Feb
23
2019

Combatting Hair Loss

Dr. Alan Bauman gave a talk about combatting hair loss. This talk was part of the 26th Anti-Aging Conference of the American Academy of Anti-Aging Medicine in Las Vegas from December 13 to15, 2018.

Dr. Bauman is the owner of many hair loss clinics around the US. Dr. Bauman said that the baldness gene is present in 4 out of 7 men. The gene codes for male alopecia, which means hair loss. We are all familiar with it. First it causes only a receding hairline in the front. Later it causes thin hair and baldness at the crown. But in later years this gene causes baldness in males. One of the metabolites of testosterone, DHT (dihydrotestosterone) causes hair follicles to miniaturize. The result is that hair is no longer covering the scalp skin as much as it used to.

Mild hair loss

In the case of mild hair loss local application of 5% Minoxidil will often make a big difference. The physician will want to order a testosterone blood level. It this is low, replacement with testosterone will restore his libido, normalize his erectile dysfunction and give him more energy. Often his hair growth will also recover to a certain extent. Together with Minoxidil 5% he may be doing well for 5 or 10 years.

But eventually the persistence of DHT as the end metabolic product of testosterone gets the upper hand and causes more hair loss.

Low-level laser therapy is another method how to re-stimulate the atrophied hair follicles to grow to full hair again. Dr. Bauman showed amazing before and after images that documented vigorous new hair growth with low-level laser therapy.

Moderate hair loss

Those men who have the baldness gene will experience more severe hair loss by the age of 30 to 40. More effective methods are necessary to help him. Oral finasteride is one medication the doctor can prescribe. But one of the side effects can be a decrease in libido, which many men will not like. But the patient can apply finasteride 0.25% topical to the hair. This reduces systemic side effects, but helps the hair to grow. Minoxidil 5% can be combined with topical finasteride.

Platelet rich plasma

One step further is the use of platelet rich plasma. Blood is collected from the patient. A dual-spin procedure produces platelet rich plasma. This was tested in the laboratory and showed about 7-fold the amount of lymphocytes, 3-times the amount of monocytes and 6.3-fold more platelets than whole blood. This PRP preparation is injected into the areas where hair growth is missing. If there are still atrophied hair follicles present in the scalp, lush new hair growth will develop following PRP injections. The effect of the PRP injections can also increase by additional low-level laser therapy. PRP is especially useful for the treatment of alopecia areata, which otherwise would be difficult to treat. To a certain degree PRP injections will also serve a male well that has androgenic hair loss.

Severe hair loss

When a male with the baldness gene enters the late 50’s or 60’s there may no longer be viable atrophied hair follicles present in the bald areas. This is when you have to make a decision whether to shave your whole head and embrace baldness or whether you are using the more expensive hair transplant method. The occipital hair, even in bald people is not responding to DHT. This is why occipital hair is the ideal donator site for a hair transplant. This consists of harvesting DHT-resistant hair follicles from the occipital scalp and transplanting them into the areas that are in need to be cosmetically improved. It is a time consuming procedure, transplanting one follicle at a time.

Hair transplant

The technique is either manual transplantation or robotic-assisted hair transplant surgery. As only parts of the occipital hair follicles are useful material, there is no scar or baldness from the surgery. In 7 days the occipital area has healed over. A man may require 3 or 4 hair transplants in a lifetime to cover up areas of the scalp that were balding because of the baldness gene. But the end result is natural looking hair that now is resistant to DHT as it was transplanted from the occipital scalp. A total of four hair transplants are possible without denuding the scalp region. Dr. Bauman showed many before and after photos of men who had hair transplants.

Combatting Hair Loss

Combatting Hair Loss

Conclusion

Hair loss is common, perhaps more so in men than in women. However, in both cases a lot of therapeutic approaches are possible. Milder hair loss responds to treatment with Minoxidil 5%. In addition finasteride in a local 0.25% topical application is a choice. When hair loss is more severe, PRP (platelet rich plasma) injections into the scalp area are a possibility, but only where viable, but atrophied hair follicles are not growing enough hair. This may give a very acceptable result.

But the aging male who has genetic baldness working against him needs to consider a hair transplant with DHT resistant hair follicles from the occipital scalp into the bald areas.

The beauty is that there is a solution for every one. Due to extensive research of the various methods you can trust that they will give you the results you want.

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Sep
09
2017

Young Heart Stem Cells Can Cure Old Hearts

Young heart stem cells can cure old hearts in rats. This is what research at the Cedars-Sinai Heart Institute in Los Angeles found. You may not be that impressed, because this talks about rats and not humans. But this is a brand-new concept, so of course research of animal experiments is first.

The heart experiment

Dr. Eduardo Marbán, MD, PhD, is the research director of the Cedars-Sinai Heart Institute. His idea was to take cardiac stem cells (called cardiosphere-derived cells) from hearts of newborn rats. He injected them into 22 months old rats. The human equivalent for 22 months old rats are older people with older hearts. Within one months of the stem cells’ injections the older rats had normal functioning hearts. Their telomeres were also normal. Telomeres are the caps of the chromosomes of the heart cells. The researchers were astonished to find that the previously short telomeres had become longer. This happened within only one month of the stem cell injections. To Marbán’s surprise the older rats also grew hair faster and gained 20% of their previous exercise tolerance limit. In other words, the injection of heart stem cells had rejuvenated the old rats.

Dr. Marbán has previously shown that exosomes play an important role with stem cell regeneration of old heart cells. These particles from the stem cell donor contain RNA and other growth factors.

Overview of how stem cells can reverse heart failure

Cardiovascular disease includes high blood pressure, coronary artery disease, stroke and congestive heart failure. About 2600 Americans die from cardiovascular disease each day in the US. This is roughly one death every 34 seconds. With old age, if a heart attack does not kill you, congestive heart failure will. With heart failure your heart ceases to pump enough blood through your system. Nutrients and oxygen need to reach all of our cells or it means death for the patient. With the knowledge of this serious background, stem cells have come into the focus in an attempt to combat congestive heart failure.

Animal experiments with stem cells in mice, rats and pigs have shown some progress in restoring better heart function. Researchers used different sources of stem cells, like cardiac stem cells that reside in the heart muscle itself. They also used other stem cell sources. Among these were myoblasts (from muscle), mesenchymal stem cells (from fat tissue) and bone marrow stem cells. Several smaller human trials showed that improvement of heart function was possible following a heart attack. In the procedure the surgeon opened coronary arteries and injected stem cells into the affected damaged heart muscle. How can we assess the result of a successful stem cell treatment? By measuring the left ventricular ejection fraction. This means that the heart can deliver a larger volume of blood every minute. The heart pumps more blood from the left ventricle with each heartbeat than before the treatment.

Other experiments that rejuvenate tissues of older animals

Another line of experiments in this paper shows that certain growth factors are necessary to activate stem cells.

  1. One experiment from the 1950’s describes the stitching together of the skin on their flanks joined an old and a young rat. After this procedure the blood vessels grew and joined the two animals circulatory systems. The older animals knee cartilage damage was no longer there, as the cells from the young animals’ blood had healed the damage.
  2. Research had no knowledge of this fact at that time. But another research group in the 2000’s repeated the experiment and could prove that the stem cells of the young animals activated the growth factors in the old animals.
  3. In 2004 Dr. Rando noted that muscle cells of aging mice were aging because of a lack of stimulation of the local skeletal muscle stem cells. These are satellite cells. Experiments similar to the rat experiment showed that there were factors in the blood of young mice that could re-activate stem cells in the muscles of old mice. Agility and movement of the older mice improved. The improvement in the older mice with knee arthritis disappearing and liver cells rejuvenating was astounding.

More evidence that rejuvenation of heart cells is possible

  1. Amy J. Wagers, a former colleague of Dr. Rando carried on experiments with respect to rejuvenation of hearts in mice. She and her colleagues found what stimulated the hearts of old mice. It was a protein called GDF11 (from young mice).  This 2016 publication describes the action of GDF11.
  2. A 2014 paper describes that GDF11 was able to restore aging muscles to a youthful state. But the researchers were also able to rejuvenate stem cell function in general with GDF11.
  3. Another paper describes that blood from young mice stimulates the brain of older animals to achieve rejuvenation. It is the protein of the young stem cells (called GDF11) and possibly other growth factors to bring about this rejuvenation. It works not only on heart cells, but also on hippocampus tissue in dementia models. This may be important in humans for treatment of Alzheimer’s disease.

“We can turn back the clock instead of slowing the clock down.” Dr. Toren Finkel said. He is the director of the Center for Molecular Medicine at the National Heart, Lung and Blood Institute. He went on to say: “That’s a nice thought, if it pans out.” But others who caution that overstimulation of stem cells could cause cancers say: “It is quite possible that it will dramatically increase the incidence of cancer,” Dr. Irina M. Conboy said, a professor of bioengineering at the University of California, Berkeley. “You have to be careful about overselling it.”

Degenerative changes in humans responding to stem cells

Many degenerative changes in humans respond to stem cell treatments. Are there stem cells present in degenerative tissue in humans similar to the animal experiments described above? Are the stem cells merely providing growth factors so the dormant stem cells jump into action and regenerate? Could it be that in future therapists could give a certain growth factor mix  intravenously to a patient, and the same effect as stem cell injections would be posssible? These are all unanswered questions, but research in the next decade should answer at least some of those questions.

Growth hormone improving heart function in heart failure patients

In 2008 a metaanalysis of human studies of congestive heart failure and treatment with human growth hormone (HGH) injections was a research topic. It showed an average increase of the ejection fraction by 4.3%. There were also increased cardiac output, decreased systemic vascular resistance and improved hemodynamic effects. The question is whether the effect is a direct effect on the heart muscle cells by HGH or whether HGH was recruiting dormant heart muscle stem cells. This is not clear at this point.

Young Heart Stem Cells Can Cure Old Hearts

Young Heart Stem Cells Can Cure Old Hearts

Conclusion

We have entered an exciting period of medical research. Although there is only a record of many animal experiments, there is overwhelming evidence that the same principles are true in humans. Many stem cell protocols for humans have already seen use for various applications. But stem cell treatments for heart disease are still in their early stages. As it becomes obvious from my review of this topic, some patients who were part of clinical trials have already experienced positive results. Congestive heart failure or poor pump performance following a heart attack have improved following various stem cell procedures. In the next few years there likely will be a proliferation of treatment options for patients. Although some critics have pointed out a possibility of cancer developing as a side effect of stem cell treatment, no evidence is noticeable at this point.

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Oct
30
2015

There Is Help For Hair Loss

It is good to know that there is help for hair loss. One area where aging shows is the head! Often people who are aging are experiencing hair loss. Some individuals have a genetic trait that makes them vulnerable to early hair loss, while others are keeping their hair until a ripe old age. With regard to hair pigment it is similar: some people keep their own hair color well into their 40’s or 50’s, but later the grey hair shows. Loss of hair color is about loss of hair pigment. One or more genes regulate whether or not we lose the hair pigment early or not. While there is not much we can do about our hair pigment other than coloring our hair every 3-4 weeks, there is something we can do about hair loss on our scalp.

Androgenic alopecia

Physicians call male and female hair loss “androgenetic alopecia”. It occurs in individuals who are genetically exposed. Interestingly baldness is rare in Chinese, Japanese and in Native American populations. Baldness more commonly affects men of Caucasian descent.

Onset of hair loss

In people who are prone to hair loss baldness typically starts in the temporal areas.

The genetic factors that lead to baldness can be inherited either from father or mother’s side. They are polygenic, meaning that there is not only one cause of hair loss. Gene frequency is most commonly associated with Caucasians. In Africans the frequency is lower and lower still in American Indians, Asians, and the Inuits.

Types of hair loss

The Norwood scale is used as classification of hair loss in men. In women hair loss is classified using the Ludwig and Savin scale. This helps to record the findings of a hair examination and is useful for research purposes as well.

Hormonal factors regarding male pattern baldness

There are several hormonal factors that are involved in the development of male pattern baldness. 5-alpha reductase converts testosterone (T) to dihydrotestosterone (DHT). DHT is more powerful than testosterone, causes shortening of the hair cycle and miniaturization of hair in the balding areas. After several years those who have genetically predisposed androgen receptors in balding areas come down with baldness. There are two isoenzymes of 5-alpha reductase, type 1 and type 2. Individuals born without type 2  5-alpha reductase do not develop androgenic baldness.

Aromatase can cause baldness

Another factor for baldness can be an enzyme, aromatase, located in the fatty tissue that converts testosterone into estrogenic hormones. A lack of testosterone can lead to baldness by this mechanism. Many men in their 50’s and 60’s who are overweight or obese are balding because of this mechanism. The other mechanism, as explained above is via DHT in genetically susceptible men. This process starts to occur mostly in individuals who are in their forties.

Treatment of hair loss

Mild cases of hair loss

This may respond to topical treatment with minoxidil that can be used on the scalp as liquid or hair foam. Systemic treatment in men is possible with finasteride (Propecia) or Dutasteride (Avodart). It helps to block the hormonal pathways regarding 5-alpha reductase and DHT that leads to baldness. In aging men in their 50’s and 60’s it may be that testosterone levels are low. Blood tests can test for this: the total testosterone level should be above 500 ng/dL. If it is less, testosterone replacement by bioidentical testosterone cream or by injection should be considered and usually works quite well with respect to regrowth of scalp and body hair.

Moderately severe hair loss

This can be treated with PRP (platelet rich plasma). This treatment modality cures about 30% of hair loss. There have to be enough hair-rejuvenating stem cells around the bald skin to stimulate hair growth. However, when baldness has set in for some time in an area of the scalp with previous hair growth, there comes a point where the hair follicles die off and even stimulation with PRP will not help. When dermatologists used extracellular matrix (called “A cell”) in combination with PRP the success rate for hair growth in a bald area jumps up to 70 to 80%. The A cell material recruits stem cells from the blood that create hair follicles in the bald skin starting hair growth again.

Severe hair loss

A cell and PRP treatment are not sufficient for this. It requires more invasive treatment: the bald skin usually does not contain any hair follicles. So, what can one do in such cases? Dermatologists detected that dense hair from the back of the head (nuchal area) is transplantable to a bald skin area. It will usually grow very well there. In the beginning of doing hair transplants little discs were transplanted and this looked at times like checkered hair growth in the previously bald area. Newer research showed that miniaturized transplants with perhaps three hair follicles harvested under the microscope from the dense area and transplanted into the bald area give a smooth, natural looking appearance. These are “follicular unit hair transplants”. Nowadays hair transplant physicians will only do this type of hair transplant procedure because of the superior cosmetic result.

There Is Help For Hair Loss

There Is Help For Hair Loss

Conclusion

Baldness is no longer a stigma in today’s society, particularly with males. So many men just shave off whatever hair they still have and live with baldness. However, other men and women want something done about the bald scalp; they can do so in various stages, first treat topically with minoxidil, then by trying PRP or PRP with the A cell treatment. Finally follicular unit hair transplants can restore a full head of hair where there was baldness before. In women with crown baldness follicular unit hair transplants can be very useful. This elegant method gets rid of this annoying crown baldness, and women who went for this procedure seem to be very happy with the results.

More info on hair restoration.

More info on hair loss.

References

Ref. 1: Hair disorders, from: “Lookingbill and Marks’ Principles of Dermatology” Fifth Edition: James G. Marks MD and Jeffrey J. Miller MD, Copyright © 2013, Elsevier Inc.

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