​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
the New York Times
 
What Happened to That Comb-Over?
Many balding men got hair transplants during the pandemic. Now they’re girding themselves for the return-to-office whispers.

​Joining the pandemic boom in cosmetic tuneups, many follicularly challenged men have used their time away from the office to embark on a fresh new look of their own: a hair transplant.

To some, a recarpeted scalp is a way of turning back the clock to a glorious youth. To others, it’s a business move, a way to burnish their image so as to rearm themselves for a return to the corporate trenches.

But to many, it’s … well, a little awkward. Wait, weren’t you the guy with the comb-over?

“Always, the dilemma is, what are people going to say?” said Robert Golden, 51, a tax adviser in Los Angeles who sprang for a hair transplant last winter while working remotely. “Do you tell anybody you’ve done it?”

Men often feel sheepish about undergoing a hair transplant, at least at first, said Fabien Beretta, the executive director of the Beverly Hills Hair Group in Beverly Hills, Calif., where Mr. Golden went for his transplant. “Men are a little more iffy about getting anything cosmetic,” he said. “Women talk about it openly. Guys want to hide it.”

There is nothing objectively embarrassing about a hair transplant. Even so, old stigmas linger. The internet is filled with articles like “Why You Shouldn’t Be Ashamed of Getting a Hair Transplant.”

New hair in general, particularly toupées, have long served as gag material in movies and television shows. “Why don’t you get a pair of white shoes, move down to Miami Beach and get the whole thing over with,” Jerry teased George in the “Seinfeld” episode where the latter bought a new rug.

This may explain why celebrities like Tom Hanks, Jude Law and Matthew McConaughey who appear, uh, “less bald than they used to be,” as Buzzfeed once put it, tend to remain mum about their bushy new manes, leaving tabloids to play the guessing game.

“It’s like one of those old ’80s rom-coms, where the geek suddenly gets this flashy makeover and shows up at the club,” said Mitchell Virzi, 29, one-third of the Los Angeles comedy team called the Virzi Triplets, identical brothers who all got hair transplants in recent months. “For a lot of guys, it can feel awkward, like you’re trying on a new personality.”

Then there are the perception problems of springing for a “luxury” like cosmetic surgery, particularly during troubled times.

Transplants are not cheap, averaging around $7,000 but often rising to $20,000 or more, depending on geography, the type of procedure and the amount of work that needs to be done, said Dr. Akash Chandawarkar, a former plastic surgery chief resident at Johns Hopkins University who is now in Manhattan.

To some guys, that can seem a little, well, vain.

“There’s still that old stigma, where guys aren’t supposed to worry about how they look and spend a lot of money on their appearance,” said Alex Virzi, another of the newly coifed triplets.

That doesn’t seem to be dissuading many balding men.

“It’s the largest demand I have ever seen,” said Dr. Marc Dauer, a hair restoration surgeon who practices in Los Angeles and New York City and has seen about a 30 percent surge in hair transplant procedures, and a 50 percent increase in transplant consultations, during the pandemic.

The Beverly Hills Hair Group has also seen a 25 percent spike in inquiries in recent months, and other cosmetic surgeons interviewed reported a similar surge.

Some of this apparent boom seems attributable to the pandemic itself.

Extended time away from the office gave men the cover they needed to slip away for the procedure, then recover away from prying eyes of co-workers.

There is also “Zoom dysmorphia,” in which people feel the need to “fix” perceived “flaws” in their appearance spotted during endless hours of video conference calls. “On FaceTime, Skype or Zoom, people are looking at themselves more than anyone they’re talking to,” Mr. Beretta said. “It’s like they’re sitting at home all day looking in the mirror.”

Then there is the emotional drain of the last 18 months, which is enough for even people with the fullest heads of hair to find their shower drains clogging with hair. Intense stress, as well as post-viral inflammation from Covid-19, can also cause temporary hair loss known as telogen effluvium.

Whatever the traditional hesitations, the old shame over new hair may be fading, especially in this age of oversharing.

It helps that the post-surgery results are not as stark as they once were. A popular method of hair transplants these days — follicular unit extraction, in which surgeons plant individual follicles from the back of the head onto the top of the head — can take months to start filling in. (“It’s like a Chia Pet,” Mitchell Virzi said.)

For Mr. Golden, the tax adviser, his initial trepidations dissolved quickly once he saw how much his new hair boosted his confidence among friends and even with his wife, he said.

And when he finally returned to the glassy high-rise office a month ago and displayed his new tresses to colleagues, the real shock was how little people cared, or even noticed.

“To be honest, it wasn’t like I walked in and people said, ‘Oh, you got a hair transplant,’” he said. “It was done so well that people didn’t even really notice. They were like, ‘Did you get a haircut? You look younger.’”

When you exit the shower, it’s not always soap and dirt you’ve left behind. Instead, you may find clumps of hair clinging to your drain.The good news is, even if you feel like the clump looks super-sized, hair falling out in the shower is totally normal — everyone, regardless of gender, sees some shedding during a scrub.

Keep reading to find out why hair falls out in the shower — and when you should call your doctor about your hair loss you see in the shower or beyond.

The Stages of Hair Growth

There are several phases of hair growth. A 2017 research review showed that these phases include the following phases:
​

• Anagen. Approximately 85% to 90% of hair is in this active growth phase at any given time.
• Catagen. About 10% of hair is in this degenerative growth phase at any given time.
• Telogen. About 5% to 10% of hair is in this resting phase at any given time.

A 2018 research review showed that when these phases are in their normal balance, the average person sheds about 100 hairs a day.

You shed your hair during the telogen phase. If the phases become imbalanced and more hair enters the telogen phase, you may observe increased hair loss.

Additional factors for hair falling out in the shower

It’s understandably difficult to go back in your shower and count each hair individually. So, before you worry about shower-related hair loss, consider a few factors:

• Your hair thickness. Thick hair typically has a higher number of hairs overall. Proportionally, you may lose more hair because you have more hair.
• When you last took a shower. Hair often falls out in the shower because you stimulate your scalp when you shampoo or condition your hair. Your hairs that were already destined to fall out get the nudge they need from shampooing, and your hair comes off your head. If it’s been a few days since your last shower, you may notice more hairs falling out.
• When you last really brushed your hair. This is a similar principle to when you shower. Combing and brushing your hair, along with showering, are the two events where you’re most likely to notice hair loss.

The shower is usually the place where you notice hair coming out the most. While it may seem like there’s a lot of hair, it’s probably just your body’s natural way of shedding.

What Could Be Causing Hair To Fall Out in the Shower

If you feel like the clumps of hair you see in the shower are larger than usual — or also are coming out in large amounts on your hairbrush — you should first consider any potential underlying causes.

Stress

According to a 2017 research review, an increase in clumps of hair in the shower is often due to telogen effluvium. This condition occurs more hairs are in the telogen phase and, thus, fall out more easily.

The same research review above showed that the most common trigger is something many people know well: stress.

Stress may be physical (such as after an illness or weight loss) or emotional. Usually, if you think back to the past 3 months or more, you may be able to connect higher stress levels to hair loss.

When to Call a Doctor About Hair Falling Out in the Shower
 
If you don’t feel like stress could be the underlying cause or you’re still not sure, it may be time to call your doctor.

One symptom that could indicate a need to call your doctor is the pattern of hair loss.

When you experience telogen effluvium, the hair loss is usually all over your head. If the hair loss is profound, you may feel like your hair is thinning significantly.

Hair loss due to other conditions, such as alopecia areata, usually causes patchy hair loss. This is a different, but treatable, underlying cause of hair loss.

Preventing Hair from Falling Out in the Shower

If you notice your shower hair loss more, there are at-home actions you can take that may slow the shed. These include:

Combatting your stress

Finding ways to relax can help fight stress, which is known to be a cause of hair loss.

Examples could include:

• getting more sleep
• exercising
• meditating
• trying to take at least 10 to 15 minutes for yourself every day

Addressing the source of stress

While this isn’t always possible, take a look at what is causing your stress. Perhaps you are taking on too many projects outside of work, or you have a friend or family member who is asking too much of you.

When possible, lessening or removing the stress source can help resolve hair loss and make you feel better overall. Talk to your employer or people who are close with you about how they might be able to help you.

Changing your diet

Your body requires a number of vitamins and minerals to grow hair. These include:

• vitamin A
• vitamin D
• iron
• selenium
• zinc
• other nutrients

While vitamins are available, often the best way to incorporate these is to add more nutritional foods to your diet.

Colorful fruits and vegetables are excellent sources of nutrients. Make an effort to add one to two a day, and you can ideally improve your hair health.

Taking gentle care of your hair

Heat styling, harsh brushing habits, or strong chemicals used on your hair can all increase the rate of hair loss due to breakage.

Taking steps such as switching to a gentle shampoo, allowing your hair to air-dry after bathing, or refraining from wearing very tight hairstyles can all help to reduce the amount of hair that falls out later in the shower.

Does shower frequency matter?

There’s some debate over whether taking fewer showers could reduce hair shedding.

If you’re using super-hot water or irritating hair products in the shower, taking fewer showers could likely reduce hair shedding. But waiting longer between showers as a way to reduce hair loss could just mean you notice more hairs in the shower.

The hairs that do fall out naturally are always going to, no matter what, and it can look like a lot more shedding that it is since they’ve had a few days to build up.

Takeaway

Hair shedding in the shower usually isn’t cause for concern — it’s just the place you’re most likely to notice your hair coming out. This is true for males and females.

Talk with your doctor if you notice any of the following:

• your hair seems to be falling out at an increased rate
• you notice patches of hair coming out
• you can’t track your hair loss back to a possible cause

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. ​

Hair Transplantation is a procedure that helps people who experience hair loss and baldness problems that occurs due to various reasons: genetic factors, stress, and hormone disorder.  FUE Hair Transplant method is a process of relocating hair follicles under local anesthesia with special medical devices from the donor area to the balding areas. In this application, hair is extracted one by one and transplanted to the balding area. Hair should be shortened to 1mm prior to the operation. The surgery is conducted under local anesthetics, so the patient will not feel any pain. Micromotor is used to extract hair grafts; the tip of the motor simply pulls the hair root; therefore, the follicle is cut in a cylindrical way along with microscopic tissue. ​

What to consider before the operation?

Hair Transplantation is a serious practice that should be done by professionals specializing in that field as the output of the operation will be seen throughout your life. Hair transplant procedures should take place at a hospital or clinic with surgeons specialized in their field.

What are the advantages?

FUE method is the most commonly used and reliable method for hair transplant. Advantages of FUE hair transplantation are as follows:

• No incision and suture marks at the site of the operation.
• The process is completed in a short time thanks to thin-tipped devices.
• Natural and aesthetic appearance.
• Short healing duration and opportunity to return to normal life instantly.

Who can get a hair transplant?

Hair transplantation surgery can be conducted for the male and female types of hair loss. Male-type hair loss affects the upper part of the head and the temple area; firstly, hair becomes skinny, and then fall out. Over time, this spill may stretch back to the temples.

Female-type hair loss works in a different way; it involves hair weakening, rarity, thinning and loss in the peak and anterior areas of the scalp.

Who can’t get a hair transplant?

Not everyone is eligible for a hair transplant; for example, it is technically impossible for people who do not have any hair in the back of the head - which is also called the donor area. Also, some diseases such as severe heart problems may be dangerous during transplant surgery.

Cases that hair transplantation is recommended

Another criterion necessary for hair transplantation is the type of hair loss. For example, people at the adolescence age are not recommended to have the operation as their hair loss may continue. However, if permanent hair loss occurs in certain areas of the head as a result of accidental damage to the scalp such as severe burns, these people can undergo a hair transplant under a supervision of a doctor. Furthermore, hair transplantation should not be performed for those with certain diseases due to vital risks such as hemophilia (A blood clotting problem), blood pressure, diabetes, hepatitis B, hepatitis C and HIV.


Where to have the operation?

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

How chronic stress leads to hair loss

Harvard University researchers have identified the biological mechanism by which chronic stress impairs hair follicle stem cells, confirming long-standing observations that stress might lead to hair loss.

In a mouse study published in the journal Nature, the researchers found that a major stress hormone puts hair follicle stem cells into an extended resting phase, without regenerating the follicle or the hair. The researchers identified the specific cell type and molecule responsible for relaying the stress signal to the stem cells, and showed that this pathway can be potentially targeted to restore hair growth.

“My lab is interested in understanding how stress affects stem cell biology and tissue biology, spurred in part by the fact that everyone has a story to share about what happens to their skin and hair when they are stressed. I realized that as a skin stem cell biologist, I could not provide a satisfying answer regarding if stress indeed has an impact — and more importantly, if yes, what are the mechanisms,” said Ya-Chieh Hsu, the Alvin and Esta Star Associate Professor of Stem Cell and Regenerative Biology at Harvard and senior author of the study. “The skin offers a tractable and accessible system to study this important problem in depth, and in this work, we found that stress does actually delay stem-cell activation and fundamentally changes how frequently hair follicle stem cells regenerate tissues.”

​The hair follicle is one of the few mammalian tissues that can undergo rounds of regeneration throughout life, and has become a paradigm that informs much of our fundamental understanding of mammalian stem cell biology. The hair follicle naturally cycles between growth and rest, a process fueled by hair follicle stem cells. During the growth phase, hair follicle stem cells become activated to regenerate the follicle and hair, and hairs grow longer each day. During the resting phase, the stem cells are quiescent and hairs shed more easily. Hair loss can occur if the hairs shed and the stem cells remain quiescent without regenerating new tissue.

The researchers studied a mouse model of chronic stress and found that hair follicle stem cells stayed in a resting phase for a very long time without regenerating tissues. A major stress hormone produced by the adrenal glands, corticosterone, was upregulated by chronic stress; giving mice corticosterone reproduced the stress effect on the stem cells. The equivalent hormone in humans is cortisol, which is also upregulated under stress and is often referred to as the “stress hormone.”

“This result suggests that elevated stress hormones indeed have a negative effect on hair follicle stem cells,” Hsu said. “But the real surprise came when we took out the source of the stress hormones.”

Under normal conditions, hair follicle regeneration slows over time — the resting phase becomes longer as the animals age. But when the researchers removed the stress hormones, the stem cells’ resting phase became extremely short and the mice constantly entered the growth phase to regenerate hair follicles throughout their life, even when they were old.

“So even the baseline level of stress hormone that’s normally circulating in the body is an important regulator of the resting phase. Stress essentially just elevates this preexisting ‘adrenal gland–hair follicle axis,’ making it even more difficult for hair follicle stem cells to enter the growth phase to regenerate new hair follicles,” Hsu said.

After establishing the link between the stress hormone and hair follicle stem cell activity, the researchers looked for the biological mechanism underlying the connection.

“We first asked whether the stress hormone was regulating the stem cells directly and checked by taking out the receptor for corticosterone, but this turned out to be wrong. Instead, we found that the stress hormone actually acts on a cluster of dermal cells underneath the hair follicle, known as the dermal papilla,” said Sekyu Choi, the lead author of the study.

Dermal papilla is known to be critical for activating hair follicle stem cells, but none of the previously identified factors secreted from dermal papilla changed when stress hormone levels were altered. Rather, the stress hormone prevented dermal papilla cells from secreting Gas6, a molecule that the researchers showed can activate the hair follicle stem cells.

“Under both normal and stress conditions, adding Gas6 was sufficient to activate hair follicle stem cells that were in the resting phase and to promote hair growth,” Choi said. “In the future, the Gas6 pathway could be exploited for its potential in activating stem cells to promote hair growth. It will also be very interesting to explore if other stress-related tissue changes are related to the stress hormone’s impact on regulating Gas6.”

These initial findings in mice need to be further studied before they can be safely applied to humans. Harvard’s Office of Technology Development has protected the intellectual property relating to this work and is exploring opportunities for collaboration on its further development and eventual commercialization.

Last year, Hsu’s group discovered how stress affects another type of stem cell in the hair follicle: the melanocyte stem cells that regenerate hair pigment. The researchers found that stress activates the sympathetic nervous system and depletes melanocyte stem cells, leading to premature hair graying. With the new study, the two findings together demonstrate that although stress has detrimental impacts on both hair follicle stem cells and melanocyte stem cells, the mechanisms are different. Stress depletes melanocyte stem cells directly via nerve-derived signals, while stress prevents hair follicle stem cells from making new hairs indirectly via an adrenal-gland-derived stress hormone’s impact on the niche. Because hair follicle stem cells are not depleted, it might be possible to reactivate stem cells under stress with mechanisms such as the Gas6 pathway.

Beyond the potential application of the Gas6 pathway in promoting hair growth, the study’s results have broader implications for stem cell biology.

“When looking for factors that control stem cell behaviors, normally we would look locally in the skin. While there are important local factors, our findings suggest that the major switch for hair follicle stem cell activity is actually far away in the adrenal gland and it works by changing the threshold required for stem cell activation,” Hsu said.

“You can have systemic control of stem cell behavior located in a different organ that plays a really important role, and we are learning more and more examples of these ‘cross-organ interactions.’ Tissue biology is interconnected with body physiology. We still have so much to learn in this area, but we are constantly reminded by our findings that in order to understand stem cells in the skin, we often need to think beyond the skin.”

This work was supported in part by the New York Stem Cell Foundation, Smith Family Foundation Odyssey Award, Pew Charitable Trusts, Harvard Stem Cell Institute, Harvard HMS Dean’s Award, American Cancer Society, James and Audrey Foster MGH Research Scholar Award, NARSAD Young Investigator Award, MGH ECOR Fund, New York State Department of Health, and the National Institutes of Health.

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

Birth control pills can cause hair loss due to their effect on a person’s hormones. Many prescription and nonprescription treatments are available for hair loss, or a person can switch to a nonhormonal form of birth control.

Any hormonal form of birth control — including oral pills, skin patches, hormone injections, and implants — can potentially cause hair loss. The ingredient in these products that may cause hair loss is progestinTrusted Source.

Progestin is a hormone that has androgenic activity, which means that it acts similarly to male hormones.

This article discusses birth control pills, their side effects, and how they may cause hair loss. It also examines the risk factors and treatments for hair loss. 

How birth control pills work

Birth control pills reduce the likelihood of pregnancy in a couple of waysTrusted Source.

Firstly, they prevent the ovaries from releasing eggs. Secondly, they thicken cervical mucus, which helps keep sperm from reaching the egg.

Other forms of hormonal birth control, including skin patches, minipills, progestin shots, and vaginal rings, all work in the same way.

Types of birth control pills

There are two types of birth control pills: combined and progestin-only. Doctors prescribe them, and a person takes one daily at the same time each day. Depending on the type of pill, some people might have a 7-day break from taking it each month.

Combined pill

A combined birth control pill, which some people simply call “the pill,” is a combination of progestin and estrogen.

Progestin is a synthetic form of progesterone, a hormone that the ovaries release naturally. The estrogen in the pills is also synthetic.

Due to the possible side effects, doctors may not prescribe these pills for:

• people older than 35 years
• those who smoke
• individuals with a history of breast cancer or blood clots

Progestin-only pill

The progestin-only pill is sometimes called the minipill.

It contains only progestin and is an option for people who cannot take estrogen.

Side effects

Both types of birth control pills can cause side effects, which can vary among individuals.

Combined pill

Side effects may include:

• breast tenderness
• nausea
• headaches
• breakthrough bleeding

The combined pill also carries some health risks, which include:

• deep vein thrombosis
• heart attack
• stroke

Progestin-only pill

Bleeding changes are the most common side effect of progestin-only pills.

The changes may be unpredictable and involve short cycles of spotting. Less often, people taking the progestin-only pill may experience heavy bleeding or no bleeding at all.

Other side effects may include:

• breast tenderness
• headaches
• nausea

Progestin-only pills do not have the risks that are associated with combined pills.

How the pill causes hair loss

Progestin is the component of birth control pills that causes hair loss.

Unlike natural progesterone, this synthetic form of the hormone has androgenic activity, so it may produce effects similar to those of male hormones.

The androgenic activity of birth control pills may cause various negative effects, including hair loss. Some progestins have a greater androgenic effect than others.

Birth control pills are more likely to cause hair loss in females who are hypersensitive to hormonal changes or have a predisposition to hormonal-related hair loss.
​
Those with a family history of hair loss should also be aware of this possible side effect. Anyone with concerns about hair loss can speak with a doctor about taking a pill that has low androgenic activity. Alternatively, they can ask about nonhormonal forms of birth control.