Science Vs - Balding - What Actually Works?

Episode Date: November 9, 2017

So... you’re losing your hair. Is there anything that can be done about it? And are the treatments dangerous -- for your or your penis? We talk to geneticist Prof. Stefanie Heilmann-Heimbach and dermatologists Dr. Wilma Bergfeld and Dr. Robert Bernstein. Check out the full transcript here: http://bit.ly/2Yvcrrm Extra reading:A review of balding treatmentsStefanie’s paper on balding geneticsThis research on the intersex population of the Dominican Republic Notes on hair transplants Learn more about your ad choices. Visit podcastchoices.com/adchoices

Hi, I'm Wendy Zuckerman and you're listening to Science Versus from Gimlet Media. This is the show that pits facts against follicles. On today's show, balding. Doctors say that they're closer than ever to finding a cure for baldness. Baldness cure would be the holy grail of medicine. A cure for the follically challenged. Is a cure really in sight? Now, you're not going to die from going bald,

but it can be so stressful that it's linked to feelings of depression. It can make people feel ugly and insecure. And wherever there is insecurity, there's money to be made. The hair loss treatment industry is worth billions of dollars every year and it can be hard to know what's snake oil and what has real science behind it. There's no easier person to take money from than a guy who's worried about losing their hair.

Matt Nelson is one Scottish lad who's been fighting the battle of the bald. He's actually a senior producer here at Gimlet Media. And Caitlin Sorey, our senior producer, had a long chat with Matt about his hairy journey. I think Matt's story is pretty emblematic of lots of guys who've lost their hair. And he used to love his hair. He used to do all sorts of weird stuff with it. hair. And he used to love his hair. Like he used to do all sorts of weird stuff with it. Yeah, it was a big point of pride.

You had like spiky hair. Yeah, it was sort of like a hedgehog style cut. And I don't know, there were sort of like eight or nine spikes on top of my head. And you really need like a lot of hair to like emulate that hairstyle as my hair started to thin it turned more into like a sad faux hawk but then that sad faux hawk it got even sadder Matt was losing more and more hair and he was only in his early 20s 21 or 22 okay it was it was young I was early it's funny because the way that I found out was like we'd gone on vacation and there was a picture of a friend and myself wrestling as you do as young men, just like shirtless wrestling one another. And the flash goes off and it sort of revealed like a lot more scalp than I was expecting. And it was it was really shocking.

It was like a sort of reveal like in a horror movie. And I was like, what the f***? Practically every time he passed a mirror, he'd check out his hair to see if he'd lost more. And it was just getting worse and it was making him feel terrible. When you're that young as well, you're basically just like, f***, I'm never going to get a girlfriend now. So Matt went online, digging for solutions, as we all do. And devoting about an hour of my day just to researching. An hour every day. I mean, that's an exaggeration.

So Matt tries all the things. He changes his diet. He starts eating a bunch of broccoli like almost every meal. He tries apple cider vinegar and even liver. Gross. He uses all kinds of hair products and spends a bunch of money on hair loss drugs including this one that can have a pretty intense side effect scariest one of all is that it can cause erectile dysfunction so i was like oh what am i gonna do

like maybe i'll have like amazing great head of hair again, but my penis isn't going to work. I was terrified. I remember like taking these pills and just being like, what is going to happen to my penis? So do you really have to choose between your penis and your hair? On today's show, we're looking at treatments for balding. And while not everyone who loses their hair has a penis, in fact, about a third of older women lose their hair too, a lot of the research looking into treatments for baldness have focused on men.

So that's what the bulk of this episode is about. And in this episode, we'll be answering the following questions. One, is there anything you can do to stop your hair from falling out? Two, how effective are the treatments that we have? And will they break your penis? And then we'll take a close-up look at some of the balding treatments at the cutting edge of science. When it comes to saving your hair, there are high hopes for the...

Holy grail of medicine. But then there's science. Science versus balding treatments is coming up just after the break. After decades of shaky hands caused by debilitating tremors, Sunnybrook was the only hospital in Canada who could provide Andy with something special. Three neurosurgeons, two scientists, one movement disorders coordinator, 58 answered questions, two focused ultrasound procedures, one specially developed helmet, thousands of high-intensity focused ultrasound waves, zero incisions. And that very same day, two steady hands. From innovation to action, Sunnybrook is special.

Learn more at sunnybrook.ca slash special. What does the AI revolution mean for jobs, for getting things done? Who are the people creating this technology and what do they think? I'm Rana El-Khelyoubi, an AI scientist, entrepreneur, investor, and now host of the new podcast, Pioneers of AI.

Think of it as your guide for all things AI, with the most human issues at the center. Join me every Wednesday for Pioneers of AI. And don't forget to subscribe wherever you tune in. It's season three of The Joy of Why, and I still have a lot of questions. Like, what is this thing we call time? Why does altruism exist? And where is Jan Eleven? I'm here, astrophysicist and co-host, ready for anything. That's right.

I'm bringing in the A-team. So brace yourselves. Get ready to learn. I'm Jan Eleven. I'm Steve Strogatz. And this is... Quantum Magazine's podcast, The Joy of Why. New episodes drop every other Thursday, starting February 1st.

Welcome back. So today we are cutting through the bogus claims about balding, and we're going to tell you what really works and how well it works. And as luck would have it, we actually found a cure for baldness. In fact, it was discovered over 2,000 years ago. Back in the day, there were eunuchs, men whose balls were lopped off and sometimes this was done for religious reasons and sometimes they served in royal courts. Kind of like that guy from Game of Thrones, Varys.

Do you spend a lot of time wondering what's between my legs? And Hippocrates, aka the Greek father of medicine, noticed a curious thing. When these castrated boys got older, they didn't lose their hair. Hey, Wendy. Hey, Wendy. Hey, Caitlin. Quick fact check from your resident Game of Thrones fan. Super fan.

Massive fan. So, old mate, old baldy Varys. Right? Yeah. He was castrated as a boy, which, as we've just learnt, means that he should have a full head of hair. I know. Toupee.

And here's the reason why Varus should have a full head of hair. Because testicles are key to the story of why we go bald. You see, testicles make testosterone and testosterone gets converted into this other substance called DHT. When it comes to balding, DHT is the critical bad guy here. And DHT is the bad guy of balding because it makes some hair follicles shrink and shrink and shrink until the hair stops growing in them altogether. And no testicles means not a lot of DHT around to shrink your hair follicles. Authors of a 1940s study looking into the effect of castration on balding were so convinced by the powers of lopping off your balls to stop that process that they wrote, quote,

castration at early ages affords a reliable form of therapy. They went on, but one in which the cure is worse than the disease, end quote. Conclusion, the cure to balding is to cut off your balls before you hit puberty. In fact, that's why they call it balding. Episode over. That's science versus... No, not really. Just a tasteless joke.

So is there anything else that you could actually do to stop going bald? Well, according to The Simpsons, no. Baldness is hereditary. It is. Does that mean that Bart is destined to have three strands of hair on his head? Well, it's not so simple. Stephanie Heilman-Heimbach is a geneticist who researches balding at the University of Bonn in Germany. And she has conducted one of the largest studies into what genes cause balding,

analysing over 22,000 men. Try to dig deeper into the details here. And Stephanie told us that a huge chunk of why we go bald is written in our genes. But what she found in her study was that the genetics of balding is actually quite complicated. There is no single balding gene. Currently, we know more than 100 that play a role. Yes, Steph found over 100 genetic hotspots that could get the bald rolling. And there were some surprising ones in the mix, like genes associated with your immune system, making fat cells, and even this hormone that regulates our sleep called melatonin.

One rumour floating around is that baldness comes from your mum's side of the family. But Steph found that you could actually get a lot of your balding genes from mum and dad. D'oh! Still, there is something to that rumour because Steph did find a handful of genes linked to balding that guys could only get from their mums. So, in a way, you can kind of blame mum's family a little bit more if you're bald.

Blaming is maybe a hard word, but it's indeed the fact that the genome of your mom plays a bigger part. So from Steph's research and others, we know that genetics plays a huge role in whether you go bald or not. But here's the thing, it still might not be everything. A study of more than a thousand identical twins, so people who pretty much have the same genes, found that while their hair loss was very, very similar, not every pair of twins had exactly the same level of baldness. So if it's not all your genes, can you change anything in your lifestyle to fight back against balding? Should you drink less, lose the man bun?

What about changing your diet? Well, that's what Matt tried. So I started eating broccoli all the time. I would have it with lunch. I would have it with dinner. Don't know if I've ever had it for breakfast, but that's probably not outside the realms of possibility because I was just so desperate to keep my hair. And if you check out balding forums online, you'll find lots of debate about whether diets really can save your hair. So, can it? Well, of the small amount of science that we could find on this,

the results are pretty mixed. Some studies find that men who drink a lot of alcohol, smoke or are chubbier are more likely to lose their hair. But then there are other studies that don't find that. Here's Stephanie. We do not know any reliable data on diet or sports or, I don't know, whatever. That is amazing, particularly when you look online at all the sort of treatments that are being thrown around.

Take this vitamin. Our friend was eating lots of broccoli. Any advice? Yeah, no, I don't have any advice. I mean, as all these things won't change your genes. Conclusion. Changing your diet, smoking and drinking alcohol, well, that doesn't seem to have a big influence on whether you'll go bald or not. Whether you lose

your hair is largely encoded into your genes, so you can blame your parents. Now that you've looked into the crystal bald, should you just give up? Or is there anything that you can do to bring back your hair? Let's take a look at the oldest FDA-approved medication for balding. No doubt you know it as... You know, a lot of men want to know more about Rogaine with Minoxidil. I want to know more about Rogaine. Rogaine with Minoxidil? Yeah. Anybody else?

Yeah. Okay. Yes, Rogaine. The active ingredient is called minoxidil. And Rogaine was actually discovered by complete accident. Okay, so it's the 1970s, and researchers were testing out this new blood pressure medication. It was here when they noticed that it had an odd side effect. Dr. Felt.

Dr. Wilma Bergfeld has been treating patients with hair loss at the Cleveland Clinic in Ohio since the 1960s, and she remembers when Rogaine was discovered. The dermatologist doing rounds on that particular ward noted they were all hairy. The patients were getting hairy all over their body. Are we talking like a werewolf? Yeah, like very hairy.

You don't grow hair on your palms and soles, but everywhere else. Soon trials were being conducted on whether this medication could be targeted at baldness. That is, could you rub it directly on your head to grow your hair back? Wilma was one of the dermatologists working on the first trials. I think that was one of the more exciting things that I ever did. And then Rogaine went on from there. Rogaine hit the market in the late 1980s, and Wilma would sometimes do these TV stints about this great new treatment. She says patients were hungry for it.

Well, every time I was on television, we almost had to hire secretaries to handle the phone calls. But the reality is I was already full. By the late 1990s, sales for Rogaine were more than $160 million per year. So they were selling a lot of it. But here's the weird thing. They didn't know exactly how it worked. And we still don't really know. Well, they know a little bit about it. Just like flipping a switch to make your hair grow.

Wilma tells us that it's thought that Rogaine can activate a protein that can trigger hair growth. It also might boost the amount of blood flow you get to your head. But the big question is, how well does it work? It's never good enough. You're never going to have the hair that you had when you were very young. Were they then a tad disappointed to hear that they weren't going to get the hair that they used to have? Everyone's disappointed in that, but you don't have the body you used to have either, or the teeth, or anything else. So to assess how well Rogaine can work,

we're going to judge it on what we're calling the Bruce Willis scale. Well, well, well. There's Die Hard 1. That's a pretty good head of hair, but it's clearly receding. All the way down to Die Hard 5. That's a pretty good head of hair, but it's clearly receding. All the way down to Die Hard 5. That's completely bald. Now, studies find that after a year on Rogaine, the men with the best results would improve from a Die Hard 3

to kind of Bruce Willis in the first movie, the original. Yippee-ki-yay, mother... But for men who are already in Die Hard 5, then Wilmer says... If you go to billiard ball, you know, almost impossible. So if you're totally bald, Rogaine isn't going to do it for you. Plus, it doesn't work on everyone. In one review paper published last year, researchers found that only a small percentage of men grew back some of their hair. For about half the men though, they kept the hair they had. Another review paper found that Rogaine might help women too. Now once you stop using the stuff, your hair

will probably start falling out again. Conclusion. Rogaine is not the miracle treatment the world was hoping for. It'll grow some hair in some men and women, and for others, it'll stop them losing more hair. But you probably won't get back your luscious locks that you had as a teenager. So, what else is there? One popular drug, a pill called Propecia, which has a kind of crazy backstory of its own.

It all started in a small village in the Dominican Republic, and scientists weren't there to find a cure for balding. No, they were there for a very, very different reason. It was because in that particular village, there was this group of about two dozen people who had been born with ambiguous genitalia. They were raised as girls, but during puberty, they would start to look like men. And this change was so striking that in the town, they were known as guevedoses,

which roughly translates to penis at 12. Now, the critical thing about these people is this, that when they grew up, they didn't go bald. And scientists wanted to find out why this whole phenomenon was happening. And they did. They got to the root of the problem. And they realized that these people had a genetic mutation that meant they couldn't convert a lot of testosterone into DHT. You know, that bad guy balding. And eventually, this work sparked a group of scientists to create a drug that they could send into battle against DHT. And so, voila! We had Propecia, a new drug that could stop your body from making so much of that balding bad guy.

Yippee-ki-yay, mother****. Dr. Robert Bernstein is a clinical professor of dermatology at Columbia University, and he says that when Propecia hit the market, there was a lot of excitement about it. In 1998, we thought that was it. We wouldn't have to worry about hair loss anymore. And by the way, this is the drug that Donald Trump uses for his hair. That's according to the New York Times. I don't wear a toupee. It's my hair. I swear. So, big question. How well does Propecia work?

A review paper analysing studies including almost 4,000 patients estimated that after taking Propecia for about a year, one in every six patients would think his hair looked better. But, much like Rogaine, you're unlikely to get a full rug of hair, and you won't wake up

like this. I have hair! I have hair! I have hair! So, some men will grow their hair back and for others it could help them keep the hair they've got. And this is actually what happened to our Scottish mate Matt when he tried this drug. But for him, those results were a little disappointing.

You know, I was hoping that in six months I would just be like, wow, I have all of my hair back, but that definitely didn't happen. But for Matt, he had one big concern while on the drug. So remember how he was stressed out about erectile dysfunction? Well, Propecia was the drug he was worried about. What is going to happen to my penis? And Matt isn't the only one who's stressed out about this. Millions of people swear by their miracle medications, but at what cost?

Could this drug that men take to stay sexually attractive in some cases be permanently damaging their sex life? He says sexual side effects started the first day he used the drug. And studies show that men on Propecia actually can have a lower libido and erectile dysfunction. A review paper estimated that for about every 80 men on Propecia, only one would have trouble getting it up. And in a small group of men, even when they stop taking the pills, they might still have penis problems, sometimes years later. Now, just quickly, there's one more serious side effect from Propecia that's been getting some attention. And it's this idea that the drug can

cause depression. In 2011, the FDA found that there was enough evidence out there to add depression as a potential side effect. But it's really hard to know how common this is. And that's partly because it's just often really hard in general to attribute anyone's depression to any one thing. Conclusion. Propecia can help you keep your locks, but there can also be some serious side effects like erectile dysfunction and potentially depression. So we've covered the two main go-to medications that dermatologists will try, Rogaine and Propecia. But after the break, a robot is hacking into heads

to save your hair. Yikes. Welcome back. So we've covered the two mainstays of hair loss medication. But what if Rogaine or Propecia don't work for you? What else can you try? This is the best kept secret in the world. It's called platelet-rich plasma therapy or PRP. Yes, platelet-rich plasma therapy. This is one of the buzziest treatment options out there right now.

Wilma Bergfeld from the Cleveland Clinic, whose phone was ringing off the hook for Rogaine, now has patients lining up for PRP. They all want it. They're all reading about it. Come in demanding it. Now, in this therapy, doctors concoct a balding treatment from a patient's own blood. Well, you bring them in and take off their blood, spin it down and inject the clear portion that has all the growth factors in it. And the idea is that these growth factors might stimulate your hair to grow. So they're loaded into a syringe along with some other stuff and then injected into the bald areas of a patient's scalp. Sometimes this is done several times in a year.

Is it like a patient's a little bit grossed out by it? Not to my knowledge. Dermatologists clued into PRP because it's being tried out in other areas of medicine, like helping with knee injuries. And it's had some promising results. But can it grow hair? Well, two review papers came out this year and they both say this treatment is really preliminary. When you look at pictures of people before and after this treatment, sometimes you can see a difference, but we don't have any good figures on how many people this helps or how often they need to be injected.

And it can be pretty expensive, potentially costing thousands of dollars. Conclusion. Platelet-rich plasma is far from a miracle cure. And in fact, when it comes to hair loss, there's really no good studies on it. Okay, so we've looked at some of the ways that you can try to grow your hair back. But when you've tried everything, it's time for the final frontier. Hair transplants. Yes, you might remember from the 1980s and 90s people getting these hair transplants which looked awful. In some cases, doctors would cut out large chunks of skin along with the hair follicles, chop them up and then reinsert them at the bald spot. You could have a scar at the back of your head and some people would end up looking like a doll, you know, with those sprouts of hair popping up unnaturally.

But things have been getting a lot more sophisticated and recently more men have been going in for surgery. In the last couple of years there's been a 60% increase in hair transplants worldwide. That's according to the International Society of Hair Restoration Surgery. So to see what the modern version of hair transplants looks like we sent our roving reporter into the fray. Caitlin, sorry, senior producer. Adventurer, ahoy. I have seen things. I went to see what hair transplants look like today. So I went to Dr Robert Bernstein's office and he's the guy we spoke to about Propecia.

He's a key player in this industry. He's helped develop a new technique that uses robots. Is it OK? Yeah. Anything touching the matter? So basically how it works, he's got this robot, looks kind of like a giant fridge with a robotic arm coming off it. So the patient's sitting face down and the robotic arm is coming in behind them and then like cutting around these little groups of hairs. Men often go bald on the tops of their heads and the hair that's usually growing freely is along the back and the sides. So that's where the robot harvests the hair. It's not just the hair, it's like the root, the skin,

all the little bits around the hair follicle that's helping it grow. That's all getting cut out. So what you're left with at the back of the head is, like, all of these, like, tiny little holes. So it's, like, lots of little red dots that would be kind of like blackheads, except it's blood, so redheads, I guess. You need to feel a little bit of pressure. OK. OK. So once you've got all these hairs from the back of the head,

then you've got to put the hair where you want it. And to do that, Bob's team make these tiny little cuts in the bald area and then poke the transplanted hair in with tweezers. Once we make the sites, then it's essentially putting a peg in a hole. And you're basically not dragging it in, but you're kind of stuffing it in. So the guy I saw having it done, he had a thousand hair groups pulled out and then put on top of his head. So that's a thousand little bits of hair that you've got to then shove back into a different part of the scalp. And it takes hours.

And so the kind of crazy thing is that once the hair has been shoved into that bald wing spot, Bob says it will just grow there. And it holds. Yeah. And it holds. And then at 10 days, the grafts are totally permanent. You can't. They're part of you. It just lives there now.

Okay. Wait. So why doesn't the new hair fall out just like the old hair did? Okay. So the thinking is that the hair on the back and sides of your head isn't bothered by DHT. So you know how DHT is that byproduct of testosterone, the bad boy of balding? So that bad boy makes the hair follicle shrink and shrink until it stops producing hair. But the hair on the back and the sides of the head isn't usually sensitive to DHT.

So when you move that hair to the top of your head, it'll just keep growing even though there's DHT around. So the big question, how does it look in the end? It can look pretty good. Let me show you a pic. Oh, okay. So I'm looking at a guy that had really quite thin, it was really thinning on top. The sort of person that you'd look at and be like, probably time to shave it off, buddy. Yeah.

And then after this surgery, it looks like he's got like a good thick hair. I'm amazed. Right? Now, clinicians reckon that this procedure is permanent, but Robert actually doesn't know of any studies tracking hair transplant patients over years, and we couldn't find any either. But still, he told us that based on the reports of procedures that are going back to the 1950s, he says there is good evidence that hair transplants last the distance.

Still, though, things can go wrong. If a doctor harvests too many hairs or they take hair from the wrong place, hair can start to fall out and patients can end up with a moth-eaten look. Yeah, that's what some doctors actually call it. Plus, this isn't cheap. These procedures can cost up to $20,000. Conclusion. Hair transplants have come a long way since the 1980s and 1990s and they can look pretty good. But if you are willing to stump up the cash,

keep in mind that this procedure is as much art as science. So, when it comes to balding treatments, do they stack up? Whether you go bald or not is largely written into your genes. And as far as science can tell, diet, smoking, being overweight or eating a tonne of broccoli doesn't have a big impact. Rogaine and Propecia will help some people grow a bit of hair and for others, they won't lose as much hair on it. But it doesn't work for everyone.

And when it comes to Propecia, there's also the small risk of side effects like erectile dysfunction and potentially depression. Platelet-rich plasma therapy might be all the rage right now, but there's not a lot of good science for it for hair growth. Finally, for people really freaking out about their hair, new hair transplant techniques mean you might actually end up looking pretty good. But the studies on it are very patchy.

So I guess the message to take home here is that while there is no miracle cure for balding and there's actually a lot of junk online, if you are really worried about your hair, there are some treatments that are definitely worth giving a try. They're not perfect, but for some people, they can help. And what happened to Matt, our Scottish co-worker? Like, what did he do? After eight years of stressing and trying Propecia and eating broccoli,

he finally found something that worked for him. The best answer for me turned out to be the most simple answer, which is basically just cut all of your hair off. Yeah. And now Matt is rocking the chrome dome. It's like completely bald, like one of those like rare exotic cats. That's science versus balding. written by Bobby Lord. Also, a big thanks to Ingrid Zuckerman, Garrett Crowe, and Matt Nelson. Thank you so much for sharing your story, Matt. Fact-checking by Michelle Harris and Rose Rimler. Next week, we're tackling the party drug MDMA. And we just let it react and kept stirring it, and it would get warm. And so we sort of started bubbling and went through a coil.

So we ended up with a white powder, pure white powder. I'm Wendy Zuckerman. Back to you next time. For a man to look good, Paul, he's got to have a nice what? Personality. He's got to have a nice personality for the win. Personality. He's got to have a nice personality for the win. Personality!