Angela Phipps [00:00:02]:
I give, you know, a lot of my time in just consultation to just patients who come in just giving them information. I don't try to give them all the treatments. We talk about all the treatments, and we figure out which one is going to work best for you, for your type of hair loss, for your lifestyle, for your budget, and come to an individualized treatment plan that's going to work the best for you.
Kevin Rolston [00:00:38]:
Welcome to Hairpod, the podcast where you get to hear real people talk about their hair journeys. I'm your host, Kevin Ralston. And each week I get to interview people from different walks of life whose lives have been touched by hair loss in some form or fashion. I'm your host, Kevin Ralston. And each week I get to interview people from different walks of life whose lives have been touched by hair loss in some form or fashion. Many of our guests have experienced hair loss themselves and found a way to get their confidence and their hair back. Today we're sitting down with Doctor Angela Phipps. Doctor Phipps is a hair transplant surgeon with over two decades of experience in the field.
Kevin Rolston [00:01:17]:
Doctor Phipps is a hair transplant surgeon with over two decades of experience in the field. She was also the star of the TLC reality series Bad Hair Day. She is an expert in all things hair loss. And today I want to ask her about a topic that, according to the NIH, affects as many as 50 million men and 30 million women across the United States. It's called androgenetic hair loss, which is hair loss caused by genetics and hormonal changes. You've probably heard of its more common name, male pattern baldness, but women experience a form of this condition as well. And today, doctor Phipps is here to shed some light on this fairly common issue and how it impacts both men and women.
Angela Phipps [00:02:04]:
Well, first I like to say they're female pattern hair loss, is what I would say instead of balding, because women don't go bald, typically, women typically have diffuse thinning throughout their areas of hair, whereas men do develop actual bald spots. So I like to call it female pattern hair loss. And it differs from men in that it usually doesn't progress to the point of they're actually having a bald spot spot. And the reason for that, potentially is because men, their hair loss is caused by one particular hormone. And if you have that receptor for that hormone in the hair, that hormone will go to that receptor and over time, kill the hair follicle. It falls out and never comes back. And so you typically have an area where you have those receptors located. So that hormone will go to that area and make that area baldeme.
Angela Phipps [00:02:55]:
Women don't have one particular hair hormone that causes their hair loss. We're a much more complicated species than that. There's multiple hormones, and so the different hormones affect different hair follicles at different areas. And it causes more of a diffuse hair loss throughout the entire top of the head and sometimes all over the head, whereas men, typically their hair loss is isolated to the front, top and the crown, but not really even in the back or above the ears. And women can experience that thinning in those zones.
Speaker C [00:03:24]:
So what is it that triggers that, and is it different in men and women?
Angela Phipps [00:03:28]:
Doctor Justin we don't really know the exact science of what triggers it. It's just genetics. You have these genetic hair follicles that are either sensitive to hormones in your body or they're not. Everybody produces the same hormones, but not everybody loses their hair, and not everybody loses their hair to the severity. So it just depends upon whether you're born with hair follicles that have the genetic sensitivity to circulating hormones. And how severe that hair loss is going to be is going to be determined by how many hair follicles have those receptors in them. And then for men, those receptors are always there, but they're not always turned on. And so we don't know what turns them on, particularly because men and women both have the same hair that they had, you know, that they're born with when they're 20 or 30.
Angela Phipps [00:04:13]:
But you didn't start losing your hair when you were five years old or ten years old or 15 years old, but those receptors are there. So there's something in the body, whether it's age related in specific people or traumatic events or what, that those then receptors will get that light switch will get turned on, and then the hormones will go to those receptors and start causing their deleterious thinning effects.
Speaker C [00:04:36]:
So how big of a breakthrough would that be? Cause I didn't realize that you had no idea what triggers these hormones. But if you could figure that out and answer that question, would that be revolutionary when it comes to hair loss in both men and women?
Angela Phipps [00:04:49]:
Absolutely. But here's the thing is sometimes that we can't even figure out, you know, well, for women, sometimes it's the shift in hormones. So, you know, they're sensitive to the hormones, but as long as the hormones are all imbalance and there's no shift, everything remains copacetic. So then, like, especially women will tend to see it during pregnancy, after pregnancy. Well, what just happened? You had a major shift in those hormones. They went high, they went low, they went all over the place. That was the catalyst for those hair follicle receptors to say, oh, no, something's going on, and they start reacting to those hormones in a negative way. The second most common time that women see hair loss.
Angela Phipps [00:05:27]:
So one is postpartum and two is menopause. And what's menopause? It's another dramatic shift in your hormones where they change. And that potentially that shift in hormones triggers that receptor, and then the hormones start having their deleterious effects.
Speaker C [00:05:41]:
Now, my question is, when it comes to, you know, some of these triggers and whatnot, I was talking to somebody that she just received a test to see when it comes to breast cancer, and she had all these different factors that they were able to see, BRCA genes and things like that. Is it something now where they could actually do a DNA test on you to see if you have those receptors and if you are more prone to any type of either baldness or hair thinning for men and women as you get older?
Angela Phipps [00:06:10]:
There is no specific genetic test for hair loss like there is in other medical conditions. Nope, not as of yet. The hair follicle is the enigma of science. I mean, you know, we're taking the same technology and biochemistry and biology that we're using in the medical field to replicate cells. Like we can now grow liver cells, liver cells can regenerate. I'm growing heart cells, we're replicating tissues, and we're taking that same technology and are trying to apply it to the hair follicle cell, and it just rolls over in the petri disk, looks up at us, sticks its tongue out, and blows a big strawberry at us. You know, I'm not going to obey all those other properties. And it's so bizarre, because we need our heart and liver cells.
Angela Phipps [00:06:54]:
They're functioning. I mean, they're vital for life. And there we're being able to learn how to replicate those tissues and cells, whereas we don't necessarily need our hair for biological life, but yet those are the most complex cells that we can't figure out how to duplicate or replicate.
Speaker C [00:07:10]:
Wow. Now, tell me, when it comes to studies, how long have people been studying hair cells to this point? I assume that probably cancer and some of the other more important organs had a head start. They probably get more funding and thus are looked at more. How does the hair loss compare to looking at some of those other conditions?
Angela Phipps [00:07:29]:
We've been looking at it for at least 15 to 20 years. I mean, you know, when I started in this industry, we were all like, okay, five more years, it's going to be here. Five more years. Five more years. Five more years. And it's just been, you know, the bane of our existence, trying to figure out how to make these hair follicle cells be able to be resistant to the hormones or can there be a biological turn off switch to that genetics? And it's to no avail as of this point. But they keep saying we're getting there and we're getting closer and that'll be the holy grail whenever we do.
Kevin Rolston [00:08:06]:
One of the reasons why I appreciate doctor Phipps is that she doesnt sugarcoat things. Shes going to tell you that theres no magic wand that science can waive to stop genetic hair loss or to reverse it permanently or at least not yet. This is important to remember because so many products out there claim to be a miracle cure thats going to fix your hair loss issues. And its a good reminder to consult with professionals and carefully evaluate the bold claims that you're going to see online. Knowing that we can stop our genetics or alter how the receptors in our follicles respond to hormones. My next question was to ask doctor Phipps if hormonal treatments have been successful for men or women who are experiencing this type of hair thinning.
Speaker C [00:08:52]:
What about the hormones that trigger the receptors and the communication that happens between them? Has there been any kind of work on maybe we can control the hormones that we have that send the signals to the receptors?
Angela Phipps [00:09:04]:
Yeah. So for men that's quite easy because there's only one hormone. And so they can take a medication every day and it blocks the production of that hormone. So if you block the production of that hormone, that hormone can't attach to the receptor in the hair follicle cells and it doesn't cause any more hair loss. My husband has been on that pill for over 20 years and hasn't lost any hair. Now with, but with women, it's caused by like six different hormones can have an effect on the hair follicle. And we can't block all six of those hormones because we need those hormones for other physiological functions throughout our life to prevent osteoporosis and ovarian cancer and uterine cancer and just other functions that we can't live without those hormones. Whereas in men after puberty, you don't need that DHT for any physiological function.
Angela Phipps [00:09:49]:
So if you block it, it won't cause any deleterious effects.
Speaker C [00:09:53]:
Now, I was on a pill called finasteride.
Angela Phipps [00:09:55]:
That's the pill for me.
Speaker C [00:09:56]:
Okay. That's what I was curious. Now, what is the success rate on that? Because I was on it for probably ten years and it significantly slowed my hair loss. But I just felt, even after a decade, that I still was losing hair. So for me, I don't feel like it was 100% effective. What seems to be the success rate on using something like finasteride?
Angela Phipps [00:10:16]:
So, in my patient population, I see 90% success rate with finasteride.
Speaker C [00:10:21]:
Cool. So I'm the 10% that it doesn't.
Angela Phipps [00:10:23]:
You are the 10%?
Speaker C [00:10:24]:
Yes.
Angela Phipps [00:10:25]:
What can sometimes happen because of that is that there's two different enzymes that convert testosterone to DHT. And so the finasteride only blocks one of those enzymes. But for the majority of people, having that one enzyme, as it blocked is enough to stop their hair loss. For some individuals, we have to go in and give you another medication called dutasteride, which can block both of the enzymes, and that can sometimes then take care of that extra 10% that you might be, you know, hair loss that you might be having.
Speaker C [00:10:55]:
I've never heard of that. So if you are taking both of those, would that, without a doubt, shut down 100%, or.
Angela Phipps [00:11:02]:
Well, you don't need to take both because the finasteride blocks one, but the dutasteride blocks both at the same time. So you just need to be on the dutasteride. But the half life of that medication is a little bit longer, and potentially side effects could be a little bit more severe, if you got any with that medication. So I always start all male patients out on the finasteride, see how effective that is, and then if they still feel like they're having continued loss or weakening effect of the medication over years, I'll switch them to the dutasteride and see how that works.
Speaker C [00:11:32]:
Okay. So, talking to somebody like me, the damage is done and there's no turning back the clock, is that correct?
Angela Phipps [00:11:38]:
Correct. But we can help to prevent it from continuing to get, you know, worse. So did you stop your finasteride?
Speaker C [00:11:44]:
I did.
Angela Phipps [00:11:46]:
Wrong answer. Because now, even though you thought you were having some loss, you were still blocking, in my opinion, 70% of you know of it. So you're still having maybe 30% loss. But 30% is a whole lot better than 100%. So I would recommend at least going back on the finasteride or switching and going on the dutasteride, because you will continue to have more hair loss if you're nothing on a DHT blocker.
Speaker C [00:12:12]:
Where were you ten years ago, doctor Fu.
Angela Phipps [00:12:15]:
That's what all my patients say is, I wish I would have known this sooner. And it's a shame that more family practice doctors and dermatologists don't take a real interest in this issue, because by the time you notice your hair is thinning, you have already lost 50% of the density, and there's no getting that back. That's dramatic. You've already lost 50% by the time you recognize it. So once you recognize that, you know you need to be on the medication, and patients need to understand that medication is lifelong. You have to continue to take that medicine every single day. Otherwise, when you stop taking it, whatever beneficial effects you got from it will start to deteriorate over time because the hormone is going to build back up and then go attack the hairs that you held onto while you were taking the medication. There's no permanent effect of taking the medication on the hair follicles.
Angela Phipps [00:12:58]:
You got to take the pill every day. And I tell patients, just like you have high blood pressure, you got to take your high blood pressure pill every day to keep your blood pressure down. If you stop taking it, your blood pressure goes back up. So you got to get back on your medicine, take your hair loss medication. If you stop taking it, the hair loss is going to resume. Now. It's not like if you took your hair medicine for five years and you held on to 70% of your hair, that when you stop taking it over the next several months, you're going to lose all that in one fail swoop. That's not how it happens.
Angela Phipps [00:13:22]:
Your hair loss rate will just resume at the same rate it was you were losing it prior to taking the medications.
Speaker C [00:13:28]:
So tell me, if somebody is listening this right now, and they see in their family that almost every generation of men or even women, they have some form of hair thinning or hair loss, would they be smart at a certain age to get on a finasteride, if they're a man, to try to be preventative so they don't get to the point where they've lost 50% density before.
Kevin Rolston [00:13:51]:
They even notice it.
Angela Phipps [00:13:52]:
Absolutely. At the age of 18. Now, I've got two kids. I've got two kids, but they're girls. But had they been boys? My husband's family has hair loss. My dad was bald. I mean, the genetics are just there. So when they turned 18, I was going to throw that pill in their cocoa puffs.
Speaker C [00:14:10]:
Wow.
Angela Phipps [00:14:10]:
I mean, you know, because the family history is there now doesn't mean that you're going to get it. But the likelihood is high. I mean, hair loss can skip, you know, like, four generations. Your dad could have all his hair, your granddad, but your great great granddad was bald. It skipped those two, and then wham. Oh, you got it. You know, or the severity of hair loss can vary from grandfather to father to son. And so your hair loss may be more severe than your parents, or it could be less severe, but you just don't know.
Angela Phipps [00:14:38]:
But if it's there, there's a high likelihood that you'll have some form of hair loss. And so if you don't want to experience that at all as early as possible, I would start taking the medication now.
Speaker C [00:14:48]:
Has the finasteride, the dutasteride? Is that the name of the other one? Have they been studied long term to see if there are any kind of side effects that. That might cause to the body? Any cancers or any kind of issues like. Like that?
Angela Phipps [00:15:00]:
Yeah. So any medication could have the potential for a side effect while taking the medication, but there have been no long term major health problems with taking these medications because it's blocking a hormone that you don't need for any major physiological function. And I say this with certainty and no reservation, because my 82 year old dad has been on this medication for over 20 years, and I wouldn't put my own family members on it if there had been any indication that taking this medication long term was going to be detrimental to any of their, you know, any of their health or major organs.
Speaker C [00:15:32]:
Evan, I am so happy to be talking to you. Now, for everybody else, I am so sad for myself that I did not talk to you a long time ago, because this really sounds like such revolutionary information on preventative hair loss procedures here. This is absolutely fantastic.
Angela Phipps [00:15:49]:
You know, patients are. Most of the time, they're in denial. You know, they look in the mirror, and they have all this. You know, they see what they want to see. And it's usually not until after the holidays when people have taken bunches of Christmas photos or Thanksgiving photos, and they see those pictures, and they're like, who's that? And their wife will say, that's you. And they're like, holy cow. I didn't really realize how much hair loss I had because I just. You know, especially if it's in the back of the head in the crown area.
Angela Phipps [00:16:13]:
Most men don't see that, and most men aren't taking mirrors and holding it up and looking at the back of their hair the way women do. And so they may have hair loss back there for a long time that they really don't even know that they have because they don't look back there. And family members might be too, you know, leery to mention anything because they don't want to hurt their feelings or it doesn't bother them. So. But, yeah, prevention is key.
Kevin Rolston [00:16:37]:
I know this message is going to bring a lot of people hope. No one wants to experience hair loss. And preventative measures that can slow down or stop your hair loss are definitely worth exploring. But drugs like finasteride or dutasteride won't work for everyone. I asked doctor Phipps if there was a way people could determine whether their hair loss is caused by male or female pattern hair loss or something else.
Angela Phipps [00:17:07]:
So it's normal to lose anywhere from 100 to 150 hairs a day. You know, a certain percentage of your hair follicles are always shedding out the dead hair shaft so that the root can grow a new, healthy one. So, you know, seeing a little bit of hair in on the pillow or just a little bit in your brush or a little bit in the drain, that's no big deal, especially for women, I tell you, because we don't always wash our hair every single day. And so if I would right now brush my hair, a gob of hair would come out and it would look like I was on chemotherapy, because now. So if I normally lose 150 hairs a day and I haven't washed my hair for two days, then when I go to wash it, 300 dead hair strands that are just laying on the scalp that have naturally shed out just because it's their time, will then all come out into my hand and it'll look like a massive amount of hair. So you got to keep in mind, you know, about what's normal. Now, if you are seeing extra more than what you know, you think is normal, and if you don't think you know, you know what's normal, that's what's when it's time to see a, you know, a hair restoration physician and, you know, and show us, because we can, you know, kind of run our hands through your hair and kind of tug and pull on your hair and see if the hair is shedding out of its growing phase, which would, you know, kind of be an indication of something else going on. And so we can kind of tell you what's normal and what's not normal.
Angela Phipps [00:18:23]:
So a little bit of hair loss is fine, but if you're having a little bit of hair loss, and then you've got a strong family history of male pattern hair loss on either side or both sides of the family, that little bit of hair loss can, you know, naturally can be combined with a little bit of male pattern hair loss, you know, a little bit, and over time, you're gonna lose it. And if the family. I just say, if the family history's there, be on a preventative.
Speaker C [00:18:46]:
Can you look at somebody and get an idea of why they're losing their hair?
Angela Phipps [00:18:49]:
Sometimes? Yes. I definitely need to do an in person evaluation because there are different conditions that can cause the scalp to look a particular way. If that's what's causing the hair loss underneath the surface of the skin or if the hairs are coming out in the active phase or in the, you know, the resting phase, we can tell, kind of tell all that when we do a physical examination of the scalp and we put your scalp under a microscope and we look, and there can be discoloration of the skin around the hair follicles. There can be microscopic inflammation. And so sometimes male pattern hair loss is not genetic. There could be other reasons going on, and those usually present themselves in a little bit of a different way. And so you really need to see a hair loss specialist so that your scalp can be evaluated. The hair shafts can be evaluated to find out what the potential cause of the hair loss is.
Angela Phipps [00:19:39]:
Because if it's not male pattern hair loss, then taking finasteride or dutasteride isn't going to stop the problem.
Speaker C [00:19:44]:
Right. So how many different strategies do you think you have and paths to curing hair loss that are out there? Finasteride, obviously, would be one. But when somebody comes in about how many different courses of action might you wind up typically giving to somebody depending upon what's going on?
Angela Phipps [00:20:00]:
Yeah. So I treat hair loss in both men and women as multimodal. So you want to do multiple different treatment types to hit the hair follicle cells by different mechanisms of action. So in men and women, you know, because we can hack for women's hair loss, we can try and alter the hormones that are being produced, the severity of it, with medications. You know, we don't completely stop the hormones from being formed, but we can maybe prevent the amount of the hormone that's being formed that could be having the deleterious effects on the hair follicles with certain medications. So I look at, you know, number one, some sort of. Some form of oral medication to affect hormones. So hormonal medical therapy.
Angela Phipps [00:20:41]:
Number two is you want to hit cellular medical therapy. So those, number one, the aging process in and of itself is making the hair cells work at a lower energy capacity. And be less strong, and then hormones make those cells work with less energy and less effectiveness. So not only do you want to block the hormone, you want to try and increase the metabolic or cellular activity of the hair follicle cells so that they can be stronger. Because if the cells are stronger, then the hair shafts that the follicles are producing can be stronger and thicker. And a thicker hair shaft covers more scalp than a skinny hair shaft. So you want to make the hairs that you're still producing be as thick and full as possible so that you can have more scalp coverage. And that's the ultimate goal, is to see less scalp.
Angela Phipps [00:21:27]:
So you want a hormonal medication, and you want a cellular medication. Not necessarily medication, but it could be a medication, or it could be a treatment. So the cellular medication that I like to use is called minoxidil, and it can be used as a topical and, or it can also be taken as an oral pill. Other cellular treatments I like to use is called platelet rich plasma injections. And that's where we actually draw your blood and we spin it down and we take the platelets out, a component of the blood cell, and we actually inject those platelets into the scalp. And those platelets have a stimulatory effect on the hair follicle cells that can increase their activity, make them stronger so that the hairs that are being produced can be thicker and stronger.
Speaker C [00:22:09]:
Is there something that you would see as the number one best treatment that you've ever come across across the board?
Angela Phipps [00:22:16]:
Best treatment is combination treatment, because you have to hit it at different levels. You need to hit it at the blocking of the hormone, and you need to hit it at strengthening the cells. And the strengthening of the cells can be used. There's different mechanisms or different treatments that you can use to strengthen the cells. I think the strongest cellular stimulator is platelet rich plasma injections. And that is actually even the safest because it's, you're using your own platelets, you're using your own cells. So it can't be, you can't be allergic to it, it can't hurt you. And they have the most powerful biological cell, you know, stimulators to the hair follicle cell.
Angela Phipps [00:22:52]:
But with that comes a price tag. And so the more potent usually something is, is the more expensive it's going to be. So that might not be a treatment that all people can, you know, fit within their budget. So you want to have other, you know, less expensive cellular stimulator options like minoxidil as well as a treatment called low level light therapy. And that usually comes in the form of wearing a hat. And light rays or wavelengths, will penetrate the skin and photobiochemically increase the hair follicle cells metabolic rate to make them stronger and produce thicker hair. So it's, in the case of hair loss, more is more, you know, the more ways you can stimulate and hit the cell, the better, because you're hitting them by different mechanisms of action. It's not like they all do the same thing in the same way.
Angela Phipps [00:23:37]:
So just pick one and you're done. The more you use, you get a compounded effect, and it's a more dramatic or better effect on the hair follicle cells and the hair shafts that are being produced, the more treatments that you use. I do have my favorite that I like to use if patients are on a budget. The two that I'm, you know, the three actually, that I most commonly recommend are, you know, finasteride, dutasteride for men because it's very inexpensive with the generics. Now, minoxidil is inexpensive and low level light therapy is relatively. It has a little bit of a price tag to it, but it's one time, once you purchase the device, then it's yours and you get your money out of it.
Speaker C [00:24:16]:
Now, my question is finding the right guidance, because you're not going to be available to everybody that is out there. And for me, just having this short conversation with you, I'm realizing that I could have used a little bit more information. And I went to a guy that's got a very fancy clinic and a very fancy bougie type of town, and it was everything you would think. He's got a very nice lobby, and he sounded great and smart and all that kind of stuff. And I may not have gotten all the advice that I needed to properly treat what was going on with my hair loss. How does somebody else in just any random town, anywhere in the world, who's listening to this, make sure that they're finding a doctor? Because you've offered a lot of different ways to treat it, and if you go to the wrong person, they might throw the kitchen sink at you with all these different price tags. And you not knowing anything about this could spend a lot of money and not see the results. And that's devastating to anybody who is trying to find hair loss.
Speaker C [00:25:09]:
Is there any kind of accreditation or how would you know that you're finding somebody that you should listen to and follow their advice?
Angela Phipps [00:25:15]:
There is some certifications and accreditations like, I'm accredited by the International Society of Hair Restoration Surgeons. That's a big thing to look for is look for a board certified physician. Look for a physician who specializes in hair loss, because this is our passion. This is what we do every single day. We only deal with hair. And so I give, you know, a lot of my time in just consultation to just patients who come in, just giving them information. I don't try to give them all the treatments. We talk about all the treatments and we figure out which one is going to work best for you, for your type of hair loss, for your lifestyle, for your budget, and come to an individualized training treatment plan that's going to work the best for you.
Kevin Rolston [00:26:03]:
Recording this episode with Doctor Phipps absolutely blew me away. Her knowledgeable, client focused approach is exactly what everybody who's going through hair loss needs. We all need to have someone in our corner who can help us determine what's causing her hair loss and to give us the tools to treat it. We want to thank doctor Fitz for sharing all of her wisdom with us. If you want to hear more from her, we hope youll subscribe to Hairpod because we are definitely going to have her back on the show. Thanks for listening to another episode of Hairpod. Check us out at Hair Club on Instagram or search hairpod on Facebook to continue the conversation. If you know someone who could benefit from hearing this episode, we would love it if youd share it with them.
Kevin Rolston [00:26:44]:
If youre enjoying the show, consider leaving us a rating and review on Apple Podcasts or youre favorite podcast app. We also have a website. Check it out by going to podcast Dot hairclub.com. we're here to build people up and share real stories so people experiencing hair loss feel a little bit less alone. And when you share, review, and subscribe, it helps us do just that. So thank you. Until next time.
