Thank you for your question.
You’re asking an interesting question because you’re stating this hormonal manipulation
for the purpose of transgender pursuit balancing where you feel that with the hormone levels
of testosterone being virtually zero and estrogen levels are close to a 100 and that a treatment
like Acell plus PRP could result in permanent prevention of hair loss.
Well, certainly I can share with you my perspective with my experience with Acell and PRP in treating
both male and female pattern hair loss. A little bit of background, I’m a Board-certified
cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have
been in practice in Manhattan and Long Island for over 20 years. I’m also the founder
of TrichoStem™ Hair Regeneration Centers where we have created a system using Acell
and PRP in our own way that helps people non-surgically suffering from male and female pattern hair
loss.
So when it comes to basic understanding of the effects of testosterone and hair loss,
it brings us to the knowledge that we have about DHT or dihydrotestosterone, understanding
that DHT sensitive hairs can be affected by elevated DHT levels. Therefore, a drug like
finasteride which lowers DHT levels or through effectively, whether it’s surgical or chemical
castration, eliminating testosterone altogether. No testosterone or lowered testosterone results
in no or lowered DHT.
Now it is known that in that scenario, men will not lose their hair but the question
remains as to the longevity of that when it comes to a situation, a transgender situation
with a genetic pattern loss that is present. Now understanding that androgenetic alopecia
has not only DHT as the only cause for hair loss, we’ve realized that essentially by
what we have observed, about 7 years ago when we were developing Hair Regeneration, the
treatment we have for hair loss, we were using Acellular matrix and PRP to help people undergoing
transplant and saw this interesting side-effect. What we can at least establish to this point
is that people who are not taking finasteride which means that they were not taking a DHT
blocker as well as women who have 1/6th the testosterone of men will both respond to treatment
with Acell and PRP combination in the way we were doing it and have been doing it. But
we can only state this for at least 5 years. We can’t say that it’s indefinite. What
we’re talking about is a theoretical potential benefit. But however, what we can at least
have to understand in the way I try to distinguish it is this way.
When we look at DHT, I think of it as something that is affecting in a toxic way the progression
of hair growth. So, in a way DHT is inhibiting hair growth. Take away the DHT, the hair should
grow. However, when we look at people taking finasteride for extensive periods of time,
they can still lose hair which means that it depends a lot on the relative DHT sensitivity
and there are other genetic factors that may be also responsible for hair loss progression
which means that you can still religiously take your finasteride for 10-15 years. You
may have slowed down the progression but you may not be able to stop the progression.
Now when we’re talking about this hormonal situation, yes, you might be on the right
track. But also, I would propose to you that when we are treating women and women don’t
take finasteride or it’s generally not recommended since we don’t believe that really it’s
the androgen sensitivity even though some doctors will try a trial of finasteride for
women. But generally speaking, female pattern hair loss, although it may look similar to
male pattern hair loss microscopically, we don’t treat it the same way. We’re able
to use Hair Regeneration effectively to treat female pattern hair loss. Again, stimulating
regrowth of hair that’s not growing, prolonging the growth cycle of existing hair, inducing
the shed of thinning hair so that thicker grows in. But again, with our data which began
7 years ago and aggregate overall the largest numbers, we have 5 years of data showing improvement
and stability for over 99% of patients.
So when I discuss the treatment plan long-term with our patients, I say that essentially
that there may be a value to a sustaining model where you may be coming in every 5 years
to get an injection to see if we can keep boosting the growth of hair. There are a lot
of things that happen every 5 years particularly on the age of onset. Because I’m a cosmetic
surgeon, I look at the many parallels between how the hair behaves on the scalp and how
skin and soft tissue behaves on the face. And so when we do PRP on the face and we do
this to help skin quality, to improve fine lines and wrinkles, to improve dark circles,
to improve acne scars, we know that we want to treat and try to mitigating or managing
a genetic progression of tissue loss. So in a way, I feel like there’s still some intrinsic
benefit in improving the skin quality of the scalp with Acell and PRP based on clinical
observations.
So depending on how your hair behaves, I think that you can certainly explore having this
treatment to maximize your hair growth if you have experienced any hair loss. But as
far as permanence is concerned, I think that’s a question that will only be resolved with
longer term use. You know, there’s a lot of theoretical ideals and there’s a lot
of conceptual theories about how these things work. This is the challenge of clinical medicine.
There’s a lot of theories but sometimes we don’t know exactly why something works
and yet, we do use these technologies because we observe that they’re safe and that the
clinical outcomes are positive. So consider this and certainly don’t stop doing research
and don’t stop asking questions but don’t make any assumptions.
I think that it’s very important, for your own health as well as the ongoing goal of
retaining your hair to keep your eyes open and to consider this concept of doing a treatment
such as Hair Regeneration in a sustainable way but when you think about having an injection
done every 5 years, that’s pretty sustainable. I think that it’s likely to be more practical
than it is to assume that there will be permanence. The reason I say that is that I tell my patients
that I don’t want to wait to see them lose hair before I do another treatment. I want
to stay ahead. So it is certainly a challenge when you do something that’s an innovation
and that’s really a development of a new category. But as long as we try to adhere
to quality of data and making good observations, I think we can only gain insight with time.
So I hope that was helpful, I wish you the best of luck and thank you for your question.