CyberHealth 10 Baldness

February 17, 1998

CONTENTS

Male pattern baldness: is that like Alzheimer’s? Hormonal and vascular mysteries of hair growth and hair loss
Demodex: the real culprit?
Is a bald spot a biomarker for prostate cancer risk?
European use of progesterone cream to arrest androgenic hair loss
Are bald men sexier? Dr. Peter Proctor helps slay another myth
Zinc, copper and hair color
Attitudes toward menopause: denial or relief?
Networking in progress: seeking a Brazilian M.D.
Feeding the roots
“My lips are sealed”: a discreet lip-developing exercise
Care of the soul: More about Eve

Male pattern baldness: is that like Alzheimer’s?
Hormonal and vascular mysteries of the hair

Well, there is at least one factor that androgenic baldness and Alzheimer’s disease have in common: atherosclerosis. The lining of blood vessels produces nitric oxide (NO, as in MiNOxidol, the active ingredient in Rogaine) and possibly other hair growth factors; when this lining is damaged through the accumulation of atherosclerotic plaque, less nitric oxide (NO) is produced.

Please don’t draw the wrong conclusion that a balding man is doomed to go on to Alzheimer’s disease or Parkinson’s. Like most men, he’ll probably die of heart disease, which is a much better way to die. Also, 40% of men die before their 75^th birthday, which also helps account for the lower rate of brain disease in the male population. Still, what happens in the scalp of a balding person (including inflammation and free-radical damage) does seem to bear resemblance to what probably goes on in the brain tissue of brain-disease victims.

The incidence of male pattern (androgenic) baldness has been found to be the highest among college professors, and lowest among skid-row winos. Winos are also known to have the cleanest arteries in the world (which of course doesn’t save them from dying of cirrhosis of the liver). Could there be a connection? Let me remind you that alcohol is an excellent vasodilator — there is perhaps nothing quite like alcohol for dilating those peripheral blood vessels. And vasodilatation implies nitric oxide release. (I’m not recommending that anyone take up drinking. For years now I’ve been haunted by the question of whether it’s possible to duplicate the benefits of alcohol in a non-alcoholic way, which would be vastly preferable. For women, estrogens seem to do something very similar, but what about men?)

For unknown reasons, androgenic baldness is more common among blond men than dark-haired men and among Caucasians than among other races. First of all, however, we need to address the most obvious question: why is baldness so prevalent among men, and relatively rare among women, especially premenopausal women?

We need to look here at how hormones affect hair. Estrogens promote the growth of scalp hair, while they inhibit the growth of hair elsewhere on the body; DHT, the strong form of testosterone, promotes the growth of body hair, facial hair, butâ€”it appears to inhibit the growth of scalp hair. The amount of DHT produced in the skin in turn depends on the amount of the enzyme 5-alpha-reductase available for the conversion of testosterone to DHT. Men with congenital deficiency of 5-alpha-reductase have small prostates, do not develop prostate cancer (no case has ever been reported), have little body hair, and do not grow bald.

Women often notice increased hair loss when there is a sudden drop in estrogens: post-partum, after stopping the Pill, and at the onset of menopause. It is estimated that a woman may lose as much as 20% of her hair at menopause. Both post-partum and menopausal hair loss, however, are not classified as androgenic alopecia, but as “endocrine alopecia,” which should really be called “estrogen-withdrawal alopecia.”

Severely hyperandrogenic women, on the other hand, can suffer from male pattern baldness even at a young age. Still, a woman can be hyperandrogenic without necessarily showing signs of androgenic alopecia, but she may have acne and increased facial and body hair. Or a woman can have androgenic alopecia without acne and/or hirsutism. This seems to be a highly individual matter.

Typically, however, it is men who start losing hair fairly early in life, sometimes already in their twenties. Men produce a lot more DHT than women do, since obviously men produce a lot more testosterone than women do (DHEA can also serve as a raw material for DHT). But it’s not the serum level of DHT that seems to matter, but the local conversion of androgens to DHT in the scalp.

Let me stress this point: it is the LOCAL excess DHT production that seems

to be the root of the problem. THE SCALP FOLLICLES OF GENETICALLY SUSCEPTIBLE INDIVIDUALS HAVE MORE OF THE ENZYME 5-ALPHA-REDUCTASE, RESPONSIBLE FOR THE CONVERSION OF TESTOSTERONE TO DHT. Most women are protected by having (1) less testosterone, (2) less 5-alpha-reductase needed to convert T to DHT, and also (3) by having more aromatase, the enzyme that converts testosterone to estradiol.

It is interesting to note that male teenagers and young men, with their tremendously high testosterone output (T production begins to decline very gradually after the age of 25) tend to have a full head of hair but generally not that much chest hair and facial hair. On the other hand, it’s not unusual to see lots of chest hair and a full flowing beard on a severely balding middle-aged man. Apparently the local production of DHT, perhaps as compensation for low serum androgens, is a significant factor here. We do not yet understand how serum DHT and peripheral DHT are related, but one hypothesis is that there is an inverse relationship. It’s just a hypothesis. Estrogens are vasodilators: they promote the release of NO from the blood vessel lining. It’s also possible that estrogens increase superoxide dismutase (SOD) activity (at least that’s one of the effects of the birth-control pill). SOD quenches the superoxide radical, a very nasty little beastie that apparently inhibits NO release.

DHT acts in a more perfidious way. Here is one emerging view of it: DHT seems to induce class-II antigens within the follicle. The immune system then perceives the follicle as a “foreign body,” and targets it for destruction. Progesterone inhibits 5-alpha-reductase, and it can compete with other androgens for androgen receptors (progesterone could be classified as a “non-masculinizing androgen”). Topical progesterone can thus arrest the progression of baldness, but it doesn’t promote regrowth. I repeat: there is no evidence that progesterone promotes regrowth. Just decreasing DHT in the scalp can at best arrest the progression of baldness. Proscar (finasteride) also decreases DHT by inhibiting 5-alpha-reductase. Proscar produces close to 70% reduction in serum DHT, but only about 34% reduction in skin DHT. Still, virtually all men taking Proscar (5 mg finasteride) report that the progression of baldness is arrested. But is a big reduction of serum DHT beneficial, or can it in fact be harmful? (Hint: DHT can’t be aromatized to estradiol, and estradiol has been implicated in prostate cancer. We discuss it later in this issueâ€”see the comment by Dr. Zava.)

CORTISOL and cortisone, the so-called “stress hormones,” are also androgens and are possibly implicated in baldness. We know for sure that they are involved in acne. Anecdotally, stress is known to cause hair loss. One study (Schmidt 1994) did find SIGNIFICANTLY ELEVATED CORTISOL IN ANDROGENIC ALOPECIANS, BOTH MALE AND FEMALE, as compared with controls. It also found alopecians to have significantly elevated androstenedione. In women there was also very frequent hypothyroidism and/or elevated prolactin (it’s possible that prolactin stimulates the production of androgens). Balding men, on the other hand, had higher serum estradiol than controls.

Schmidt makes a very big point of the finding that women suffering from androgenic alopecia do not necessarily have higher serum androgens (other than cortisol, generally not classified as an androgen, though it should be). She thinks that THE MAIN HORMONAL DISTURBANCE LINKED TO FEMALE ALOPECIA IS HYPOTHYROIDISM. It’s likely that hypothyroidism leads to abnormalities in both estrogen and androgen metabolism. I’m amazed that this study didn’t look at insulin, since elevated insulin has been linked to alopecia in hyperandrogenic women. Anecdotally, lowering insulin with drugs and/or diet does seem to improve hair growth in both men and women.

As you can see, the situation gets more and more complicated the more hormones you look at. Finally you just want to throw up your hands and say, “OK, it looks like all the hormones are out of whack.” To put it more formally, androgenic alopecia is a multi-hormonal disorder. You can’t just say “too much DHT.”

Malnutrition and stress can obviously cause hair loss, but it appears that the primary causes are genetic-hormonal-immunological and vascular (it’s not really possible to separate the endocrine system from the immune system from the nervous system and so forth). In other words, to preserve our hair, we must keep DHT and cortisol at bay and strive to preserve clean arteries. But see the mite article below for yet another complication. On a personal note, I noticed both hair loss and a distinct deterioration in hair quality during perimenopause. (Interestingly, my cholesterol suddenly began to soar.) I was beginning to have nightmares about developing a bald spot (I should have been having nightmares about getting a heart attack, but you know how it’s only human to worry more about appearance than about dying). You can imagine how thrilled I was to see complete recovery with the use of nhrt (my cholesterol dropped to 170 also). In fact I am now more bushy-maned than I had ever been after turning 40 (at least until several days ago, when my dieting, aspartame-crazed hair-dresser took out her aggression on my hair).

Of course what is easy for a woman with no special genetic susceptibility and with access to sufficient doses of female hormones is not easy for a man, or even for a woman with a genetic susceptibility. Later in this issue we’ll discuss what can be done.

For the easy cases, that is, women with some typical menopausal hair loss, here is what you need to remember: estrogens, fish oil, the flavonoids in red wine, and arginine are NO-releasers, and hence at least theoretically can stimulate hair growth. The best proven case here is estrogens. Progesterone inhibits the conversion of testosterone to DHT, so it is helpful also. Finally, topical NO-releasers are available in special shampoos. With this hormonal, nutritional, and topical arsenal, you should be able to regrow and maintain a magnificent head of hair. Night-night, and don’t let the androgens bite.

(Sources: Schmidt JB. Hormonal basis of male and female androgenic alopecia.

Skin Pharmacol 1994; 7: 61-66; Van Deusen E. What you can do about baldness. Stein and Day 1978; Jaworsky C, Klingman AM. Characterization of inflammatory infiltrates in male pattern alopecia: implications for pathogenesis. Br J Dermatol 1992;127: 239-46; Mercutio M. Androgenic alopecia in women. Medscape/women’s health 12/7/97; Rittmaster R. 5-Alpha-reductase inhibitors. J Androl 1997; 18: 582-87; Proctor P, alopecia post on the Internet, 1997. An important part of the research was supplied by Starla Taliaferro.)

IS A MITE THE REAL CULPRIT IN BALDNESS?
THE DEMONIC DEMODEX

A scientist at i, a manufacturer of hair-care products (those nice tingly conditioners), looked at the human scalp through a new hand-held microscope that can magnify up to 1,000 times. And what did he see? Mites. Demodex follicularum feasting on the sebum. According to the UPI dispatch, “as many as a dozen of the mites burrow head-down in every hair follicle.” And by late middle age, we are all infested. All of us harbor Demodex. But apparently only some of us have the unlucky genes that cause the body to mount an immune response that ends up destroying the follicles while the demonic Demodex goes on feasting. In fact, it is well known that oil-glands enlarge and increase production as the hair falls outâ€”hence the proverbial sheen.

It’s not clear how DHT and cortisol fit in with this new discovery. There is no doubt, however, that steroids profoundly modulate the immune system. Since Demodex has long been known to cause hair loss in animals, there is a good reason to take the mite seriously.

The scientists at i are already busy trying to find a way to starve Demodex by blocking jits ability to digest sebum. The big question remains:

suppose you do succeed in wiping out the miteâ€”will there still be androgenic baldness?

My grandmother used to say, “Whoever discovers the cure for baldness is going to be the richest person in the world.” Nioxin has joined the race. Stay tuned.

(Source: a recent UPI news release on Dr. W. i lecture at the 1998 annual dermatology meeting in Miami; supplied by Starla Taliaferro)

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Gail comments:

Re: “by late i age, we are all infested.” . . . Well, thanks a lot for telling me!! Yuck! Although, I will say, I’d read about the mites in our eyelashes (and saw disgusting pix), and perhaps these are the same?

Ivy:

Yes. Demodex lives anywhere on the body where you find hair. I suspect that the itching around the rim of the eyelashes is often due to the irritation caused by this disgusting micro-animal.

The big mystery is how androgens fit into the mite picture.

IS A BALD SPOT A BIOMARKER FOR PROSTATE CANCER RISK?

Both androgenic baldness and prostate trouble involve DHT, so it’s plausible to hypothesize that a high degree of baldness might indicate higher prostate cancer risk. It’s so plausible, in fact, that the authors of the study which found otherwise seem to have a great deal of trouble accepting their own findings.

The subjects were 315 men between the ages of 50 and 70; 159 had prostate cancer; 156 served as controls. Their serum androgens were tested, and the degree and pattern of baldness (frontal vs vertex) were judged by a panel of judges according to the Hamilton Baldness Scale.

Free testosterone was found to be higher in prostate cancer cases than in controls (the difference was statistically significant, though the numbers themselves don’t show anything dramatic); it was also higher in men with frontal baldness and particularly in men with vertex baldness (the bald spot). And yet: “the data indicate that hair patterning DID NOT DIFFER between prostate cancer cases and controls.” Neither the degree nor the kind of baldness had any correlation with prostate cancer. The authors still express hope that a different experimental design, such as a long prospective study, might confirm the hypothesis after all. They fail to comment on the most interesting finding of this study: that DHT/T RATIO WAS HIGHER AMONG CONTROLS. Yes, that’s right: DHT, the “strong testosterone,” the most macho androgen (5 to 6 times more potent than testosterone), was higher in relation to testosterone in the serum of healthy men.

Intrigued, I read another study, this one simply investigating serum androgens of prostate cancer cases vs healthy controls, and lo and behold, THE HEALTHY MEN HAD HIGHER SERUM DHT. The authors cite a number of other studies that have also found this inverse correlation of serum DHT with prostate cancer, and hypothesize that perhaps higher serum DHT means lower DHT production in the prostate.

There is also a study that shows that a certain body type is a biomarker for higher prostate cancer risk: a rather tall man with a poorly developed upper body bones and muscles (the “leptomorphic build”), the opposite of the top-heavy “male male” with a broad chest and big upper-body muscles. This also shows a hormonal influence, but not the sort that used to be expected. (I can’t help noting here a parallel with the pear-shaped “female female” who is at a lower breast cancer risk than the usually taller, thick-waisted hyperandrogenic woman.)

Returning to bigger upper-body muscles, even though the study last cited may point to developmental hormonal and nutritional influences going back to childhood and early adolescence, we know that exercise at any age has a significant positive physiological impact and seems to reduce the risk of a number of cancers. Perhaps the best thing a man can do for his health is exercise with weights and build up those lats, delts, pecs, etc. (Bones will thicken automatically too.) More lean body mass significantly changes metabolism and reduces insulin. Insulin has been heavily implicated as a growth factor for tumors.

(Sources: Demark-Wahnefried W et al. Serum androgens: association with prostate cancer risk and hair patterning. J Androl 1997; 18: 495-500;

Signorello L et al. Steroids in relation to prostate cancer risk in a case-control study (Greece). Cancer Causes and Control 1997;8: 632-36;

Demark-Wahnefried W et al. Anthropometric risk factors for prostate cancer.

Nutr Cancer 1997; 28: 302-307)

Dr. Zava Comments on Androgens and Prostate Cancer Risk

Dr. David Zava:

Yep, the testosterone/DHT story and prostate cancer is an interesting one. If you carefully study the literature it reveals the opposite of what you would expectâ€”individuals with low androgens are at increased risk for prostate cancer. A new school of thought is now proposing that prostate cancer is actually caused by estrogens, not androgens. However, once the tumor is initiated by estrogens, growth is promoted by androgens, particularly DHT. Preventing conversion of T to DHT with 5 alpha reductase inhibitors would therefore be of benefit to those of us at high risk of prostate cancer. Guess what blocks 5 alpha reductaseâ€”saw palmetto and progesterone. Progesterone may be very beneficial for men with prostate cancer for this reasonâ€”but studies need to be done. The publication by Morgentaler A. (Occult prostate cance in men with low serum testosterone levels. JAMA 1996; 276: 1904) is quite revealing. Men with low T had a very high incidence of prostate cancer not clinically manifest by digital rectal exams or PSA tests. Current thinking by those I would consider the most innovative is that estradiol initiates the tumor and estradiol plus DHT (not T) drives the growth of the tumor if other conditions are right (low zinc and selenium, compromised immune system, bad fats, etc.).

A group of articles showing that progesterone inhibits the conversion of T to DHT, and also blocks DHT binding to androgen receptors can be found in wonderful book published in 1980 — a must read but hard to find. (Percutaneous Absorption of Steroids, P. Mauvais -Jarvis, et al. eds., Academic Press, 1980, pages 81-89, 123-137).

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Ivy:

Since there are progesterone receptors in the prostate, and since progesterone appears to inhibit the production and binding of DHT, it’s strange that the potentially important protective function of progesterone in prostate tissue has been so neglected.

As I keep saying about the bone tissue: surely those progesterone receptors aren’t there just for decoration?

Men do produce progesterone, and it stands to reason to suppose that due to aging and stress some men produce an inadequate amount. I know that the idea of progesterone deficiency in men sounds startling, but there just might be something to it.

Of course the big degenerative cascade seems to start with testosterone deficiency. A man’s physiological age seems more closely correlated with free T than with any other biomarker, with the possible exception of lean body mass.

Obese men show abnormally high serum estradiol, and obesity (high waist-hip ratio) appears to be a risk factor for prostate cancer; there may well be a connection.

On the other hand, estrogens shrink the prostate; hence the new interest in low-dose DES as the cheapest prostate cancer therapy, more effective than castration. This might catch on with the HMO’s, which currently promote castration as the cheapest prostate cancer therapy.

TRANS-FATS appear to be heavily involved in cancer risk, including breast cancer, colon cancer, and prostate cancer. Everyone: don’t even think of eating margarine. If it’s still in your house, toss it. Corn oil and other commercial vegetable oils belong in the trash right with margarine. OK, what about commercially baked cookies and other “goodies”? Sorry, they are loaded with carcinogenic trans-fats.

A reminder: all men should be taking zinc and selenium, as well as i supplements if tomatoes are not their favorite food.

My dream is that one day there’ll be public service billboards asking:

“Men! Have you eaten a tomato today? Or at least a slice of pizza?” A note to women: if you’d like to have your partner try progesterone, be assured that it won’t hurt him. It’s best for a man to apply or take progesterone (men usually take 100-200 mg) at bedtime to take advantage of its sleep-promoting properties. (If your mate has acne, the results of P cream are quick and satisfying; but if you are trying to arrest baldness, you must be persistent. Remember that progesterone will not cause hair regrowth.)

EUROPEAN USE OF TOPICAL PROGESTERONE
TO ARREST THE PROGRESSION OF BALDNESS

This is just a quick note on dosage. The cream for anti-baldness use is generally no more than 5% in potency, and the most you can expect is stopping the progression of the balding process. Other products need to be used to obtain regrowth.

If the only cream available is your mate’s 10% cream, don’t worry. Yes, it’s OK to use it, and you won’t grow breasts or experience any other feminizing effects.

A man’s body normally produces a small amount of progesterone. Progesterone at any dose is nontoxic for either women and men. It is so safe that it is the only hormone approved by the FDA for use during pregnancy.

DR. PROCTOR ON TREATING FACIAL HAIR,
AND THE MYTH OF SEXY BALD MEN

Dr. Peter Proctor is regarded as the foremost authority on treating alopecia. He holds many patents in the field, and has formulated a hair-regrowth shampoo that is supposed to be more effective than Rogaine. The chief active ingredient is NANO: 3-carboxylic acid pyridine-N-oxide. NANO is known as “natural i.” Two stronger products are available for those with more severe hair loss.

Dr. Proctor has given me permission to quote our recent correspondence. Ivy: Do you think that topical spironolactone (or any other topical anti-androgen) might be effective in treating facial hairâ€”at least in decreasing or slowing down the growth?

Dr. Peter Proctor: Yes. It has been used this way. It works some. But the best thing is to use it systemically, which is done a lot in women. In fact, this is probably the single major use for the drug. Ivy: How can one get topical spironolactone?

Dr. Proctor: It has to be formulated and it is very unstable. I’ve been able to stabilize it mostly, but the techniques are proprietary at the moment. Anyway, women can use the systemic drug.

Ivy: It seems from anecdotal reports that estrogen and progesterone creams (both OTC and prescription strength) have been rather disappointing in their results on facial hairâ€”could it be a matter of needing to provide more through high-frequency application (a few times a day)? Or is it a hopeless battle, i.e. once facial hair sets in due to increased androgen/estrogen ratio, nothing can stop the growth?

Dr.Proctor: Actually, in women female hormones are best used systemically, as long as there in no possibility of pregnancy. Also, I recommend using laser hair removal techniques over electrolysis. They work pretty well, but may take repeated treatment and lots of power.

Ivy: There is terrific interest in phytoestrogens, especially genistein from soy. To your knowledge, is there any nitric-oxide-releasing and/or anti-androgen action here? Since there’d be no feminizing effects from weak estrogens of this sort, they might be of interest.

Dr. Proctor: Estrogens are thought to protect against heart attack by enhancing NO (nitric oxide) production. Unfortunately, I don’t know what the ones you describe do.

If ignorance were bliss, etc.(G).

Ivy: Since there seems to be a strong connection between clean arteries, sexual potency (found to correlate with higher HDLs), and less baldness (due to more NO release by healthy arteries), the old myth about bald men being more sexy is, I suppose, the exact opposite of truth, i.e. in the same age group we’d expect the less bald men to have less atherosclerosis and better potency. Am I reasoning correctly?

Dr. Proctor: You bet…

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Ivy: It’s interesting to consider one of the factors that hair growth and potency have in common: nitric oxide (NO) release. The new potency-increasing drug, Viagra, is a NO releaser. Alternative health “male power” products generally contain arginine, which enhances NO production.

Re: facial hair and systemic spironolactone. There is now more interest in

Propecia. Preliminary trials indicate that it might weaken facial hair growth without having any side effects.

In regard to phytoestrogens: it’s been noted that baldness among Japanese men used to be relatively rare. Now both baldness and prostate enlargement appear to be on the rise. Could there be a connection with the departure from the traditional diet containing a substantial amount of soy products? Soy estrogens appear to protect the prostate, and it would not surprise me if they had some anti-androgen effect in the scalp as well. (By the way, it is now possible to take genistein in supplement form; two tabs of LEF’s MegaSoy are supposed to provide 100 mg of genistein, an amount shown by studies to be able to lower cholesterol and increase bone density. It would be fascinating to explore what other effects this dose can have in men and women.)

Ginkgo biloba is also supposed to contain flavonoids (weak estrogenic compounds) that dilate the small peripheral arteries. Alternative health publications claim that ginkgo increases potency. So far I haven’t encountered reports of improved hair growth with ginkgo, but there is that theoretical possibility.

On the other hand, ginkgo contains quercetin, which acts as an aromatase-inhibitor, and might thus lower the conversion of T to E2 — a good thing in some circumstances, not so good in others. Believe me, when you start getting into the details, you quickly find yourself on the brink of insanityâ€”hormonal effects are incredibly complicated and dose-depedent. Dr. Peter Proctor can be reached at <[email protected]> Please respect his time and do not go into long details of your hair loss. The treatment is essentially the same for all, except that more potent products are used for more severe cases.

You can get more information about Dr. Proctor’s formulas by calling the Life Extension Foundation, 800-544-4440.

ATTITUDE TOWARD MENOPAUSE: DENIAL OR RELIEF?

Virginia writes:

I had to put in my 2 cents worth in when I read about menopause and denial. I had never heard any kind of talk about menopause when I was growing upâ€”or even much laterâ€”except maybe in a negative sense. But when I realized it was happening to me, I was relieved. No more periods and no more worries about getting pregnant. Therefore, no more need to take birth control pills which made me fat and depressed.

Ivy:

Personally I had both reactions: first denial: “But I’m too young to be menopausal!”; then terrific relief, once it really registered on me that I’d have no more periods and no need for contraception. And when I had a nightmare that my periods were back, that really brought the “relief” part into the foreground. I realized I was born to be postmenopausal. I also love this statement by Dorothy Canfield: “One of the many things nobody ever tells you about middle age is that it’s such a nice change from being young.”

This is not just a cute quotation. Women in their fifties and sixties have been found to enjoy the best mental health. These are truly the “power years” for a woman, and with further advancement in nhrt (for instance, small doses of growth hormone need to be included; nhrt needs to be started way before menopause), and in our knowledge of exercise and nutrition, we should be able to include the seventies and eighties as well. Remember Dr. Julian Whitaker’s formula for successful aging: “Maturation, not deterioration.”

I truly appreciate what Virginia wrote. I think menopause is a blessing. For me, it also took good nhrt to make it a blessing, but I can see how even without it, it is nature’s great gift to women to terminate the hormonal yo-yo of the menstrual cycle once and for all (except that nature didn’t design women to be having lots of periods; women were designed to be pregnant). Of course birth control pills could be made with natural hormones and they wouldn’t have these side effects, either, but that’s another issue. The third-generation Pill, made with less androgenic progestins, is a lot better. Could it be that we are moving toward the contraceptive use of progesterone, which is what Pincus, the pioneer of oral contraception, originally intended?

As an aside, I hope that all CH readers realize that you can enjoy the benefits of nhrt without having artificially induced periods. All it takes is adequate doses of progesterone taken every day.

Gail:

If pseudopregnancy is a good thing to shoot for, what about the fact that even though nature wants women to be pregnant a lot, still one can’t be pregnant all the time . . . there is a gap between pregnancies, when hormones drop radically.

Ivy:

True, but intense lactation, as still practiced in tribal societies, also suppresses the menstrual cycle. Thus a woman may eventually get pregnant again without even having a period first. I guess I’m just against periods and the hormonal yo-yo of the menstrual cycle, with its attendant endometriosis and increased breast cancer risk. Mark my words: I predict that medical science will ultimately move toward abolishing the menstrual cycle for women not desiring reproduction.

As for “natural,” all nature wants is maximum reproduction. After menopause, there is rapid senescence, as reflected in morbidity and mortality statistics. It’s either tough luck, baby, you’re finished (the old maxim in biology: “When reproduction is finished, the animal is finished”), or else you use your brain and make these the best years of your life. For a human being, to use those oversize brains is only natural.

SEEK AND YE SHALL FIND

Kolodie writes:

I have just now found two pharmacies in Vancouver that will compound testosterone, progesterone and tri-est. For your files if anyone is looking it’s Finlandia Pharmacy in Vancouver and Peoples Drug in Whiterock. As you said, if a woman really wants her hormones working she’ll find a source.

Ivy:

I’ve seen it again and again: once a woman makes up her mind about nhrt, pretty soon she has at least progesterone, then tri-est or Estrace, and before long she’s querying me about testosterone cream. P.S. It’s typical of women to write me or tell me things like, “I’d love to get the estriol cream for my face, but I know that my doctor would never give me more estrogen.” NEGATIVE THINKING is rampant among women. They won’t even try.

Remember, when you “think negative,” you are sending a “die” message to your spirit and your body. If you really talk yourself into believing that you can’t get natural hormones, you end up not only hormone-deficient, but also feeling depressed and powerless; the biochemistry of despair created by negative thinking then opens the door to disease. Don’t do this to yourself! Thousands and thousands of women are getting their nhrt prescriptions, and so can you.

If your doctor keeps trying to force Provera on you, remember the simple

fact: there are other doctors. If you really want to find a doctor who will

prescribe natural progesterone or estriol or 3-E cream, you will. THE

FIRST STEP IS TO EMPOWER YOURSELF WITH KNOWLEDGE; the second step is to

remember the ancient wisdom of “seek, and ye shall find.” My mother likes to reinforce this with: “Never give up. Never give up.” Anyway, in these days of Internet networking and hundreds of thousands women and men already using nhrt, it’s not as heroic as it used to be. If you have a “sweetheart” type doctor who wants you happy but doesn’t necessarily have any knowledge of hormones, please highlight for him/her the part in CH 9 article about NO SYSTEMIC EFFECTS with the .3% estriol cream. I’ve just talked with a doctor who expressed great interest in the effects of estrogens on the skin. He believes that plastic surgery shouldn’t be performed without adequate estrogen support.

DARE TO THINK POSITIVE. Dare to ask. “Ask, and it shall be given to you,” right?

But some women would rather complain about horrible doctors than educate themselves, network, seek, and ask for what they want. You can put hours, years, decades, your whole lifetime into complaining, or you can take a few minutes to make a call to a large compounding pharmacy (WIP at 800-279-5708 is the biggest) and ask for their nhrt information package. Just take the first baby step, and the rest will follow.

KNOWLEDGE AND NETWORKING EMPOWER WOMEN

Starla writes:

Life experience has led us to coming to the realization that doctors DON’T know it all (like we were taughtâ€””do what the doctor says”), that DRUGS are not a cure and just as often cause a problem as correct one, and that we have to do our own research and find out what is really best. Also, it’s led us to helping other people by giving them the information they need to make wise decisions.

Ivy:

I want to emphasize Starla’s “WE HAVE TO DO OUR OWN RESEARCH AND FIND OUT

WHAT IS REALLY BEST.” And it only makes sense to share that information with others.

I experienced a moment of enlightenment while watching the movie “The Little Buddha.” I wasn’t sure what to do with my lifeâ€”whether to continue with creative writing, take a teaching job, or maybe write a non-fiction bookâ€”and then I heard the statement, soon after the Buddha’s “awakening” under the Bodhi Tree: “We have the duty to transmit knowledge.” I started CyberHealth in June 1997 with 60 subscribers. Today we have around 310, but I know the knowledge reaches more people than that. Another group of women have recently formed an organization called AWARE, and they are also spreading this type of knowledge. There is no stopping it. If you are wondering how come most doctors are so far behind, just open any gynecology or urology textbook. If you really want to scare yourself, check one that’s over 10 years old.

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Here is another example of how knowledge and networking empower women.

Miriam writes:

In a little while I will go to my HMO doctor, to give her one more chance to double the prescription of Estradiol and Progesterone. If she doesn’t, I have the names of three doctors who may be willing to do so. I’m at the end of my hormonal rope. I’ve been trying to work with my HMO doctor because I have no insurance for other doctors, but I’m not willing to live with such low levels of estrogen.

Ivy:

Having the names of doctors recommended either by a compounding pharmacy or by other women beats slipping your recalcitrant doctor a note that reads, “I am out of estrogen, and I have a gun.”

I remember how having a name of a doctor willing to prescribe Armour Thyroid empowered me to be assertive with my HMO doctorâ€”and sure enough, I got my Armour that very day!

NETWORKING IN PROGRESS: SEEKING A BRAZILIAN M.D.

Jorge in Brazil wonders if he can find an MD in Brazil to prescribe progesterone for his wife (natural progesterone, to be obtained from a U.S. compounding pharmacy).

An OTC progesterone cream will not do. Jorge’s wife needs prescription strength progesterone.

If there is a Brazilian M.D. among CH subscribers, or if anyone else can

help Jorge, please write to him at his email address: <[email protected]

I wonder if this is perhaps the type of case where a pharmacist at WIP,

with their large oversea business, might help. WIP can be reached at [email protected]

COPPER, ZINC, AND HAIR COLOR

Here is something from my personal experience that maybe a CH reader can corroborate. I’ve just had a haircut, and my hairdresser exclaimed, “Have you done anything to your hair? It’s darker!”

Now, mind you, a hairdresser can tell at a glance if the hair has been artificially colored because of the unnatural uniformity of the color. She knew that wasn’t it, and was very curious.

One possible explanation that occurs to me is this: I received a coffee maker for Christmas, at my own request (I read the exciting reports about polyphenols in freshly brewed coffee, and how coffee drinkers have the lowest rate of breast cancerâ€”the newest Harvard Nurses Health Study). And to get even more polyphenols, I started drinking my one cup of morning coffee as mocha, made with cocoa powder.

How might that result in darker hair? Well, chocolate is a source of copper, and copper is necessary for the conversion of the aminoacid tyrosine to the copper-containing enzyme tyrosinase, involved in the production of melanin by the melanocytes in the scalp.

The production of the enzyme is known to decline with age. Estrogens are known to increase the absorption of copper, and also to stimulate the activity of melanocytes. I first noticed that my hair was growing out darker after I started nhrt.

It’s also possible that all the extra polyphenols from coffee and chocolate have been helping the melanocytes work better.

I’ve also added 20 mg of zinc to my supplement regimen. Zinc likewise is involved in the production of melanin.

The herb ashwaganda is reputed to darken hair, but I have never tried it. By the way, I know some of you may be wondering if maybe I started taking PABA, reputed to darken hair. As luck would have it, just when I started drinking my mocha, my health food store introduced its own inexpensive brand of PABA, but at only half my previous dose. So my hair got darker in spite of the much lower dose of PABA (which maybe is the better dose for me). Thinking back, my hair was lightest in color when I was both hypoestrogenic (to the point of losing my periods) and zinc-deficient when I experimented with being a vegetarian.

Of course I’m speculating here, but if you notice a definite lightening in your hair color, it would make sense to consider the possibility of hormone deficiency or mineral deficiency or both.

Caution: nothing in excess. Too much chocolate means too much oxalic acid, which could reduce the absorption of calcium and really cause trouble for individuals prone to kidney stones (the susceptibility usually runs in the family). And taking excess copper in supplement form could disturb the copper-zinc balance. One milligram is probably enough, if you suspect you need a supplement (wouldn’t it be wonderful if doctors tested us for nutritional deficiencies?)

Some holistic experts believe that prematurely gray hair implies copper deficiency, but to my knowledge there is no proof of that. In women at least, the causes are more likely hormonal (see the article on premature graying and osteoporosis; yes, copper is necessary for bone health). If you’ve noticed changes in your hair color that seem related to hormones or nutrition, please write to CyberHealth.

FEEDING THE ROOTS

Eggs, eggs, and more eggs. If you want to have beautiful hair, eggs are at the top of the list for promoting hair growth and hair quality. Eggs contain just about every known nutrient required for good hair production. If you’ve ever visited a mink farm, you know what these lively creatures are fed to make them produce thick glossy coats: lots of fish and eggs. We’ll get to fish in a moment, but first let me explain that in addition to all the pro-hair vitamins such as biotin and inositol, eggs are the richest natural source of cysteine. Now, hair is made of a type of protein called keratin, and keratin is unusually rich in the aminoacid cysteine. Cysteine contains sulfurâ€”hence the sulfurous smell if hair is burned. Another aminoacid that eggs provide is tyrosine, needed for hair pigment.

It is also vital for thyroid function and brain function.

Eggs appear to promote hormone production in general, and the right hormones are indispensable for healthy, bushy hair. Eggs are such wonderful nutrition that it should be against the law for misguided health gurus to preach against them and promote egg substitutes. An egg substitute next to real eggs is what canned baby formula is next to mother’s milk. Unless you are in a genetically susceptible minority, eggs will not raise your cholesterol to any significant extent. They may even lower it due to their high lecithin content. Dietary cholesterol as a rule has no influence on serum cholesterol. Most cholesterol is produced by the liver. I know I’ve already said it two or three times before, but in these days of misinformation and paranoia about foods that kept our ancestors healthy for millennia, one sometimes has to say things over and over to counteract the incessant brainwashing. Your grandmother knew best: eggs are nature’s perfect food. And there is evidence to support the emerging view that they are in fact heart-healthy.

In fact, one study found a 10% RISE IN HDLS WHEN TWO EGGS A DAY WERE ADDED

to the usual diet of subjects with cholesterol in the normal range. The rise in total cholesterol was only 4%, indicating an improved lipid ratio. Another study used subjects who had high cholesterol. The addition of two eggs a day resulted in a slight, statistically insignificant rise in LDLs, and, again, in a statistically significant rise in HDLs. The new thinking is that the most important indicator of cardiovascular health and longevity is high HDL levels, for both men and women.

When my hairdresser commented that she can tell by my hair that I eat healthy food, I told her I eat lots of eggs and sardines. She said, “You’re so funny.” But of course I was completely serious.

Sardines are not only a wonderful source of protein, but also of those fabulous anti-inflammatory fish oils. Fish oil helps inhibit the production of inflammatory prostaglandins that appear to be involved in hair loss. And listen to this: omega-3 fats, of which fish-oil EPA is one wonderful representative, increase the production of NO, which dilates arteries (hence the greater cardiovascular health of fish eaters) and also promotes hair growth. Sardines provide IODINE as well; iodine, zinc, copper, and selenium are all important for the hair.

Silicon is probably important for the hair. In any case, it’s certainly important for clean arteries, and if you have good blood circulation and clean arteries, your hair is going to benefit both from the nutrients and from NO release. Estrogens increase silicon absorption. NO release and clean arteries are closely related; arteries damaged by plaque released less hair-growth stimulating NO. The kind of diet that is good for your arteries is likely to be good for your hair. Thus, olive oil and avocadoes, with their benefits for the arteries, are likely to be good for the hair.

Exercise? You bet. It raises HDLs.

The heart-healthy low-glycemic diet, with some dry red wine thrown in for even lower insulin and cleaner arteries, should also result in result in improved hair growth. Interestingly, some people who have tried the low-glycemic diet have reported more hair growth; there is also some anecdotal evidence that when diabetics lower their insulin dose, their hair grows more abundantly.

Basically, if you are well-nourished and already take a whole range of supplements, you shouldn’t have to take any special “hair nutrients.” Just remember that eggs and seafood seem especially beneficial for the hairâ€”and of course are wonderful all-round health-giving foods for the whole body. Likewise, remember that clean arteries and healthy hair also go together. Why does hair become so straw-like on very low-fat diet? I suspect the biggest factor is the drop in hormone production. There may also be downright malnutrition. My grandmother would immediately prescribe two eggs a day and chicken soup. And a glass of red wine “to put color in your cheeks.”

(Source: Schnohr P et al. Egg consumption and HDL cholesterol. J Inter Med 1994; 235: 249-51; Knopp R et al. A double-blind, randomized, controlled trial of the effects of 2 eggs per day in moderately hypercholesterolemic and combined hyper-lipidemic subjects taught the NCEP Step I diet. Am J Col Nutr 1997;16:551-61.)

“MY LIPS ARE SEALED”: A DISCREET LIP DEVELOPER

Some of you have written to me that the lip exercises are great, but provoke merriment when done in public.

Considering that commuting, standing in line, etc is a wonderful time for developing your lips, here is a more discreet exercise that develops your lips, chin, and lower cheeks. It also seems to improve lip color and helps smooth out the laugh lines.

The exercise is simplicity itself. Imagine that you are trying to seal your lips really, really tight. Press your upper lips down upon the lower lip, while the lower lip is trying to push up. Another way of saying this is: purse your lips together as tightly as possible. Your mouth should look very small, but the lips aren’t pulled in, as in the more extreme Mona Lisa smile.

If you feel a lot of tension in the laugh-line/lower-cheek region, you are doing it right. Press your lips together as hard as you can several times. Pretty exhausting, eh?

For a more friendly look, or just for variety, pucker up rather than purse your lips.

Basically, if these exercises sound complicated to you, just keep puckering up. Surprisingly effective.

Don’t let young women have monopoly on full, sensual, luscious lips! Just as one can develop muscles at any age by lifting weights, so too anyone can develop fuller lips (with a little assist from nhrt to prevent skin and lip atrophy; otherwise you can kiss your lips goodbye).

California Age Management

… Growing Older without aging

CyberHealth 10 Baldness

February 17, 1998

Male pattern baldness: is that like Alzheimer’s?
Hormonal and vascular mysteries of the hair

IS A MITE THE REAL CULPRIT IN BALDNESS?
THE DEMONIC DEMODEX

IS A BALD SPOT A BIOMARKER FOR PROSTATE CANCER RISK?

Dr. Zava Comments on Androgens and Prostate Cancer Risk

EUROPEAN USE OF TOPICAL PROGESTERONE
TO ARREST THE PROGRESSION OF BALDNESS

DR. PROCTOR ON TREATING FACIAL HAIR,
AND THE MYTH OF SEXY BALD MEN

ATTITUDE TOWARD MENOPAUSE: DENIAL OR RELIEF?

SEEK AND YE SHALL FIND

KNOWLEDGE AND NETWORKING EMPOWER WOMEN

NETWORKING IN PROGRESS: SEEKING A BRAZILIAN M.D.

COPPER, ZINC, AND HAIR COLOR

FEEDING THE ROOTS

“MY LIPS ARE SEALED”: A DISCREET LIP DEVELOPER

* * * CARE OF THE SOUL * * *

February 17, 1998

Male pattern baldness: is that like Alzheimer’s? Hormonal and vascular mysteries of the hair

IS A MITE THE REAL CULPRIT IN BALDNESS? THE DEMONIC DEMODEX

IS A BALD SPOT A BIOMARKER FOR PROSTATE CANCER RISK?

Dr. Zava Comments on Androgens and Prostate Cancer Risk

EUROPEAN USE OF TOPICAL PROGESTERONE TO ARREST THE PROGRESSION OF BALDNESS

DR. PROCTOR ON TREATING FACIAL HAIR, AND THE MYTH OF SEXY BALD MEN

ATTITUDE TOWARD MENOPAUSE: DENIAL OR RELIEF?

SEEK AND YE SHALL FIND

KNOWLEDGE AND NETWORKING EMPOWER WOMEN

NETWORKING IN PROGRESS: SEEKING A BRAZILIAN M.D.

COPPER, ZINC, AND HAIR COLOR

FEEDING THE ROOTS

“MY LIPS ARE SEALED”: A DISCREET LIP DEVELOPER

* * * CARE OF THE SOUL * * *

Male pattern baldness: is that like Alzheimer’s?
Hormonal and vascular mysteries of the hair

IS A MITE THE REAL CULPRIT IN BALDNESS?
THE DEMONIC DEMODEX

EUROPEAN USE OF TOPICAL PROGESTERONE
TO ARREST THE PROGRESSION OF BALDNESS

DR. PROCTOR ON TREATING FACIAL HAIR,
AND THE MYTH OF SEXY BALD MEN