Ep.89 Winning the Battle Against Midlife Hair Loss - Treatments, Nutrition, and Regenerative Therapies

Have you ever looked in the mirror and noticed your hair isn't quite as full as it used to be? You're not alone. On this episode, we have a heart-to-heart with Dr. Alan Bauman of Bauman Medical, who brings empathy and expertise to the table as we tackle hair loss in midlife, particularly for women. From genetic factors to emotional impacts, we cover the gamut of this surprisingly common yet often unspoken struggle. Dr. Bauman's personal journey from the inception of his "hair hospital" to becoming a beacon of hope for those facing thinning locks is as inspiring as it is informative.

Nutrition isn't just about waistlines; it's integral to our hair's health, too. We chat over the intricacies of hair loss treatments and the role of diet, spotlighting the promise of nutraceuticals like Nutrafol. Dr. Bauman and I debate the pros and cons of prescription treatments, such as the anti-androgen spironolactone and the off-label heroics of finasteride in postmenopausal women. Plus, for all the biotin believers out there, we clear up any dosage dilemmas. Precision tools for tracking treatment progress come under the microscope as well, proving there's more science to hair care than meets the eye.

In the realm of hair restoration, it's not just about what's on top that counts. Dr. Bauman guides us through a tour of cutting-edge therapies that are changing lives, strand by strand. From the gentle glow of red light therapy to the meticulous process of modern hair transplants, we uncover the art behind regrowing confidence. And for those fascinated by the flutter of lush lashes, the soaring demand for eyelash transplants emerges as a surprising trend. Whether it's crafting the perfect eyebrow or rejuvenating a hairline, the transformative power of these procedures extends far beyond the physical. So tune in, and witness the artistry and science that's giving hair care a whole new meaning.

We also discuss PRP and microneedling as options to stimulate hair growth. The Turbo LaserCap is the ultimate powerful, portable, hands-free, cordless, and rechargeable low-level laser therapy device for men and women designed to deliver non-drug laser therapy for hair growth in a convenient and discreet way.

TED uses an ultrasound-based system that uses sound waves and air pressure to enhance the penetration of a powerful topical hair growth formula into the scalp. This combination is designed to increase blood flow, optimize scalp health, and stimulate hair follicles to produce thicker, stronger, healthier hair.

Nearly fifty percent of Dr. Bauman's patients start their journey with a virtual consultation. You can also ask questions about your hair loss concerns by going to his website. Someone on his staff will always get back to you with an answer.

You can also find on the website the thousands of papers he has written and vi

I'd love to work with you! Let me help you reach your health and fitness goals.
https://www.fasterwaycoach.com/?aid=MicheleFolan

Have questions about Faster Way? Feel free to reach out.
mfolanfasterway@gmail.com

Follow Asking for a Friend on Social media outlets:
https://www.instagram.com/askingforafriend_pod/
https://www.facebook.com/askforafriendpod/

Please provide a review and share. This helps us grow!
https://lovethepodcast.com/AFAF

This podcast is for general informational purposes only and does not constitute the practice of medicine, nursing, or other professional healthcare services, including the giving of medical advice. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they may have and should seek the assistance of their healthcare professionals for any such conditions.

Transcript

Michele Folan: 0:07

Health, wellness, fitness, relationships and everything in between. We're removing the taboo from what really matters in midlife. I'm your host, Michelle Folan, and this is Asking for a Friend. Welcome to the show. Everyone Our hair.

Michele Folan: 0:31

We often don't appreciate what we've got until it starts thinning. It can be a slow loss or one of those clumps in the shower moments that send us into a total panic. Is this change in our hair inevitable or are there steps we can take to help us preserve our precious locks? On a side note, one of the great aspects of doing this podcast is the engagement from the listeners. A listener asked that I cover the topic of female hair loss and thinning, particularly in midlife, and as I was commencing my Google search to find that said expert, I received an email from a publicist who represents our next guest.

Michele Folan: 1:15

Dr Alan Bauman is a full-time hair transplant surgeon who founded his medical practice, Bauman Medical, in Boca Raton, Florida, in 1997 and has treated nearly 30,000 patients and performed over 10,000 hair transplant procedures to date. His compassionate, patient-centered philosophy and individualized, artistic approach to protecting and restoring the appearance and health of the hair and scalp is what sets him apart from non-specialists and other practitioners. He received his MD degree from New York Medical College, Surgical Residency Training at Mount Sinai Medical Center and Beth Israel Medical Center in Manhattan and Hair Transplant Fellowship Training in New York. Dr Bauman has many associations with professional networks, has authored numerous articles and textbook chapters and has been featured on the Today Show, Good Morning America and Forbes, just to name a few, and there were a lot of name mentions and all sorts of great things that you've done. So thank you for being here. This is such an honor to have you on the show.

Alan Bauman, MD: 2:29

Well, thank you, michelle, it's great to be here with you.

Michele Folan: 2:31

I would love for you just to fill in some of the details that maybe I didn't get to. Anything personally, you want to share, like where you're living. Yeah, share, share, share, share.

Alan Bauman, MD: 2:42

I met my wife in New York during my training and we moved to Boca Raton, florida, to open up the practice. It's been an amazing journey because we started with just a small sub-least space a thousand square feet. My wife was answering the phones and I was doing consultations, and we had the teams coming in on a per diem basis to help with the procedures. We had one operatory and no full-time staff, but we always kept it very personal. What we tried to do is hit a home run for each patient every single day, and so I can't believe it's been over 25 years and 33,000 patients later. Today we have a nearly 12,000 square foot hair hospital, as some of my friends like to call it.

Michele Folan: 3:23

Oh, that's amazing.

Alan Bauman, MD: 3:24

Located in downtown Boca Raton. I have over 35 team members, various departments that specialize in just scalp health, of course, my role as the chief surgeon to continue to perform hair transplants every single day. And we have other interesting parts of the practice in aesthetics, to take care of the skin as well as the scalp, even something that is relatively new to the practice, which is called Bowman Performance, which helps out with longevity and wellness and things such as that. So it's been an exciting ride, but the best thing about being a hair restoration physician is the ability to change people's lives for the better because, as your listeners probably mentioned, when hair loss occurs it can be devastating, not just for men and for women, but to anybody who's experiencing hair loss Teenagers who have suffered trauma, scarring and accident victims, as well as patients who lose their hair through chemotherapy or autoimmune disease, not just male and female pattern hair loss, which is what we primarily treat at Bowman Medical.

Alan Bauman, MD: 4:24

These are very rewarding practice to have. It's fun to do it every single day. It combines what I would consider hard skills and soft skills. Hard skills, you know, making sure the hair grows when we transplant it, but yet the soft skills of helping the patient through their journey. And then the artistry of the procedure, creating something that looks 100% natural, that mimics what mother nature would do. It's a fun practice to have and I wouldn't change it for a minute. I would go back and do it all again.

Michele Folan: 4:48

I have to think it's really rewarding. Hair loss is super emotional for men and women, but particularly women. I hate to say that we have some identity in our hair, but we kind of do. By the time a patient comes to see you, they've probably tried quite a bit on their own and they are really emotional. So your ability to cater to that person who is really distraught, I think is a gift that you have when treating those patients. So kudos for that.

Alan Bauman, MD: 5:21

Well, thanks. Yeah, we always say that hair follicles are a very emotional organ.

Michele Folan: 5:25

They absolutely are and, having known quite a few people who have been through this, my mom had alopecia Again. It's that identity with our hair. We wanna look feminine and look like a woman and it can be very difficult. You were talking about the different reasons. People might come to see you. Hair thinning for women can be very gradual over time as we hit menopause. There are those times when there's that sudden, acute hair loss. One of the questions that one of the listeners asked me was why is it that not only is my hair thinning, but the texture is actually changing. It's getting more fine and more frizzy.

Alan Bauman, MD: 6:10

That's very, very common. Not only do we lose the quantity of our hair, like, literally, follicles can miniaturize and eventually shut down so that we don't have as much volume as before, but also, as your listener saw, the hair caliber can change as well as the texture. So all of these factors, many of them, come back to genetic conditions, obviously male and female pattern. Hair loss is a gradual miniaturization of hair follicles over time, and in women it happens in that frontal zone. First it diffusely, so it's not like a big bald spot that appears like you would see in a male patient, and it's not really a super receded hairline, at least not in the beginning, although that can happen in women as well. But also, as we age, remember that our metabolism is changing and hair follicles are one of the most highly metabolic cell populations in your body and that's why it's maybe such a strong barometer of our health and maybe one of the reasons why, evolutionarily, it's so valuable to us. We want it to be an outward sign of how we're feeling and doing and sometimes, unfortunately, it may be an outward sign that we are getting older, that we are aging or maybe not taking as good care of ourselves. Some of it is within our control. Some of it is not just as many other medical conditions. You've got a genetic tendency, and then you have the epigenetic factors, which is our lifestyle. So everything from nutrition and diet and our stress, our sleep, wake cycles, hormone changes, as you mentioned, happen during life. They can happen after childbirth, they can happen even earlier, from PCOS, for example, but of course, as menopause comes along, we see changes in hormone status and our skin changes. Right. Our skin becomes less resilient, it's not as shiny, it's not as brilliant, and so our hair follicles also can be affected in that way. And so if you wanna try to optimize your hair, you really have to take into account the holistic situation. What's going on with all of those factors that I mentioned, as well as try to target the actual hair follicle itself?

Alan Bauman, MD: 8:07

And so, briefly, that's our approach at Balmond Medical is that we take a very, very deep dive into lifestyle and holistic factors. I want to know are there biomarkers that we should be testing, that we're looking at, that show us that there's poor nutrition or a change in iron levels? And are you anemic? Or are the hormone levels out of control? What's going on with the thyroid? And so we can go on and on and then take a very, very proactive approach. What can we do to stimulate those follicles to be better? What are the things that we can do in terms of lifestyle? And hopefully we can rescue follicles that are failing and improve the aesthetic value of the hair that you have, or restore the hair that you lost if you need it over time, and that's really the main goal of what we do. So everything from scalp health issues to hair loss, that's what we're focusing in on, as well as a functional medicine point of view. What's going on with you medically as well, as we age?

Michele Folan: 8:57

I like your inside out approach. Let's look at what's going on on the inside, because it reflects on the outside. Are there certain foods that you recommend women in midlife eat, that we may be missing, that affect our hair?

Alan Bauman, MD: 9:12

Well, I think nutrition is extremely important, but we want to make sure that we're getting in a protein and we understand that, how important that is for muscle strength and bulk and how that determines our longevity over time and our resilience to things that could put our health at risk, so to speak. As we age, frailty and sarcopenia, which is muscle loss, obviously, is critical for longevity to address. For longevity, protein is critical for hair, obviously. That's what you see, that you see the dead tissue which is like your fingernail, right, the hair fiber is made of keratin protein, and so if you're protein deficient for whatever reason maybe a special diet, or maybe you're trying to lose weight, or maybe you're on a weight loss program or weight loss medication or weight loss surgery and your intake of nutrients and fuel is going down, you're not gonna grow good hair. And obviously there are extremes, right, we can see kids that are starving in Africa is like what the physicians always say and what my mom told me when I wouldn't finish my plate of food when I was little. But the point is is that they go bald, right, because they don't have enough protein intake, and so that's an extreme view, but it just shows you how critical the protein is and that your body will sacrifice growing hair to maintain core function. That's one of the main things I mean.

Alan Bauman, MD: 10:20

Yes, biomarkers are something that we do absolutely in our perimenopause and menopause patients because we wanna see what else is going wrong that could be affecting the hair, and also taking a detailed history. So what's going on with your hair? How quickly has it changed that ponytail volume? Is it shrinking, like you said, slowly over time? Or is it more of a sudden shed that was maybe triggered by something like an illness, hospitalization God forbid a medication that you started? Did you get COVID a couple of years back? Did you get vaccinated, which also seems to dysregulate autoimmune and hair follicle function, unfortunately, I mean, there's a lot of different things that can be elucidated through a detailed medical history.

Alan Bauman, MD: 11:01

So, but yeah, do I have a specific kind of like hair diet? Well, there's a list of suggestions that you can pull off my website that we've compiled and probably it would ring true for most patients. Making sure the protein intake is good. Could be poultry, could be salmon, omega-3s, things like that, is it nuts and things. All of those things are critical, as well as maintaining a good gut microbiome, and I'm sure you've had guests on in the past that talk about maintaining those little buggers. Oh, yeah.

Alan Bauman, MD: 11:28

That were carrying around with us, that genetically make up more than are some total of DNA in our body. But these microorganisms, not only in our gut but on our skin, are really important for keeping everything kind of under control, not just emotionally but also in terms of nutrient absorption and things such as that inflammation in the body A lot of things that we go into when it comes to diet. Again, it comes down to a detailed deep dive for each individual patient.

Michele Folan: 11:52

Well, and we do talk about protein a lot, because it's been very eye-opening for me talking to all these experts and I'm like, okay, okay, okay, I get it, I get it, I need to increase my protein. You are talking about biomarkers, thyroid what should patients be asking for? So, say, they're going back to their GYN or their dermatologist. What should they ask for in terms of biomarkers to be tested?

Alan Bauman, MD: 12:18

Yeah, so we do look at thyroid levels, we do look at female hormone levels, we look at your iron. It's a very, very probably more detailed blood test than maybe what you would get typically or OBGYN Unless your OBGYN happens to be inclined for age management and hormone optimization. They may not necessarily be looking at all of that and what they would consider actually normal. Maybe some testing labs might put you in a normal range, but that may not necessarily be optimal for you. So again, when thyroid is unbalanced, certainly it can affect your hair too much or too little. Actually there has to be a balance there.

Alan Bauman, MD: 12:55

We don't have like a magic bullet in terms of estrogen, progesterone, those types of things, female hormones, but we do know that those female hormones can affect the hair follicle. The hair follicle is very responsive to hormones. I mean, obviously in male pattern hair loss, we know exactly the androgen that causes the follicles to miniaturize over time. And as women age, we feel like maybe androgens do play a role also in miniaturization of the hair follicles. And we see this probably most obviously in women who are on hormone optimization therapy, with testosterone for example, because many patients come in and as soon as they've started the testosterone replacement therapy, which of course is great for muscle mass and libido and all the other good things, it can start to degrade the hair quality if they're genetically susceptible to female hair loss.

Alan Bauman, MD: 13:43

Again, a deeper dive, probably more in-depth than what we can talk about in the simple podcast. But looking at all of these different things to see what's going on and many times we'll do genetic testing on our female patients to see what different metabolic pathways that are related to hair tell us and that also gives us an idea of maybe what therapies and treatments might be more precise to start with than just the typical therapies that you might think of the medications, topicals and oral treatments and so forth. But I'm very, very keen on supplementing with nutritional supplements. I've designed actually a supplement line that hits all the main points, including multivitamins, biotin and even nutraceuticals. Like you mentioned, I think, Nutri-Fall in the opener. I'm a big fan of the Nutri-Fall company and the Founders I know very well and personally when they first launched the product because they did clinical trials to show that it improved and helped women improve their hair and they had very, very good data on that much, unlike other nutritionals or nutraceuticals that you see out there on the market that are kind of Johnny come lately's.

Michele Folan: 14:44

Right, you see the hair, nail and skin formulas and those sorts of things and I'm assuming by the time somebody has come to see you they've tried a lot of the basic over-the-counter type of things. Sure, I wanted to get back to the testosterone comment because I did have a listener say that she was put on sprelactone, which I'll have you explain what that is, to help with her female hair loss. Do you recommend that for patients that have higher than normal testosterone levels?

Alan Bauman, MD: 15:17

The first thing is that high or low DHT dihydrotestosterone could be the trigger for female pattern hair loss and it doesn't necessarily need to be way above normal. You could just have a sensitivity to that. So that's the first thing. People say oh well, my DHT dihydrotestosterone which is a metabolite of testosterone, by the way is very low. I'm a woman. I should be very low. I shouldn't have this receding hairline like a man, even though I'm on testosterone replacement. Just be aware that you could be sensitive to DHT at very low levels and it can cause almost like a male pattern look like a receding hairline loss in the temples, as well as a traditional female diffuse loss up top.

Alan Bauman, MD: 15:57

But sprelactone originally aldactone was a diuretic, but it also has anti-androgen properties. It's relatively safe, meaning that you can start at low doses and ramp it up and it will address to some degree the androgens as an anti-androgen and many women will start somewhere around 20 to 25 milligrams a day and some women are actually up to 200 milligrams a day. But the issue with sprelactone is number one. That's a potassium sparing diuretic. So years ago we used to have to monitor women's potassium to make sure that it didn't get out of whack. So looking at your electrolytes is really, really important.

Alan Bauman, MD: 16:33

The other thing it can do is dehydrate you and that's not so good either, but a lot of dermatologists do like sprelactone. I do often combine that with oral monoxidil and I'm sure we're going to get into that a little bit later on, but it's a very, very common treatment. But I have used off-label finasteride and dutasteride in our postmenopausal women as well. Again, that's a more potent androgen blocker, if you will, inhibiting the production of DHT in the body, which could be that thing that dysregulates the follicle and those women who are sensitive.

Michele Folan: 17:03

Have you had good results for those women when you've used that combination? Oh, absolutely. Ok.

Alan Bauman, MD: 17:10

Yeah, absolutely, and this is a very, very well-known treatment option for women with hair loss, and so how do we know what results are? As you said, many people have tried things at home and they're not really sure did it work? Did it didn't work? I mean, I have patients that come in and they say, well, I was losing hair for 10 years and then I went on this treatment and I didn't see any change. And then I said, well, wait a minute, just assume that it failed. But she was on this treatment and she didn't see any change. Well, that means you got worse for 10 years in a row, but then for the past two years, you didn't see any loss, right? So that's actually a good thing and that sometimes maybe not the answer that they want to hear or the result that they were hoping for from the miracle treatment that they found online, but actually stopping the progression of hair loss is a win and we'll take it.

Michele Folan: 17:52

Yes, absolutely.

Alan Bauman, MD: 17:54

One of the things that we do in the office when patients come in is we do a detailed hair measurement. So we have AI-powered microscopes today here at Balmain Medical. We look at hair density and hair caliber in a variety of different zones. We also do cross-sectional trichometry, which is basically like a little caliper that measures small bundles of hair in different zones in a very, very specific and accurate way so we can go back to the same location time and time again. So it becomes baseline measurement initially and part of the diagnosis initially. But then also we can track your progress how well we're either stopping the progression of the loss or how well you're responding in each area to a variety of therapies or treatments that you're doing.

Michele Folan: 18:34

Oh, that's super interesting.

Alan Bauman, MD: 18:35

Yeah, I mean, that's a critical step.

Michele Folan: 18:37

Because you got to have the data, because you got to know if what you're doing is working. So I love that. I want to go back to the neutrophil thing because I was out with some friends and one of my friends was talking about neutrophils. She's been on it for quite some time. It's not inexpensive but she's had great results with it. I did have a listener tell me that she had been on neutrophil and her gynecologist was surprised at her biotin levels after. I guess being on the neutrophil Are having high biotin levels an issue in terms of blood serum.

Alan Bauman, MD: 19:16

So biotin has no upper limit in terms of dosing. Years ago we used to treat patients with like 2,500 micrograms and then for some reason it was up to 5,000. Today, 10,000 is kind of the average per day. You want to make sure you're on a good quality biotin. To be honest, neutrophil, I don't think has a lot of biotin in it.

Michele Folan: 19:33

Oh, really Okay.

Alan Bauman, MD: 19:34

So it must be a separate supplement. I mean it may have a little bit, but typically if you're on neutrophil we usually have to supplement the biotin Okay With something else. So that's a little bit unusual. The only thing that really biotin can sometimes do is it can throw off some of the biomarker measurements in some cases. So there's been some warnings that have been put out by the FDA and so forth that if you're on biotin it might confound some of your blood work numbers. That's really the only issue. Otherwise, biotin is very safe. It's water soluble. You pee out whatever you don't need. We've been using biotin for very many years. A lot of people maybe expect more from biotin than it actually does, but there's no question in my mind that biotin does something. In fact, I just had a patient this past week who had come in about three or four months prior. He had been on no other therapies and we put him on a biotin supplement as well as some multivitamins and he had a pretty dramatic improvement in hair quality. Oh, wow.

Alan Bauman, MD: 20:30

Did he make other nutritional changes or not? But we know that biotin seems to impact hair growth. There's not a huge amount of scientific data, unfortunately. You know, when you're looking for peer reviewed studies, sometimes you see more warnings than positive things. But biotin, I believe, is very, very helpful and is an essential nutrient for hair regrowth. So NutriFall can work, but remember we talked about what are we treating here. If you are on a very restrictive diet, you know you have this strict vegan or vegetarian and maybe you're protein deficient and you're taking NutriFall, thinking that's going to be a miracle. Well, unfortunately, you're maybe providing good signals to the hair, but you're not providing the building blocks. Again, you know it sometimes can be more complicated than just pull this vitamin off the shelf and go with that.

Michele Folan: 21:15

Hey it's not that easy, we know, we know it's not that simple. One other thing I want to touch on before we get into more of the surgical type of scenarios oral monoxidil. So we all know the topical monoxidil, I know actually. Another listener said that she had tried the serum but didn't like the greasy, dull look of her hair. She doesn't wash her hair every day and then the foam didn't seem to really get down to her scalp and so now she's looking at maybe the oral monoxidil and was curious about that.

Alan Bauman, MD: 21:53

Yeah. So, michelle, that's very, very common over the counter Rogaine or generic Rogaines or even the cloud pharmacy versions, and even today, some of the compounded versions of monoxidil. They're just not made very carefully and so, yeah, make containment oxidil, but the base, the vehicle, is just nasty. If you're a guy with a crew cut, well then, no worries, whatever, just foam it on and go. But for women, what we realized 20 years ago is that the base makes a huge difference. The vehicle, it's got to be scalp friendly, it's got to be easy. The dispenser has to go right down onto the level of the scalp so you can get it where it needs to go. There's no use in spraying your fertilizer on the leaves of your plants in your garden, right? Yeah, that's not what it's for. Now, making the leaves shiny is a different story. We can take the analogy further. But we want to get monoxidil into the scalp. So very often patients will use something like formula 82M or 82F, and that's a compounded recipe for monoxidil plus flucinolone, which is anti-inflammatory in a very gentle, easy to use base and packaging. And the 82F is monoxidil plus finasteride, so you get that little anti-androgen effect as well.

Alan Bauman, MD: 23:02

But we all know that using topical medications can be difficult, and as you age, of course, more than 50% of women over 50 are going to have some hair thinning. That's obvious. We're also going to have less oil production at the level of our scalp and skin, you know. The sebum starts to decline, and so we're not going to shampoo our hair as often, and so we don't want something to build up or to create itching or inflammation up there, and so a lot of our patients are decreasing their topical use and they're going to the oral, and really, as a hair surgeon, we've been using oral monoxidil for a decade or more, but it really came to fruition, like in the general public, when the New York Times did a cover story on it about a year or two ago over the summer, and then, of course, there was a huge flood of people wanting oral monoxidil and a shortage thereafter, oh yeah.

Alan Bauman, MD: 23:46

But so we start low and go slow, because at large doses, monoxidil can cause your blood pressure to drop, which could manifest as headaches or dizziness. So those are the risks. You could also get water retention, which is often why it's combined with the spironolactone that we talked about, which would help as a diuretic. But we start very, very low, because even a low dose monoxidil can have a very powerful effect on hair follicles over time, and so we measure and monitor how things are going with that low dose. We can always increase it. If we go too far, we can always backtrack a little bit. But monoxidil oral has been a game changer for many, many, many patients, both men and women. Actually Big question.

Michele Folan: 24:26

Am I going to have increased chin hair doing oral monoxidil?

Alan Bauman, MD: 24:32

Well, increased body hair is certainly a possibility. With oral monoxidil, most women know if they're prone to it. If you're waxing your upper lip or you've been dealing with, you know, excessive sideburns or something, especially when you hit menopause, then that might get a little bit worse. With oral monoxidil it is dose dependent, so you could try to cut back down on it. At the practice we also have laser hair removal and electrolytrolysis and that yeah.

Michele Folan: 24:58

Just for those reasons.

Alan Bauman, MD: 25:00

So sometimes we have to fight both of those battles at the same time, just like with testosterone and hair loss. You know, on the scalp we don't want to eliminate the testosterone because we're getting such great effects, but we have to fight it in another way. So right, this is the art within the science of getting older and really of aging and longevity. I know we just have to fight a little bit harder, but that could be a side effect of oral monoxidil, especially at the higher dosages. I've seen patients who grow a ton of hair, like even down their neck you know women on oral monoxidil and other places too, in their arms and such.

Alan Bauman, MD: 25:35

But usually, ethnically, you're going to kind of know. If you're prone to that, like if you're looking at your arm and you're like I haven't seen hair there in decades, it's very unlikely that you're going to grow a hairy arm from oral monoxidil, okay, so don't be afraid, don't be afraid.

Michele Folan: 25:50

Don't be afraid. Okay, I think that's great advice.

Alan Bauman, MD: 25:53

And start low, go slow, Okay.

Michele Folan: 25:55

I'm going to put all this in the show notes, because I think this is really great stuff. One quick question. I hadn't planned on asking you this, but in terms of how often we should be washing our hair, is once a week enough, or should we be washing our hair more often than that?

Alan Bauman, MD: 26:11

Oh, it's a magic question I get every single day, no matter what age male or female patient. They always want to know are they shampooing their hair enough, not enough, too much, too little, with what and how? All you know all of these questions. It's a very individualized question. So remember, just like taking care of your skin, right, you're not going to use the same kind of skincare regimen in your 20s, or even as a teenager, as you enter into middle age and menopause and so forth, right? Your skin changes with time, and so does your scalp, and we already previously mentioned that the sebum, which is the oil production at the level of the scalp, diminishes with time, usually as you go through years and years in life. Now, some women do find that their scalp does get oily, and if that is you, then you're going to need to shampoo more often. And don't forget about conditioning. You need to follow with the conditioner to replace the moisture in the hair. But if you overdo it, what could happen? Well, it could dry out your skin, and that's not good either. That could create inflammation, even ulceration in serious cases, and so that's not so good either. What are you styling with? Are you coloring your hair? Have you had a perm? Have you had a straightening treatment? Have you had a smoothing treatment? What's the length of your hair? And all of these things are going to play into how often you should shampoo and with what, and how you should condition your hair, and very often the scalp is dry and needs to be treated in a certain way. And then but the hair is different and needs to be treated in a different way. So it's not an easy answer.

Alan Bauman, MD: 27:37

I have two types of shampoos and conditioners in the practice. One is geared for hair growth. It's called boost. It has a shampoo and conditioner with a number of hair growth ingredients in there. And then we have another one that has all the hair growth ingredients, but it's called soothe and that's for people with inflamed scalp.

Alan Bauman, MD: 27:52

But the amount that you use it is very critical. Oh, and how much you use right? Are you going to like fill your palm up with this huge glob of shampoo if you don't have a lot of hair and you haven't worked out and you're not exposed to the elements or you haven't been to the beach? No, you're going to let it go, just do it. One of the things that we see often in the practice is dry shampoo. Yeah, what I found is that a lot of women don't use dry shampoo correctly. Basically, think about dry shampoo like cornstarch it's going to absorb the oil and so after a little hour long at the gym, spin class or whatever, you can use a little dry shampoo but brush it out, otherwise it's going to like stick to your head.

Michele Folan: 28:28

Yeah.

Alan Bauman, MD: 28:29

Literally your scalp and really really dry things out and build up is no good, Not great.

Michele Folan: 28:35

Yeah, okay.

Alan Bauman, MD: 28:36

So whenever I get that question in the office, I might spend a little bit of time, like we just did, but the most important thing would be is that I tell them listen, talk to my in-house board certified trichologist, this hair and scalp expert, who can do a deeper dive into your regimen, your hair styling. She's a cosmetologist but as an expert in hair and scalp health, and she can guide you. She can apply treatments to exfoliate your scalp, to clean it. She can apply moisturizer, smoothing treatments to the hair, help you with color and things like that, and so that's a department inside my practice that very few doctors have and we work very, very closely. Kimberly is amazing, and so Kimberly is my in-house certified trichologist and she answers that shampoo and conditioning question like every single day.

Michele Folan: 29:20

Oh, this is great. I didn't even know that was a thing, but yeah, it's a thing. I want to come visit by a plane ticket and come down and see you you should. I do want to talk about hair transplantation and that process. I know it's changed a lot. One thing that I think scares people is the old plug. Look, sure, it's gotten a bad rap from all those pictures that we see. Tell me a little bit more about the process and who is a good candidate for that.

Alan Bauman, MD: 29:52

Just remember that in our algorithm, so to speak. We've talked about nutrition and lifestyle factors. We've talked about medications which might be appropriate. Just for your listeners, be sure that they know that there's other therapies, like red light, low-level laser-like therapy, as well as regenerative treatments like platelet-rich plasma, pdo, polydioxinone and TED treatments, which I'm sure you'll want to circle back to, but those are going to be a little bit less invasive than the hair transplant. But transplants are important to understand.

Alan Bauman, MD: 30:19

For many years, transplant surgeons would not operate on women, and the reason why is because they either didn't have the confidence that they could execute an effective procedure or they didn't have the tools that were available now that we can use to get in between existing hairs to get a good result. So what's happened over the years is that today, nearly 50% of my patients are women and we're dealing with scalp hair issues, but also eyebrows and eyelashes and sideburns and scars and things such as that. Your listeners should know that. Yes, today we're not dealing with a plug which contained like 30 or 40 hairs at a time. That looked kind of like Barbie doll hair on the top of the scalp. That's technology from the 1970s and 80s.

Alan Bauman, MD: 31:04

In the 1990s, we used to take a strip of scalp from the back of permanent hair and that was dissected into grafts, literally in the operatory, and then applied back into the scalp. We don't have to do that anymore. So there's no linear scar, there's no stitches or staples, there's no extensive recovery with pain medications or anything. Today we're using microsurgical tools to harvest individual, as little as a single hair, individual grafts right from the back of the scalp, so we can actually do that without trimming any hair whatsoever, which is another nuance that wasn't available years and years ago. Taking those grafts where the hair follicles around the sides in the back of the scalp those follicles, remember, are relatively permanent, even in women, and we would verify that with measurements, obviously, before we execute a transplant and we look into the areas that we hope to improve upon. And if we can fit our instruments between existing hairs, then that makes you a better candidate, a good candidate for hair transplant procedure.

Michele Folan: 32:06

Listeners, I highly recommend you look at Dr Baumann's website. You have incredible before and after photos of hair transplantation for women. What a life-changing thing for women who have that terrible tinnitus, particularly in the front, sure and down the middle. I mean I know that can be just devastating for a female to go through. So that is great to hear that it's not Barbie hair plugs like we've all seen.

Alan Bauman, MD: 32:38

No, not anymore. So you know there's hard skills and soft skills, right. So a hair transplant procedure is comfortable. It's going to take a full day in the office typically. So figure, you're going to be here for about six hours. We'll feed you lunch Hopefully don't have to feed you dinner you can get bathroom breaks, we'll give you some snacks and you're going to be completely comfortable using local anesthetics. You're not going to feel anything that we're doing. There's no sharpness or pain during the procedure at all. It's a very comfortable process.

Alan Bauman, MD: 33:01

Most patients snooze through most of it, if not all of it. They'll watch TV, netflix, whatever, listen to music. At certain points by the end of the day they might be singing karaoke with the team, I don't know. But we have a good time, we keep you comfortable and we execute the procedure. Of course there's a little bit of downtime.

Alan Bauman, MD: 33:17

Crusting and scabbing is going to be visible for about a week or so, but then you're back to normal. You can be back in the gym in three or four days even, but the hair growth comes on much later. It takes about four to five months for it to start to grow in a year to see the full final result. And yes, as you mentioned, we can do not just the density down the middle, but even the hairline. Lowering procedures are very, very popular today because a lower hairline is going to look more youthful. A fuller hairline is going to look more youthful and more aesthetically pleasing. That's a very, very common procedure that we do, in addition to the other things I mentioned, like eyebrows and eyelashes and sideburns, which can sometimes be removed from plastic surgery and things like that, and scars from brow lifts and such.

Michele Folan: 33:59

With the amount of women that are doing the eyelash. What do you call that? Extensions, Extensions. Are you seeing a lot more women coming in with eyelash trauma from those procedures?

Alan Bauman, MD: 34:13

Oh yeah, so traction alopecia is the medical term for if you've pulled on the follicle too much, too hard, too long, like either hair extensions on the scalp or eyelash extensions in the eyelid. It causes the follicles to miniaturize and eventually die. They will not produce hair. Eyelash extensions have caused an epidemic of what we call scientifically hypotricosis, which is basically just weak eyelashes. Now you can be born with weak eyelashes, short, thin, sparse ones, and of course, as we age they can even get shorter, thinner and sparser. Eyelash transplant includes taking the follicles from the sides and the back of the scalp, implanting them into the eyelid. It takes about an hour per eye although you're usually spending most of the day with us here in the office and it does take about a week or so for the bruising to go down and the healing to complete. But then the lashes start to grow, and boy do they grow.

Alan Bauman, MD: 35:07

Eyelash transplants, like eyebrow transplants, come with scissors. Yeah, because they grow pretty long. So you have to trim them occasionally, maybe once or twice a month at least, and you might need to curl them, depending on the curl of your hair. So it's a very intricate procedure, but I'm blessed to have been taught that technique back in the 1990s by a very prominent plastic surgeon from Brazil and I've used that technique. I've perfected that technique, enhanced that technique and I'd probably perform more eyelash transplants than any other English speaking surgeon on the planet. Maybe there are other surgeons in the Far East because eyelash loss is more prominent over there, but we do eyelash transplant like every single month. We're doing cases of eyelash transplantation. It's one of my favorite procedures to do.

Michele Folan: 35:49

This is so fascinating. I am just like blown away because I didn't even know that was a thing, but that's why I love doing the show. I get surprised every day. I do want to talk about PRP because I know I've been offered PRP when I've been getting a facial. I did micro needling and did not know this was a thing for hair loss. Can you talk a little bit about that and some of the other things like laser?

Alan Bauman, MD: 36:17

Absolutely so. Prp is now a very, very popular treatment in regenerative medicine. It's really the workhorse of regenerative medicine. Prp stands for platelet rich plasma. So the idea, the concept, is to take a small blood sample and to spin out the platelets, to remove them from everything else, concentrate them and then use them. Why would you use platelets for things? Well, platelets contain very powerful growth factors. They contain chemical messages that are biologic in nature, that trigger the body's natural rejuvenation and healing process. If you did, let's say, cause a wound on the skin, like, let's say, you're trying to brighten and tighten, so to speak, you use a micro needling tool on your skin. Even if you applied these growth factors from platelets on the outside, they will soak in and they will rejuvenate the skin to some degree. You can even use PRP. If you have a wound, a paper cut, an injury, you could put platelets on from the outside. If you think about it, what, mother Nature, does you ever see that yellow stuff? That you clear yellow stuff under a scab that kind of oozes out a little bit. Yes, well, that's a lot of platelets actually. But we're going to concentrate our platelets and focus them into an area.

Alan Bauman, MD: 37:25

Many athletic injuries can be treated with PRP, like if you hurt your knee or you have a tendon injury. Years ago, basketball star Kobe Bryant went to Germany to get PRP. Well, he can get that same treatment today, down the block from here in the US, but 15 years ago it was a pretty new bit of business. But the thing that most people miss and this is true of dermatologists as well is that you have to dose the platelets correctly in order to get the result that you want. What does that mean? Well, very low dose platelets can be helpful with wound healing. They use them in dentistry all the time. Prf is a very low dose of platelets that plugs a little pocket where they took out your tooth, and that's great.

Alan Bauman, MD: 38:07

But for the scalp, we want a high concentration of platelets that can trigger this hair regrowth, and I don't know why the concentration works, but I have some ideas. Over 12,000 treatments and 16 years of performing PRP, we feel like we got it down, not just how to create PRP properly, but also how to apply it into the scalp painlessly. That's really important. You don't want to create a stress response. That's the last thing you want to do for hair. Stress is a killer for hair follicles, so you don't want to create a stress response. We want to keep you comfortable, relaxed, apply the PRP and the correct dose in the correct layer of skin, where the follicles are, and give you the best chance of success with platelet-rich plasma. So that's one of the things that we've helped.

Alan Bauman, MD: 38:50

Kind of pioneer is the understanding that the dose of platelets is critical. And so what's the dose? Well, 12 to 14 billion platelets is what we're going to use in one single PRP treatment. Now, you can't get that from a little test tube and a little salad spinner or desktop centrifuge. You need special tools, special equipment, special kits in order to make that happen. But that's what we have and that's what we've developed over time. It's a very special dual spin process with some other things that can help enhance it as well. And you mentioned micro-nataling. We actually do micro-nataling at the level of the scalp, while the scalp is numb After we've injected the PRP at the correct level, and so that creates that trigger of wound healing that tells the platelets. This is the area that we want to do the work.

Michele Folan: 39:36

You do the micro-nataling after you do the PRP.

Alan Bauman, MD: 39:40

Correct.

Michele Folan: 39:41

All right, that makes sense.

Alan Bauman, MD: 39:42

Now, sometimes we'll do micro-nataling as a standalone treatment with a growth factor cocktail or exosomes applied topically. We didn't really talk about exosomes, but we can. But these are things that are again biologic signals that can be applied to the outside of the skin without injecting, and you can do micro-nataling to make them penetrate better and to effect change.

Michele Folan: 40:03

And exosomes are.

Alan Bauman, MD: 40:05

Exosomes are little packets that come from stem cells. They're typically collected in laboratories. Billions or trillions of them can be concentrated into a small vial and frozen and then sent to the clinic for application topically. Exosomes are the chemical messages that come from stem cells that tell the body to rejuvenate and repair, very much like the growth factors that are found inside the platelets. In fact, platelets have exosomes. That's what we're telling the platelets to release in the area when we do a little bit of micro-nataling or inject a little calcine chloride, which is another trigger for releasing platelets growth factors. But you can collect exosomes from stem cells in tissue banks in laboratories and then those are sent to us for cosmetic use topically.

Michele Folan: 40:49

Okay, and then how does laser fit into this?

Alan Bauman, MD: 40:52

Red light therapy or low-level laser light therapy. When I was in medical school almost 30 years ago, we didn't hear anything about how red light affects the skin. I mean, the only thing that we knew affected the skin back at then was probably UV and it was like no bueno, no good right. But red light is visible light, it has no side effects or harm to it whatsoever, but it can cause a very, very powerful effect at the level of the skin and probably many of your listeners have been seeing Information about red light therapy, maybe at their local gym or anti-aging professionals may have red light therapy, but red light, and especially laser, increases blood circulation, decreases inflammation but, more importantly, causes a burst, a huge amount of ATP production at the level of the follicle in the skin.

Alan Bauman, MD: 41:38

Remember, hair follicles are highly metabolic. Atp is the energy currency of the body. If we provide more energy to the follicles, they will perform better, and that's what red light therapy, low-level laser light therapy, does. And the science of photobiomodulation has come light years in, literally, you know, just 15 years, 18 years, since I got my first red light device and Actually tried to disprove that it would do anything whatsoever. But once these patients started healing better after surgery and they started growing thicker hair. I was like, oh my god, this is like actually working. A non-drug treatment option, great for hair growth.

Michele Folan: 42:11

So that capitalist, there's that cap you can wear in your home while you're watching Netflix. Do those work.

Alan Bauman, MD: 42:19

Yeah. So I met dr Michael Raven at a conference in Amsterdam, probably about 2008, and he handed me his invention, which was the laser cap, and it was a dome-shaped device with 100 laser diodes in it and a battery pack powered thing, and I said this is gonna be awesome. Send me a case of these for my patients. He's like, well, it's only one problem, this is the only one. Oh, but he was happy to meet me and eventually, obviously, mike Raven's invention has been copied a zillion times by many, many different manufacturers. But dr Michael Raven, the original laser cap inventor and the founder of the original laser cap Company, we've worked together in many different projects, not only to achieve the FDA clearance of his devices for hair regrowth We've proven that in the office many, many years ago a decade ago perhaps but also to reimagine the lasers in a way that gets a better result. And so, yes, you can find these kinds of lasers available at Costco. Now you can see them on Amazon. But remember, just like TVs, you get what you pay for.

Alan Bauman, MD: 43:22

In terms of electronics, these things are mass produced in China and the quality might be questionable. They certainly don't have warranties like a lifetime warranty. You certainly don't have the power, the horsepower that you need, which comes from the numbers of diodes, the output of the diodes, which is critical, and then the usability or portability. Remember we talked about early in our conversation about topical medications. It had minoxidil. So why didn't it work? Well, it was greasy, gooey, it was messy, it was terrible for the skin and the hair.

Alan Bauman, MD: 43:51

Well, laser devices that are clunky, like the bicycle helmet or something that you can't pack or travel with, not gonna do you any good. You need something that's flexible, portable, that has hundreds and hundreds of diodes, that packs completely flat, with a lifetime warranty and Just as five minutes a day on the scalp, and that's the turbo laser cap. That's the one that we worked with dr Raven to create. So the Bowman turbo laser cap, oh, is the award-winning device that we carry. Some other physicians carry it as well. Many of the people that we've trained in our hair coach program or certification program do also carry the turbo. But that's really the award-winning premier device that was physician designed and invented and that's what keeps it literally heads and shoulders above the rest of the pack, so to speak.

Michele Folan: 44:35

That's great advice and I appreciate that. I will put that in the show notes as well. Just in terms of other innovation out there, is there anything new on the horizon?

Alan Bauman, MD: 44:47

Oh yeah, so there's some exciting things that are happening. One of the things that we tested and tried, starting about a year and a half ago, is a treatment called Ted Transepidermal delivery, where we use ultrasonic sound waves to push growth factors and peptides through the skin, and we just presented those results at MCAS, which is in Paris this past year, and also in New Delhi at the International Society of Hair Restoration surgery, and we showed a dramatic increase in hair growth from that treatment, which requires no needles. So for those folks who are needle phobic out there, it does require one treatment a month for four months to start to see the results, and you can get improvements in hair quality, texture and also color with this device, which is really exciting. So we're getting some repigmentation of the hair.

Michele Folan: 45:31

Oh really.

Alan Bauman, MD: 45:34

That's called Ted transepidermal. Now if the melanocytes are totally dead and gone, then you're probably out of luck on those hair strands. But we've seen some interesting results on the photography and we have some devices now that are tracking hair to hair with the microscope so we can actually keep an eye on the exact same hair over time and see how it's doing in terms of its pigment as well as its thickness and Its length. So that's been exciting. That's routine in our practice now. I have a room that we only do Ted treatments all day long for our patients. Women love it, they come in, they make their appointments now they're just doing it once a month ongoing and they're doing great, loving that results.

Alan Bauman, MD: 46:09

The other exciting thing that we've launched is hair follicle stem cell banking, and so we're working very closely with the only hair follicle stem cell banking company in North America. This could either be a non-invasive Hair follicle harvest, meaning, like during a simple visit, we pluck a couple of dozen hairs, check it for biologic material and then they're shipped in a very special way for cryopreservation to store those hair follicle stem cells Not only for the long term, which we hope will be for hair cloning, but also for the short term we can get some growth factor cocktails back from the laboratory that are Autologous, meaning they're created right from your own cells, almost like an exosome therapy that you can apply to your scalp. Stay tuned for the data and the research on that. Very exciting. And the other benefit in terms of longevity Is that eventually the research is going to be able to help us produce organ repair, organ replacement, tissue Regeneration in the future.

Alan Bauman, MD: 47:05

And it would be really nice like if I need a kidney when I'm 80, I'd be nice to go back to my hair follicles when I was 53, and so that's why last month I banked my hair follicles, because those contain mesenchymal stem cells which could potentially allow us. Those could be formed into any kind of organ tissue. That's already been proven muscle, nerve tissue, bone cartilage. You know you can create those types of tissues from mesenchymal stem cells locked in the hair follicles.

Michele Folan: 47:33

That's incredible. I mean you all can't see me right now, but I am just like my eyeballs are popping out of my head because this is really fascinating stuff and they're so much ahead of us. I mean, look where we've come, right. We've come from the 70s bad hair plug days to now we're doing non-invasive type of Hair procedures to help people with their hair. This is all just amazing stuff. It gets me really excited, you could tell. I do want to ask you this is a lot more of a personal note what's one of your important pillars of self-care? What do you do that is important to you?

Alan Bauman, MD: 48:14

Yeah, you know I get this question all the time and mostly from people who know that I'm a bit of a biohacker and I've got all these wearables and techniques and things that we do, and whether it be supplements or peptides or things like that. They all want to know, like you know, like a bedchiller, I mean, or a ring if you can see me on video, you know yeah, I see it, you know they all want to know what's the best biohack, and so I always say vitamin G, and then they have a quizzical look.

Alan Bauman, MD: 48:39

Well, vitamin G is gratitude. I think that if you can start your day and finish your day with a pinch of gratitude, I found that that is been the most powerful tool for me in terms of setting my brain straight, setting my mind straight into what I need to do for that day ahead. Not only to be present and focused for my patients in surgery, which takes quite a bit of concentration, being there for my patients in consultation during an emotional situation obviously hair loss, a very emotional organ, as we said but more importantly for my family, for my wife and my boys, to be focused and present for them as well. And gratitude, I think, is an underused biohack, if you want to call it that. It's an underutilized tool in our toolbox. It's also free, by the way. I would just say that vitamin G is my best biohack ever oh, dr Baumann, I love that.

Alan Bauman, MD: 49:30

thank you for sharing well, thank you for having me. I'm gonna give you some gratitude. Thank you for having me on because you are going to be introducing. So many people who may be struggling with this hair loss condition have tried other treatments or procedures, didn't know where to turn, and now they're gonna have a lot of knowledge.

Michele Folan: 49:48

We look forward to helping them and also answering any of the questions that they might have thank you for that, and that's what I love about doing a podcast is I get to arm my listeners with information so that they can go and ask the questions, go find answers. If they're not getting it from their current doctor, go find someone that can help you, like you. Speaking of that, how can people find you, dr Baumann?

Alan Bauman, MD: 50:14

Well, most people find me first of all on the website Bowman Medicalcom. There's a great plethora of information. There are thousands of pages that I've written over the past 25 years I think we've kept almost every single one and hundreds of hours of video content that you can absorb. Of course, there's so much audio and video, podcasts and such I've been on, as well as those news programs. You previously mentioned articles that I've written both scientifically and also for the lay press.

Alan Bauman, MD: 50:39

Depending on what your situation is, even if you just want to ask a question, you can go to Bowman Medicalcom, b-a-u-m-a-n Medical all one word dot, com slash ask, and you just get a little prompt and you can type in your hair loss question there or any question. Actually it's almost like chat GPT. You can ask it anything. No, but you could ask a question and I promise that I will get an answer through my team back out to you. Hopefully you don't have to go to chat GPT if it's like a question about life, the universe and everything, but no, you're certainly welcome to start that conversation there. You can also ask for a consultation. So you request a consultation on the website. That can be done virtually to begin with now, obviously virtually.

Alan Bauman, MD: 51:18

We're going to miss some of the technology that we could do in the office, like the AI powered microscopes, the hair density measurements and things like that, but at least we can start the journey of what's going on with your hair.

Alan Bauman, MD: 51:29

You're going to submit some photos, which is today's technology in terms of photography. It's right in the palm of your hand, so from your home or your phone, you could start your virtual consultation, and nearly 50% of my patients start their journey that way from all over the world, and it's a blessing to help folks who are down the block because I've lived here in Boca for 25 years or so, but also to help folks from all over the world with their hair loss situation and if there's something that we need to diagnose further, sometimes we can send you to a location local to you either get blood work or other things, or even a certified hair coach that might be in your area that we have taught and trained how to measure hair. But, of course, invite you in, as many of our patients do. Come in for their procedures and treatments to the mothership, as we say in downtown Boca Raton's for a hair restoration vacation, I guess here in beautiful, sunny south Florida.

Michele Folan: 52:19

Yeah, sign me up. Ah, it's a great destination. Honey, I'll be gone for a week.

Alan Bauman, MD: 52:26

I'll see you oh absolutely, you wouldn't be the first.

Michele Folan: 52:30

I know. I can only imagine this was great. I'm so happy we connected and that we were able to have this conversation. Dr Ellen Baumann, thank you so much for being on the podcast.

Alan Bauman, MD: 52:42

Michelle, it's truly my pleasure to be with you.

Michele Folan: 52:51

Follow asking for a friend on social media outlets and provide a review and share this show wherever you get your podcasts. Reviews and sharing help us grow.