The Hair Loss Strategy Every Man Should Know

[00:00:12] My wife likes to call him Theo, my nickname for him is Teddy Oh really? That's so cute And we put him in this like teddy bear onesie So like I was like okay that works out How'd you get to Eddie? Teddy Teddy That's why you look so shocked Yeah I know honestly fatherhood has been such an incredible journey so far Such a challenge I had no anticipation that the sleep It's a shock Yeah It's a real shock Well there's no amount of preparation that I thought I did

[00:00:42] That's all useless Just survive and enjoy it Yeah Like you're really just trying to figure it out as you go Yeah My wife and I have been talking about how our communication is being tested Like when you have a new kid Your relationship really gets put under fire And you really gotta figure out Oh wait till you have three I was gonna say the same thing And at two we were actually better So two you get your life back a little bit Then you have a third And then oh Why not have a fourth? Yeah Your relationship's ruined

[00:01:12] You might as well have a good relationship with your kids Well you know what I was thinking about this too For men We're kind of watching our wives go through these physiological changes These emotional changes These mental changes over nine months Ten months You're just trying to build a connection with this child But you don't actually I mean I don't know if you felt this way I was kind of watching my wife go through the changes And I'm like I'm kind of waiting for this connection to happen That everyone talks about Yeah I felt like a lamp

[00:01:42] So that's the way I describe it Okay I'm substituted with a lamp for the first year of life I wasn't really attached Not the first year but probably like No it took me a year The newborn phase is The second one took me even longer Okay I was losing my hair It was a disaster And then all of a sudden they say dad Yeah You know at some point in a year And they'll be Well mine completely did Da da da When we used to walk into the house So then Then your heart melts And then they're all yours Yeah And it's worth it I mean It's time that you're talking about losing hair Because we're having a conversation today

[00:02:12] About hair loss for men And this conversation doesn't happen without our friends at Rogaine So very thankful to be chatting Because August is hair loss awareness month Oh cool I think they're all hair loss awareness month I think every day of the year should be hair loss awareness Exactly Because a lot of men struggle with that Yeah And we don't really do a good job talking about it I mean we don't do a great job talking about things When it comes to mental health and confidence in general Guys tend to just hold things back

[00:02:39] But I think there's a really good opportunity here To de-stigmatize the conversation around hair loss The fact that it happens Let's not pretend it doesn't And how we can potentially change that course for a lot of men And make them feel more confident Right We know that it affects their lives Their professional careers How they show up in the workplace at home In their relationships when they're dating So maybe here we can start with just a brief intro Quentin we'll start with you

[00:03:09] Sort of what's your backstory And how you got to working in this field Sure I'm Dr. Quentin Shivers I'm a plastic surgeon in Toronto I trained all over Canada I started in Edmonton in pharmacology actually And then went to Calgary for med school Toronto for aesthetics fellowships I actually did a hair transplant fellowship Okay I've struggled with hair loss I've had two hair transplants I've done everything that I needed to do Well it looks great I married She thankfully agreed to marry me Before I lost all my hair But it's still a struggle

[00:03:38] And it's just even a personal thing now Even a personal Just like everyone has With their hair personal attachment Other than that we want to practice In two big practices Plastic surgeon dermatology offices In northern Toronto And I practice with my wife Well I love the fact that you're talking about it From the lens of personal experience Yeah I think that brings real credibility To what we're going to talk about today It's like you've gone through it

[00:04:04] And you've taken steps to deal with that We should have taken them earlier Yeah I think a lot of men would agree with that Yeah Renita how about you? I'm Dr. Renita Alawalia I'm a dermatologist I did my dermatology training at U of T And I have both a medical and cosmetic practice And one of the conditions we really like to treat Both medically, surgically And with over-the-counter products Is hair loss Because we can really make an impact for people

[00:04:32] Especially when it's caught early And when you see those first signs of loss If you're able to intervene It really does change the trajectory of someone's life And of all the conditions I see And this has been studied in the literature as well Hair loss causes one of the greatest impacts On quality of life And I see that every day in my practice too Those are the patients that are coming into the office And they are often in tears

[00:05:01] And so stressed out Because they don't know why it's happening And what to do about it Yeah Well, you know, I have two cousins of mine Who, when they were in high school They started showing signs of hair loss And it really affected their confidence There were times where they would cancel dates Because they just didn't feel right Or they'd have to put on a hat And they weren't happy with it But I think we start this conversation Really and truly by understanding

[00:05:30] How that even happens How does hair loss happen? Is it genetic? Is it like you're doing something yourself? I remember when I was in high school I used to plaster, you know, a handful of gel Into my hair And I was always told like That's going to make you lose your hair If you tie your hair back Let's say if your hair is longer Hair loss And when you think about hair loss You divide it into Inflammatory processes That can cause scarring

[00:05:58] And then non-inflammatory processes And the most common type of hair loss The most common type of hair loss That men experience Is a non-scarring hair loss Called androgenic alopecia And that is where you're losing hair At the vertex Like the sides And the crown And that affects most people At some point in their lives And, you know, some people experience it very early And some people start to experience it later

[00:06:27] And certainly the things you mentioned Like tight hairstyles Like if you're repeatedly doing that That can cause another type of alopecia Called traction alopecia And products usually don't have an impact on loss But certain stresses Like for women It's often postpartum Often if like there's an iron deficiency Or B12 deficiency Or thyroid deficiency It can push you into a state of shedding

[00:06:57] Which is a different type of hair loss Where you lose a lot of hair And often the two can co-exist But the androgenetic kind The kind we're talking about the most today That is influenced largely by your genetics Okay, so if someone in your family Has dealt with hair loss If you look at your dad And your uncle And your grandpa And your cousins And you see that's there Does that mean chances are higher

[00:07:25] That you will also have the same challenge? I believe they've Yeah, they used to be on the paternal side Or maternal grandfather side of things But now I think it's There's multiple genetic components That they've found So it doesn't necessarily mean That just because your grandfather was bald That you will be But it could be from either side But there's definitely A strong genetic component to it Okay And what's the mental cost of this? Because I mentioned it a little bit earlier

[00:07:55] The number of guys that I know Who've gone through this challenge Who, like I said, skipped dates Or, you know, had to wear hats all the time And you know why they do it And it's like that unspoken thing What do you think the mental cost is on men? I think there's both I think it's male and female And just from running the practice I was thinking that when Dr. Renita My wife was talking about that You know, the types of patients That come into practice We get thousands of hair loss referrals Actually into the practice

[00:08:25] So many that it's almost difficult to handle I'd say a lot of the referrals That we get are oftentimes even female Because females are oftentimes more open To just exploring options And admitting they have problems with hair loss And I find that there's The females are often thinking It's a medical component to it And unfortunately a lot of times They find out it's not And it's just, again, just a genetic component To female pattern hair loss

[00:08:53] For men, there's two parts to that question I guess how it affects us And that's a whole topic That we can talk about for the next hour But I think a lot of men know That it's actually genetically linked And they've seen other friends or family Because, you know, it can happen Oftentimes it even happens earlier in men I would say statistically I think before men were also always told To just kind of suck it up Or like this is just what happens And they make a joke about it And I think that's one thing

[00:09:21] That is really great about your podcast And you do it a lot on like different topics It's for the emotionally aware man And like that old masculinity Those old notions are no longer there And it's okay to feel upset That you are starting to lose your hair And it's not something that you need to cover up and hide Like you said, your cousins were cancelling dates Because of their hair loss

[00:09:48] And people are trying all sorts of different haircuts And strategic ways to hide their hair Or wearing hats And, you know, it's okay to feel bad about it And it's okay to do something That may be perceived as cosmetic To intervene to get on top of it Yeah, I think the key thing there is Understanding that it's okay That it doesn't somehow I mean on the topic of masculinity And the modern man I think a lot of men still feel that If they were to spend any time

[00:10:18] Taking care of their look That somehow that takes away from their masculinity But deep down they're still feeling some kind of insecurity Anxiety In some cases maybe even something worse And we need to try to reframe the conversation around hair loss That it happens It's way more common than people think It affects both men and women I truthfully did not know The extent to which it also affects women You kind of typically think of it as a man's issue Which is also important for men to understand

[00:10:47] Especially in, I think one of you mentioned postpartum That being a consideration How do you Do you have any advice on how you change the narrative around this? Like what you would say to someone in your life That might be going through it? I don't know if I downplay it Because I think There's certain things that You know, in society I think people do sort of Place You know Not a value But people do I think

[00:11:17] Possibly look more favourably On people with thick heads of hair And you know It's perceived as more youthful Or potentially more Yeah Potentially someone that's able Even at the genetic level Able to You know Have Children Or be more It's I think it's I think it's a mix of both things I think it's I think it actually is a real phenomenon That you know Men want to keep their hair And it's potentially more attractive There's always that person

[00:11:46] In their early 20s That's lost their hair And shaves their head And looks great with it And has a nice shaped skull And can get on the rest of Of their life Without their hair But the rest of us Having a nicely shaped skull Yeah The rest of us You know It has strong facial beard hair And maybe you can pull it off In other ways Or just otherwise attractive And rich and tall And they've won the lottery In other ways That they can make up for it But For the rest of us You know In your 30s You start to lose your hair And you start with

[00:12:16] You know A widow's peak Or slightly thinning on your crown It's more difficult To potentially Cover up and live with Because You know You're adjusting hairstyles You know You can see it And other people can see it Oftentimes as well And then it's just Trying to figure out What to do with that You know Yes You can just live with it And own it Which is great For the people that can But I think especially In your early 30s When you're maybe not as Confident with that

[00:12:46] Aging process And you haven't met your partner You know It's just finding The information And the right information About what you can do Thankfully I was born in 1980 So I'll just say that Out loud here But you know The information back then Was absolutely terrible And the treatments Were actually probably Not as good And now there's a lot Of treatment modalities That can actually help Prevent further hair loss And restore the hair loss That you've had So from a surgeon's perspective You know We're always thinking About this as a keep

[00:13:16] Versus a replace And you can't actually Replace all your hair If you're looking at it From how male hair loss occurs It's you know It's dihydrotestosterone Affecting your hair follicles At a cellular level And typically your hair follicles All around the back And the sides Are dihydrotestosterone resistant So most people Won't lose that hair And from a transplant perspective You can take that hair You can rob Peter to pay Paul And place it wherever you want

[00:13:45] But from a transplant perspective You know Every transplant You might get Two to three thousand Hairs maximum And if you just look at it From like this perspective If you were taking a graft Or you know this If you were taking Individual hairs You could take this much hair And put it wherever you want But you're never going to be able To cover an entire scalp With hair With a transplant And even after Two hair transplants In my perspective Or you know You can go to three Potentially four You run out of donor hair And you're never going to get That density That you want To actually cover A full head of hair

[00:14:15] Especially if you're destined To lose a majority Of your hair And also Just the The pattern of the hair And the Where you're able to fill in You know You won't have enough To actually To take To fill it in The way you want So you have to Stabilize your hair loss In terms of The keep Perspective Versus being able to take So if you don't Stabilize your hair loss It'll be very difficult Unless you were only Ever going to lose A small amount of hair Again Genetic lottery

[00:14:46] To be able to replace it So keeping is actually More important I mean in the keeping There's different things That we're going to talk about today And Rogaine being one But one You're trying to Try to densify your hair You know You're trying to Make the caliber Of those hairs thicker So they cover a bigger area I always think of it As a forest You know If you're taking If you're looking at a forest You want to You want to cover the front area You know As thick as many hairs as possible But then as soon as you Go up top Or as soon as someone's Standing over you Or your hair's wet You're going to notice those Patterns of baldness Much more

[00:15:15] So you want to thicken your hair You want the hairs That are there to be You know If you have a little bit Of wave or curl You know It's going to cover a bigger area And then you want As many of the miniaturized hairs To grow as possible So there's different things That are actually going to Result in a better coverage That you can do And that's where All the modalities work together In terms of You know Rogaine And you know Some of the oral treatments That actually block Dihydrotest That dihydrotest

[00:15:44] I'm not even trying to Repeat the word DHT The block DHT Dihydrotestosterone From affecting the hair follicles Yeah And you know That's when you're Finasteride and do test ride And all of those Oral treatments And ketoconazole shampoo And PRP And red light lasers That have lesser Lesser Lesser efficacy But they still work together In combination To keeping as much As you can And especially early on In your life You know You really want to keep As much of that hair As possible

[00:16:14] Even later You know To regrow And to get that density back Because you're never Going to be able To replace it all And it works in combination So that's really important You mentioned DHT DHT Yeah Is thicker No So DHT Dihydrotestosterone What is actually affecting The cell at a cellular level And And Causing miniaturization Of hair follicles That's typically How male pattern Baldness works Which is the majority Of hair loss We should probably state that You know A lot of people Think it's medical

[00:16:43] And once those medical Causes have been ruled out And I think again They're more The medical reasons For our hair loss Patients That you know Thousands of referrals Are getting into the clinic It's typically more females What do you think? Yeah It's 50-50 Like I think females They are more willing To seek treatment And I think that's also Associated with the stigma That men have Of coming in Because they're told It's just normal And as a father Of three girls I mean It's horrible For women To lose their hair too And it's different Like thinning hair Is also As big For sure For both men And women

[00:17:13] But you know What's basically Happening under the Influence of DHT Is that the hair follicles That were Thicker and fuller Are now becoming Miniaturized So they are smaller Smaller follicles So they are smaller follicles And then eventually They will fall Yeah So if you actually Look at a scalp So DHT almost Chokes off the blood Supply to the To the hair follicle And if you actually Look at someone That's completely bald Maybe not for many years

[00:17:42] But losing their hair You actually If you look under Microscope You can see all these Miniaturized hair follicles You wouldn't even Perceive it as hair Follicles can get But you'd never notice it In terms of coverage On your hair And once that process Has been in For a long time You can never Actually reverse it So we can talk about How you know Rogaine works And other products Like so if you're Looking at Finasteride Dutesteride There'll be 5 alpha reductase

[00:18:11] Inhibitor So what that really means Is it stops the conversion Of testosterone To dihydrotestosterone And that actually Cycles into estrogen As well It kind of just goes Into a pattern Right your hormones Your sex hormones Are actually just Converted by enzymes That's usually One enzyme away That's why men Can get gynecomastia too Because testosterone Can freely get Converted into estrogen So there's an estrogen Blocker For your Sex hormones But Dihydrotestosterone

[00:18:40] Is what is involved Predominantly in Male pattern baldness And the enzyme 5 alpha reductase Is predominantly In the vertex And the crown And eventually If you follow Norwood patterns Of baldness That connects Into a full Calde sac But that's where You're going To lose your hair Because the other Hair on the sides And in the back Of your head Are they don't Have that enzyme And so the Testosterone doesn't Get converted Into dihydrotestosterone Which doesn't Ultimately lead To hair loss In those areas So it's why In a hair transplant You can take

[00:19:10] Those hair follicles And put them Wherever you want Because they don't Have the enzyme That's going to Cause hair loss Because the Testosterone Is not going To get converted To dihydrotestosterone You can use Those hairs Wherever you want And obviously There's going to Be a lot of men I shouldn't say A lot I don't know For sure But you know Thinking for Myself Personally I'm not sure I would be Comfortable Going the route Of a hair transplant I'd want to I'd want to use I'd want to use A product That helps Regrow What's possible For sure And like For many reasons That's not even An option For most people

[00:19:39] And I think You know Before we Settle in And talk Specifically About Rogaine It's good To just have An overarching View Of what The treatments Available Are So you have Topical treatments With Rogaine Being the Most well Known And you have Oral treatments That Quinn Referred to To like Finasteride And Dutasteride Some people Take oral Minoxidil too There's in-office Procedures That we do That a lot Of people Like to do Like PRP Where we

[00:20:09] Take your blood We spin it We take the Platelet-rich part And inject it Back into your scalp And that can Help some people There's Microneedling With exosomes That like Signal your body To maybe Produce more hair And then Quinn talked About the Surgical side And there's At-home devices That people Invest in too But still The most Affordable And one of The treatments That actually Has the most Science behind It is Rogaine And I think If you think Of how does Rogaine work

[00:20:38] You think about It as each Hair follicle Being a plant And those We talked about How those Hair follicles Get miniaturized So the plant Is like Not doing Well Right So what does A plant need To do well You need Sunlight You need water You need Fertilizer So Rogaine In a sense Is that Fertilizer Right So it can Actually help The hairs To become Stronger And thicker In a lot

[00:21:08] Of patients Who are using It Amazing I Before we dive Further into That I actually Wanted to go Back and ask One question That was Top of mind For me As I Was thinking About this Conversation Top of mind I mentioned I used to When I was In high school I used to Plaster Like loads Of gel Into my hair Every single Day And like Slick it Back And as Tight as Possible And then As I got Into my You know 20s And early 30s I grew My hair

[00:21:37] Out It was Shoulder Length But I Didn't Feel like Styling It So I Wore Hats A lot And now I notice For example When I Go to Wash My hair I find Little bits Of hair In my In my Hand And I Don't Know If that's Something That I Should be Concerned About Or whether That's Just Common And I Think For a Lot Of Men They Don't Quite Know Yet What's The line Between Hey This is A sign That Something Is Happening Versus Just Natural Like You Run Your Hand Through Your Hair And You're Bound To Get Something Out Of That It's Normal To Lose 100 To 200 Hairs A Day A

[00:22:07] Day Okay Your Hair Is Always Going Through Cycles And So There's Antigen Phase Which Is The Growth Phase Cata Phase Where You're Losing Your Hair And A Telogen Phase Where It's Dormant And Getting Ready To Grow Again And There's Lots Of Things That Are Important About That Because One Of The Way Minoxidil Works Is Minoxidil From A Scientific Way Actually Works On Opening Up The Potassium Channels And Increasing The Blood Supply It's One Of The Ways It Works More Blood To That

[00:22:37] Area Like The Plant Analogy My Wife Gave Is More Blood More Nutrients To The Hair Follicle And It Helps Preserve The Hair Follicle In Terms Of The Growth Phase The Antigen Phase So Your Hair Could Be Dense It Could Be Thicker And It Could Be Healthier But It Also Takes It Out Of That Telogen Phase Which Is Where The Hair Is Dormant It Also Helps Cause It To Regrow A Little Bit Faster But You Can

[00:23:15] Hair Come Out Of That Cycle As Well But If You Noticing That You All Of Sudden Are Losing More Hair And Maybe You Don't See The Specific Signs Of That Vertex Or Crown Loss Yet But You Noticing That More Hair Is Falling It

[00:23:45] Sudden Shift I Mean I Think It Is Important To Talk To Someone As Well Or I Mean There Is A Lot Of Research Available On The Internet Nowadays But The Only Problem Is Now There Is An Over Abundance Of Information There Is Too Much Right So You Don't Even Know Where To Start And What It Is Always You

[00:24:15] Have A Good Head Maybe Now You Got Your First Baby I Certainly Exactly Because We Also Don't Know If It Is Mitochondrial Health And All These Other Things To You Know Sleepless Nights But It Is A Lot Of Just Genetics Which I Think Is Important To Say Out Loud You Are Not Unhealthy Because You

[00:24:50] You Can You Can Change Unfortunately But For For hair loss, yeah, it's a large part a genetic component.

[00:25:20] And then it's getting that right information to be able to help prevent further hair loss. Again, keep what you have. And then eventually, if you can, replace where you need to. But there's no point, even as a hair transplant surgeon, these surgeries are expensive. And flights to Turkey are expensive too, even if you get it done there cheaper. And you don't know what the providers are going to be like. And there's a whole bunch of research you're going to have to put into that aspect as well. And natural hairlines and recreating what you've lost.

[00:25:47] And you still want all that information that you can get to keep. Because I can't stress it enough as a hair transplant surgeon. Again, those procedures are $10,000 to $20,000. And forget that. You can't even get the density that you're going to need without keeping what you have. So then it really comes down to what are your treatment options, what works in science. And minoxidil Rogaine is something that is 100% studies. And it's usually the first thing people do.

[00:26:15] Because the next stigma is a lot of people are okay usually putting a foam in their hair, if you tell them. You have to explain how to use it properly. And we can maybe get into that. Because it's not like you put the foam in it, you've got a full set of hair the next day. Yeah. Well, that's something that I would really want to better understand. You referenced. And then just to finish that thought is then you're on the oral treatments. Because that could be oral minoxidil, where it's going to just the same drug, but just delivered in another way. DHT blockers, finasteride, dutasteride.

[00:26:46] The rest is kind of fringe, even though we offer. Well, not all of it. PRP for sure has some studies behind it. But it, again, depends on the PRP that you're getting. Red light, ketoconazole shampoo. But those are, heck, even, we were just in a study nationwide to just study all the things that actually affect, actually improve hair regrowth. And there's thousands of things that are on the market. And those are kind of your five, six. And very few actually have the scientific evidence behind them. And a lot of those things you want to look at is what harm can they possibly do, right? Sure.

[00:27:16] As well. So, like, those other three that I'd mentioned, you know, like, those are all things that you can add with very little kind of side effects. The blockers, you know, you want to get medical advice for, but they definitely work. And I definitely think you should add them if you're able to. And then replacement. But all of that is one package of hair. The best word is hair restoration. It's not, you know, it's, you need to, again, stabilize your hair loss before you can even replace it.

[00:27:45] You mentioned a study earlier. And I've got some stats here that I wanted to throw out there, which a lot of them were quite surprising to me. 41% of Canadians experience hair loss or thinning with only 7% using proven medicated treatments like Rogaine. So 41%, that's a huge number. For sure. I'm surprised it's not higher, to be honest. I think as the population ages, that number gets even higher.

[00:28:15] But I bet that number is for a younger population. Yeah, if I looked around my friends, it's probably closer to 80%. Okay. That's, yeah. That was a, yeah. That was a, when I read that stat, I was like, whoa, that's, that's a lot. It's one of the most common complaints. Like, even when people are in our office for other reasons, they, they also, it's always something like, well, their hand is on the doorknob. They're like, oh, and my hair. What can I do for my hair? It's interesting that they, they treat it that way.

[00:28:44] It's like, oh, by the way, you know, this is something where it's like, let me throw that out there and just see. Because it's something that's on their mind. Kind of, and that's not what, what the primary reason was for their visit. And they see, okay, they can maybe help, you know, with, with this too. Well, hopefully this conversation and the work that Rogaine is doing can help change that stigma for a lot of people. Yeah, it's good for people to know that there are simple things that you can do. Like you said, not everyone is a candidate for a hair transplant or not.

[00:29:13] Everyone has access to a dermatologist and wants to do in-office treatments. Some people, especially when you're having those first signs of hair loss, those younger patients, especially, want to do something that they can be proactive. And if you start early, I have many patients in my practice who've started at the first signs of loss with Rogaine who are just using that as a monotherapy and are very happy with the results that they're getting. But it does take time to see those results.

[00:29:41] Like Quinn said, it's not, you put it on and overnight. Well, I think without medical direction, that's where you're going to potentially, you know, it's like having a personal trainer in the gym. You know, how do I use these products? What's next? What's the next steps? You know, having that plan, you have to apply it for, I would say at least four months before you're going to see, you know, a real result with the product. Hair goes through that cycle. So that full cycle of hair, even after you transplant a hair, you put a hair in, it falls out within the first two weeks when you transplant.

[00:30:08] You have to wait a year to see the result because it has to go through those cycles of hair, has to go dormant, has to start the regrowth and actually to grow and to see full density. You're looking at six months to a year, you know, to actually see that. So you have to be compliant. So someone's watching this, listening to this, hears this conversation, is struggling with hair loss or hair thinning, wants to take action. We've talked a little bit about Rogaine here. What's the first step? What do they do?

[00:30:35] So I think it's hard to access a physician for your hair loss. It's hard to access a physician, period. In general, absolutely. So I think when you have something that's well-known like Rogaine, you can pick it up, you know, on Amazon or at a drugstore. And the product monograph explains quite nicely how to use it. And that's something that you can start with, like the 5% foam is usually what I recommend to patients.

[00:31:04] And it shows you how to apply it to your scalp. And we tell them that it's going to take time and you have to be consistent because everyone wants that instant gratification. Or they understand that it's going to take time, but they think, okay, maybe in like six to eight weeks I'm going to see results. So at the very earliest, at the eight-week mark is maybe when you might see something. But we tell our patients, you know, it'll be four to six months before you see results. And most people do see some type of result with using it.

[00:31:29] Whether it's growth or maintenance, people are generally very happy with what it's doing for their scalp. It's interesting that you talk about, you know, the consistency piece. It seems like it aligns consistency and expectation. They expect to see results like the next day. They're like, okay, I'm going to make the effort. I'm going to do this. I'm going to be consistent for a few days. And then I'm not seeing anything. And consistency can be very hard in any walk of this.

[00:31:57] And it's so overwhelming for the consumer because there's so many different things that are out there. And there's so many, you know, false promises. And, you know, if something's not working, then you want to switch right away and use the next product. And I see that a lot with all conditions that I treat. People come in with the bags of things that they've tried. But if you dissect, have you been using it? They're like, well, I tried this for a week. Then I switched to this. It takes consistent use to see results. We do hair loss studies now actually in our clinic.

[00:32:26] And I think that was something I just learned this year is, you know, a lot of people are bringing in photos of their hair. People will take photos daily or weekly, you know. And say there's no change. Well, they're just looking at their own hair loss. Yeah. And you really have to. I think if you're going to look at this from a personal perspective too, you have to take those photos probably like quarterly, you know, like every three, four months and look for improvements that way and not, you know, place too much stock in what you're seeing day to day, week to week.

[00:32:54] Just because the way the anatomy works and the way a hair follicle grows and is restored, you know, it takes up to a year to actually see full results. So, and a lot of people don't want to buy into that because, you know, they think, oh, it doesn't work the first day. This product doesn't work. You know, it's the product's fault. But patients. Unfortunately, yeah, it's a lot of it. Because you want to see that that hair follicle is getting stronger and that you're producing more hair and that process takes time.

[00:33:20] And what Rogaine also does is it prolongs that antigen phase, which is the growth phase of the hair. So you'll stay in the growth phase longer. But that takes time. The one of the other stats that stood out to me was that 63% of men wish they started their treatments earlier, their hair regrowth treatments earlier. Once you have miniaturization and those hair follicles are gone, they're gone.

[00:33:47] So as someone that is now just trying to preserve their hair for all reasons, but you 100% wanted to start it earlier. When you actually know the science behind it, and I guess I'm sort of privileged in that way that I'm a physician. Now at least you have access to physicians. At least you're watching the right shows, right? Like you can actually see, you know, make sure you're following the right people, right?

[00:34:09] Because there's, again, so many people are just trying to sell products and not maybe looking for someone's best interest in terms of their hair restoration. But once that hair is gone, that hair is gone. And so I would have loved to have keep as many hair follicles as I could. And a lot of that, even as a physician, like I don't want to take medication. You know, who wants at 30 years old to take medication?

[00:34:33] But I do see this younger generation of men, like 25 to 30, who are more aware and they are seeking treatments. And they feel less of that stigma than the generation above them. They definitely do. They want to be proactive about it. And those are some of the patients that we're seeing the best results in. The ones who are starting early at the first signs of loss.

[00:35:00] They're getting an excellent response with their treatment. I think a lot of people, though, still also are medication averse and they just want to jump towards treatment. A lot of people now, because it's a little bit more accessible potentially, or they just have the financial means. Or maybe it's emphasizing how important hair is to men. They just jump to transplantation. And I'm just here to tell you that as a hair transplant surgeon, you can't, you know, maybe if you have very little thinning, you can get a hair transplant in your 30s. And it might look great until you're 32.

[00:35:28] And that process of hair loss is still happening. And I always tell people. It doesn't actually solve the problem. No, if you're getting a hair transplant. Yeah, that's a good point. If you're getting a hair transplant and you come in in five years and you look the same, I think that's a win. Because, you know, we've stabilized your hair loss. Because what's happening when you transplant those hairs is you're continuing to lose hairs. You know, your life is going to continue on its trajectory and that miniaturization is going to happen. It's a chronic condition like any medical problem that needs ongoing management. So keep as much as you can before you replace.

[00:35:58] And if you're going to replace, that's great. But you still got to maintain what you have. One of the key pieces of that stat that I threw out there was the term earlier. And you kind of hit the nail on the head when you said at the first signs. I want to go back to that a moment and just really understand what's considered a sign. Because I think for a lot of men, like what, how do you distinguish a meaningful sign from that 100 to 200 hairs that you're losing per day?

[00:36:26] So I think when you look at the top of your head, are you starting to see that the density doesn't match the back? And the same with the vertex, with the sides on the front. One of the other things that Quinn mentioned earlier was, is, are you developing like a widow's peak hairline where like the front is coming out more and the sides are looking regressed?

[00:36:47] So when you start seeing those signs or that the follicles are appearing thinner in those areas, at the first signs of that happening, that's the time to start. What kind of role does stress play in hair loss, hair thinning? Yeah, stress plays a huge role in our overall health status and in our hair. Stress is known to cause a different type of hair loss called telogenofluvium, which is stress response hair loss. So that's the kind that we alluded to.

[00:37:14] I think a short term and long term, I think we're going to find out to that, but you're talking about severe stress. No, but like any, like, you know, even slight lab abnormality, any physical emotional stress, postpartum, that's the type of hair loss you get where the hair goes into a shedding state. And that often reveals androgenic alopecia earlier when your hair sheds. So sometimes you can see the signs before you would see them naturally. And then I think there's still a long term component to that.

[00:37:42] So that's, you know, shedding more than that amount of 100 hairs, you know, and having rapid women complain about that at all because they can see it in the shower, you know, coming out and shedding. Men might notice it too. But maybe if you're applying lots of that gel, you alluded to earlier and you see it in your hands. But I think there's also, you know, as we're learning more and more about cortisol and chronic stress and, you know, plaques in the arteries and just lower nutrients delivered to the hair follicle.

[00:38:09] You're going to, now we're even linking it to mitochondrial health of the hair follicle because mitochondria are the energy powerhouse to the hair. And they're saying now that, you know, stress and mitochondrial health is actually what contributes to graying hair too. You know, there's a genetic component to graying hair, but people's hair can go from gray to black to gray and black to gray to black again just by relieving stress in that. Because your body basically what it will do is the melanocytes that actually give your hair its color as well.

[00:38:36] When you're stressed, chronically, your body will shunt that energy to where it needs it. You know, your body's like, no, right now I need to, you know, make my heart beat faster. I need to, you know, just go in preservation mode for my sleep deprivation with my baby. But hence the graying hair. Yeah, coloring your hair is not your body's number one priority, right? It's a nice to have, but your body recognizes that it's not an essential. And so that's why your hair follicles can lose pigment. Not always.

[00:39:04] You know, there's definitely people that have a genetic component to graying hair as well. But it's also a big component of hair loss. I think chronic stress. But again. And that puts you in that chronic telogenesis. Again, I can't stress. And I think minoxidil will help with that too. Just, you know, without the science, it's increasing the blood supply. It's going to help with that. But again, I can't stress enough that a lot of it's genetic. And you're not unhealthy just because you're losing your hair. Yeah. But, you know, there's things that you can do. That's a good message. But like that's a separate type of hair loss. The androgenic.

[00:39:31] And then what I was talking about is that acute telogenifluvium. And what Quinn is talking about is a chronic telogenifluvium that like is because of that unhealthy state. But the androgenic alopecia that most people experience as the most common type of chronic hair loss, that's largely out of your control.

[00:39:55] So I guess would I be correct in assuming or understanding that if you're predisposed to having hair thinning or hair loss because of genetic components, stress will expedite that process? Yes. Yes. Through a different mechanism. Okay. To go back to the Rogaine piece here, if there's always inevitably going to be a skeptic out there listening to this and says, hey, I've tried a million different products. Why should I try this one? What would you say to that person?

[00:40:25] I think it's the lowest cost investment compared to the other treatments. And if your hair loss is bothering you a lot, as we know it bothers a lot of people a lot, then it's an effective solution that you can try. It doesn't necessarily work for every single patient. But in 90% of patients in some of the studies, people are maintaining and growing their hair.

[00:40:50] And from our experience, many of our patients are very happy with it, either as monotherapy or part of a long-term 360-degree approach to their scalp and hair wellness. So it's backed by science and it works in many people. I would say, listen, I know you think you're special like me, but hair loss affects so many people. You've just read the statistics. You're not the person who's lost their hair.

[00:41:18] And there's thousands of randomized controlled trials to show what's actually working and what's not working. And the things that we know that make the difference, that we've just mentioned, minoxidil, medications that block. We know the science behind why people are losing their hair. This isn't new. You know, the dihydrotastolosterone is what causes miniaturization. You know, whether there's other things that eventually we'll be able to use is a different question. But right now, the treatment, not right now.

[00:41:48] These have been over 10 to 20 to 30 years, you know, that we've studied these treatment modalities, that this is what's working. And this is what does work. And if you have a better way, I'm sure it will, you know, come to market very quickly because hair loss is such a problem. But the treatment modalities that work are the ones that work. And I'd want them to be using the things that are backed by science because it's such a big problem that we're talking about.

[00:42:16] So one of the biggest problems, again, with hair loss is that people are using the wrong treatments. Right. And the treatments don't work. And that's sad, too. Is there anything that we haven't talked about in relation to the treatments through Rogaine that if someone was watching this, listening to this and going, you know what, I'm dealing with some hair thinning. I'm dealing with some hair loss. Maybe they're basically like at that stage already where they've gotten desperate. They're really feeling it. They're anxious. They're really struggling.

[00:42:40] I think minoxidil is just the easiest treatment that people can initially pursue to see if it works with the least side effects. And a lot of science behind it. And a lot of science, you know. Exactly. And so, you know, you're applying a product that, again, causes largely vasodilation, increasing the blood supply directly to where you're putting the product. Hopefully you're applying it properly into your scalp, not onto the hairs like I do. Because it's actually a pretty good product, but we'll get into that after.

[00:43:06] But, you know, if you're using minoxidil, your side effect profile is limited and your chance of thickening those hair follicles and causing for summary growth is greatest. Before you look down the pathway to other things that potentially you'll need to help restore your hair. So what I look at, like whenever I'm evaluating something, is it safe and is it effective? So the safety data is there and the efficacy data is there.

[00:43:33] The investment is lower than anything else for hair loss. So when you have that trifecta and you want to do something, it's the first thing I usually recommend to my patients. Amazing. Thank you both for joining me today. This was insightful. Thank you. I know what I'm recommending to some folks in my life who I know are a little bit challenged with this and are going through it.

[00:44:01] And I really like that we started the conversation by talking about the impacts on their mental health and their wellness. Because really and truly it does affect their confidence, the way they show up, like I said, at work, at home, with their friends. The quiet insecurity that boils just beneath the surface when they're hanging out or going out for a night on the town with their buddies. And they're the one guy whose hair is obviously thinning and, you know, they're conscious of it.

[00:44:28] So I appreciate having a conversation like this because I really do think we need to destigmatize this for men. And the point you made, too, about, you know what, you're not actually special in the sense of it happens to way more men than you think is such an important one. Because in all things for men, I find, and I don't know if you would agree with this, anytime something happens to us, we tend to think, oh, I am so unique that this only happens to me that nobody would understand.

[00:44:58] And so to destigmatize that and go, no, no, you're special in a lot of ways, but this is not one of them. This actually happens to a lot of men. And there are solutions out there, which is, I think, such a powerful point to have. Yeah, and I think as men, you know, get married later, men and women get married later and, you know, education is taking longer and, you know, taking so long to save up to buy a house in Toronto.

[00:45:19] You know, before you're actually having your family, you know, the hair loss piece is becoming even more and more important for a lot of men and women. But, you know, especially if you're getting married in your 30s or 40s, a lot of that hair loss has already happened. And if we can reach some people in their 30s early, you know, again, you're going to help push that curve out further and allow them to go further down that treatment curve at a later stage, which is potentially good.

[00:45:46] And especially for the steroid blockers, you know, before they have a family potentially or they can come off that earlier or later and then eventually get hair transplants. I want to ask, I want to throw the last question over to you. There's going to be men out there who are struggling with hair loss, hair thinning, and will take actions to do something about it.

[00:46:13] There's also going to be women who listen and watch this episode who have a man in their life who's struggling with it, who may not take any action because of the stigma. What advice can you give those women in terms of having that conversation with those men in their lives? I think it's like that. And I always tell Quinn when I give him constructive feedback. This isn't even constructive because, you know what, this is a very good question. I'll give my perspective after. You know, like you're doing great, but this can help.

[00:46:42] And a lot of women are using these products too. So often, and I noticed that with other procedures that we do, like the girlfriend or the wife comes first and she sees results and then she tells the partner about it and they start coming and doing procedures and treatments themselves. So I think just, you know, having it available on the bathroom counter, using it yourself. Well, I try to do that with the sunscreen.

[00:47:09] It's not 100% effective yet, but maybe we're moving in the right direction. And just having those open, supportive conversations about it. It's funny that she says that because now we've been married for seven years. I'm not sure. I should know. When we started our relationship, I don't think she was like that. And I think that's another thing that, you know, men should know because, you know, you're the first person. A guy's the first person to know when he's losing his hair. You know instantly. You've taken that picture.

[00:47:38] You know your crown, thinning at your crown. You know you're thinning at your vertex. Then you're, like you mentioned, then, you know, a subtle hint might be from a friend. Like you didn't notice, you know, he's like, oh, you're losing your hair. And you're like, yeah, no kidding. You know, but you knew that, right? And what you're really waking up to at that point is that it's now noticeable by other people. You know, when you're happily married to a beautiful woman, you know, she doesn't potentially say anything initially in the first stages of your marriage. You know, she's just being kind. You know, she's just like, ah, you can't really see it. You know, but you know it's there.

[00:48:07] And again, these are all lost opportunities. That's the sad part. It's the lost opportunity, though, to start these treatments early. To maintain it earlier. Because you're just lying to yourself or your partner's just lying to you. Well, listen, thank you both for coming in and having this conversation. I certainly learned something. And I hope that anybody who watches this, listens to this, understands that there is a solution out there, Rogaine. And that it is readily available.

[00:48:36] I think the thing that I like the most is you can just pick it up off Amazon or off a store counter where you don't necessarily need to book the time with the physician, do the whole works. And go down that path. And I think that makes it a lot more accessible, which is a big thing for a lot of men. But listen, thank you both for your time. Thank you. And I hope to have another one of these conversations because I think this is so, so important. Absolutely. Thank you so much. Thank you, everybody.