“I see women that are at their wit’s end with everything, and it’s so emotional to have something that we see as a beauty marker or a feminine marker of who we are in our identity. And so, the issues with hair loss go very deep. It’s not just with the hair. There are very emotional, psychological components to it.” – Dr. Michelle Jeffries
Hair issues are near and dear to my heart. Whether it is losing hair on the head or growing it in unwanted places, it is a struggle that many of us face. Women with PCOS are 60% more likely to have mood related disorders. And I know for me, when I was struggling with hair loss, it really added to my sense of depression and isolation, and it exacerbated those emotional issues. So, I invited Dr. Michelle Jeffries back to give us some answers about why we experience hair loss and what we can do about it. Listen in (or read the transcript) as we discuss:
- Types of hair loss and the relationship to PCOS
- Hormone and nutrient deficiency testing
- Suggested supplements
- Alternative Treatments: Essential oils, Acupuncture, Laser, electrolysis, platelet rich plasma (PRP), Saw palmetto, Nutrafol
- Topical over the counter and prescriptions
- Hair transplants
Mentioned in this podcast:
- Podcast # 117 with Dr. Jeffries: Practical Tips for Healing PCOS Acne [Podcast]
- PCOS Confidence Grant
- Morrocco Method hair products
- PCOS Diva Private Facebook Group
Amy Medling: I’m thrilled to welcome back Dr. Michelle Jeffries. She is a triple board certified osteopathic physician in dermatology, pediatric dermatology, and integrative medicine. And we talked on podcast number 117 about PCOS and skin issues. Specifically acne. So if you’re struggling with skin issues and acne be sure to tune in to episode 117. But today we’re going to be tackling hair issues in PCOS. So, Dr. Jeffries, thank you so much for coming back on the PCOS Diva podcast.
Dr. Jeffries: Oh, thank you so much. I’m so excited to be back. We got so much to talk about today.
Amy Medling: Yeah, we sure do. And I know that you see a lot of women in your practice with PCOS, and I think hair issues are one of the most difficult to deal with. I know they were for me. Mentally and physically it’s so hard to be losing hair where you want it and growing hair where you don’t want it.
Dr. Jeffries: Oh my goodness. I see women that just are at their wit’s end with everything, and it’s so emotional to have something that in a way we see as a beauty marker or a feminine marker of who we are in our identity. And so the issues with hair loss go very deep. It’s not just with the hair. There’s, like you said, very emotional, psychological components to it for sure.
Amy Medling: Yeah. And it’s part of my mission to help women with PCOS regain their sense of femininity. Hair issues are near and dear to my heart, and I know that women with PCOS are 60% more likely to have mood related disorders. And I know for me, when I was struggling with hair loss, it really added to my sense of depression and isolation and it exacerbated those emotional issues. So it’s really my goal to give women in this podcast just kind of some answers. Like why they’re experiencing hair loss and what they can do about it.
Dr. Jeffries: Yeah. I definitely agree with you. When you don’t feel your best and you don’t look your best, it’s hard to feel good about yourself and it’s hard to feel confident and empowered and happy all the time when you just don’t feel good and you just don’t feel like you look your best too. So, I love your mission and what you’re doing to help women reverse a lot of the PCOS symptoms.
Amy Medling: Oh, well thank you and thanks again for being here. So, we have two sides of a coin. So, why don’t we start with hair loss. And maybe you can describe the different types of hair loss and where does PCOS fit in?
Dr. Jeffries: Yeah, there actually are a lot of different types of hair loss. So, when I see a patient who comes in for hair loss, there’s actually a lot of different types that we have to go through and it all depends on the pattern of the hair loss, how it’s looking, what’s going on with the scalp. So, with women with PCOS, the most common type of hair loss I see is the androgenic alopecia. And that’s where there’s a lot of thinning on the top of the head or in the temples. Sometimes a little bit in the front. It’s also knows as the male pattern baldness. And it can be genetic, but most likely more hormonal for most of the PCOS patients.
Amy Medling: Yeah. So if you’re grandmother suffered from hair loss or even your mother, I always think that chances are they may have had PCOS and it was undiagnosed.
Dr. Jeffries: Exactly. Yes, that also might be true. What’s really cool about the hair is … I mean we do have a ton of hair on our body. We have like five million hair follicles on the whole entire body. And 100,000 of those are on the scalp and lucky for blondes, they have about 20% more hair and redheads about 20% less. But then when you notice a difference in the distribution, meaning where your hair is located and the texture and the thinning of it, you definitely feel like you have a lot less hairs on your scalp and it gets very concerning.
Amy Medling: So, I know for me when I experienced hair loss in my life, it was after a period of physical stress like childbirth or mental emotional stress. And I know that that is a different type of hair loss.
Dr. Jeffries: Yes. Absolutely. There is actually a postpartum, meaning after you deliver a baby, alopecia or hair loss that happens and then also with extreme stress. So what we think happens in the body is when we’re under that stress, our body doesn’t know if it’s real or made up in our mind. It just decides that everything’s real even though it might just be a psychological stress. Obviously when you deliver a baby there’s a big physical stress that happens too. And our body goes into that flight, fight, freeze mode where we have to either fight off the stress, freeze so it can’t hurt us, or run away from it so it can’t get us. And that system, once those hormones get released to trigger that system, it triggers the muscles to work really well, the heart to work really well, the lungs to work really well, but our hair and our skin, it doesn’t care what’s that’s doing. It doesn’t care about digesting food. So, that’s when people that are really stressed, you can lose hair, you can get skin breakouts, you can get stomach aches.
And I really feel this is really evolutionary and has been a benefit to us over time. Not current in our modern technology in modern times, but in the past if we actually were chased by something that could hurt us, if we had patches of hair loss or we had a weird rash, we wouldn’t be as appetizing to whatever predator was trying to hurt us. But now we don’t need to do that. But that physiology is still stuck on our system, so that’s usually the process that happens with that stress hair loss. And that’s called telogen effluvium. And that’s a big huge medical word. Telogen is just one of the main stages of your hair and the process that it goes through. We grow our hair for a period of time. It rests for a period of time, and it sheds for a period of time. And it’s normal to have all three of those cycles. And the growing phase can last like … We average between two to six years, the resting phase, a couple weeks, shedding can last a couple of months. But when our body shifts into that fight, flight, freeze mode, that shedding cycle, the amount of hair we lose increases, and it can happen even months after that stress happens. And that’s when we notice more and more shedding going on and that’s what that effluvium means is excessive shedding of the hair.
Amy Medling: Yeah, I’ve experienced it like three to four months after the event. Whatever that might be. I will have like an extreme shed and my hair will be really thin for a while. But then the good news is that for me, it grows back as soon as my life gets back into balance, and I’m better able to manage the physical and the mental stress. But I do think that you had mentioned the hormonal androgen-based hair loss, or the androgenic alopecia. That’s different from the telogen effluvium, although you still have sheds. Maybe you can talk a little bit more about the hormones that come into play for that type of hair loss.
Dr. Jeffries: Yeah absolutely. And you’re exactly right. That telogen effluvium, the hair does come back. So, if that’s something that you’re experiencing and the shedding, while you’re going through the shedding it can be very upsetting, but that is one of the types of hair loss where everything does come back eventually. And it is common like you said too that, it can be months after your stress. You’re like, I’m not stressed anymore. That was like months ago. Why am I losing my hair now? And that’s usually why. Your body’s just catching up.
And then shifting now over to the hormonal part, we actually have receptors on our hair follicles and on the oil glands of the hair follicles for testosterone and the breakdown products of testosterone. So, when our ovaries or adrenals and different parts of our hormonal tissues are not in balance, and we’re making more of maybe some testosterone derivatives, what happens to the hair follicle is there’s a little hormonal signal that gets received on that hair follicle and it starts miniaturizing and getting smaller. So, as the new hair grows in, it’s a little bit smaller. And as it grows in again, it’s a little bit smaller. So, it’s kind of a different type of hair loss, where it’s getting a signal from the inside and it’s kind of shrinking or miniaturizing is what we call it, of the hair. As that process proceeds, the hair gets smaller and then not as much hair grows in that area.
Amy Medling: So, what can we do about it? I know for me, and I think with everything with PCOS, there is really no one size fits all approach. You kind of have to look at each person individually and I think it takes a lot of trial and error. But for me, I’m just going to say that going to all natural hair care products have really helped. I really like this hair care line called Morocco Method. It’s kind of like a mud based shampoo system, and that’s really helped me. Whether it would help everyone, again it’s like trial and error. But when you have a woman that comes to your office that has this type of androgenic alopecia, what do you recommend that she start with?
Dr. Jeffries: Yeah, like you said, there is so much to this. And usually each person comes in and they’re at a different stage of their hair loss. And then different things have kind of led there. So, we talked about hormones as one of them but there can be other factors of inflammation. So, in a lot of PCOS patients there’s a higher level of glucose and hyperinsulinemia and other things going on that kind of gum up the blood vessels and kind of make things a little bit more sticky. So inflammation can be a component to, as well as hormones. And then stress, as we talked about. And then also sometimes some micronutrient deficiency. So kind of piecing together all of those and then also talking with someone about, where did they want to start? Do they want to start with nutrition, essential oils, shampoo, conditioners, topical things? Have they already done a lot of that and they kind of found their way through that and they want to add in some supplements and need some guidance on that? Do they want some other kind of topical recommendations or even prescriptions? Or are they looking for something more like acupuncture to help and wanting to know if that will help them? Or are they at the point where everything is just so thin they just want a hair transplant and what can they do?
So, we can definitely kind of dive into each one of those because I think probably some of the people listening to you might be in different stages with all of those options or want to mix and match and combine things.
Amy Medling: Yeah, that would be great. Let’s start with the nutrient deficiencies that you see.
Dr. Jeffries: Yes. When someone comes in for hair loss, this is one of the things that, if there’s something nutrient wise that we can reverse or help with, that’s usually a pretty easy fix. It’s just finding out what is going on, what micronutrient or what thing is happening. So I do like to do some blood work with that. Or sometimes it’s a matter of people just admitting they’re not eating healthy and we just kind of walk through that. But the main one that I see is iron deficiency. And so that one is a blood test. There’s a couple of different things that can be measured on a blood test to check your iron stores and how much iron you have. There’s probably about three or four tests that we order just looking at iron. So, that’s a big one that I see. And then the micronutrients that can be associated with hair loss is being deficient in zinc, selenium, biotin, silica, vitamin A, vitamin D, vitamin C, all of those. And so in addition to looking at hormones maybe for hair loss in blood work, we may or may not do some of those tests as well.
And some of these tests, they’re not covered by insurance and that’s always a mindful thing to talk with your physician with. Sometimes the diagnosis of androgenic alopecia, when we put it on a lab slip and we send you off to the lab, some of those labs aren’t going to be covered by insurance. So walking through that also cost wise of what we’re looking at can be helpful too.
Amy Medling: So, and I know there’s a lot of hair and nail skin supplements out there on the market that are formulated just for replenishing those type of nutrients. Is there something out there that you particularly like?
Dr. Jeffries: Yeah. There actually are a lot of options out there. I don’t like doing biotin by itself because it’s not the only micronutrient that might be related to hair loss. So there also is a recent research study that came out about biotin supplements and sometimes interfering with some lab work. So definitely when you do any lab work, let your physician know that you’re on biotin because they just make a note to the lab. The one that I’ve had really good success with, you may have heard of, it’s called Nutrafol. It addresses the hormonal components of hair loss, inflammation, stress and the micronutrients. And so it has different ingredients that target all of those areas. So, that’s why I like that one. I’ve had really good success with it. But you do have to take it for a couple of months before you notice a change.
Amy Medling: Mm-hmm. That’s a great tip. Now let’s move to essential oils and oils in general. I know I recently have had a lot of luck adding castor oil to my regimen.
Dr. Jeffries: Yes.
Amy Medling: In that I put some rosemary, which I know stimulates hair growth. And that’s what’s worked for me. But what are you seeing is working for your patients?
Dr. Jeffries: Yeah absolutely. So rosemary, thyme, peppermint, lavender, and then diluting it down. So when you apply essential oils to the scalp, sometimes they’re very potent and very strong and they can cause some scalp irritation. So testing it out on your skin first, but diluting it with castor oil or also like argon oil. Diluting it with that can be helpful. Or jojoba oil. So the peppermint component of it, it’s very invigorating. It definitely will wake you up if you’re feeling a little sleepy. What it does is it dilates a little bit of the blood flow and the blood vessels around the hair follicle so that some more of the nutrients can get there. And that’s actually some of the foundations of a lot of the other prescription things or over the counter things that you could put on your scalp. But peppermint’s a great essential oil as well as rosemary and thyme like you said.
Amy Medling: Yeah. And actually I just got a comment on my private PCOS Diva Facebook community. And anybody that’s listening out there, you’re welcome to join. It’s a really wonderful group of supportive PCOS Divas going through this journey together. But a woman had posted about having dandruff. And I think a lot of women with PCOS deal with scalp fungus issues that are probably exacerbating the hair loss issues. But I know tea tree oil is a great antifungal oil that you could probably add to that mixture.
Dr. Jeffries: Oh absolutely. I love the doTERRA scalp shampoo and conditioner. It has tea tree oil in it and it’s just fantastic. So you definitely can even get … there’s different products that will be out there that’ll have mixtures of some of these things too. So you don’t have to create your own too, you can just buy it if you’re stuck on time and don’t want to create your own scalp oil too.
Amy Medling: And I love that you mentioned acupuncture. Acupuncture has been shown to help women with PCOS in a variety of ways, trying to conceive. Certainly for me it helps with stress and supporting my adrenals. But for hair loss, tell us about how acupuncture is helpful for hair loss.
Dr. Jeffries: You know it’s the same concept, where you know having acupuncture … The foundation of it is that we have different lines of energy that flow throughout our body. And sometimes targeting one point in that line and releasing that point increases the flow of that energy so it can flow better. And so, using needles in certain places on the face, the body, the scalp, it can kind of open up some of those energy channels but also promote blood flow and all of those things can stimulate hair growth as well. So I think the stress component is also helpful. Because a lot of times when you do acupuncture they’ll put in the needles and then you actually rest for a period of time. And you’re not going to be moving or going anywhere with needles around. And so you have nothing else to do but just relax and enjoy the moment and allow everything to work. So, I definitely work with some acupuncture specialists in town and coordinate with them. It’s not the one and only treatment that my PCOS patients do. There’s obviously a lot of layers to this, but it definitely, if that’s something that aligns with your beliefs, is something you’d be interested in and you haven’t done it, I would recommend trying it and just adding it to your regimen.
Amy Medling: Yeah. And it helps on so many different levels for sure. So, I also wanted you to just talk about some of the topical over the counter and prescriptions that are common in addressing this type of hormonal hair loss.
Dr. Jeffries: Yeah one of the more natural things I like Is using a low level laser light. Some of the brands are Capillus, or HairMax. And it’s basically a light energy device that you wear on your scalp. It has little red LED lights in it. The Capillus is a full top of your scalp. The HairMax is kind of just a band. And basically you wear it for a few minutes a day, a couple of days out of the week, and it can stimulate those follicles to get more of the micronutrients by dilating those blood vessels as well. So, that’s definitely an easy treatment to do.
Side effects, some people feel a little kind of burning with the red light. Kind of interesting enough, depending on how thin the hair is. And then there’s research going on about how many LED light you need in the cap depending on what type of hair or how much scalp exposure you have and how thick your hair is. And so I don’t think we have the exact answer to that, but I think that’s an interesting research that’s coming out soon. A lot of my patients have already tried Rogaine and don’t like it because it sticks to the scalp, it kind of creates some flaking, some scaling. Other than that, I haven’t had a lot of trouble with it. I know there can be some side effects topically other than that but I haven’t had much trouble with that.
Amy Medling: I know that’s something that I tried early in my journey. It didn’t really work for me. I didn’t see a lot of benefit, I guess. But that was just me.
Dr. Jeffries: Yeah. I mean I see that too and I think, I also probably get patients once they’ve already tried a few things and nothing worked and like okay now I need help. Like what else can I do? If you wanted to try Rogaine, I do recommend if you’re going to try it to do the 5% and not the 2.5%. The understanding is, when you have hair loss, if something’s going to be effective the 5% can be a little bit more helpful than the 2.5 for females. It was just indicated for men but I think now they’re opening it up for women as well. So, if you were going to do it I would bump it up to the 5%. But like I said, usually patients have tried that and it’s like no, what else can I do? I do like a product haircare system called Retress and it was developed by a dermatologist. And it’s a shampoo, conditioner, and hair serum. There’s also a supplement that comes with it. It’s not as comprehensive as Nutrafol. But it does have some of the micronutrients in it. And what I like about the Retress system is it’s sulfate free, there’s no minoxidil in it. Their formula is proprietary, so I don’t know all of the ingredients that are in it, but it’s more of a biotin based topical and I’ve had some really good success with patients using that.
And I’m sure there’s a lot of other product lines that are out there too that people like. There’s also a procedure that maybe you have heard of called platelet rich plasma or PRP.
Amy Medling: Yes. Tell us about that.
Dr. Jeffries: That is a procedure where someone draws your blood, they spin down the blood, and in the blood … You know gravity. When you spin something gravity will kind of take things that weigh a little bit less and put it towards the bottom of the tube and things that are lighter in your blood will kind of spin to the top. And there’s a layer of platelet rich plasma which is supposed to be very micronutrient rich. And then what happens is you extract that out of the blood draw after it’s been spun down, you dial it up in a syringe and then you inject it into the areas of the scalp where you’re experiencing hair loss. And then that combined with other treatments can be helpful. And it’s not just one time of doing that injection. It’s usually several times of coming in and doing that and doing them about six weeks apart.
Amy Medling: So, you had mentioned hair transplants. And do they really work for women?
Dr. Jeffries: You know, if you’re not having progressive hair loss, so if your hair is still shedding or still losing hair and you haven’t stopped that process, you wouldn’t be a good candidate for the hair transplant because you could lose the transplanted hair and anyone who is doing the hair transplant hopefully they’re going through that with you. But I have had incredible success of people that have just gotten to the point where nothing’s really worked and they’re at the point where they don’t want to take any other prescriptions or doing anything else, and they do the hair transplant. And there’s a couple of different ways to do it. The ideal way is where they take some of the hair from the back of your head where we typically do not lose a lot of hair. We have usually pretty thick hair at the back. And then taking those individual hair follicles and moving them to the front or the top of the scalp where you’ve lost hair.
Amy Medling: So, I do want to draw some attention to something that was really a viable solution for me when I was experiencing really extreme hair loss postpartum after my third child. I ended up getting a hair topper from this company called Follea. And they have beautiful wigs and hair toppers. And honestly, it was so natural. Like it just kind of clipped into the hair that I already had. Because most of us still have … We don’t have alopecia areata where we’ve lost all of our hair. We still have hair on the sides. It’s just kind of thinning on top. And it looked beautiful. And I wore that for many, many months until my hair grew back. So wearing hair is also a real option.
Dr. Jeffries: Oh most definitely. Definitely if you’re wanting to hold off on prescriptions and give your hair time, but you kind of are wanting to do something to make your hair look a little bit more natural and fill back in. There’s been a lot of times where I’ve actually even written a prescription for that and tried to help people get that covered by insurance. It does take some finessing with the insurance to do that. But that is something that your dermatologist can help you with if you’re looking into doing that. Not all insurance plans cover it and there’s different prices on the different pieces that you can buy. But certainly if you can get some assistance with your insurance that’s also another amazing option that you could have too.
Amy Medling: Yeah that’s a great point. All right so let’s shift gears to hair growth or hirsutism. And a lot of women with PCOS experience hair growth where they don’t want it. Whether it’s facial or body hair. And actually I know that there are some guidelines now that any woman that is exhibiting hirsutism should be screened for PCOS. And is that something that you kind of recommend in your practice when you see somebody that doesn’t have PCOS listed on their medical chart but definitely has hirsutism?
Dr. Jeffries: Yes. And hirsutism is when you’re growing hair in the male pattern areas. So you’re growing chin hair. A little bit underneath the chin. Some women can even grow hair on their chest and in places where men would normally grow it but females don’t. And then also kind of on the center of the chest, but also we do have normal dark hairs that can occur around the breast, around the nipple, but sometimes that can be a little bit more than usual. So that’s the definition of hirsutism. There’s another type of excessive hair called hypertrichosis, which just means you have excess hair. It’s not related to hormonal changes or things like that. So a lot of times when I’ll be just doing a regular skin exam on a young woman, you know, looking at her moles, screening her for skin cancer, I’ll look at the chin area and I’ll notice there might be a couple little stubble dark hairs there. And I might be the first person that asks her, “Gosh how often do you have to get that lasered? How often are you working on that hair growth?” And they may have no idea that was related to PCOS or anything.
So, if you are experiencing chin hair growth and a lot of thicker hairs on the face, certainly that could be one of your one and only signs visible that you might have PCOS. So that is something as dermatologists we pick up on quite frequently.
Amy Medling: I think that’s another symptom that a lot of women sort of dismiss is that, my grandmother had it, all the women in my family have excess hair. When in fact the women in your family might have PCOS.
Dr. Jeffries: The kind of more genetic like everybody is having a lot of hair, I’ve seen that too. And sometimes it’s more on like the cheeks and the temple and sometimes you might have a little bit more hair on your back or your arms. And that tends to be just like a genetic variant and it’s when it’s kind of thicker, harder, more stubbly type hair on the chin and chest is what you want to look for. And I agree, I mean most women just are embarrassed by it, want to hide it, don’t want anybody to know about it, and it’s just something between them and their person that’s doing their hair removal laser treatments.
Amy Medling: And I know that that is a symptom that doesn’t really go away and can actually worsen as you get older with PCOS. And then there’s some things that do lessen. Women with PCOS as they get older tend to regain cycles. Cycles become more regular. But it’s been shown in studies that hirsutism is pretty persistent and can get worse as you get older.
Dr. Jeffries: Absolutely. I also see patients where I notice it and they say, “Yeah, yeah I know. I have PCOS and my PCOS is under control but this is still there.” And they’re very upset and frustrated by it. So it is one of the last symptoms or things that can persist long after you have your PCOS well controlled.
Amy Medling: Yeah. And I think that’s really frustrating because I think a lot of women who have changed their lifestyle and they feel better and their periods have come back and a lot of their PCOS symptoms have subsided, once that hair follicle has changed and it’s become sort of that coarse dark hair, it’s not going to change back. That’s my understanding.
Dr. Jeffries: Yeah, you’re exactly right. And you know there is a misconception that by cutting or shaving your hair it’s going to come back thicker, and that is not true. And so I do have some women that shave, some that do laser hair removal, some that do waxing and different options. Our hair grows from something called a hair bulb. Kind of deeper into the skin and so if you’re able to get to a point where you can destroy that hair bulb, the hair is not going to come and grow back. And so definitely we don’t want that to happen on our scalp, but we probably do want that to happen on our facial hair. And so doing treatment options that kind of help with that can be another option too.
Amy Medling: So I just did want to mention that in my journey, I was feeling a lot better with PCOS but the hair was still such a troublesome issue. And I ended up going to get laser hair removal, and it was so expensive. I had to sign up for a series of eight treatments. And my sister loaned me the money to do that, and it literally changed my life. Because I didn’t feel like I had to hide anymore. I always had such shame around that. The hair that was growing and I was shaving every day and plucking. It totally consumed my life.
And once I had that laser hair removal, it literally changed my life. And just so listeners know that PCOS Diva and PCOS Challenge, it’s the nonprofit organization for PCOS awareness, we teamed up and created a grant. And PCOS Diva, my company has endowed multiple grants over the last five or six years so that women with PCOS who can’t afford laser hair removal or treatment for acne, or hair loss, to get a wig, or a hair piece, we provide funds for that if you are in distress. So you can learn more about that. We’ll put a link in the show notes for this podcast. But for me, that laser hair removal was so life changing. And I just was hoping that you could talk more about how that works and who it’s effective for. Because it doesn’t work for everyone unfortunately.
Dr. Jeffries: Yes absolutely. And oh my goodness, that is so amazing. I didn’t know that about your organization that you’re able to do that for women. I’m sure that means a lot to the women that are able to receive that and it definitely changes their life. Not just on the outside, but just on the inside too so much. Thank you, thank you for doing that. For helping women on that level.
So, the laser hair removal does require multiple treatments. The way that it works is that it actually targets the color in the hair. And so if you have darker hair and really light skin, it works amazing. If you have dark hair and dark skin, you might notice that it might eliminate some of the color in your skin, so you might end up with some white spots or you might end up with some dark spots on the skin. And then unfortunately, if you have more blonde hair or light hair, it doesn’t seem to work as well. Most people that have darker hairs on the chin are relatively good candidates for the laser hair removal. But there also is electrolysis which is another procedure. There aren’t as many practitioners in my area that do electrolysis. And what electrolysis is is using a probe that goes into the follicle and it targets that hair bulb that we talked about that is where the hair grows from. So it’s a much more permanent type of treatment.
The laser treatments that you would do, it’s usually six weeks apart and it’s four to six, maybe eight treatments. And then some women also need a touch up once a year or a couple times a year. So, the laser isn’t as permanent as the electrolysis.
Amy Medling: Yeah, one thing that I was just going recommend is that, I went and had the professional laser treatment. But then for touch up, I used an at home laser and I purchased this many years ago. I’ve written about it on PCOS Diva. But it’s called the Tria at home laser. And I used that for several years. And now I’m at a point where I don’t need to use anything. But it’s been a long process, but I am light skinned with dark hair. So, fortunately it did work for me. But for women who are blonde and have blonde hair, what do you advise for them?
Dr. Jeffries: You know there’s always waxing. So you can definitely still do waxing. Just remember, before you do any waxing that if you’re on any Tretinoin or Retin A, or over the counter retinal, that you do stop it a couple weeks before you do waxing because it can accelerate the wax peeling off one of the top layers of the skin. Electrolysis would be an option if you’re able to find a reputable practitioner in your area. So that could work too. And it’s funny that you mentioned the Tria because that is the one that I bought years ago just for armpit hair and bikinis, for stuff I could do at home. It’s just sometimes they hurt, those little home lasers.
Amy Medling: Yeah. No, they do. It’s not the most comfortable thing in the world but it works. So what about prescription and topical? I know years and years ago I tried Vaniqua, I think it was called. Like a topical. It wasn’t that effective for me. Have you seen any results in your practice?
Dr. Jeffries: You know, years ago I probably prescribed it a lot more when it first came out. And what it does, it’s a topical cream that’s a prescription that you would get from your dermatologist. And you would apply it twice a day to the areas where you have excess hair growth. Once you stop using it though, that hair comes back. And it is a cosmetic prescription, so most insurance companies don’t cover it. And the tube can run a 100, $150 a tube. So for something that’s not more long lasting, I feel that money would be better spent doing laser treatments or something else. So I haven’t prescribed it as much anymore.
Amy Medling: And then what about prescriptions like, I know a lot of women are on Spironolactone. That was something that I went on early in my journey. I really don’t know how much it really helped me. I did not want to be on a pharmaceutical long term, so I came off of it. But is that something that you’re prescribing in your practice and how does that work?
Dr. Jeffries: Yeah. It is something that I do prescribe and it just depends on where someone’s at. So if we’re having a lot of hair loss and we definitely want to dive in a little bit deeper, but we want to start something, Spironolactone is one of those prescriptions that can be started. It’s a pill that you take. I’m one of the practitioners that starts out low and then goes higher as we go. And so I usually just start out with one 25 milligram pill a day. You kind of get the hang for some of the side effects. And then you can go up to one twice a day. And then I have you come back and see how things are going and then we can increase from there. It’s not something that we know for sure how long you’ll be on it. Ideally, not too long. I mean I think the shortest time though is probably at least six months until you’re getting other things in order. If you do start Spironolactone and you think there’s an underlying hormonal issue, I would recommend getting your blood work done first before you start it because it does impact sometimes your testosterone levels. So if there was an issue with your serum testosterone before, you’d want to know that. And then also you can track it as you’re on Spironolactone.
The biggest side effect I run into with it is that it’s used as a diuretic. So what that means is it gets off excess water. And so you urinate a lot, you can get dry eyes, you can get dizzy because you don’t have a lot of fluids in your body so your blood pressure gets a little bit low. You can get headaches. Things like that. So definitely … I live in Arizona, so increasing your hydration can be very, very helpful. It is a type of diuretic that retains your potassium. So you do have to be mindful of potassium rich foods. And one of the things that can make you retain more potassium is coconut water. And then also being mindful of how many low sodium things you’re drinking. The low sodium soups and products like that typically replace sodium with potassium. So you have to be mindful of that. And then a lot of the electrolyte drinks also can ramp up your potassium so you have to be mindful of that.
Some women have some menstrual irregularities where they spot a little bit. And obviously you don’t want to get pregnant on it. But it’s a great option. Another option is Saw palmetto, which is derived from a berry. Native Americans used it. And that’s something else that has been researched with PCOS patients. It’s in the Nutrafol supplement and so that’s usually how I like to use it. In combination with other things. But you could also take it on its own and it’s usually about 160 milligrams twice a day. That’s another kind of alternative natural option. And that helps balance out the testosterone component of the hair loss. Maybe even some of the acne and things like that too.
Amy Medling: Yeah. I think that that is a very beneficial supplement for a lot of women that are dealing with these high androgen related symptoms.
Dr. Jeffries: You know there was a really interesting study that came out not too long ago that combined low dose Spironolactone with oral Minoxidil, which is Rogaine. So Rogaine or Minoxidil came in a pill form initially, and it was a blood pressure medicine. And then they noticed excessive hair growth in the patients that took it and that’s where it became a topical option. But they have actually had significant hair regrowth and there is a few patients in my practice that have opted to do that and I have seen some dramatic results. And it’s definitely not for everybody. There’s a lot of off label things and some side effects and things to go over. But for some reason that combination of really low dose oral Minoxidil and low dose Spironolactone sometimes for those genetic types of hair loss where it’s not really much hormonal to be done anymore and it’s at a stagnant point, I’ve actually seen some hair regrowth with that combination.
Amy Medling: That’s the first I’ve heard of that. That’s interesting.
Dr. Jeffries: Yeah, it’s been fascinating. It definitely doesn’t … It’s not without risks and things like that. I definitely like to do other things before that. But it’s just kind of nice to know that there’s some other options and people are actually researching some unique combinations to help.
Amy Medling: Well, we covered so much. This is a big topic and I thank you for all of the great information that you shared with us. So, if somebody is interested in working with you, can you tell us more about your practice? I know you have a great website with lots of resources too.
Dr. Jeffries: Yeah, I have a great website. It’s drmichellejeffries.com. I believe the spelling of that will be in the show notes, correct?
Amy Medling: Yes.
Dr. Jeffries: Okay. So that would be a great place. And there’s lots of resources on there. My premise is kind of doing more of a mind, body, spirit approach to skincare and blending all those things together. So, you’ll see different articles and resources focused on those different aspects. I do live in Phoenix, Arizona, and I do work in a private practice in Phoenix, Arizona. We do take insurance. We do 15 minute consults, so if you wanted to contact the office you could call us there.
Amy Medling: Excellent. And yes, we will put that info in the show notes. And again, thank you Dr. Jeffries. This was super-helpful for any woman that’s struggling with PCOS related hair loss and hirsutism. And again, if you are struggling, check out the PCOS Confidence Grant and we will have links to that in the show notes as well. So thank you for your time Dr. Jeffries.
Dr. Jeffries: Thank you so much for having me.
Amy Medling: And thank you to everyone listening and I look forward to being with you again very soon. Bye-bye.