Why Do Men Lose Their Hair? with Chey Ranasinghe, MD

Podcast Transcript

John Horton:

Hello, and welcome to another Health Essentials Podcast. I'm John Horton, your host.

Hair loss is one of the most common changes men experience as they get older. And for a lot of guys, it can start earlier than expected. But while balding is incredibly common, that doesn't make it any easier to accept if it happens on your head. So what can you do about it? We're going to talk that through today with dermatologist Chey Ranasinghe. Dr. Ranasinghe is one of the many experts at Cleveland Clinic who visit our weekly podcast to answer health questions. Now, let's see what advice she has to lock down our locks and keep a hairdo from being hair done.

Welcome back to the podcast, Dr. Ranasinghe. We are always glad to get some time with our dermatology team because people just have so many questions about their skin and hair.

Dr. Chey Ranasinghe:

Thank you so much for having me back. Glad to be here.

John Horton:

Well, you're here today to talk about a pretty big topic, and that's why men tend to lose their hair, especially as they age. I know it is a worry for a lot of fellas, and I've got to be honest, I have checked every so often to see if I'm a few follicles down. So far so good. Everything seems to be hanging in there.

Dr. Chey Ranasinghe:

Good. Well, I truly enjoy treating hair loss because it's not dangerous. It's not life-threatening. But for many individuals, and I know we're focusing on males, so for many males, it can truly be life-changing.

John Horton:

It does a lot. You don't realize how much your hair means, but you think when you're going out, when you're doing anything, I mean you fuss over it a little bit. You want to look good. You feel better when it's kind of there and doing what you want it to.

Dr. Chey Ranasinghe:

Exactly, exactly. Our hair — I don't think people take time to think about it — but our hair is tied to our identity. Our youthfulness, confidence, and that confidence can make the difference for someone to want to go for that job interview and further their career or pursue a relationship and maybe meet their lifelong partner.

John Horton:

Well, I think my hair has gone past youthfulness now. I'm squarely in the oldness, so the color's kind of giving it away there.

Dr. Chey Ranasinghe:

It adds to some wisdom and maturity, John.

John Horton:

Well, that's what I try to go with, but we're working on it. So when we're talking about hair loss, what's causing guys to just kind of lose their hair?

Dr. Chey Ranasinghe:

The first question is, "Doc, I don't understand why this is happening to me."

And I tell patients, male pattern hair loss is incredibly common, and most men don't know why it's happening or what they can do about it. And a lot of times, there's all these myths and all these other reasons why patients think this is going on. I mean, I could list them for you. My testosterone's too high, or I'm wearing my baseball cap too much, or I'm overly stressed. But for the vast majority of men, none of those are actually the primary reasons. The real culprits, too, I'll blame, are our genetics and our hormones. Hormones being the major, major culprit there.

John Horton:

So what is it with the hormones? What's going on that just kind of causes your hair to kind of recede?

Dr. Chey Ranasinghe:

So there's one major player called DHT. It's a hormone otherwise known as dihydrotestosterone. And I love using analogies in my clinic with patients. So I say, compare the hair follicle to a factory, and think of that hair follicle as a tiny factory that's producing a hair fiber. And in male pattern hair loss, that factory doesn't just shut down overnight. It just gets smaller and less productive. And some men inherit factories that are just extremely sensitive to that hormone we just referred to of DHT.

John Horton:

OK. So does the DHT just kind of slow down? Do you not have as much of it?

Dr. Chey Ranasinghe:

So where does DHT even come from? So testosterone gets converted to DHT, and DHT is completely normal. It's not harmful. The problem isn't that you have too much of the DHT. The problem is that your hair follicles are just too sensitive to the DHT.

John Horton:

Oh, so it's not the DHT that's changing. It's just the hair follicles kind of just, they don't ... is it absorbent, right? They just don't respond to it as well?

Dr. Chey Ranasinghe:

Those hair follicles are genetically susceptible to the DHT. So when the hair is exposed to DHT in certain follicles, in a certain pattern distribution, for example, for males that are having that receding hairline, in that pattern distribution on the temples, those hair follicles are not just suddenly dying. The factory isn't just shutting down when DHT is exposed to it. The hair follicle is just shrinking, otherwise known as a “process called miniaturization.” So the thicker hairs become thinner, those longer hairs become shorter and, eventually, those follicles just produce something a little bit more than peach fuzz, otherwise referred to as “vellus hairs” in our clinic.

John Horton:

So you're just kind of going backward there, and the follicles, they kind of slow up and they just aren't going to give you that lush hair that maybe you had when you were a teen.

Dr. Chey Ranasinghe:

Exactly. You got it right.

John Horton:

Wow. OK. So that's what's going on on the hormone front.

You had mentioned genetics, and I had to laugh when we talked ahead of this — I've always heard, I guess the same wives tale that everybody's heard, that it involves your mother's father. And if you look at them and they have a full head of hair, you're good. And you told me I've been sold a bill of goods. So what is the genetic component there?

Dr. Chey Ranasinghe:

Yes, I hear that question so often. I mean, I just heard it this morning, today, when I was chatting with one of my friends. Which parent did I inherit this from? And the truth is, it's both. Hair loss is polygenetic, meaning multiple genes are contributing to that process of the miniaturization and where that pattern distribution of those genetically susceptible hair follicles are. So bottom line is you can't blame one side; it's both.

John Horton:

OK. Well, moms everywhere will be happier. I guess moms’ dads will be happy to know they're off the hook.

Dr. Chey Ranasinghe:

Yes, exactly. Exactly.

John Horton:

Now, what about just aging in general? Because obviously, it does seem to come with years that the hair will kind of go back. Is that just what we were talking about with the hormones that that process, just … we see it kind of evolve as time goes by?

Dr. Chey Ranasinghe:

For the majority of the men that I see in my clinic, yes. But there's always an exception to the rule. So typically, I have, unfortunately, I can see some patients as early as their late teens, early 20s, that have hair loss. That's quite noticeable. But the majority of the time, it's around age 35, about two-thirds of men will notice some degree of hair loss. Honestly, the hair loss, probably that process probably started in their mid-20s, but at around age 35, it becomes more of a notable thing that they're saying, "Yeah, when I'm walking by a mirror, I'm just starting to see my scalp more easily." Or old photos, "My hairline has really receded." And by age 50, roughly 50% of men have significant thinning. They have widening of the midline part or they have what we call that “endline recession” as well, with the widow's peak becoming a little bit more apparent. But bottom line is it's so common — 85% of males will experience some degree of male pattern hair loss in their lifetime.

John Horton:

Wow, 85%. So we're all in the same boat then, it seems like for the most part.

Dr. Chey Ranasinghe:

Yes, yes, exactly. It's something that patients don't realize is a medical condition that is common and it's just not talked about.

John Horton:

Well, we're not good at talking about things. As you know, it's not something we like to share. I think guys, you get sensitive about it and you don't really want to bring it up.

Dr. Chey Ranasinghe:

It is associated with a lot of, like I said, the identity, masculinity. So I understand it's a hard topic to approach, but it is something that, if it's on your mind, important to seek help for it.

John Horton:

Now, you had mentioned that pattern, and I think we've all seen it with people close to us, where it kind of starts at the temples and it works back and all that happens. I take it there's a reason why it goes in that sort of loss pattern.

Dr. Chey Ranasinghe:

So when your genetic blueprint is being made, when you're being formed, if you will, it is in that particular distribution. For some individuals, it's right on the temples. For some individuals, it's right on the vertex of the scalp that those genetically susceptible hair follicles that are very sensitive to DHT are being placed. And that is how that pattern distribution of the male pattern hair loss presents.

John Horton:

So it's coded in. I mean, you're created, everything's mixed up. It comes out, it's already programmed in that this is how your hair is going to gradually recede. And it does seem like you see it's in the temples and it kind of works its way back. You get that little peninsula sometimes in the front and then that bald spot right in the back. And then, it seems like they just kind of meet in the middle.

Dr. Chey Ranasinghe:

Yeah. So that's why when there is even the earliest sign of a change that's happening, it's very important that patients come in and see their dermatologist because there are treatments that can slow this process down, that can maybe even stop or reverse some of it if done early.

John Horton:

All right. Well, we're going to get to that here in a second. And so I want to say, as far as age, you'd said most of them, it's around 35 you really start to notice it, but it can start much, much earlier. I mean, you will see those almost teenagers or college kids, and it's like it's already moving back. So is that something you see a lot of or are people just kind of sensitive, they don't come in?

Dr. Chey Ranasinghe:

I think because my practice does focus on hair loss, I probably do see it more than the average dermatologist seeing those younger pediatric patients. Probably my youngest patients that I'm working with right now are around 16, 17 years old. And a part of it could be mom and dad are noticing these changes and one of them have experienced some form of hair loss and just want to be proactive. Or social media … that is bringing awareness to treatment options or patients are able to see, "Hey, this is a problem and there is something I can do about it." So I do think I am seeing more patients earlier than maybe I would've 10 years ago.

John Horton:

A lot of times, do people come in because they think it's something else other than hair loss? They think maybe there's another medical condition. Could it be another medical condition? Especially if you start seeing it very early.

Dr. Chey Ranasinghe:

So a lot of patients are worried that it has to do with something underlying, like a hormonal issue. And what I tell them is, what's happening in the bloodstream and what's happening at the level of the hair follicle are often two very different things.

So hair loss does not equal a high testosterone level. Rarely, hair loss can be associated with hormone abnormalities, but that's the exception, not the rule. So in certain individuals, after we do a very thorough clinical history and clinical intake on them and after our discussions, if I feel like there may be something more going on, such as a thyroid abnormality or an adrenal gland abnormality or testosterone imbalance, I certainly do get the appropriate labs and rely on my endocrinology colleagues as well for assistance if needed in those rare cases.

John Horton:

But it sounds like for the most part, if you're losing your hair, it is just, you are losing your hair. It's usually not something more sinister underneath.

Dr. Chey Ranasinghe:

Exactly, exactly. Male pattern hair loss is usually a clinical diagnosis. Labs are often normal in majority of my male patients, which is good, which is reassuring. So like I said, it's good to talk with your physician and make sure we're not missing anything else that may be going on.

John Horton:

Now let me ask you this. Why are guys the lucky ones here? We're the ones who experience the hair loss. I'm glad women don't have to deal with it. I guess what's kind of causing it to happen on one side as opposed to the other?

Dr. Chey Ranasinghe:

It's the testosterone. So females do experience female pattern hair loss as well, but it's in the postmenopausal phase of life. We see it more often because in postmenopausal phase of life, the estrogen goes down and the testosterone goes up. So females just experience this pattern hair loss in a different stage of their lives, not as early as males because we have the estrogen for protecting us from that testosterone and that DHT. So that's why the timing is different, but the prevalence is actually quite similar between males and females with this form of hair loss.

John Horton:

OK. All right. It seems to happen in a different pattern, though. I mean, you just don't see it. It doesn't seem as pronounced. I know maybe a little thinning, some things like that, but not that same receding, the temples and the-

Dr. Chey Ranasinghe:

…not as often will we see the receding hairline in females. It will be almost like a Christmas tree pattern, is what we describe it as. Just thinning along the midline frontal hairline right here. And then, it's almost like just a backward triangle going here to our vertex where we'll see that thinning there. It's, again, just a part of our blueprint, our genetic makeup when we were formed.

John Horton:

All right, so obviously then, we have all this going on. We have this hormonal thing happening. We have genetics that we're dealing with. But as we've talked about ahead of this, there are things people can do to maybe stop some of that receding or at least slow it down a bit. So walk us through this. How can we stop hair loss?

Dr. Chey Ranasinghe:

So again, going back to another analogy I like to use. Right now, we're outside a lot. We're tending to our gardens and tending to our lawns. And I say, it's much easier to keep grass healthy, your lawn healthy, than to have to regrow the grass after the lawn is bare, right?

John Horton:

Right.

Dr. Chey Ranasinghe:

And they nod their heads, OK. And I say, in other words, hair loss treatment is about preservation first. Regrowth is second. So again-

John Horton:

…keep what you got.

Dr. Chey Ranasinghe:

Yes, exactly. So it's a hard pill for patients to swallow when they hear that, oh, I just can't give them a pill, and in two weeks or three weeks that quickly they can just be cured of hair loss. No, it's a chronic condition. There is no permanent cure.

John Horton:

We're not Chia Pets™, is what you're saying.

Dr. Chey Ranasinghe:

No.

John Horton:

Not going to happen.

Dr. Chey Ranasinghe:

But whatever we're starting together, if you develop hair that you like, the hair is growing because of what we started. So you need to be on whatever we start forever if you want to keep the hair that we've grown together.

John Horton:

Yeah, let's talk through those medications. I think we've heard about them, but what's the main, the go-to one?

Dr. Chey Ranasinghe:

The go-to’s, yes. So there are two FDA-approved treatments. One is topical minoxidil. And interestingly enough, minoxidil was actually not developed for hair loss. It still is used as an oral blood pressure medication. And it was developed back in the '70s, where researchers saw, OK, the blood pressure's under better control, but also these patients have really good hair.

John Horton:

Yeah, look at their hair. Yeah, they look fabulous.

Dr. Chey Ranasinghe:

Well, back in the '70s, that led to the topical formulation of topical minoxidil, and that's found over the counter. So if males are noticing thinning, topical minoxidil is often the first line of treatment I recommend. It works best if used early, obviously, if used consistently. So that is one option.

John Horton:

OK. Now, you said it's a topical, you can get it over the counter. Is it just, you do a little dab, you kind of put it in, rub it around daily or something like that?

Dr. Chey Ranasinghe:

So it depends on the distribution of the thinning and where the patient is concerned for where they want to try to grow more hair. The way I instruct it may not follow exactly what's on the box. But for example, if we're just worried about the frontal hairline and the temples, I tell them directly, with that, that it's a tube that comes with the nozzle attachment on top. Just apply that nozzle right along that frontal hairline there. And I know it may sound odd for some patients, but if they don't want to use their fingers to apply it in, believe it or not, I tell them to use either a new makeup brush that they're not going to use, if it's a female for example, or a male, or use a new toothbrush that again, you're not going to use in your mouth to apply the medication because that dermabrasion allows for the medication to be applied more precisely to the level of the scalp.

I really don't want you to waste that medication on your actual hair because that's not where the magic happens. The magic happens right here on the scalp, and it allows for a more precise application so the cosmesis of it is not too disruptive to hairstyling methods, for example.

John Horton:

So using your lawn example, it sounds like then, you're kind of fertilizing the lawn a little bit right on that ridge line.

Dr. Chey Ranasinghe:

You got it.

John Horton:

And does that help then? Because you said the hair never just goes away. It's just not growing as strongly as it did before. So I take it then that this minoxidil, it kind of works to bolster the hair that's there and maybe have it grow a little thicker, a little longer?

Dr. Chey Ranasinghe:

You got it. You got it. Exactly. So minoxidil is promoting blood flow to the scalp so that those hairs can stay thicker and fuller longer and be in the anagen or the growth phase much longer.

John Horton:

And you said guys can just go pick this up and experiment with a little bit. Are there things they have to worry about, some side effects? Any concerns?

Dr. Chey Ranasinghe:

So like with anything, there's always some considerations and side effects. The main one being scalp irritation some patients can experience. The dosing is twice daily on label, but sometimes that can be too irritating. Even once daily could be too irritating for my more sensitive skin type patients. So that's one consideration.

Another is if the patient has cats or dogs, I always counsel, you need to make sure that animals are not coming in direct contact with the scalp or with the product itself because it can be really harmful and dangerous to their heart.

But those are the main drawbacks I would say for my male patients to consider. And also not everyone responds.

John Horton:

What is the success rate? When you start putting it in, you fertilize the field, what are we looking at?

Dr. Chey Ranasinghe:

There's so many variables. I don't think I can give you an exact number because I don't know how far progressed that patient is, what are the other factors we've reviewed and are they being consistent or not? So if you're coming in early and you're just seeing a little bit of thinning, and if you are going to be putting that medication on daily, twice a day, religiously, I would say at least an 80 to 90% success rate that I've seen in my clinic. So it is a great first-line medication for majority of my patients.

John Horton:

And success rate, when we're talking about here, is that just then you're not losing more, or do you actually see some regrowth eventually?

Dr. Chey Ranasinghe:

Both.

John Horton:

Both. Wow. So you do see regrowth. All right. I take it you're not going to have a giant bushy head of hair maybe again, but just you can get a little bit back?

Dr. Chey Ranasinghe:

Yeah, I would say a lot back. Again, it just depends on how far progressed you are. But at the end of the day, I think the goal is just, are we happy? Truly. I always tell patients, "I'm happy when you're happy. If we have gotten you to a point where you're not having to think about your hair daily, I would consider that a win."

John Horton:

Now, we've been talking about the topical minoxidil. You said now it's also available in oral form?

Dr. Chey Ranasinghe:

Yes. So oral minoxidil, again, this is now … we're using it off-label for male pattern hair loss, and it's widely used off-label by dermatologists across the world. It is a great option for patients who have tried the topical minoxidil and they've either had side effects or the big factor is the cosmetic aspect of it, meaning they don't like how their hair feels. The hair can kind of feel like a straw-like texture when used for certain individuals or they've experienced the scalp irritation or they just don't have the time and they're not compliant. They're like, "Doc, I can't put this on my entire scalp twice a day, every day. I got to go to X, Z meetings and I can't keep up with it." So they'd rather just take a pill a day. And the results are equivalent to what we would see with topical minoxidil. It's just way easier to take.

John Horton:

OK. I take it that's something, too, if you have pets or things like that, it might be a better option, especially if they're ... I mean, pets are always all over the place. If they sleep with you in bed, things like that, I'd imagine that topical cream, it just gets places.

Dr. Chey Ranasinghe:

Exactly, exactly. It's so much more convenient to take a pill, but then there are side effects to a pill because now we are systemically absorbing that medication versus just being able to control topically where it goes on our body. So the main side effect with that is increased hair everywhere.

John Horton:

OK. That's the cruel thing when you end up, you're losing your hair on your head and yet it's going crazy everywhere else. Your eyebrows, your ears, it's not fair.

Dr. Chey Ranasinghe:

I know, right? There's no perfect, perfect medication. But I will say the body hair honestly does not affect majority of my male patients. Obviously, where's it going to be most obvious is the facial aspect of it, but males honestly don't seem to mind that as one of the side effects, which is good.

John Horton:

Yeah.

Now, the oral one, is that prescription only or can you get that over the counter?

Dr. Chey Ranasinghe:

That is prescription only. Again, because there’s more side effects that needed to be reviewed. It's also off-label use. And we have to do screening. We need to make sure patients have optimized their cardiac health, as well as there's no kidney issues, and need to make sure they aren't predisposed to swelling. So there are some things we need to discuss in a clinical setting to make sure that this is something that's appropriate and safe for them to take.

John Horton:

All right. Well, that was the minoxidil side.

You said that there was another FDA-approved approach to restarting that hair or addressing this. What would be the other one?

Dr. Chey Ranasinghe:

The other one is called finasteride. So finasteride, that is an oral medication. Again, actually that was originated as a completely different medication. That was for and is still being used for enlarged prostates. And when patients take that, we see you have a really great head of hair, too.

John Horton:

It's so wild how these things just, they target one thing, and it's like, wow, we're seeing some good stuff over here, too.

Dr. Chey Ranasinghe:

Yes. Yes. And this is working a different pathway. So finasteride is reducing the amount of DHT that's being produced because it is blocking the enzyme that is converting testosterone to DHT. So remember that DHT, that's the hormone that's responsible for that miniaturization. So patients can be actually on two medications. Most of my patients are actually on two medications, meaning some form of the minoxidil, either topical or oral, and the finasteride, because the minoxidil helps the hair grow. It's the fertilizer, like you said, and the finasteride addresses why the hair is shrinking.

John Horton:

OK. So you're hitting it from both angles there.

Dr. Chey Ranasinghe:

You got it. And it's fairly well tolerated. But now, thinking about what are the side effects for the finasteride, there are some concerns for sexual side effects associated with the finasteride, and that's often our biggest barrier to treatment. But like any medication, side effects can occur, and that's just another conversation to be discussed with your physician.

John Horton:

All right. So we've kind of covered then the medication side. What other sort of treatments are available to maybe stimulate that hair and get it growing again?

Dr. Chey Ranasinghe:

There's definitely add-ons, add-ons to treatment. So one of them would be talking about red-light therapy. And there are red-light therapy devices that are FDA-cleared for treating androgenetic alopecia, otherwise known as the male pattern hair loss. And the important thing I tell patients is you need to look at the manufacturer's description because they need to make sure they're listing the specific wavelength. It's a sweet spot. It's 633 to 660 nanometers that this wavelength has been shown to promote cell regeneration and boost hair regrowth. So definitely a great thing, add-on that people can do at the comfort of their home.

John Horton:

Yeah. Now, when you say the red-light therapy, is this just ... I'm envisioning almost like a little cap that you wear that just has this red light and that just stimulates the follicles and helps them grow?

Dr. Chey Ranasinghe:

Yes. When you Google it, there's different forms that you could administer the red light. I personally like devices that are just easy to use. There's wands, there's headbands, there's helmets, but I am gravitating right now toward actual caps. They look like baseball caps, and within them, there's the red-light diodes. And you just put them on for six minutes a day while you're drinking your cup of coffee or watching TV or reading a book, you put them on at the comfort of your home with minimal side effects.

John Horton:

Wow. I mean, it sounds like an easy way to go about doing it and maybe just keep things growing.

Dr. Chey Ranasinghe:

Keep things growing and again, just add that additional coverage to preserve those hair follicles. I think the biggest factor to consider, though, is they are a financial investment. But in my opinion, it's worth making if it's the right product.

John Horton:

When you say financial investment, are we talking a hundred? Are we talking a thousand? In between? What are we looking at?

Dr. Chey Ranasinghe:

It ranges. I think the models that I'm gravitating toward, because they have great clinical data, and also my patients are using them, and they're coming back and I'm seeing the clinical results, are ranging between $800 to $1,500. Yeah. Yeah.

John Horton:

But if you want to keep the hair in there, I guess it's what you do.

Dr. Chey Ranasinghe:

Preparation. Yes. Yes. So not necessary, not mandatory, an add-on and adjunctive to our therapy.

John Horton:

Now, there was one other thing I know we wanted to touch on, which was platelet-rich plasma. Walk us through that treatment and how you go about maybe getting that.

Dr. Chey Ranasinghe:

Yes. PRP is a wonderful in-office procedure that we provide at the clinic. I do this procedure. And what happens is, you come in and see me, and you need to make sure you're very well hydrated days before our procedure because we're going to draw a good amount of blood from you. And what happens is, once we've drawn the blood, we put it in a centrifuge. We spin that blood down and that separates our blood into different components. And what I use is that top-most component, which is liquid gold, literally. It's our PRP, and it has growth factors, it has stem cells, it has healing proteins that your own body has created. We remove that top layer, the supernatant from that test tube, and we inject it right into the scalp to, again, boost the hair follicles, help with that cell rejuvenation. Again, it's an add-on therapy, not a necessary thing that needs to happen. An add-on therapy to the topicals and the orals we previously discussed.

John Horton:

Yeah. And is that a one-time treatment thing or do you have to keep coming back?

Dr. Chey Ranasinghe:

Yes. Like with anything, maintenance is required to see results. So typically, patients come and see me monthly for the first three to four months, and then typically, every six months to maintain the results.

John Horton:

So it sounds like it's one of those things, once you start going down the path, there's a lot of different approaches you can take. You kind of see how it's going, and then it sounds like you, say, experiment a little bit, but you just see what's working and what extra you might need.

Dr. Chey Ranasinghe:

You got it. It's trial and error. It's definitely a long conversation we have in these appointments, going through what are the pros and cons of each of those treatment options. What is going to fit with your lifestyle? There's so many considerations that go into deciding it, but the bottom line is determining what you're comfortable with and what you will want to continue for the rest of your life.

John Horton:

Yeah. And you had said that there are other treatments coming down the pipeline. I guess if 85% of guys are dealing with this, you understand why they're looking to get new products out there. It looks like there's some real advances being made?

Dr. Chey Ranasinghe:

Yes. What's so exciting is, for nearly three decades, 30 years, we've essentially had the same two FDA-approved treatments, the topical minoxidil and the oral finasteride, and that's finally going to be changing. So there are two new medications. One's a new topical and one's a separate new oral medication that's coming down the pipeline. It's projected for early 2027, and if approved, they would have the potential to significantly expand our treatment options for male pattern hair loss. So I'm excited that there's something more that I can provide for patients in the near future.

John Horton:

Yeah, we'll have to have you back. So that's an excuse to bring you back on, which I always like.

Dr. Chey Ranasinghe:

No problem.

John Horton:

So we've touched on the medical side of it and the things you can do in these treatments. Are there just basic lifestyle changes that you can make that'll make your hair happy and just kind of help it flourish?

Dr. Chey Ranasinghe:

It goes back to again, the basics. Hair is protein. It's made out of protein molecules. So we need to make sure we're nourishing our body with the right amount of protein and the right amount of protein and the micronutrients as well, meaning zinc and iron vitamins in order for our body to have the building blocks and the foundation to build the hair. So if we're not focusing on nutrition, which I know we spent some time talking about the last time I was on the podcast, again, the hair won't be able to grow. So that's a big portion of it, is our nutrition, on top of considering our hormones if there are any hormonal imbalances.

John Horton:

And that's eating just a healthy diet. I think we had mentioned before the Mediterranean diet, which is the answer to everything from your heart to your hair to everything. I think it's the solution for all that ails you. Getting in some protein.

I know when we talked earlier, you wanted to make sure that we address that there are some things you should not take. And I think it was biotin?

Dr. Chey Ranasinghe:

Yep. So when we're thinking patients will come in, because my patients are so knowledgeable with the internet, but sometimes there can be supplements that are poorly marketed. So one of them is biotin. And biotin is a supplement that when we look at the scientific literature, patients who are taking biotin versus patients who are not, there is no statistical significant difference in terms of their hair regrowth. On top of that, it can also alter our thyroid functioning testing and it can mask enzymes that are elevated in a heart attack.

John Horton:

Oh, wow. Yeah.

Dr. Chey Ranasinghe:

So I'm like, just save your money. Honestly, spend that on a vacation rather than spending it on the supplement because that will make your hair grow more, just relaxing a little bit on vacation more than the biotin.

John Horton:

Well, I want to make sure we touch on it because you were like, "No, that's a definite. Stay away from it." It sounds like it's marketed that way because, like you said, you go online, you can find an awful lot trying to go, "Hey, take this and you'll have a lush head of hair pretty soon."

Dr. Chey Ranasinghe:

Yes. Wonderful marketing, but we don't have the science to truly back up the claims.

John Horton:

All right. So kind of a good multivitamin hit your, you said your vitamins A, B, C, D, E. I mean the alphabet soup there, zinc, iron, calcium, selenium. I think we're all good for hair. OK.

Dr. Chey Ranasinghe:

Yes. Yes, you got it. Well-balanced diet. I'm more about eating it rather than taking it in a supplement or a pill form.

John Horton:

What about stress? I know you had mentioned that earlier. I think we all kind of associate high stress with not being good for everything with your body, but also with hair loss. Can that play a role in what's happening up there?

Dr. Chey Ranasinghe:

Definitely. I'm not going to say it's a major reason for why males are having male pattern hair loss, but it is certainly a contributing factor because it is increasing our cortisol levels. And this hormone imbalance then disrupts the hair cycle and that then leads to follicle dysregulation. And the hair is a very sensitive organ. Again, people don't think of it as an organ, but it is.

John Horton:

It is weird to think of it that way. You just think of it as hair. I mean, an organ, you think of your heart and your lungs and things like that. I don't think of my hair the same way.

Dr. Chey Ranasinghe:

Yes, it's a very sensitive organ. So another analogy, this will probably be my last analogy, but another analogy I share in clinic, it's like a rose bush. Roses are so hard to grow. You have to have the right amount of sunlight and water and soil preparation and fertilizer. But if any of those factors are skewed, forget it. You're probably going to kill your rosebush. So same thing with the hair. If we are not having our stress under good control, if our hormones are imbalanced, if we're not using the fertilizers or we're not using the minoxidil, if we don't have the nutrients, like the diet we talked about, we're not going to be able to grow and have the hair that we're striving for.

John Horton:

And it sounds like that's just overall just good hair care, good scalp care is all kind of taking care of that garden that we have up here.

Dr. Chey Ranasinghe:

Yes, yes. Thank you for also mentioning scalp health as well. That is another big focus that we do talk about in my clinic as well is shampoo and hair care practices and how we're cleansing the scalp, how often we're cleansing the scalp, because a healthier scalp: healthier hair.

John Horton:

Yeah. I feel like if someone's listening to this, they're getting great hair tips and also fabulous long hair tips. I mean, we're kind of hitting everything.

Dr. Chey Ranasinghe:

Two for one.

John Horton:

So with everything that we've just covered, and there was a ton, and a lot that people can just do on their own, steps they can take, all of that and be very proactive. But if someone is listening to this and wondering, "What is the first step? What do I need to do?" What would be your advice to them?

Dr. Chey Ranasinghe:

Yeah. If you're noticing thinning, widening part, recession at the temples, just seeing your scalp more easily, don't assume it's too early to do something about it. Seek a dermatologist, board-certified dermatologist, to make sure that they are doing a complete intake on all aspects of your life and getting the lab work if found appropriate, because the biggest mistake men make is waiting. And as simple step as talking with a professional and/or just starting the over-the-counter minoxidil will help those hair follicles stay. It's easier to save those hair follicles, preserve the hair follicles rather than try to resurrect them.

John Horton:

Well, and that's the thing. It sounds like the things that we have to deal with it, they're not miracle workers. I mean, they're not going to take a bald head and all of a sudden, seed it and give you a whole head of hair. You've got to take care of it as it's starting to recede.

Dr. Chey Ranasinghe:

Exactly. Exactly. And remember how we talked about the statistics? Male pattern hair loss is incredibly common and it's not a reflection of your health or masculinity or something that you've done wrong. It's biology. Fortunately, it's one of the most treatable forms of hair loss that we see in clinic.

John Horton:

Well, I think you've given people a lot of reason for optimism.

If you are a guy and you're looking in the mirror and wondering if things aren't moving in the direction that you want with your hair, it sounds like, get on the phone, get an appointment, get in there and talk to somebody and you can probably, hopefully save what you got.

Dr. Chey Ranasinghe:

Couldn't agree more.

John Horton:

Well, Dr. Ranasinghe, this has been a fabulous discussion. I'm sure there's a lot of guys who will be listening to this and, hopefully, maybe taking a closer look at what they've got going on and maybe take action.

Dr. Chey Ranasinghe:

Yes, I hope so, too. Thank you so much for having me, John. It was always a good chat.

John Horton:

We love having you in here. We'll have you back soon.

Dr. Chey Ranasinghe:

Thank you.

John Horton:

If you are experiencing hair loss, know that there may be ways to slow your hairline's retreat, especially if you start early. So don't brush concerns off. Talk to your healthcare provider and get a treatment plan in place.

If you liked what you heard today, please hit the subscribe button and leave a comment to share your thoughts. Until next time, be well.

Speaker 3:

Thank you for listening to Health Essentials, brought to you by Cleveland Clinic and Cleveland Clinic Children's. To make sure you never miss an episode, subscribe wherever you get your podcasts or visit clevelandclinic.org/hepodcast. This podcast is for informational purposes only and is not intended to replace the advice of your own physician.