the biggest downside is that it's kind of a long-term commitment like marriage, because if you stop taking them, we think that you will lose all the hair that it helped you retain in the meantime.

Scot: Oh, really?

Mitch: Yeah, that was [crosstalk 00:18:30].


Dr. Johnson: We don't really know that for sure, but you should go into it expecting to take it for years and years, as long as you think you want to retain your hair, and some people are just sort of not into that.

While they are safe, potential side effects do exist for Finasteride especially. There's been some buzz about sexual dysfunction, which a lot of guys aren't into. I personally feel that the research says that it does not cause sexual dysfunction, but rather people like to blame their problems on the medicines that they are taking, but that could certainly turn people off as well.

Troy: Now, with Finasteride also . . . and help me out here too on understanding how it works. My understanding is that it doesn't reduce testosterone levels, but it blocks the testosterone, and that's kind of the mechanism. Is that correct?

Dr. Johnson: That's correct. That's how it works for hair loss.

Troy: Yeah. Any concerns with that? Because Mitch started a testosterone treatment, and then it sounds like, as a result of that, started to have some hair loss, and then is this now starting Finasteride going to affect any impact from that testosterone treatment?

Dr. Johnson: So the studies say that it's quite safe in that regard. Again, maybe that's why some of this sexual dysfunction stuff shows up.

There's also potentially a recent association with depression and suicidality. I think that that data is currently unclear, but certainly if people are taking it and have any of those feelings, stop and get help if you need it.

And then also, if you're looking online, there are some men who claim to have what's called post-Finasteride syndrome, meaning even after they take it and they're done taking it, they still feel weird afterward and they think it's the fault of the medicine.

I think most medical scientists and doctors don't feel that that's a true medical entity, but I tell my patients, "If you look online, those are the sorts of things you'll see," and I tell them, "These are the reasons I don't think they're true." Sometimes I tell them I'm taking it myself, but that's what they'll find out there.

Mitch: Troy, it means so much that you think of all of my meds. I didn't even think of asking that question to a doctor. I'm sitting here and I'm like, "Why didn't that even come up?" Of course. But yeah, it's good.

Troy: I just keep a record here of everything you say on the show.


Mitch: I appreciate it.


Troy: I'm like, "Let's see. Let's review Mitch's medical record." And you've already said these things publicly, so I'm not . . .

Mitch: Oh, yeah. No HIPAA stuff going on here.


Scot: That was kind of fun to listen to that, to hear Troy connect all those things because I hadn't connected those things either, Mitch.

Dr. Johnson: Well, it's true that when people start testosterone treatment, this is one of the side effects that we see, along with acne is a real common dermatologic side effect of testosterone treatments. And it can be an issue like in our trans community, for example. And then if people are on testosterone for something like that, you probably don't want to be messing with it by giving them Finasteride, even though the doses are low enough that I doubt it does anything. But it can be a tough spot to be in.

Mitch: Scot, you had mentioned that you didn't know if you would get prevention or anything, but if you started to see a lot of hair loss, do you think you would go in? Did you know there was a pill? Is that a treatment that you would seek out?

Scot: It's interesting because I was . . . I don't know. It's weird, right? This is the point I should act because there's a little bit going on, and I was sitting here questioning asking myself, "Well, what would stop me from going and getting those pills?" And I don't know.

It's weird because I'm vain, but yet I don't want to appear vain, and I'm afraid if I go and get pills for hair loss, this shows that I'm vain. Why should that matter that much to me, especially at this point in my life? It's just something that happens.

Dr. Johnson: See, this is where I have an out because I can be like, "I'm a dermatologist so I need my patients to look at me and be like, 'I want my skin to be like yours. I want my hair to be like yours.'" So this is really research I'm doing on behalf of my patients.

Scot: And you need to show them that this stuff works. You do totally have an out. I guess my out could be the "Who Cares About Men's Health" podcast. Guys, we're going to do an experiment. We're going to see how all these medications work.

Troy: Exactly.


Scot: I can totally justify that.

Troy: See, my biggest fear in doing it would be exactly what you mentioned, Luke, of doing it and then thinking, "Okay, maybe I don't want to keep taking this," and then thinking, "Wow, if I stop this, I'm suddenly going to go bald. All this hair that has just been clinging on because of this medication, I'm going to stop it and it's going to lose that effect and all that hair is going to fall out." I'm kind of more like, "I think I'm just going to ride it and kind of see where things go with my hair." I don't know.


Scot: Instead of a massive change, just let it be gradual.

Troy: Just let things happen the way they're going to happen. Yeah.


Scot: I have a question. So what about any sort of other types of treatments like hair transplants? Are those a thing, and does that thing work?

Dr. Johnson: There are many other things that exist. The pills are just kind of the easiest, but hair transplants is kind of the nuclear option, and they do generally work. They're technically challenging, meaning you have to find somebody who's pretty good at it to get it done for you, but basically they take a strip of hair from the back of your head and then they cut it into little tiny pieces to get all the little bits of hair out and then they stick those into your scalp. But it can certainly be effective. It leaves you with a scar in the back of your head.

Scot: All right. Sounds kind of like what you do if your lawn was starting to get spotty. You'd go get some good lawn and put it in the bad lawn.


Dr. Johnson: Yes, except you would be taking a piece of your lawn from your backyard and putting it in your front yard in little pieces.


Troy: So it's always from the back of the head? I thought it was from your back or some other body hair.

Scot: How much hair do you have on your back?

Troy: I don't have any hair on my back, but I'm just talking about dudes . . .

Dr. Johnson: Is it because it's all been transplanted?

Troy: It's all transplanted, that's right. That was my grandfather's secret. I don't know, but it sounds like you've corrected a myth that I may have misunderstood that basically people who have that are having back hair on their head. It's just the back of their head.

Dr. Johnson: Yes, the back hair from the back of the head.

Troy: From the back of the head. Okay.

Dr. Johnson: And then other treatments that have been explored more recently include microneedling. So that's when you have a device that stabs a bunch of little tiny needles into the scalp or anywhere on the skin over and over again. That can potentially be combined with medicines that you then put on the skin after the microneedling so that they can kind of get into those little holes that you have made.

Also, there has been significant, I would say, pretty decent improvement in the studies with people using platelet-rich plasma, which means you come into the clinic, somebody draws your blood, and then it spins in this spinning device called a centrifuge, and then they get just the plasma from your blood.

The plasma is supposed to be full of what's called growth factors and other goodies to help your hair grow, and then that plasma is injected back into your scalp to help the hair regrow.

I do think the data is fairly good for it and it's certainly a safe procedure. Probably fairly expensive and you have to find a clinic that does it, but those are some options as well.

Scot: All right. And out of those options, when you're counseling a patient, how effective are they?

Dr. Johnson: I think they're pretty effective. The hair transplant thing, I don't have a lot of people who are interested in that because it's pretty expensive and it's a big procedure. You've got to cut out a big old strip and you're there all day basically. But the plasma injection thing I think is a good option.

Scot: All right. The guy that cuts my hair actually brought that up when he was pointing out . . . He knew somebody that did that and said that it actually worked really well for them, and I was skeptical. I'm skeptical. I don't know why I'm so skeptical of all things hair loss that say they're going to help me. I don't know why that exists. Is it the spray-on hair? Is that what's soured me to everything? I don't know.


Dr. Johnson: Hey, don't hate on the spray-on hair. These camouflage devices can be really helpful for some of our patients.


Troy: So those are legit? You're recommending those?

Dr. Johnson: Yeah. They're usually electrostatically charged little flakes that help disguise the bald spots. There are also markers that color the skin more permanently than my kid's Crayola markers that you can kind a rub on there and look like you have a fuller head of hair for a week or two.

Mitch: Oh, wow.

Troy:I didn't know that that was legit, but you're actually recommending it and people are using it just to kind of cover up those bald spots.


Dr. Johnson: For sure.

Troy: Interesting. I'm surprised, though, you haven't mentioned anything about those hats with lights in them, like the infomercials for those. I'm guessing those are not legit.

Dr. Johnson: Actually, those are legit.

Troy: Oh, really?


Dr. Johnson: So the medical studies on them show that they do help. They probably work by increasing blood flow to the hair, which is nourishment for your hair, but the studies usually say, "Yeah, the hair is a little thicker. There's a little bit more of it per square centimeter," but there haven't been studies that I have seen that say that patients have noticed more hair. So they do increase hair growth, but whether or not it's enough for anybody to notice, I'm not sure.

Good news is, again, they're safe. It is kind of expensive and it's just a one-time purchase. You three guys could all share it together. Scot can have it on Mondays and Wednesdays, etc.


Troy: I like it. Just pass the hat around. Wow. I thought those were a total joke and I was saying it as a joke, but it's interesting that there's actually maybe some science behind it.

Dr. Johnson: Yeah, we used to sell it in our dermatology clinic before COVID shut down our store.

Mitch: Oh, wow.

Scot: So it sounds like if I was to come into you with my hair loss concerns, you would most likely put me on a medication or two that would help slow that down, and then maybe pair that up with something else. If I didn't like that little spot that's forming, perhaps some sort of . . . I don't know. I hate to say spray-on hair because I want to give it more respect now that you've given it more respect. What is that actually called?

Dr. Johnson: We just call it camouflaging techniques.

Scot: All right. So you might prescribe a couple of pills. You might maybe suggest a camouflaging technique. You might recommend, if I had the money, maybe some PRP treatments or some hair transplants. By the way, do those, when they regrow the hair, is that fairly permanent hair regrowth? And I'm mostly interested in the PRP, the platelet-rich plasma.

Dr. Johnson: I don't know if the technique has been around long enough to answer that question.

Scot: Okay. Yeah, if you're spending the money, you'd want it to hang out for a bit I suppose. But it sounds like you would have maybe a multi-pronged approach for some people.

Dr. Johnson: For some people. I'm not a hair loss expert. I feel like I know the basics to more than the basics, but not advanced techniques. I usually suggest that people start Finasteride and minoxidil and just kind of take it from there. If people want more treatment, they're usually seeking somebody else.

Troy: And I will say this, too. We are seeing a lot more ads on TV for I think stuff that guys are embarrassed to go to doctors about, like specifically erectile dysfunction and hair loss. I think it sounds like a lot of the Finasteride marketing is maybe coming through that.

Do you recommend if someone's just like, "Hey, I don't want to go in and talk to a doctor," that they potentially consider that and talk to one of these online services? Any specific thoughts with those sorts of things?

Dr. Johnson: I think if you use the right service, it can be fine. There are actual dermatologists who could see you for what's really a telehealth consult or can look at pictures, etc. My concern with some of these approaches is that they have a harder time truly diagnosing you.

So if you have just classic male pattern hair loss, then I think that'd probably be all right. But if you had hair loss and it was not quite exactly right, then it's hard for a dermatologist on the other side of the country who's looking at you through a video to figure out if you might have something else going on.

Troy: Yeah, and my understanding too is a lot of those things, you're just paying out of pocket. They're not taking insurance, where this sounds like it's something that's fairly inexpensive and it's going to be covered by your insurance.

Dr. Johnson: Yeah. I think I pay like $10 to $20 a month for my hair loss meds.

Scot: All right, Troy. After this conversation, where are you at? How's your hair? Are you concerned? Are you going to do anything about it or are you still going quietly into the night?

Troy: I think I'm going quietly into the night. I don't know that I'm concerned enough right now. It's probably just more self-consciousness that I've just thought, "Oh, maybe there's a little bit of a change." I'm not going to jump into anything right now, but this has been great information and I think I would be much more comfortable talking to my PCP about it or a dermatologist or someone else just based on what we've talked about.

Scot: Mitch, you're already being proactive. So did you take away anything from this conversation?

Mitch: Just that I guess I've taken a step to holding onto every little piece of hair that I still have. I guess I'll just be on this pill forever, until I decide I'm ready to do something different.

Scot: Until you're ready to let it go?

Mitch: Yeah.

Scot: I don't know where I'm at. I think I'm still kind of neutral. You've given me a lot of stuff to think about though, Dr. Johnson.

Dr. Johnson: Really?

Scot: Yeah, you have. You've given me a lot of stuff to think about, and I think ultimately I'll handle this situation like I handle most of my situations, which is I'll just let my head make the decision for me. I'll just put it off long enough that that's the decision that's made. No, I don't know.

It's good to know that this stuff does work and it's good to know that you're on it and it's good to know that it's been working for Mitch.

So if you are on any sort of hair loss regimen or it's something you've thought about or you have thoughts, we would love to hear those thoughts. You can always reach out to us at

Thank you very much, Dr. Luke Johnson, for being on the show, talking about hair loss today, and thanks for caring about men's health.

Dr. Johnson: You're welcome. Thanks for having me, guys.


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