This section is for the "Follically Challenged".  There are so many conversations and articles on the topic and I want make sure you are getting good information. 

This month's article is from a site I follow called:

​For many people, as they age, hair loss can be a pressing — at times upsetting — concern.

Androgenetic alopecia is the most common cause, which is experienced by more than 50 percent of people over age 50, according to the U.S. National Library of Medicine.

There are countless over-the-counter and prescription treatments for hair loss. Still, one popular anti-baldness drug, in particular, has generated controversy over recent reports that tie it to the incidence of depression — including suicidal ideation — and other negative health effects among users.

The headlines concerning these reports offer a reminder to those seeking anti-baldness treatments to consult their doctors about any new medication they might be considering.

Concerning Findings

The drug in question is finasteride, which is sold under the brand name Propecia.
Due to an investigation by Reuters, unsealed court documents and records reveal that U.S. regulators and drug manufacturer Merck were aware of reports of suicidal behavior among users of the drug.

They failed to include information of these potential risks in a 2011 update of the drug’s warning label.

Reuters revealed that since that call over whether that information be included on the warning label, the Food and Drug Administration (FDA) received more than 700 reports of suicidal thoughts and deaths by suicide among those using Propecia or its off-brand generic versions.

That number included at least 100 deaths. The news agency reports that within the first 14 years of Propecia sales, the FDA received 34 of these reports, which include those of 10 deaths.

They report that an internal company assessment shows that in 2009, Merck itself received 200 reports of depression — including suicidal ideation — among male users.

It was determined there wasn’t a high enough number of reports or enough specifics about cases of suicidal behavior and depression to require more than what was deemed regular monitoring of this data.

It’s not the only worrying data around this medication.

A studyTrusted Source published in 2020 showed that reports of anxiety, depression and suicidal thoughts among young men 45 or younger who used this drug increased significantly in the years since 2012.

That information was derived from a World Health Organization (WHO) database of drug safety reports from more than 150 nations, mirroring a 2015 study that looked at cases of sexual dysfunction and suicidal thoughts among people ages 18 to 45.

For its part, Merck said that “the scientific evidence does not support a causal link between Propecia and suicide or suicidal ideation and these terms should not be included in the labeling,” in a statement released to Reuters regarding the latest report.

“Merck works continuously with regulators to ensure that potential safety signals are carefully analyzed and, if appropriate, included in the label for Propecia,” the statement reads.

The FDA issued its own statement, asserting that it “continues to monitor postmarketing safety data for Propecia.”

The agency added that these kinds of reports do not “mean the drug caused the adverse event” and that related medical problems can be due to the “underlying disease being treated, caused by some other drug being taken concurrently, or occurred for other reasons.

What to ask your doctor before going on Propecia

Given Propecia, and other drugs like it are so commonly used, how concerned should you be if you’re seeking hair loss treatment?

“Patients should keep in mind that Propecia, or finasteride, is a very effective medication for most patients with male pattern hair loss, androgenetic alopecia, and that most people will feel better taking it because it is helping their hair loss,” said Dr. Carolyn Goh, associate clinical professor of dermatology at the David Geffen School of Medicine at UCLA.

Goh added that people pursuing this medication “should be aware of their mood while taking it” and look to “alternatives if they have a history of depression or other mental health problems.”

Dr. Barney Kenet, a New York City-based board-certified dermatologist, echoed those thoughts that if someone had a pre-existing mental illness, “it would be of concern that Propecia would unmask or exacerbate some mental health conditions symptoms.”

“There is also a low incidence of sexual side effects — low libido and erectile dysfunction — and for those reasons, it’s important that they have a good working relationship with their doctor,” Kenet told Healthline.

Despite the recent negative stories about the medication, a quick social media search finds direct-to-consumer companies such as Hims and Roman Health regularly touting the drug.

When asked whether she felt this is a drug that should be highlighted right now, Goh told Healthline that it should be made clear that it is “generally a safe and effective drug.”

“Direct-to-consumer companies have the benefit of making effective drugs more widely available, which is great, but perhaps discretion is advisable in this situation,” Goh added.

Kenet said that when you offer these medications to a wide audience through these kinds of channels, some customers who are at higher risk for negative side effects might not be getting all the information they need from a “glorified mail-order company.”

Both doctors said that, as with any medication, consult a doctor and medical team.
Research the medication and review with a doctor or medical team to discuss any underlying medical conditions to ensure appropriate treatment.

What else is out there?

If you have a history of depression or other forms of mental illness, what are alternatives if the reports about Propecia are a concern?

Goh suggested topical minoxidil, an FDA-approved treatment for baldness.
Topical minoxidil is also FDA approved for this kind of baldness, while it might not be as effective as finasteride, she added.

“Low dose oral minoxidil can be prescribed and may be a reasonable alternative. Topical finasteride can also be specially compounded and prescribed,” Goh said.

She cited studies in a 2018 reviewTrusted Source that show there “may be some benefit and safety” in topical finasteride, but “the studies are not rigorous and there is no commercially available formulation of it to know if it would be consistently helpful.”

“The laser comb, band, or cap — low-level laser therapy — is another option but tends to work less effectively. Platelet-rich plasma therapy with or without microneedling are other options as well,” Goh added.

Kenet also cited low-dose systemic minoxidil, but he stressed that this needs to be under the direct care of a doctor.

“There are weaves, toupees, and hair transplantation that are non-pharmaceutical,” Kenet added.

Hair loss and mental health

Underlying this discussion of safety around Propecia is the impact hair loss can have on one’s mental health. It can be distressing and sudden.

It also must be stressed that it impacts both men and women.

Estimates show that more than 50 percent of women will experience noticeable hair loss by age 50 and that female-pattern hair loss affects about 30 million women in the United States.

Essentially, for all people, it can take a psychological toll, especially those with underlying mental health conditions.

Whether compounded by the medication a person takes or not, what can one do to manage stress tied to balding?

Kenet said that “baldness is a big part of our culture, from movie stars to athletes.”
He said that while there is less shame attached to it now and that it doesn’t bear the stigma it had in the past, “it still can be quite traumatizing.”

Kenet recommends support groups like the digital platform “Patients Like Me” as well as the “The Bald Truth,” a radio show that is all things hair loss.

Goh highly recommends seeking help from a mental health professional.
​
“Online forums can be very helpful and are easily accessible, but they may not be moderated, so should be approached with caution,” Goh explained. “Many people may be hesitant to discuss with family and friends, but they may be surprised by how many people have experienced similar situations, so could be a good source of support.”

If there is anything to learn from the COVID-19 pandemic, it's that we are constantly discovering new things about the virus and its associated infection. Now new findings suggest hair loss may be a common long-term health consequence for patients who had severe COVID-19 that required hospitalization.

The findings, published in The Lancet, also suggest women may be at greater risk of suffering from long-term health consequences. 

Previous research has found 1 in 10 people may have persistent health consequences up to three months after their COVID-19 infection has passed. People that have long COVID commonly report symptoms of fatigue, loss of taste and smell, nausea, diarrhea, and abdominal, joint, and muscle pains.

The new study confirms that some of those commonly reported long COVID symptoms such as fatigue and joint pains could be considered as primary long-term health consequences of the virus, as their findings showed they were still reported six months after patients hospitalized with COVID-19 had recovered. Furthermore, an additional health concern was revealed: hair loss. 

The study investigated 1,655 patients that had been discharged from the Jin Yin-tan Hospital in Wuhan, China between Jan 7, 2020, and May 29, 2020, after being treated for COVID-19.

Six months later patients were examined again with blood tests, a physical exercise test that consisted of a six-minute walk, and a questionnaire to assess whether they had any long-term symptoms after their COVID-19 experience. 

The results indicated that 63 percent of patients had reported fatigue or muscle weakness, 27 percent reported sleep difficulties, and 22 percent reported they had experienced hair loss during the last six-month period since having COVID-19.

"At 6 months after acute infection, COVID-19 survivors were mainly troubled with fatigue or muscle weakness, sleep difficulties, and anxiety or depression," the authors wrote in the study. However, hair loss was also one of the highest reported symptoms six months on.

It's worth noting that hair loss is not uncommon during infections, and may occur for short periods of time after recovering from a regular cold. The American Academy of Dermatology Association (AAD) explains: "Temporary hair loss is normal after a fever or illness. Fever is a common symptom of COVID-19. A few months after having a high fever or recovering from an illness, many people see noticeable hair loss."

The AAD also says losing hair after infection could continue for up to six to nine months and that this could be made worst by stress, which is prevalent during a pandemic with all the health, social, and economic challenges it presents. Furthermore, worrying about losing hair could cause more stress, which can result in a vicious feedback loop, so learning ways to mitigate stress is important.
​
Your hair should return to normal on its own over time, but if you are concerned speak to your health care provider or a dermatologist.

This section is for the "Follically Challenged".  There are so many conversations and articles on the topic and I want make sure you are getting good information. ​

This month's article is:

 Platelet Rich Plasma for Hair Loss
PRP is an all-natural, minimally invasive treatment option for men and women with hair loss.

Androgenetic alopecia, or AGA, is the most common cause of hair loss among both men and women, affecting up to 40% of women and 70% of men. Visually, it's characterized by decreased hair density, diameter and length as thick, terminal hairs transition into thin, vellus hairs.

These changes often occur in a characteristic, gender-specific pattern. AGA has been associated with negative social implications and psychological conditions affecting quality of life. Current Food and Drug Administration-approved treatment options include oral finasteride for men and minoxidil for men and women, which are associated with potentially irreversible side effects, and linked with low patient compliance and suboptimal results. Due to limited effective therapies for AGA, platelet rich plasma – or PRP – has become an effective alternative treatment. PRP is an all-natural, minimally invasive treatment option for men and women with hair loss.

PRP is an autologous concentration of platelets in plasma with numerous growth factors that contribute to hair regeneration. The growth factors contained within platelets act on stem cells in the hair follicles and stimulate development of new follicles along with growth of new blood vessels. Since the early 2000s, PRP has been used across medical specialties such as neurosurgery, orthopedics and maxillofacial surgery for its wound-healing properties. Orthopedics has had success using PRP in joints after surgery and injuries, where they found there was less pain and faster healing due to its regenerative properties.

PRP is a volume of blood plasma that's concentrated (more than 1 million platelets/μL) with platelets. It's rich in growth factors contained in platelet granules. These growth factors bind to their receptors in the hair follicle, in turn helping to activate the growth phase of the hair follicle. Platelet-rich plasma has multiple actions at the hair follicle, leading to alterations in the hair cycle and improvement in hair growth.

Most of the literature and research supporting PRP for hair loss is with male or female pattern hair loss, or AGA. At the initial consultation, a doctor will discuss personal and family history of hair loss, along with dietary and lifestyle habits. It's important to discuss expectations and expected treatment outcomes with your provider, too.

Ultimately, PRP works best in combination with other therapies, both topical and oral, in order to address all the factors that can cause hair loss. It's also recommended to avoid NSAIDs, blood thinners and herbal supplements (such as garlic, ginko, vitamin E and St John's wort) for two weeks prior to treatment in order to decrease the risk of bruising and ensure the platelets are not affected. And it's advised to not color or dye the hair 48 hours before and after treatment. Hydration is also essential for 24 hours prior to injection, in order to ensure the maximum amount of plasma will be collected for each treatment. The procedure involves drawing blood, spinning it in a centrifuge for 10 to 15 minutes and then separating and preparing the PRP. Once it's prepared, it's injected into the thinning areas of the scalp through numerous injections.

From clinical experience, I recommend the use of PRP as a co-adjuvant treatment for AGA and encourage patients to continue topical and/or oral therapies (such as minoxidil, spironolactone and finasteride), as PRP does not suppress the hormonal component of AGA.
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Overall, our male and female patients have had positive results from PRP injections in AGA in terms of regrowth, increased hair density and improved quality of life. One are athat requires more research is how effective PRP is beyond one year of treatment. While many prospective and randomized controlled trials show benefit at three to six months of treatment, it's unclear when peak hair density is reached, how long treatment effects last and how often treatment must be continued after the short term. Longer-term, controlled studies examining these questions could eventually assist clinicians in establishing standardized treatment protocols.

It can be alarming to look at your comb or the shower drain cover and see a clump of hair. Not only could it clog your pipes, it can cause you to worry that it’s a sign of serious hair loss. But chances are what you’re seeing isn’t anything to be concerned about—and if you want to be sure, there are easy ways to check for abnormal hair loss without visiting a doctor.

The average person loses somewhere between 50 and 100 strands of hair per day, according to the American Academy of Dermatology. Yes, that’s a lot, so don’t panic if you see a few strands in your bathroom.

Hair shedding versus hair loss

While we’re on the topic, there is a difference between hair loss and hair shedding. The AAD notes that hair shedding—or temporarily losing a little more hair than usual—is completely normal, and usually occurs after a major life stressor or body change, like losing 20 pounds or more, giving birth, having a high fever, going off birth control pills, or caregiving for a loved one. Excessive hair shedding usually lasts for six to nine months, and then your hair growth and hair loss returns to normal levels.

Hair loss, on the other hand, is when something happens that actually stops your hair from growing, the AAD explains. Examples of this include hereditary hair loss, losing hair because of a medication like chemotherapy, using harsh hair care products, or having a compulsion to pull out your own hair. In these cases, the hair will not regrow until the cause stops—though that’s not possible in every case (i.e., if genetics are to blame). If you still have questions about the difference between hair shedding and hair loss, it may be a good idea to talk to your doctor.

That said, if you want to test your own rate of hair loss, here are two ways to go about it:

Pull test

​For a simple at-home test, Dr. James C. Marotta suggests you take about 60 hairs between your fingers and pull a little bit as you run your fingers through your hair. It’s normal to see five to eight hairs in your hand. If you have 15 to 20 hairs, though, you could be losing more hair than normal. Marotta explains:
​

Comb test

Here’s another test to try: Before shampooing, comb from the back of the top of your head forward to the front of the scalp for one minute. Do this while leaning over a lightly colored bed sheet, then count the hairs on the sheet. According to a study published in the Journal of the American Medical Association: Dermatology, you should see about 10 hairs. If you see more, you might be experiencing excessive hair loss.

Of course, there are a few caveats to both of these methods, including that these numbers are approximate and may differ between people with different types of hair. Also, we tend to lose more hair as we age, which, again, is normal. But the general idea is to get a baseline for your own head so you can tell when your hair loss has gotten worse.
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This story was originally published in November 2016 and updated on Dec. 2, 2020 to perform a copyedit and align the content with current Lifehacker style guidelines.