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Bernstein Medical - Center for Hair Restoration
Bernstein Medical In The News

Dr. Bernstein Featured in Huffington Post on Hair Loss Genetics

Huffington Post on Hair Loss GeneticsDr. Bernstein addresses the common myth that hair loss is inherited exclusively from the mother’s side of the family – and, more specifically, from your mother’s father. While your mother’s (or maternal grandfather’s) genes can be the culprit, the characteristics of your hair are influenced by many different genes that may come from either or both sides of your family.

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Hair Restoration Answers

Does Frequent Combing Cause Hair Loss?

Q: Is it ill-advised to comb one’s hair more than twice a day, especially hair that has been transplanted? Will frequent combing induce hair loss? — G.K. ~ Paramus, N.J.

A: Combing or brushing one’s hair does not cause hair loss – no matter how many times a day you do it. However, constant traction with braids or hair extensions can cause hair loss and this loss can be permanent.

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Hair Restoration Research

Study Identifies A Possible Cause of Age-Induced Hair Loss

We have known for decades that the incidence of male pattern baldness increases with age. New research published in the February 2016 edition of the journal Science has shed light on why this is the case. Researchers examining the role of hair follicle stem cells (HFSC) in the hair growth cycle have found that accumulated DNA damage in these cells results in the depletion of a key signaling protein and the progressive miniaturization of the hair follicle (and eventual hair loss). The study represents a breakthrough in our understanding of the cell aging process and could open new pathways for the treatment of not only hair loss, but other age-related conditions as well.

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Hair Restoration Answers

Can Resistance Training Accelerate Hair Loss?

Q: I have read several articles on the internet which suggest that resistance training can accelerate male pattern baldness. Is there any truth in this? — B.F., Altherton, CA

A: Anything that raises androgen levels in your body can potentially accelerate hair loss. That said, I suggest to exercise as you normally would. As long as you don’t take drugs to enhance your workout, the effects should be minimal.

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Hair Restoration Research

How Does Minoxidil Work? A Review Of Recent Research

Since 1993, minoxidil has been the most successful topical treatment for hair loss in both men and women, yet its exact mechanism of action remains unknown.

A 2004 review of minoxidil’s possible mechanisms of action (A.G. Messenger & J. Rundegren, 2004) suggests that the best evidence supports the idea that minoxidil causes hair follicles in the later phases of their resting phase (telogen) to shift prematurely into an active growth phase (anagen) sooner than they otherwise would; this causes rapid increase in hair growth. They also found good evidence that minoxidil works to thicken the hair by increasing hair diameter.

While minoxidil’s effects on other critical factors known to affect hair growth — such as cell proliferation, collagen synthesis, vascular endothelial growth factor and prostaglandin synthesis — remain uncertain, more recent research has found evidence that it may also suppress the androgen-androgen receptor responsible for androgenetic alopecia (Cheng-Lung Hsu, Jai-Shin Liu,An-Chi Lin, Chih-Hsun Yang, Wen-Hung Chung, & Wen-Guey Wu, 2014).

Understanding minoxidil’s exact mechanism of action remains today an important line of research both for the development of better hair loss treatments and for a better understanding of the biology of hair growth.

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Hair Restoration Answers

Why Am I Still Losing Hair (Shedding) After 6 Months on Minoxidil And Finasteride?

Q: I have been using an increased dosage of Propecia now for around 8 months and Rogaine for about 6 months. I know that shedding can be expected for the first 3-6 months, but I believe I am now beyond that timeframe. Have you seen cases in which these products merely exacerbate hair loss without the expected regrowth? — N.E., Travilah, Maryland

A: It is a bit long to still see shedding, but from my experience, either the medications are working (and you are still in the shedding phase) or you are not responding to them. I have not seen minoxidil or finasteride worsen hair loss. My advice would be to continue the same course for at least a year before re-evaluating their use.

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Hair Restoration Answers

Can Andro Gel Cause Hair Loss?

Q: The last few months my friend and I experimented with andro gel thinking it would make our T levels go up and make our work outs better. We got the andro gel online with no prescription (which I know is really stupid on our behalf). The past couple of months I have been experienced a lot of acne and hair loss. I went to the doctor and confessed and said what I did, and he was very disappointed and lectured me on how dangerous it was and stupid on my behalf – which I totally agree. He told me the rise in testosterone from andro gel contributed to the acceleration of hair thinning and acne. I had mild hair loss prior but the andro gel seem to have accelerated it. The doctor put me on Propecia and gave me some acne cream for the acne. He said the Propecia will undo some of the damage it did for the hair. In your experience, can Propecia reverse some of the damage? I am 28 years old.

A: Your doctor is giving you the right course of action. Testosterone supplements can accelerate hair loss, particularly in those with underlying genetic hair loss. Finasteride 1mg (Propecia) should help you to grow your hair back. You may also want to consider using minoxidil (Rogaine) in addition.

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Hair Restoration Research

Prostaglandin Discovery May Lead To Hair Loss Treatment For Men And Women

Miniaturized human hair follicle shows concentration of Prostaglandin D2 (in green). Credit: Garza and Cotsarelis/Penn Medicine)Researchers at the University of Pennsylvania, who were investigating the biological causes of androgenetic alopecia or common genetic hair loss, have discovered that levels of a certain inhibitor protein, called Prostaglandin D2 (PD2), are elevated in bald areas on the scalp. This discovery could be an important breakthrough in developing a medical hair loss treatment that regulates the production of the protein, or one that blocks it from attaching to its receptor protein.

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Bernstein Medical In The News

Fat Cell Discovery An “Important Step” In Understanding Hair Loss

In what might be another illuminating discovery on the inner-workings of hair growth, Yale University scientists have discovered that cells from the fat layer in the skin of mice contribute to the stimulation of hair follicles.

Dr. Bernstein, who was interviewed for the ABC News article, called the findings, “An interesting development in understanding why millions of people go bald.”

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Hair Restoration Research

Researchers “Accidentally” Reverse Hair Loss Caused by Stress

Sometimes an “accident” in the laboratory can lead to a remarkable breakthrough. Penicillin, Botox, Viagra, and Minoxidil — the active ingredient in Rogaine — were all unintended discoveries that led to treatments for a variety of conditions. A similar twist of fate, this time by researchers at UCLA, could lead scientists to a new hair loss treatment.

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Hair Restoration Answers

Does Sebum Cause Hair Loss By Blocking Pores On Scalp?

Q: I have been on finasteride for about 7 months. After my latest haircut I can see that my scalp is shiny. I read that is from sebum buildup and it can cause a layer that clogs the growth of hair. I was wondering if this is true and, if so, how can it be treated? — T.C., Philadelphia, PA

A: It is not true. Hair loss is caused by the miniaturizing effects of DHT on the hair follicle, not by blocked pores.

For more on this topic, view our pages on the causes of hair loss in men or the causes of hair loss in women.

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Hair Restoration Research

Dr. Christiano at Columbia University Identifies APCDD1, A Newly Discovered Gene Associated With Hair Loss

Dr. Angela Christiano of Columbia University in New York and a team of scientific researchers, have identified a new gene involved in hair growth. Their discovery may affect the direction of future research for hair loss and the diagnosis and ultimate prevention of male pattern baldness.

The condition, which leads to thinning hair, is called hereditary hypotrichosis simplex. Through the study of families in Pakistan and Italy who suffer from this condition, the team was able to identify a mutation of the APCDD1 gene located in chromosome 18. This chromosome has been linked to other causes of hair loss.

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Hair Restoration Answers

Why Does A Hair Transplant Work?

Q: Why does a hair transplant grow – why doesn’t the transplanted hair fall out? — J.F., Redding, C.T.

A: Hair transplants work because hair removed from the permanent zone in the back and sides of the scalp continues to grow when transplanted to the balding area in the front or top of one’s head. The reason is that the genetic predisposition for hair to fall out resides in the hair follicle itself, rather than in the scalp. This predisposition is an inherited sensitivity to the effects of DHT, which causes affected hair to decrease in diameter and in length and eventually disappear – a process called “miniaturization.” When DHT resistant hair from the back of the scalp is transplanted to the top, it will continue to be resistant to DHT in its new location and grow normally.

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Hair Restoration Answers

How Are Hair Cloning, Hair Multiplication, and Follicular Neogeneis Different?

Q: What is the difference between hair cloning, hair multiplication, and follicular neogeneis? I have read about these terms on the internet and am completely confused.

A: Cloning generally refers to the multiplication of fetal stem cells or embryonic tissues. “Hair cloning”, as the term is generally used, involves the multiplication of adult tissue cells that are used to induce the formation of new hair, so the term is not exactly accurate.

“Hair multiplication” refers to the multiplication of adult hair structures. This model is not actively being pursued since the hair follicle is too complex to be simply cultured in a tube. Instead individual cells called fibroblasts are removed from the scalp multiplied in tissue culture and then these are injected back into the scalp in the hope that they will induce intact follicles to form.

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Hair Restoration Answers

Which Contributes More to Hair Loss: Stress or Genetics?

Q: Can stress accelerate hair loss? I am 25 and there is balding on my dad’s side of the family. I never had any thinning or hair loss till this year. I guess you can say I’ve been under a lot of stress. When I did notice shortly after my 25th birthday I started stressing even more, which led to more hair loss. It is thinner up front and it is thin on top. I have heard of some hair docs mapping your head for miniaturization, do you do this too? — E.W., Miami, FL

A: Yes. The presence of miniaturization (decreased hair diameter) in the areas of thinning allows us to distinguish between hair loss due to heredity (i.e. androgenetic alopecia) — in which hair progressively decreases in diameter under the influence of DHT — and other causes. The degree of miniaturization can be assessed using a hand-held instrument called a densitometer.

The pattern of hair loss and the family history are also important in the diagnosis.

Stress more commonly produces telogen effluvium, a generalized shedding that is not associated with miniaturization and is often reversible without treatment.

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Hair Restoration Answers

What Causes Patch of Hair Loss in Women?

Q: I am a 34 year woman with a patch of hair loss by my temple. I went to the salon to have my hair done and to my surprise my hairdresser told me that I have Alopecia? First time I’d heard of it, my G.P is not very concerned about it but having read so much about it on this site I am becoming a bit concerned. The rest of my hair is healthy any suggestions and diagnosis? — M.V., Williamsburg, Brooklyn

A: “Alopecia” is just a generic term for any kind of hair loss.

It sounds like you have a specific condition called alopecia areata. Alopecia areata is an autoimmune disease that presents with the sudden appearance of well localized bald spot(s) on the scalp or other parts of the body. The underlying skin is always normal.

The treatment is injections with cortisone. Hair transplant surgery is not indicated for this condition.

You should see a dermatologist to confirm the diagnosis and treat.

Other diagnoses to consider are triangular alopecia (which would have been present since childhood) and traction alopecia (that is cased by constant tugging on the hair).

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Hair Restoration Answers

Can Women Experience Hair Loss from Hormone Replacement Therapy with Testosterone?

Q: Dr. Bernstein, a lot of older women are taking testosterone to restore libido, but are they going to suffer hair loss as a consequence?

A: They can. In women there is a delicate balance between the androgens, i.e. testosterone and estrogens. Estrogen is protective to some degree against hair loss in women, which is why most women don’t experience such severe hair loss as do men.

When a woman takes testosterone supplements it upsets that balance and can cause hair loss. However, hair loss in post-menopausal women is usually due to age related changes. Typically, the hair decreases in size in a genetically determined progression that seems not to be directly related to changes in the levels of hormones.

For more information, please see the Causes of Hair Loss in Women page on the Bernstein Medical – Center for Hair Restoration website.

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Hair Restoration Answers

Can Hair Loss be Caused by Thyroid Problems or Fluctuations in Hormones?

Q: One of the things that I have noticed as a person who has needed to take thyroid medication for a long, long time, is that when my thyroid gets a little bit out of balance – when I’m not getting quite enough, I begin to notice is that my hair starts falling out. What about the role of thyroid for hair loss? — T.K., Mineola, NY

A: Both increases and decreases in thyroid levels can cause hair loss and changes in the levels of thyroid hormone can change the consistency of one’s hair. Elevated hormone levels cause scalp hair to be fine and soft, with diffuse thinning being relatively characteristic.

When thyroid hormone levels are low, the hair becomes dry, coarse, and brittle. Hair loss can be either patchy or diffuse (involving the entire scalp).

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Hair Restoration Answers

What Causes Common Hair Loss or Baldness?

Q: I know that I am going to be bald because my father is bald and I am losing my hair just like him. What actually causes this kind of hair loss? — J.P., Paradise Valley, Arizona

A: Although there are many different causes, the overwhelming number of people that have hair loss have what is referred to as “patterned hair loss” or “androgenetic alopecia.”

In men, it is due to a hormone called DHT, which is a by-product of testosterone produced by the action of the enzyme 5-alpha reductase. This enzyme is inhibited by the hair loss medication Propecia. See the causes of hair loss in men page on the Bernstein Medical – Center for Hair Restoration website for more information.

In women, the mechanism is a little bit more complex as another enzyme, aromatase, is involved in the metabolic pathway. See the causes of hair loss in women page on the Bernstein Medical – Center for Hair Restoration website for more information.

We know that the inheritance comes from both the mother’s and father’s side, although the actual genes causing hair loss in men and women have not yet been identified. Statistically, the inheritance from the maternal side appears to be a bit stronger, but the reason for this is unknown.

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Hair Restoration Answers

Is Hair Loss Hereditary and are Genes Inherited from Mother’s or Father’s Side of Family?

Q: Why do some people have a full head of hair into their seventies or eighties and others start to go bald in their late teens or early twenties?

A: The cause is genetic and this poly-genetic trait can be inherited from the mother’s side, the father’s side, or both.

There is an old wives’ tale that it is inherited only from the mother’s parents. Although the inheritance can come from either side, it is actually greater from the mother’s side – but only slightly.

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Hair Restoration Answers

Is Success of Hair Transplant Affected by Age or Scalp Fibrosis?

Q: It is my understanding that as a person loses his or her hair, the skin of the scalp undergoes a number of changes, namely there is a loss of fat, an increase in cellular atrophy, and of course the dreaded perifollicular fibrosis (now that’s a mouthful). It seems to me that these changes, in particular the fibrotic scarring, are the main obstacles in the way of regrowth, and the reason Propecia does not work for extensively bald men. What can be done about this demon we call fibrosis? Can it be slowed, stopped, prevented, reversed? If we could somehow counteract collagen formation, wouldn’t our baldness problems be solved for good? If a bald scalp is atrophic, how does it have the capacity to hold a whole new head of transplanted hair? Is there a limitation to the number of hairs we can transplant (outside of donor limitations)? — R.L., Rivington, C.T.

A: The findings that you are describing are well documented; however, it is not clear if these changes are the cause of the hair loss or are the result of having lost one’s hair. Most likely, the DHT causes the hair follicles to miniaturize and eventually disappear. This, in turn, causes the scalp to thin and lose its abundant blood supply (whose purpose is to nourish the follicles). The changes in the scalp are also affected by normal aging, which causes alterations in connective tissue including the breakdown of collagen and other components of the skin. The changes seen with aging are greatly accelerated by chronic sun exposure.

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Bernstein Medical In The News

NPR Interviews Dr. Bernstein on Hair Transplantation and Hair Loss

Here is one exchange from the interview:

Moderator: How one can tell the difference between hair loss from hormonal imbalances and common baldness?

Dr. Bernstein: Measuring hormone levels alone, although important for medical management, does not necessarily reveal whether the cause of the hair loss is actually hormone related or is genetic. The diagnosis is made by examining the scalp and looking at the hair under close magnification using an instrument called a “Densitometer.”

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