The Truth About Topical Hair Loss Treatments

The Truth About Topical Hair Loss Treatments

Episode 49

The Truth About Topical Hair Loss Treatments

The Truth About Topical Hair Loss Treatments
Topical hair loss treatments are one of the first options many people turn to, but it’s not easy to separate effective solutions from marketing hype. Hair restoration surgeon Dr. Ross Kopelman joined me on HairPod to discuss the effectiveness of topical solutions and how to determine if they’re the right fit for you.

Do Topical Hair Loss Treatments Work for Everyone?

Topical hair loss solutions, including serums and leave-in treatments, can benefit both men and women experiencing mild hair thinning or loss. These treatments, however, require consistency and long-term commitment due to the natural hair growth cycle. Dr. Ross Kopelman often recommends topical minoxidil as an effective option for many clients. Still, he cautions that individuals with aggressive or advanced hair loss may need a combination of treatments, as topical solutions alone might not deliver the desired results.

The Role of Natural Topical Solutions for Hair Loss

Natural remedies for hair loss are gaining popularity, with rosemary oil being a standout option. Dr. Kopelman highlighted research comparing rosemary oil to 2% minoxidil, showing promising outcomes, particularly for those unable to use stronger medications, such as pregnant or breastfeeding individuals. While natural solutions can support hair health, they do not directly combat dihydrotestosterone (DHT), one of the primary causes of hair loss. A balanced approach combining natural remedies and proven treatments may offer better results for many.

Treating Hair Loss Holistically

While topical treatments and natural solutions can help manage hair loss, addressing the underlying cause is critical for long-term success. Dr. Kopelman discussed advanced options like oral finasteride and dutasteride, which block DHT, and oral minoxidil, which extends the hair growth phase. Although finasteride and minoxidil are currently the only FDA-approved hair loss treatments, they may carry side effects. Dr. Kopelman emphasized the importance of working with a hair restoration professional to develop a comprehensive treatment plan that minimizes risks and maximizes results.

Can Hair Loss Be Cured?

The idea of a permanent hair loss cure is highly appealing, but Dr. Kopelman clarified that no definitive cure exists at this time. Future advances in genetic modification and cloning could revolutionize the field, but current options like minoxidil and finasteride remain the most effective tools. Success requires patience, professional guidance, and a customized approach tailored to individual needs.

Dr. Kopelman’s insights highlight that while hair loss treatments have evolved significantly, finding the right solution involves understanding the cause, committing to a regimen, and seeking expert support. This holistic approach ensures the best possible outcomes for managing and minimizing hair loss.

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Episode.49 Transcript

Dr. Ross Kopelman [00:00:02]:

Look, at the end of the day, this is about eating a balanced diet, you know, having all the right nutrients, protein, minerals in your diet. And I think if you’re eating a balanced diet, you don’t necessarily need to seek out an intake of other multivitamins. One of the things that I stress to all of my patients is that having a blood test is essential because we want to make sure your levels are sufficient. If your levels are abnormal, then that’s when we want to do replacement.

 

Kevin Rolston [00:00:41]:

Welcome to HairPod, the podcast where you get to hear real people talk about their hair journeys. I’m your host, Kevin Rolston, 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. This week on HairPod, we’re going to be talking about a topic that you’ve almost certainly crossed paths with if you’re looking for a way to remedy your own hair loss. If you’re searching for solutions that are non invasive or even natural, you’re not alone. There are so many options out there, it’s tough to know where to start. We brought in hair restoration expert Dr. Ross Kopelman to break down this topic and give us some insights into what works, what doesn’t, and why.

 

Dr. Ross Kopelman [00:01:33]:

I think one of the challenges with hair loss in general is that you really have to have a commitment to using anything that you’re, you’re using on your hair for a long period of time because, you know, our hair goes through hair cycles. Okay. Expect immediate results. So when I read an article and it says patient applied X shampoo to their hair and the next week they stopped shedding or they started to have new hair growth, I’m very skeptical because we have to wait four to six months to really see the results with whatever you’re applying to your scalp.

 

Kevin Rolston [00:02:07]:

Oh, wow. Okay. And what should it look like? If you have something that is effective, what are the things that you start to notice to say, okay, I’m heading in the right direction.

 

Dr. Ross Kopelman [00:02:16]:

So, you know, there’s an objective way to look at this and there’s a subjective way. The objective way is that if you were seeing a dermatologist or a hair surgeon, we would do a trichoscopy test. We’d be able to look at with like a fine microscope at the scalp and we would see new hairs popping up. We would see those little baby vellus hairs turning to thicker hair follicles okay. But if you don’t have that flexibility to see a dermatologist or a hair surgeon, it’s really subjective. You might feel that there’s more density to your scalp, there’s less see through. And the other way that you could do it in a more kind of, I guess, objective way is you could take photos. So you take photos when you start and every couple of weeks.

 

Dr. Ross Kopelman [00:02:56]:

I want to do it every single day, but I would do it every couple of weeks. I would take progressive photos. And then that’s another way to kind of measure the success that you’re having.

 

Kevin Rolston [00:03:03]:

And just how much can it correct. Now, what kind of hair loss would you have to have? Because there’s so many different, you know, scales of how much you’ve lost. And so who would be a good candidate for somebody who wanted to go with something that might be topical? Because I would imagine that your hair loss wouldn’t be severe for this to be the right option for you. Am I correct in that?

 

Dr. Ross Kopelman [00:03:26]:

So topical hair loss solutions can really be used for most any patients. The question is, how effective are they going to be? That’s really what this boils down to. If you have mild hair loss, I would say that they’re probably going to have a bigger role to play. But if your hair loss is pretty significant, it’s going to be minuscule in relation to taking an oral medication to address your hair loss.

 

Kevin Rolston [00:03:49]:

So we already are talking to a limited number of people that are suffering from hair loss and the people who really don’t have a massive case of hair loss in the first place, correct?

 

Dr. Ross Kopelman [00:03:58]:

Correct, that’s true.

 

Kevin Rolston [00:04:00]:

So tell me about the different varieties for the people that are out there. When you talk about a topical serum, I assume that’s something that you just kind of put on your scalp, but you know, you have leave in conditioners, you have things like hair masks and other things that are out there. What is your thoughts on the topical serums? Are they effective and if so, which ones?

 

Dr. Ross Kopelman [00:04:19]:

Okay, so at the top of the list would be using 5% Rogaine foam. Foam specifically because the liquid form is more irritating to the scalp and because you have to use Rogaine on a daily basis. Now, on the bottle, it’s interesting. I wish I had the bottle in front of me, but on the bottle it says apply twice a day, which you don’t need to do because the half life of this medication is 18 hours. So once a day is more than adequate. Second thing that’s interesting is that we recommend that both men and women use 5% as a concentration when you’re using foam, because the 2% we don’t think is as effective. And even though the bottle says men’s Rogaine, and actually in the back of the bottle of the men’s Rogaine, it says not for women, it’s absolutely safe for women. Okay, so that’s where I would say to start your hair loss journey.

 

Kevin Rolston [00:05:09]:

Why would they do that? Any reason why the company would do that? If it is okay for women, why would they put that?

 

Dr. Ross Kopelman [00:05:14]:

Absolutely. That’s a great question. So it’s likely because the Rogaine was originally approved for treating male androgenetic alopecia. They didn’t go through an FDA trial specifically to address female balding. And I also think there’s a marketing play. Yeah. Because they have created a female 2% bottle and now they have a female 5% bottle. But it’s a pink tax.

 

Dr. Ross Kopelman [00:05:38]:

It’s the exact same ingredients are in the men’s Rogaine as. As the female Rogaine 5%. So I would say to any female patients, buy the male bottle because it’s cheaper and it’s exactly the same bottle.

 

Kevin Rolston [00:05:50]:

You are hitting really on what I think the nerve of this conversation is, Dr. Kopelman and I feel like a lot of things are marketing hype out there when it comes to hair loss. And even looking at the effective serums, you see right away that these are the kind of things that if you don’t have a full understanding of what you’re getting yourself into, you can really find a pitfall of spending more money than you need or finding something that is not going to be effective at all in the first place.

 

Dr. Ross Kopelman [00:06:17]:

Absolutely. Look, this is a huge market. Hair loss impacts millions of men and women, you know, just in the United States alone. And everyone wants to provide some sort of band aid solution. But not everything works.

 

Kevin Rolston [00:06:34]:

Dr. Kopelman’s insight into minoxidil, the generic form of Rogaine, underscores why it’s one of the most well known treatments for hair loss. With millions of users globally, it’s clear that the market for hair loss solutions is massive, driven by a strong demand for effective and accessible options. But minoxidil is just one piece of the puzzle. While it’s backed by years of research, not everyone is ready to commit to products with active chemicals or medications. And that’s where natural solutions enter the conversation, offering an alternative approach for those looking to promote healthier hair without synthetic ingredients.

 

Dr. Ross Kopelman [00:07:16]:

So one of the challenges with all these natural hair loss solutions is there haven’t been really an adequate number of studies really looking at these natural solutions to derive really, truly determine how effective they are. With that said, there are some studies that have looked at, for instance, rosemary oil. And what they did was they looked at rosemary oil with a concentration of. What they did was they. They compared rosemary oil topically to 2% minoxidil, okay. And they found that rosemary oil was as effective as applying a 2% solution of minoxidil, which is promising for a lot of people who don’t want to use any medical solutions to address their hair loss. But one of the things that I’m very hesitant about, which I alluded to earlier, is that we really find that 5% minoxidil, and that’s Rogaine is the commercial name. Minoxidil is, is the medicinal name.

 

Dr. Ross Kopelman [00:08:09]:

We find that 5% is really what female patients and male patients need to be on. And the 2% is not going to be as effective. It’s not going to give you the bang for the buck that you want in terms of the effectiveness for your hair. But I am in the camp that 2% rosemary oil is as effective as. Not 2% rosemary oil is as Effective as a 2% solution of minoxidil. And I do recommend it to patients who, for instance, like, let’s say you’re breastfeeding or you’re pregnant or you’re thinking about getting pregnant. You know, there’s a lot of medications you can’t be on. So natural solutions like rosemary oil are absolutely something that I’m supportive of.

 

Dr. Ross Kopelman [00:08:47]:

And you can do this in conjunction with using other hair loss medications as well. So that’s rosemary oil. Then we have saw palmetto, which is a pill that you can take. And what’s nice about saw palmetto, and I would actually put saw palmetto up at the top of the list as, as a kind of a natural solution. And the reason is that there’s some evidence that, that saw palmetto acts as a DHT blocker. Okay, now, dht. I’m sorry, Kevin, if I’m going too quickly, but interrupt me at any point.

 

Kevin Rolston [00:09:16]:

I love all this stuff. This is great. You’re on fire right now. Keep it going, baby.

 

Dr. Ross Kopelman [00:09:20]:

So DHT is dihydrotestosterone. It’s the major, major contributor for androgenetic alopecia. And so there’s evidence to show that it decreases this floating DHT in our bloodstream, which could have a positive impact on preventing hair loss. Because at the end of the Day. That’s, that’s really what we want to do with the rosemary oil. Rosemary oil is not blocking dht. Okay. And either is minoxidil.

 

Dr. Ross Kopelman [00:09:47]:

Both of those work in very similar ways, which is improving blood circulation to the scalp. Okay. And prolonging the growth phase of the hair follicle.

 

Kevin Rolston [00:09:57]:

Very different.

 

Kevin Rolston [00:09:58]:

If I had to categorize DHT and just what it does, in a sense that chokes off the hair follicle. Is that correct? Is that really what DHT kind of does when it gets in there?

 

Dr. Ross Kopelman [00:10:07]:

Yeah, I would say that’s the number one killer in terms of miniaturizing the hair follicle and eventually leading to complete hair loss.

 

Kevin Rolston [00:10:14]:

Okay.

 

Dr. Ross Kopelman [00:10:15]:

But there’s other components. Remember, hair loss is multifactorial. There’s, there’s hormonal issues going on.

 

Kevin Rolston [00:10:20]:

Yeah.

 

Dr. Ross Kopelman [00:10:21]:

There’s, there’s sometimes underlying medical issues that need to be addressed.

 

Kevin Rolston [00:10:24]:

Yeah.

 

Dr. Ross Kopelman [00:10:25]:

And yeah. So we, we have to look at hair loss from multiple lenses.

 

Kevin Rolston [00:10:29]:

Okay. So one will be good at kind of minimizing the DHT and then the other is more just about blood flow and kind of creating a healthy scalp in a sense having a good garden with great dirt to grow hair in.

 

Dr. Ross Kopelman [00:10:40]:

Absolutely.

 

Kevin Rolston [00:10:42]:

One real quick sidebar, as we were just talking about the hormonal part of it, kind of the double edged sword here is I know a lot of middle aged men who are dealing with, or women too, or dealing with hair loss. They sometimes look into their hormones. And what’s very popular now is these clinics where you can balance your hormones and you can get testosterone and things like that that, you know, give you a little bit more vigor and umph. And are supposed to balance you out. So my question is, if you were doing something like that and you were doing synthetic testosterone, is that going to in any way increase DHT or be a negative effect on you losing your hair?

 

Dr. Ross Kopelman [00:11:21]:

Yeah. So if you’re a female, you’re postmenopausal and you’re looking for hormonal replacement. Well, one of the things I first want to emphasize is that before you went into menopause, your estrogen was very high. And estrogen is protective to prevent hair loss. When you’re in menopause, your estrogen goes for a nose dive and your androgens actually increase. And as they increase, that has an impact on hair loss. And one of the components is, yes, you get an uptick in dht. So if you’re going and you’re getting exogenous testosterone or any increase in those androgens.

 

Dr. Ross Kopelman [00:11:56]:

Yeah. That can definitely be a contributing factor for why a female would have progressive hair loss. So it’s something to be cautious about. But at the end of the day, you got to weigh the reasons why you’re getting hormonal replacement. And at the end of the day, our hair is our hair. But there’s probably a different reason why you need those that hormonal replacement.

 

Kevin Rolston [00:12:16]:

Okay. I just want to know if there’s any kind of cause and effect that was going on there. Now, we’ve talked about some of the natural stuff. One thing that I’m hearing is being hailed as some miracle ingredient for hair growth is biotin. Can you tell me exactly what that is, and is it living up to the hype that I’m hearing?

 

Dr. Ross Kopelman [00:12:34]:

So biotin is an important component that helps build the keratin structure of our hair follicle. Okay. So don’t think it’s not important. But one of the things that I spent a lot of time talking about is that we normally have sufficient levels of biotin. It is very, very rare to have a biotin deficiency.

 

Kevin Rolston [00:12:56]:

Okay.

 

Dr. Ross Kopelman [00:12:56]:

One of the problems is that if you are. If you’re taking in too much biotin into your body, one of the risks is that you can have a misleading lab test. Your thyroid levels could be off, your cardiac levels could be off. Doesn’t mean you have a cardiac problem. It just means that, okay, if you were to have blood tests, the blood test might signal that there’s something going on in your body that’s actually not happening. So I always urge patients, don’t seek out exogenous biotin pills. Avoid vitamins that have biotin in them. I think a small amount is okay to ingest, but don’t go for a biotin specific vitamin.

 

Dr. Ross Kopelman [00:13:38]:

And then if your shampoos have biotin incorporated into the shampoo, that’s okay. But again, it’s not something you absolutely need because everyone, for the most part, has sufficient levels of biotin in their bloodstream.

 

Kevin Rolston [00:13:57]:

Dr. Kupelman’s perspective on biotin is a good reminder that more isn’t always better when it comes to supplements. While it’s a popular ingredient in hair health products, he makes it clear that taking high doses isn’t necessary and could even be counterproductive. Instead, he highlights the importance of balance and moderation, especially when it comes to what we put in our bodies. This naturally leads to the bigger picture, how our overall nutrition plays a key role in hair health. Let’s dive into Dr. Koppelman’s insights on how what we eat can Impact the strength and vitality of our hair.

 

Dr. Ross Kopelman [00:14:39]:

Look, at the end of the day, this is about eating a balanced diet. Okay? So, you know, having all the right nutrients, protein, minerals in your diet. And I think if you’re eating a balanced diet, you don’t necessarily need to seek out an intake of other multivitamins. One of the things that I stress to all of my patients is that having a blood test is essential because we want to make sure your levels are sufficient. If your levels are abnormal, then that’s when we want to do replacement.

 

Kevin Rolston [00:15:07]:

Okay.

 

Dr. Ross Kopelman [00:15:08]:

If you don’t have abnormal levels, there’s no reason to add additional supplements, vitamins, minerals into your diet because those can cause more harm than good and you can get complications from overdosing on certain vitamins and minerals.

 

Kevin Rolston [00:15:22]:

Oh, wow. Okay. Well then what kind of foods would you recommend? If I want better hair health, are there a couple things you can lay it on the table that are going to help me out?

 

Dr. Ross Kopelman [00:15:30]:

Again, it comes back to eating protein, eating your vegetables, eating your fruits. All right, as long as you’re eating a balanced diet, I think you’re in good hands. But I really think at the end of the day, what’s important is for everyone to seek out a blood test and just make sure those levels are normal.

 

Kevin Rolston [00:15:50]:

Dr. Koppelman’s advice about getting a blood test before starting any treatment is a crucial step that often gets overlooked. Understanding your body’s unique needs and potential deficiencies can help guide you toward the most efficient and safe solutions. Once that foundation is set, the next step is exploring proven treatments. When it comes to hair loss, There are only two FDA approved options on the market. Finasteride and Minoxidil. Here’s Dr. Kopelman explaining why these treatments have stood the test of rigorous clinical trials and what makes them the gold standard in hair restoration.

 

Dr. Ross Kopelman [00:16:31]:

There are only two medications that are approved by the FDA for hair loss, and that’s finasteride and minoxidil. Off label, we use dutasteride. Now, dutasteride and finasteride are DHT blockers. As we discussed earlier, DHT is a major contributor for hair loss for both men and for women. Finasteride blocks the ability for the DHT to to build up by about 65%. And Dutasteride does it by about 90%. Now it’s off label. There’s not a lot of doctors in the United States that feel comfortable prescribing dutasteride because it’s not FDA approved.

 

Dr. Ross Kopelman [00:17:11]:

But as a physician, we can prescribe medications that are off label. And in fact, I put most of my patients on dutasteride and I find it to be most effective. Now with, when we talk about DHT blockers, we can only prescribe these medications to certain populations of patients because you can’t give a DHT blocker to a premenopausal woman who has not been pregnant before because of the teratogenic risk to a fetus. So there’s a limit in terms of what we can prescribe to women. For men, we can prescribe DHT blockers at any age when they’re in their 20s, their 30s and whatnot. The only time we encourage a male to stop finasteride or dutasteride is before they’re trying to get pregnant, because there is some evidence that sperm count decreases. And the last thing that you want to do as a physician is have any contributing factor. You don’t want to contribute at all to why they might not be able to have children.

 

Dr. Ross Kopelman [00:18:11]:

But at the same time, there’s no evidence in the literature that that’s ever been the case. But if you want to take the highest level of precaution, I advise patients, to male patients, to stop these DHT blockers. Now, females can take finasteride and dutasteride. When they’re absolutely done having kids, it’s safe for them to do that, and it’s very effective. The next medication we have is oral minoxidil. Now, we talked about Rogaine and we talked about that as a topical solution. Oral minoxidil is also a great medication to do, join in combination with one of these DHT blockers, it’s safe to give oral minoxidil to premenopausal women. And again, when you take an oral pill, it’s very effective at helping prolong the growth phase, thicken the hair follicle.

 

Dr. Ross Kopelman [00:18:55]:

So very effective. Now, the third drug I’ll talk about, because we prescribe this commonly to women, is spironolactone. Spironolactone is a drug that’s been used by millions of people to treat acne. But what we find is if we use a small dose for men, it’s very effective for preventing. Now, the finasteride and dutasteride block the ability for more DHT to be made. Spironolactone blocks the ability for the DHT to bind to the androgen receptor. So when we combine a small dose of spironolactone, we can prevent the DHC from binding to the receptor. And so for Women, we give a higher dose.

 

Dr. Ross Kopelman [00:19:40]:

For men, we give a smaller dose. And those are really the three main. The four main drugs that are at. Are in our arsenal. And then underneath that, then we go to topical solutions, and we talk about Rogaine, we talk about rosemary oil, we talk about saw palmetto. And there’s. Then, obviously, we keep going down and down and down on the list, and there’s more and more treatments, but the most effective treatments are always going to be oral solutions.

 

Kevin Rolston [00:20:06]:

Really. Okay, over the topical?

 

Dr. Ross Kopelman [00:20:08]:

Over the topical, yes.

 

Kevin Rolston [00:20:10]:

So to hedge your bets, if you are concerned about losing your hair, should you get on everything that you just talked about?

 

Dr. Ross Kopelman [00:20:18]:

So it really depends upon how severe your hair loss is and what age you’re at.

 

Kevin Rolston [00:20:23]:

Okay.

 

Dr. Ross Kopelman [00:20:24]:

You really want to throw the kitchen sink at your hair. Now, at the same time, we want to be very cautious because we don’t want complications, we don’t want side effects. So sometimes with some of my patients, we go incrementally. We start where they feel comfortable. But, yes, I’m in the camp that the more aggressive we are at addressing your hair loss, the better. But sometimes it’s better to go slow because you put in one drug, you see how effective it is. You put in another drug, you see how much. What that incremental increase is, and then you can moderate based upon what you think is what’s working and what’s not working.

 

Kevin Rolston [00:20:59]:

Okay. Now, we talk about a lot of oral medications here that you say are very effective, and they’re getting you there, but it’s still not the ultimate cure for baldness. And my question, in your expert opinion. I’ve seen studies that are even done. There’s one about a sugar gel that was made from sugars that occur naturally in the human body. They tested on mice, and it seemed to help them grow new hair follicles. Almost like a miracle cure for balding that you take a pill and guess what? You got. Hair again.

 

Kevin Rolston [00:21:29]:

Are we close to the absolute cure for hair loss in humans?

 

Dr. Ross Kopelman [00:21:35]:

Well, I don’t. I don’t think that’s an. That’s not targeting the root cause of why we have hair loss. I think that study looked at dexoribose sugars in a similar way. They discovered that when you rub this sugar in the area where you’re experiencing hair loss, what it’s doing is it’s stimulating blood circulation and blood flow to the hair follicle, which is important for bringing nutrients and oxygen. Very similar to what we would do if you used a topical minoxidil, a rosemary oil, anything that you’re applying to your scalp to improve circulation. So they’re suggesting that maybe it’s in that camp in terms of being effective to stimulate the growth phase. But what it’s not doing is it’s not targeting that DHT which is contributing to hair loss.

 

Dr. Ross Kopelman [00:22:18]:

And at the end of the day we’re really, Kevin, at the, I think the, the early stages of really being able to target why we have hair loss and genetically do modifications. But that’s, I believe that’s not going to be for a while and a lot of that’s going to come down to CRISPR technology, genetic modifications. I think we have a long time until that happens. I will still be doing hair transplants for a while.

 

Kevin Rolston [00:22:47]:

While the technology and treatments we have today can’t completely cure hair loss, the scientific community is making progress in understanding and targeting its root causes. From the science behind FDA approved treatments to the role of nutrition and natural solutions, Dr. Koppelman provided many valuable insights to help demystify the options that are out there. We want to thank Dr. Koppelman for sharing his expertise and shedding light on the thoughtful on the science backed approach we can take toward better hair health. His practical advice is a great reminder that while the journey may not be easy, the tools to take the first step are within reach.

 

Kevin Rolston [00:23:26]:

If you want to take the first.

 

Kevin Rolston [00:23:28]:

Step, check out our show Notes for a link to a free consultation to determine the extent of your hair loss and to start the process of getting yourself back to a healthy, full head of hair. For more inspirational stories and words of wisdom from people who have been through hair loss, make sure to subscribe to the show on your favorite podcast app. 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 you’d share it with them. If you’re enjoying the show, consider leaving us a rating and review on Apple Podcasts or your favorite podcast app. We also have a website. Check it out by going to podcast.hairclub.com we’re here to build people up and share real stories so people experiencing hair loss feel a little bit less alone.

 

Kevin Rolston [00:24:21]:

And when you share, review and subscribe, it helps us do just that. So thank you until next time.

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