Hair Today, Gone Tomorrow Part 3: I Asked An Expert
With all the discussion around my first two posts on my experience with hair loss over the age of 45, I was compelled to reach out to someone who has made it her business the last 30+ years. Her name is Dr. Karen Neubauer and she is my cousin, whose opinion I trust implicitly.
I remember when I was in high school, she started specializing in men’s hair transplants and one of the things that stuck in my mind the most when I asked her about the procedure, she said, “Balding doesn’t affect men’s hair on the lower back portion towards the neck, so that’s where we take the hair from and transplant it on top of the head or the sides where the balding is prominent.”
Don’t ask me why I remembered that from when I was 16 years old, but I did.
Fast forward to my forties where I have been riding the perimenopause train which, not surprisingly, comes with thinning hair. After doing a ton of research on my own and trying to get two gynecologists to put me on HRT and being denied, (that’s a whole other effing story which I apparently included in this story), I succumbed to the fight and just started using Rogaine and taking overpriced vitamins to little avail. It wasn’t until I wrote the two pieces for Substack that I was compelled to actually dig deeper and man oh man, you won’t believe the things I uncovered, discovered and was downright shocked by.
Conversation below. (fyi, it’s a quicker read than it looks!)
In Laughter,
LStL
LStL: What is going on with us, and our hair, as women? What happens as we age? Is it just that testosterone levels get higher in women and lower in men and that is what is causing all hell to break loose?
Dr. Karen: To some degree, but not exactly. So, when your ovaries shut down, you still make testosterone but you don’t make estrogen or progesterone, but the levels are still lower. So hair loss can be for a lot of different reasons: You can have androgenic alopecia which is, the androgens that are circulating miniaturize the hair follicles causing it to thin…the smaller the follicle, the smaller the hair. That is more of a genetic issue, typically that runs in families.
LStL: Is that where the idea that you get your hairline from your mother’s father?
Dr. Karen: That’s actually a falsehood, because it can be either side. It doesn’t have to be on one paternal or maternal side. It’s either side.
LStL: WTF?? I literally believed that my whole life.
Dr. Karen: I used to believe that too. And that is usually characterized by, if you part your hair down the middle, it’s a widening of the central part. It’s how you can kind of see it, and so women tend to retain a fringe of hair around the frontal hairline and, along the back by the neck, and the top gets thinner.
LStL: That’s what’s happening Karen! I remember when you were going to school for this and something that stuck with me, isn’t it weird the shit that sticks with you for no apparent reason, you said once, when you were working on men and you were doing hair transplants, you said that the men were still growing thicker around the nape of the neck, it would be thicker than the rest of the head, and take that hair and transplant it to the top and the front.
Dr. Karen: Yes, yes, and that is still what they do. They still transplant the hair from the occipital scalp where the hormones don’t affect the hair there. The follicles are not affected. The follicles that are, are on the top of the head.
LStL: Well, I can see and feel that on my own damn head right now, where the hair is thicker and normal at the back towards the neck and not on top. Wow.
Dr. Karen: Okay, so when did it start?
LStL: I didn’t really notice until about two years ago.
Dr. Karen: Did you feel like it was gradual? Or did you feel like it would come out in clumps like when you would comb it or take a shower?
LStL: Gradual loss over the years. And I started using all the fuckin’ products, the minoxidil by mouth then the Rogaine for Men because it is stronger than the Women’s version.
Dr. Karen: They are both the same, they are just marketed differently. But I have found, for my patients, that the foam is much better tolerated and a lot less irritating vs. the icky liquid.
LStL: My doctor said I had to use it everyday. So how many days can you miss it where it doesn’t affect the process of growth?
Dr. Karen: For all types of hair loss, actually oral minoxidil is more effective.
LStL: When I took that for a year, I started to see extra hair growth all along the left side of my body; my neck my arm, it was weird.
Dr. Karen: (Laughing) huh? That’s bizarre. That is one of the side effects. They say that typically you will get a little more peach fuzz on your face, and people use that, you know those eyebrow shavers to scrape off peach fuzz on the face.
LStL: Does that make it grow back thicker? When you use a blade?
Dr. Karen: No. No. Cutting the hair on the surface does not make it grow back thicker. You’re not affecting the follicle, the follicle is where it’s growing from, it has nothing to do with it.
LStL: So that’s also a fallacy?! A follicle fallacy!
Dr. Karen: (Laughing) Yes. Totally.
LStL: So if we literally shaved our faces with a razorblade like men do, it wouldn’t come back like a man?
Dr. Karen: No. It has nothing to do with it. It might feel thicker because it is a blunt cut, so you’re feeling it as thicker but it isn’t.
LStL: My whole life I was told the opposite.
Dr. Karen: Me too. So back to the oral minoxidil, if you are growing extra peach fuzz on your face then that is typically a sign that it is working.
LStL: Well, the growth freaked me out so recently, my doc put me back on the Rogaine topical and prescribed spironolactone, 50 mg/day which is an anti-androgen that helps in blocking the hair loss. And it also gives a little vitamin A so you don’t need your expensive retinol cream. Am I saying that right and do you think that using both of those now is a good choice?
Dr. Karen: Yes. So, you can do Spironolactone and minoxidil or you could do Spironolactone and topical minoxidil. What it does, is it basically competes for testosterone at the hair follicle so it kicks testosterone off of the hair follicle.
LStL: This makes me think of the cause and effect of things which brings me back to the hormonal aspect of being a “woman of a certain age.” About 5 years back I went to my gyno for my annual visit and told him that my mood was fluctuating a LOT. I was depressed but not the kind that was kill-yourself-depressed because I knew it was hormonal. So he prescribed Prozac. It felt completely wrong to me that I was being prescribed a psych drug to address something that I knew in my guts was hormonal. .
Dr. Karen: Yes. It’s completely ridiculous.
LStL: So I literally never took it! I just pitched it when it expired and I’m like, if we’re looking at aging where men start looking like women and women start looking like men, then it must all be hormonal and shouldn’t that be what treatments should be focused on?
Dr. Karen: Yes.
LStL: And with that, when we are talking about menopause in general, wouldn’t it be a good idea to address ALL of these issues with Hormone Replacement Therapy (HRT)?
Dr. Karen: Yes. 100%. Actually, I am right now, doing a complete deep-dive on this because, I feel like we were sold a fake bill of goods. When I first got out of medical school, because I went more of an internal medicine route, I would ask patients who were coming in for dermatological issues if they were taking hormones and they would say, “no”, and I would tell them that they really needed to be on HRT because it protects your heart, it protects your bones, it helps prevent other metabolic things like type 2 diabetes and insulin resistance, and mood…just everything. So I would advise them all to go on HRT.
Then, in 2002, the Women’s Health Initiative (WHI) came out and that study, which was flawed but no one had dissected it at the time, and neither did I, I just fell for it hook line and sinker, which said that women should NOT be on HRT/estrogen-progesterone replacement because it increased their risk of cardiovascular disease and increased their risk of stroke as well as breast cancer. And now, that is ALL BEING DEBUNKED.
LSTL: Woooooooooow.
Dr. Karen: So, my mom died of breast cancer and as soon as that study came out, I basically freaked and automatically I decided that I would never go on HRT at all because of my risk for getting breast cancer too. So for the last 10 years I have not been on hormones and I have done myself a complete disservice and I am currently looking for a doctor and it is almost impossible to find one who will prescribe it for me.
LStL: Oh my god!! Me too! I know! Two different doctors refused to put me on it because of that exact same study!!
Dr. Karen: It makes me so mad at myself that I didn’t dissect that study myself because I could have been on it the last ten years and actually helping my body be stronger and healthier. The women who participated in the study that were older were having more side effects but women who are older are by nature, more prone to have a higher incidence of stroke, dementia and cardiovascular illness etc. but actually estrogen is protective of all of the things that prevent those illnesses. So we’ve all been sold a bill of goods there.
LStL: Men were probably the ones doing the research.
Dr. Karen: (Laughing) Yeah, probably! It’s crazy. Just breast cancer risk alone was increased by 1 case per every 1000 women, I’m not exactly sure of the particulars, and it was not good in any way and we took it all as gospel.
LStL: So a year ago, I went to my gyno, a different gyno, a woman, and she asked why I was there because it wasn’t my annual checkup and I said, “I would like you to put me on HRT and was told that only my gynecologist can do that.
Dr. Karen: Did she not want to have any part of it?
LStL: None. I told her I was losing my hair, I have mood swings, all of it, and she says, “I’m sorry. I can’t give it to you. You’re aren’t really a candidate for it and it causes more problems than it helps.” Exactly what you just said!
Dr. Karen: Oh my god. So she is completely uninformed too which is scary.
LSTL: So here we are, once again women being completely fucking ignored and not by men…BY OTHER WOMEN!!
Dr. Karen: Oh, it’s bad. It’s really bad. Um, so you need to start following Dr. Mary Claire Haver, MD (@drmaryclaire) who just came out with a new book on menopause. She posts a lot of research articles and all of the stuff we are talking about now and the positive effects of HRT: decreased risk of dementia, increased bone density, etc. I mean, if you think about it, most women when you get to a certain age, what you die of typically is, you fall and break your hip and then you have osteoporosis and you don’t have the muscle mass to really sustain you either. We get, basically frail.
LStL: And then you go in the hospital and you get fucking sepsis like my dad.
Dr. Karen: Yeah, and then you die of that! And these are all things that could have been prevented really. Because we probably weren’t designed to live this long? So we are living like, two-thirds of our lives without hormones. I asked one of my friends who is on HRT where she went to get it and it was like “spa” that one side of it is run by a gynecologist who has nurse practitioners attending to patients, but the other side of it is an actual spa with face treatments and massages.
LStL: That seems trashy and underground and no one wants to do that! I want to go to an actual doctor who has gone to medical school man and not the University of Phoenix Online for my shit.
Dr. Karen: Yeah! Right! Dr. Mary Clare Haber just put out a booklet that you can download all about all of it. What kind of HRT is better. I mean the ones back in the day were made from estrogen from horse pee.
LStL: I just threw up a little in my mouth.
Dr. Karen: And back to asking the question about, if this were men, wouldn’t they have this figured out by now?
LStL: Well, they are more worried about selling dick pills and making sure that their manliness is protected over the actual health of the women they are trying to have sex with. Which brings me to the point of, if our hormones are falling off, is there a point where we just accept that we are here now. I mean, do we have to, should we be fucking into our 90’s? Really?
Dr. Karen: That’s the other thing. It’s like, we are supposed to accept that men can pretend to be 30 years old forever. But I think that you are in a better place because I feel like I wasted ten years of not doing anything about it. I’m afraid to get my bone density done now. So I kind of feel like I want to read a lot more now that I know that that study was terrible and it has really harmed a lot of women.
LStL: Yup. And when you know better you have to do better. The calling is upon the experts like you and Dr. Mary Clare and all the OBGYN’s out there who CAN make the change from women being ignorant, to being informed.
Dr. Karen: There’s a website that where you can find providers in your area that deal with the menopause and the perimenopause and hormonal stuff. A lot of OBGYN’s don’t even want to go there so it’s important to find one that is willing to have the conversation.
LStL: This has been so incredibly informative Karen. Thank you so much for taking the time. And to circle back to the topic I originally called you about, HAIR LOSS, can you give me your down and dirty professional opinion on what to do with two scenarios: 1.) If you are rich and can afford the best regimen and 2.) If you aren’t rich and need the normal person’s regimen. GO!
Dr. Karen: Okay, a rich person’s, and regular person’s regimen would be to do what you are doing now: oral minoxidil + the Spironolactone. Now, if you are rich you can ADD to that regimen with the PRP (platelet-rich plasma injections) first and if it’s pattern hair loss and it’s not coming back, you could do hair transplants.
LStL: So you can do the minoxidil, the spironolactone and the PRP together? And if all that fails, you’re looking at a hair transplant?
Dr. Karen: Yes.
LStL: PRP is expensive isn’t it? Here in NYC I think it’s about $1K per treatment?
Dr. Karen: Yeah, it depends on where you live.
LStL: Well, I gotta take my kid on his first driving lesson. Give me the run down of how someone who is experiencing hair loss should approach their treatment. GO!
Dr. Karen: You want to make sure you have basic blood work done to make sure that there is not some reversible cause. Ie. You want to make sure you aren’t anemic or have thyroid disease. Sometimes you go through a sickness, like you experienced hair loss with Covid, people lose their hair after child birth, or they experience something very stressful that causes their hair to fall out. You want to essentially eliminate other factors with your doctor before you agree on a treatment plan.
LStL: So If you were to get HRT, would you recommend continuing the monoxidil + Spironolactone + PRP while you take HRT?
Dr. Karen: I would probably overlap it.
LStL: (Laughing) If we can find someone to actually give us the hormone replacement therapy in the first place.
Dr. Karen: (Laughing) Right.
Dr. Karen Neubauer, DO is a mohs micrographic surgery specialist in Leawood, KS and has over 32 years of experience in the medical field. Dr. Neubauer has extensive experience in Skin Cancer & Excision. She graduated from A. T. Still University Kirksville College of Osteopathic Medicine in 1991. She is affiliated with medical facilities Saint Luke's Hospital of Kansas City and Cox Barton County Hospital. She is accepting new patients.
RESOURCES ON MENOPAUSE
ZocDoc HRT Positive OBGYN Finder:
Dr. Mary Clare Haber’s Book:
https://www.amazon.com/New-Menopause-Navigating-Through-Hormonal/dp/059379625X
CBS did this great piece on Menopause and how/why HRT became ostracized by the medical community. Aired 4/7/2024:
https://www.cbs.com/shows/video/wi94eIzGFPpE_yuHjfuc42GVfeDCBcNN/
Great read! Natasha is going through similar with her hair now... I'll pass this along.