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 �
32 medicalforum