Supporting young men with Androgenetic Alopecia
Rising awareness and social acceptance is prompting more men in their teens and early 20’ s to seek advice for Androgenetic Alopecia.
Nedlands based, immediate past president of International Society of Hair Restoration Surgery, Dr. Jennifer Martinick says hair loss can be devastating for young men. Psychological effects, feelings of loss of youth, identity and sexuality can lead to depression or suicidality. These men are vulnerable, often misinformed and try ineffective, unscientific / expensive‘ snake oils’ to regrow hair, leaving them disappointed / out-of-pocket. General practitioners should be sensitive, supportive, reassure and advise about clinically approved medical / surgical treatments. Quick Facts: 1 70 % of men suffer Androgenetic Alopecia 2 Onset: puberty to fifties 3 Family History: not always positive 4 Polygenic inheritance 5 5alpha reductase increases DHT production, miniaturising terminal follicles 6 Gradual Loss, usually following a classical pattern with retained occipital fringe
CONSULTATION CRITERIA
1. Exclude other causes of hair loss Patchy loss? Consider Alopecia areata, Cicatricial alopecias, Trichotillomania, Syphilitic Alopecia, Tinea Capitis Diffuse loss? Consider Telogen Effluvium, medication side effect, dietary deficiencies, systemic disease Consider scalp biopsy or Dermatology referral.
2. Support and empathy It is normal for men to be concerned with body image; there is no shame getting help. Have them express their feelings and assess for depressive symptoms; consider counseling.
3. Educate patient Hair loss continues throughout life. Medical treatments are effective short / medium term. Surgical hair transplantation is the only permanent treatment. 4. TGA Approved Treatments Minoxidil 5 % topically daily. Minoxidil up-regulates VEGF, retaining and regrowing hair. Finasteride 1mg daily Finasteride, a 5 alpha reductase inhibitor, blocks over 70 % DHT. It regrows terminal hairs in the vertex and midscalp. Recent claims of persistent sexual dysfunction after cessation of Finasteride have caused controversy. Clinical trials covering nearly 13 million total patient years have shown no definitive link. Lasercomb 655 nanometre wavelength stimulates mitochondrial activity 2mm into the skin. Research suggests a decrease in cell apoptosis.
Note: all other commonly advertised medications / remedies do not have TGA approval and lack evidence for efficacy or safety
Surgical hair transplantation Modern hair transplantation provides permanent and natural results. Patients interested in surgery or those who have failed with medical treatment can be referred to a hair loss physician who can assess them for suitability for surgery.
Further information: www. ishrs. org or Dr. Jennifer Martinick 9386 1104. Author of the article is Dr Sara Kotai MBBS Hons.
Things in the abdomen
Continued from P31
Obesity Surgery trends
Dr Harsha Chandraratna, who does obesity surgery, has mirrored the US trend of moving from gastric banding to gastric sleeve surgery.
“ Surgery is not a quick fix for obesity. If you don’ t change your lifestyle habits and have an operation, within 3-5 years your weight will come back up. We see that frequently and there are programs now for people to‘ maintain their sleeves’ or health weight loss.”
“ People like the reversible idea with banding but the truth is if you take it out you put your weight back on. There’ s an electrical vagus nerve stimulator coming onto the market, which only gets you 10-20 % weight loss and you have to wear a pacemaker and laparoscopically put hooks onto the vagus nerve. We think other things do the job better.”
He mentioned the endoscopic sleeve, where a metre-long stent is placed in the pyloris and food is barely absorbed – it can only stay in for up to six months, producing temporary results, much like the gastric balloon.
He says bariatric surgeons have been lucky in Australia in that there is no restriction on what surgery gets refunded and no prerequisite programs mandated by health funds, like in the US.
“ We like to think we can make an unbiased decision on the right surgery but patients go to surgeons who do what they want, or what their friend had.”
It is the patient push for long-term results and discontent with dietary restrictions that has moved him from banding to sleeve surgery. However, he acknowledges the greater risk profile from this more major surgery, particularly the risk of a post-operative leak, which can then lead to laparotomy and repair, prolonged hospitalisation and perhaps death. �
A Bloke’ s Bible
By Dr Rob McEvoy
The Men’ s Advisory Network’ s The Blokes’ Book is the perfect size and a perfect companion to help men keep tabs on their physical and mental wellbeing.
Now coming up to its first anniversary, the booklet, which is both a resource, with references to just about every health and social service a bloke would ever need, and a health checklist has been a huge success.
Issues such as diet and exercise, relationships, fatherhood, alcohol and drugs, emergency help, accommodation, finances and legal matters are all dealt with in a friendly but straightforward way. And most importantly is a guide to a vast array of community and government services.
The Department of Health provided $ 30,000 to MAN to produce the booklet and a 20-panel pocket directory of WA services for men.
The book is available from MAN, Tel 9218 8044 or online at www. man. org. au �
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