Hey everyone! It’s Whatever Wednesdays again, and I’m here to talk about… Hair Loss and Denial.

This subject may seem pretty mundane, but I think it is important, so please hear me out.

Evil Kermit is in Denial.

So here’s the thing. I started losing my hair around the middle of college. However, I was in denial about it for a good 5-7 years before I did anything about it.

I can talk about it pretty easily now since that was a long time ago and I have long since accepted it. However, while it was happening I struggled with it.

Why was I already losing my hair?

I’m only 20 years old… or I’m only 25 years old… or whatever. I’m not losing my hair, it’s too early. Or it’s just from the stress related to college/medical school/whatever.

Denial runs deep here…  and your friends, family and significant others will notice it before you accept it. However, approaching the subject is difficult. No one wants to be the person who pointed out your hair loss to you. So, trust me, if someone mentioned it to you, they’ve probably noticed for a long time.  More so than that, if you were like me and went to college away from home and your mom points it out to you when you come home to visit… then yea, you’re definitely losing your hair.

Unfortunately, this denial will happen for a long time. You will rationalize it with any host of other reasons. “Oh, I’m just too stressed from school.” You may even try to blame that new shampoo you tried. Or perhaps you think to yourself that the water in your shower was just too hot… or whatever excuse you can think up.

It’ll stop. – I thought to myself

It doesn’t, but you keep denying it anyways. Accepting the fact that you are losing your hair is very, very difficult. Looking back on it now, I had definitely been losing my hair since college. I clearly remember taking a shower and seeing a significant amount of hair in my hands from shampooing. However, at the time I was able to deny it, even with my hands full of proof.

Then what happens?

You get busy with other things. I threw myself into my school work. Studying for the MCAT and then studying for medical school.

It’ll stop eventually. I’m too young to be losing my hair.

For those of us in medicine, many of us are able to deny our hair loss until we are young attendings because medicine typically consumes our lives as being more important. This fuels your denial all the more.

But eventually the denial gives way. Enough people comment on your hair loss that you can’t deny it anymore. So you start trying stuff for hair loss. The big contender here is of course Minoxidil (Rogaine). And by now you’ve probably heard their pitch:

“Men’s ROGAINE® Foam revitalizes hair follicles and is clinically proven to help regrow hair in men who used the hair regrowth treatment every day for 4 months*.”

This stuff is expensive. A 3 month supply is ~ $40, so you’re spending $160 a year on this stuff at least. And their pitch even says you need to use it at least everyday for 4 months to see any results.

It’s not worth it. – I thought to myself

I tried Rogaine a bunch of times, in college, in medical school and in residency. However, I usually only bought them one at a time and I think I used it on and off for a few months at a time. I didn’t notice any difference at all in my hair loss so I stopped using it. I was not one of the lucky few who had miraculous results of hair regrowth. (This is also part of denial.)

However… it probably did slow my hair loss by a good amount. Unfortunately for the young naive me, that wasn’t enough…. and so I stopped using it.

It’s just a scam. – I thought to myself

This evil company is just trying to make money off of me and my own insecurity.  I mean…. we don’t even know how Rogaine even works!

“Minoxidil appears to work by widening the hair follicle, causing a thicker strand of hair, and by prolonging the anagen stage of hair growth which results in longer and a higher number of hair strands. The exact physiological basis for these effects remains unknown, but it has been shown to be safe and effective when used properly.” –  Livestrong (emphasis mine)

What kind of scam is this? Shame on them! This hair loss will stop by itself — right Evil Kermit? But it doesn’t.

So what happened?

Then finally, I bit the bullet. I bought a year’s supply of Rogaine foam ($160!). I’ll do it for a year, we’ll see what happens.

I used it everyday, twice a day, for a year, like clockwork, as if it was prescribed by a doctor.

Did you regrow the hair you lost?

Nope. However, my friends, family and significant other all noticed that I wasn’t losing my hair anymore.

Was it really worth it? – I thought to myself

I decided to stick with it for another 6 months ($80!). At this point, I started noticing that there was definitely less hair in my hands after shampooing than there was before. Did it go away completely? No, I was still losing my hair, but everyone loses some amount of hair. However, I now was in a steady state.

The amount of hair I was losing was about equal to the amount of hair I was regrowing.

So then, for me that equates to paying $160 a year in order to keep the hair I have, so ~$13 a month. To me, that is worth it. For others it might not be.

Here’s the important point of this article:

If I had started using Rogaine regularly 2-3 years later, it might have been too late for me. I am almost positive that if I had waited until the middle or end of my radiology residency to begin using Rogaine regularly that there would not have been enough hair to save. Since I am not part of that minority that has miraculous results, I likely would have given up on using Rogaine and just accepted becoming bald.

Of course, going bald is fine for some. However, for those who want to keep their hair, you need to accept that you are losing your hair early on. The earlier you accept that you are losing your hair, the earlier you can take steps to keep the hair you have. If I had stuck with Rogaine during college when I was in denial, you might not be able to tell that I was losing my hair at all. Instead, if you saw me on a consistent basis, you will notice that I have the characteristic pattern of male pattern hair loss, albeit relatively mild. However, it has looked like that for the last 10 years.

The current me wishes he could go back in time and punch past (college me) and say “Hey dummy, stop being in denial. The Rogaine will work for you if you give it a chance.” For those who tried to tell me back in college and early medical school, I’m sorry that I didn’t listen. I now know that you were only trying to help.

The other important point is:

No one wants to talk about hair loss. It’s embarrassing for both parties involved. The one who is losing their hair may also become defensive and feel hurt. However, let me re-iterate that if someone tells your about your hair loss, then everyone can see it. So if someone brings it up to you, don’t get defensive.

Do some introspection. Think about the past. You’ve been losing your hair far longer than you thought.

Now you just need to decide whether you want to try to prevent future hair loss, or embrace your hair loss and go bald.

For those interested, there is something called the 60 second hair count.

There is an article about standardizing it in JAMA: Standardizing the 60-Second Hair Count

“Among the 20- through 40-year-old men, the shedding range was 0 to 78 hairs, with a mean of 10.2 hairs. Among the 41- through 60-year-old men, the range was 0-43 hairs, with a mean of 10.3” (emphasis mine)

Now, if you did the test and you have 11 hairs or something, that doesn’t necessarily mean you’re losing your hair. This is something to check every few months to make sure there hasn’t been a sudden increase in hair loss. I’m 100% sure my hair count was significantly higher than this back in college/medical school/residency.

Might be worth doing this test, then trying Rogaine (4+ months!) or some other hair loss treatment Finasteride (Propecia, Proscar) and seeing if it helps.  For some, the ability to quantify their hair loss might be what they need to shake them out of their denial:

Do a 60 second test and maybe lose X strands of hair
Then use your treatment of choice for 6 months or so
Then re-test to see if there is a significant (and reproducible) lower result

It would difficult to ignore your own results.

TL;DR

Hair Loss and Denial go hand and hand. Evil Kermit is in Denial.

Rogaine may not work for everyone, but it worked (reasonably well) for me.

You have to give it at least 4 months, and I would advise at least 6-12 months.

It’s not necessarily about regrowing your lost hair, but preventing you from losing more.

If someone mentions your hair loss to you, then everyone has already noticed it.

Don’t become defensive. Acceptance is important.

Consider doing the 60 Second Hair Count.

I thought this was going to be short, mundane post… but it somehow became very lengthy.  ¯\_(ツ)_/¯

-Sensei

Agree? Disagree? Questions, Comments and Suggestions are welcome.

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DISCLOSURE:

I’ve used Rogaine Foam for the past 10+ years. Depending on where I’ve lived I’ve bought it at Walmart, Target, and Costco. I would buy it on Amazon and just have it shipped to my house, or get it by subscription and save more money… but they don’t ship it to Hawaii. I think it has something to do with being aerosolized and therefore somewhat dangerous for shipping over the Pacific Ocean. There are of course many other alternatives to Rogaine, and the generic version is Minoxidil. Kirkland (Costco’s Brand) has it for instance. However, I’ve never tried it. After I got used to using Rogaine Foam regularly for 18 months, I decided to just stick with it, since it was working for me.