Interview with Malcolm
August 19, 2008
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The NHI Experience
August 19, 2008
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Patient Spotlight
August 19, 2008
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Sex, Drugs & Rock-n-Roll
August 19, 2008
by Malcolm Mendelsohn, Hair Loss Counselor, Manchester. UK
I heard a recent report proclaiming that men think about sex every eight seconds. "Strange," I thought to myself. "I haven’t thought about sex for months." It hadn’t occurred to me that anything was wrong. I hadn’t developed any particularly unusual tendencies. Twenty five years of working with bald men may get to some guys psychologically, but not me, one of the world’s greatest lovers (you know what I mean. guys, you’ve all been there).
O.K. I admit, I’d had a couple of years on my own after quite a long relationship, but there was no particular psychological reason why I’d stayed solo. Let’s face it, it’s hard finding a partner, let alone a woman prepared to accept a middle-aged hippie in a business suit. Imagine my surprise when, for the first time in two years of convincing myself that my new-found celibacy was a gift from God, I met one of HIS Angels.
Blonde, beautiful, half my age. into mature men and obviously short-sighted. What a combination!
About this time, I heard and read reports announcing the likely release of Propecia. The headline in one of Britain’s most respected tabloid newspapers, the Daily Mail, read "Pill to Get Your Hair Back May Hit Your Libido." One of the topics of the day discussed on our National Talk Radio was "Would you consider saving your hair if it meant losing your sex-drive?"
A few people called the radio station commenting that they would never sacrifice their manhood for their appearance. One guy, however, phoned in to say that losing his hair had affected his confidence to the agree that he as unable to communicate with potential partners, a comment that I’m sure we in the hair replacement industry have heard on numerous occasions. He continued by saying that he would use the drug to re-grow his hair, regain his lost confidence, find a new partner, and then quit the drug.
Then some guy called John said that he had been using the so-called new drug for about four years before the problem hit. (Well I wasn’t about to give my real name, was I? I mean, it’s one thing to admit to you guys that I had sexual dysfunction, but not on National bloody Radio!)
Now, I’m not sure whether any of you will remember me, but my success with finasteride was one of the features in the April 1994 edition of forum. I was the man who was using finasteride for hair growth two years before the presentation by David Whiting at the Toronto conference.
There I was, minding my own business when some well-meaning individual let it be known to Dr. Norwood that I had been using the drug for some considerable time. The good doctor asked me to send him my ‘before and after’ photographs, which I did with alacrity. Well you would, wouldn’t you? My face in Forum; what a great chance to boost my career. The proverbial marketing man’s dream. Wow!
I should have known better. Dr. Norwood only featured shots of the top of my head, but then he’s a scientist and I’m a marketing man; there is a difference.
In fairness, if there is one thing that I am quite well known for, it’s being in the right place at the right time, I’ll give you a few examples: I was in the right place at the right time when I first met our present illustrious editor Dr. Richard Sheill. It was Richard who trained me to counsel hair loss people in the 70’s when (due to a combination of paranoia and family genetics) I joined the hair restoration industry. Richard was in the UK training doctors for a British transplant company. He was associated with another Aussie, Dr.William Pouw. And, it was Bill who performed my first surgery. It was also the time when the clinic’s nurses had a premonition of Bay watch with it’s golden beaches and brilliant sunshine. When they saw these examples of Aussie men, half of them wanted to emigrate, but then there’s no accounting for taste, is there.
I was in the right place when the news broke about Minoxidil. I was resident in New York during the early 80’s and returned to he UK with prior information on the treatment. making it available to many other hair-nuts, years before it’s eventual release here.
Now I find that I am one of the few people in the industry to have long-term experience of finasteride, news of which is about to heaped (or should I say hyped) upon us in very large doses by the world’s media. Whether or not I can claim to have been in the right place at the right time on this occasion, is questionable. To put it another way. in response to the bright spark on Talk Radio who suggested he would manage with the drug until he found the lady of his dreams, I would say, "Forget it pal; you haven’t thought it through".
When my beautiful girlfriend fell victim to my charm, my wit, and my Retin-A assisted looks, the inevitable happened, or should I say, it didn’t happen. Can you possibly imagine how I felt? It was he first time in my life that I had ever experienced anything like it. I had never even suffered with what the English refer to as a "brewers droop" (a temporary inadequacy due to the consumption of excessive alcoholic beverages).
Have you ever had a dream where you found yourself walking down the street in broad daylight without your pants on? Well, this nightmare doesn’t come close to the feeling of humiliation which I experienced when confronted with a "power failure" just when my world was about to light up.
In retrospect, it was about 14 months ago that I began to notice that something wasn’t quite right "down below". I was wakening without any sign of "morning glory" and when I thought back about it, I realised that I hadn’t had sex on my mind for some time. Could it be that I was finally maturing, getting my priorities right for the first time in my life?
Not according to my urologist. In his opinion, my long term use of small doses of finasteride (which I have used in combination with 4% Minoxidil since 1991) had effected my libido. His diagnosis was confirmed when all became normal about three weeks off the drug. But then my hair started falling out again.
When Merck Sharpe & Dome get the go-ahead with Propecia, it will have been on the basis of a twelve month clinical trial. My problem took four years to develop. All I can say is that, when the Chinese are awarding their people cash benefits to limit themselves to one child per family, and at a time when the world’s scientists are becoming increasingly concerned about over-population, MCD could sweep the board. If my experience is anything to go by, MSD scientists may well be in line for a Nobel bloody Prize for population control.
The news report also told about cases of birth defects amongst animals following use of finasteride and the need to use contraception at all times. In my experience very few UK doctors are prepared to issue finasteride for hair loss. In fact they would only do so after a seriously worded disclaimer was signed. Apart from the occasional paranoid hair transplant consultant, you had to be gay, have a vasectomy, or past it sexually to qualify. Can you imagine asking a 23year-old man with galloping testosterone and a few beers inside him, to pause and fit a condom? I don’t think it would work.
There is however, a happy ending to my story, I have re-commenced the use of finasteride, halted the hair loss, and reversed the considerable loss of penile volume I experienced when on it. What’s more, I am now enjoying a normal sex life so don’t bother offering to help out.
I’m not going to discuss the details of how I overcame the problem, that would be getting far too personal, but I did carefully note the news story about the Israeli who had to be hospitalised after suffering a 36-hour erection when using a anti-potency treatment. Who knows I may call my next article "From Stud to Dud. . .and Back again."
Don’t despair guys, even if the drug succeeds in bringing the industry to its knees. Just think, you can have a 4 year break from operating, maybe in the Bahamas, and when you return to work, you will be overrun by patients wanting to have their hair transplanted. Then if you get really lucky, you can sell them one of the new injections or creams for impotency as well.
Cowboy Clinics
August 19, 2008
SEPT-OCT 1998 – HAIR TRANSPLANT forum INTERNATIONAL
Cowboy Clinics Ride the British Range
By Malcolm Mendelsohn, Manchester UK
Malcolm has had many years’ experience in the hair restoration field. He knows the British clinical scene very intimately from the viewpoint of management, as an employee and as a patient. I have known him for nearly a quarter of a century and greatly respect his acumen, knowledge and also his enthusiasm.
- Richard Shiell, Editor
“I arrived at the clinic at 8.30 am as arranged. They were closed. I sat in my car in the parking lot until 10 am when they finally arrived and opened up. One of the staff made some mumbled excuse for their being late and I was ushered to a room where I waited another half-hour before I was led to the operating room. I wasn’t even offered a cup of tea for my trouble.
Two nurses performed my surgery. It was only towards the end of the procedure that the Doctor appeared. He looked me over, had a few words with the nurses and then went. During the operation one of the nurses asked me how much I had paid their representative for the surgery. I told her and she questioned why I hadn’t bothered to‘barter’ with their representative to get the price down. I had obviously paid ‘through the nose’.
Within a few days of surgery I developed an infection. A large puss-filled lump appeared in the front of my head. I called the clinic and they told me to “pop it with a needle”, not surprisingly I was absolutely dumbfounded. My own doctor prescribed a course of antibiotics and the infections eventually cleared. I have since discovered that the local health authority had closed down one of the operating rooms they used for ‘liposuction’.
Apparently a couple of ladies had developed serious infections after the operations and complained to the authorities. The story was well covered in the local press. The results of my operation were abysmal. Many of the grafts failed to grow and I am now left with the remnants of the failed surgery in full view since losing further hair. I thought this sort of practice disappeared in the Middle Ages.”
This was part of a letter I received from a “victim” of unscrupulous practice. It isn’t the first and in a country where with your neighbour’s consent, you can legally perform surgery on him (without even a qualification to your name), but not on his dog. It
certainly won’t be the last. It is no wonder that we have more than our fair share of “Cowboy Operators”. We also have a highly sensationalist press who take great pleasure in dragging up the worst cases of abuse and presenting them to the
public as an everyday occurrence. So rife was the run on hair transplantation clinics at one time. A national newspaper with the highest circulation (5 million) actually advertised for “victims” of Hair Transplantation malpractice to contact them with their “horror stories”. They then published an expose a month later featuring the worst cases. As it transpired, the best they could do was feature cases of ‘botched’ plug surgery dating back to 15 years ago. The most recent was 5 years ago. Nevertheless, the damage was done.
Consequently, since the time the British “tabloid press” first latched onto the Hair Transplant Industry, we have endured bad press at regular intervals. It must have been some 20 years ago when the first expose appeared. It concerned the hair transplantation Doctor who left his patient alone in the theatre while he “test-drove” his new car. The good Doctor returned to find his patient on the surgery floor, having fainted through loss of blood.
More recently, those amongst us who really care about our industry, are unaware of flashes of light at the end of a very long tunnel. If the changes continue the “tabloid press” will have lost a “filler” for whenever there is a shortage of gossip. It would
appear that the Advertising Standards Authority (ASA) have finally begun to clamp down on the activities of some of the more outrageous of our brethren. The Authority would appear to have developed teeth. In fact, for a part of last year I was convinced that they had them firmly attached to my left buttock.
For about eight months, the ASA and I was almost inseparable. Their envelope with its “now familiar” logo on the front, (a red box with a “tick of approval” in the middle) would arrive with the latest judgments from their monthly “committee meeting”. They were pretty happy with most of my advertising content but not about one line in particular. It read “25 years presenting some of the world’s finest Hair Transplant Surgeons”. This is perfectly true and I have provided the references to prove it. The ASA simply wouldn’t have it. In the end, I was adamant about the issue. I was even prepared to go as far as the courts to “fight my corner”.
What made it worse was the adjoining advert to my own, in a national men’s magazine, was making a complete mockery of the advertising codes and getting away with it. Their marketing man was using “before” and “after” photographs “nicked” from another surgeon as an example of his Doctors’ work. He was claiming “Gold Award” winning surgery for his clinic when the “Gold Award” winning surgery belonged to the surgeon whose photos he had “acquired”. His claim of having “advised 100,000’s of hair loss sufferers” was fiction and he implied in the way he “slanted” his advertising that he (the salesman) was a member of the ISHRS. In all, there were seen separate claims that were either misleading or an outright attempt to “take the piss” out of the rest of the industry. At worst, he was the proverbial “accident waiting to happen”. The media’s next
“scoop” and another three months of reduced-advertising inquiries. And here am I getting “grief” over my claim, based on facts.
I was so angry I was, as my dad (God rest him) used to say, “spitting feathers”. I began to feel paranoia coming on. I was being “victimized”. My last communication with the ASA was outrageous. I didn’t even edit it. I simply didn’t want to remind myself of it contents, it was that bad. All I can bring to mind was one small part of the document. It posed the question, “How can a body of nameless individuals, with such little knowledge of my industry, other than what they read in the press ‘sit in judgment’ at their monthly committee and ‘rewrite’ my bloody life history for me?”. Not the best way to influence people.
And then it happened. I got a phone call from a close friend telling me to get a copy of that day’s Times, one of the more believable papers. There it was two pages across, of the latest abuse. Only this time it wasn’t Hair Transplant Surgery. It was cosmetic surgery. But more significantly (and to me, more importantly), it outlined some of the more overall “controls” that have now been imposed on the industry as a whole, with regard to future advertising.
Fantastic! Unbelievable! Cancel the Prozac! I screamed inwardly. It wasn’t me they were after, it was everybody! I just happened to get caught up in the overall “swing of things”. In an instant my anger disappeared, my paranoia close behind. I even felt a warm glow in the pit of my stomach toward the ASA.
Added to that, the offending clinic I mentioned was forced to change its advertising. I was so delighted I immediately changed the offending line of my advert to “25 years of counseling on behalf of some of the leading exponents of Hair Transplant Surgery”.
That was six months ago and all is calm. The good news is that I no longer live in fear of some “investigative journalist” penning yet another expose about my industry.
Hair Loss Drugs
August 19, 2008
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The Facts: It is established that ‘Minoxidil’ even in its most potent strength 6%, will do little more than slow down hair loss for a period of time. Although there are cases of re-growth – generally young men with very recent hair loss. It is usually minor growth, which doesn’t tend to develop past the intermediate stage. Added to that, time has shown that the benefits of Minoxidil wear off after two to three years of continuous use. In short, the treatment is useful to help ‘take the pressure off’ young men, suddenly facing hair loss. Allowing them more time to come to terms with the problem. Most Clinics offer a range of ‘additives’ to the basic Minoxidil therapy. Progesterone and Tretinoin in the main. Or a combination of both. Progesterone, (an anti-androgen, purported to block the formation of the male hormone (testosterone) in the scalp). Allowing the Minoxidil to have more effect. Tretinoin – a derivative of Vitamin A is used as a ‘vehicle’, allowing the Minoxidil to penetrate the scalp more effectively. These are topical solutions applied to the scalp. Consequently, they remain ‘localised’ in the target area, rather than being absorbed into the main bloodstream. Unlike Finasteride, which is taken orally. To those unfamiliar with Finasteride, let me explain a little of its history: Finasteride is a drug, which began life as a treatment for prostate cancer. As is occasionally the case with newly developed drugs, Finasteride was found to have a beneficial ‘side-effect’, totally unrelated to the drugs intended use. During the drugs initial clinical trials for prostate, it was realised that a considerable number of men being tested showed initial signs of growing some of their hair back. I read about this development in 1992 and commenced using the treatment myself shortly after that. In 1997 (6 years after the manufacturers initial discover), The FDA (America’s Food & Drug Administration) licensed the drug for use as a hair growth treatment in the US. One could ask why, knowing Finasteride’s potential for growing hair, the manufacturers limited their clinical trials to only 12 months? Could it be that, had they extended the trials, they would have had to admit that their drug too, has limitations? Interestingly, a recent television report featured one man having complete re-grown his hair with the pill and one other looking like he was about to do the same. All I can say, is that after 11 years personal use of the pill and feedback from the hundreds of men who acquire treatments through my company’s Doctor – No one has re-grown significant volumes of new growth. Yes, it can prevent further hair loss and does so for something like 84% (published) of users. Yes, it can improve the ‘volume’ and lustre of their existing hair. It can also produce the first signs of new growth but this growth tends to remain fine in texture and short in length. In amongst a man’s existing hair, the fine, short growth which achieves its original pigmentation, rather than remaining velus (translucent) gives a much-improved appearance to the overall ‘look’ of his hair. Unfortunately, to apply similar results to a bald scalp would appear insignificant. Therefore, the way one views Finasteride’s success depends greatly on one’s current state of hair loss. To men who are just recognising the first, subtle signs of oncoming hair loss, Finasteride is all that’s required to ensure them of a hirsute future. That is, for as long as they continue its use. Stop taking the pill after a few years and all the hair the man has prevented from falling out – will disappear. Not over a period of years, as would likely have been the case but over a period of weeks. Hirsute to hair-less, in a few short weeks! There are those, of course, who are simply happy to maintain the ‘status quo’. They can live with their hair loss as it stands but are unhappy at the thought of it getting any worse. These men too would value the treatment, especially if it improved on the overall appearance of their existing hair. Finally, there are those who have lost some, but not all of their hair. They opt for hair-growth treatments, hoping that they are among the rare cases of ‘total re-call’ we occasionally see on television documentaries. Then, having likely narrowed the gap between what they had and what they wanted, they, as I have, opt for Hair Restoration Surgery to achieve their goal. Knowing that they do not face losing more hair, once the surgery is completed. Contra Indications Propecia (finasteride) Does finasteride cause any side effects?In clinical trials, finasteride was very well tolerated in men, with most patients reporting no serious side effects. The principal side effects associated with finasteride were decreased libido (1.8% of finasteride patients versus 1.3% on placebo) and erectile dysfunction (1.3% finasteride versus 0.7% placebo). In addition, decreased volume of ejaculate was reported in 0.8% of men treated with finasteride and 0.4% of those on placebo. All of these side effects resolved upon discontinuation of therapy, and also resolved in many men who preferred to continue therapy. Is there any evidence that long-term use of finasteride is dangerous or detrimental to a man’s health?Finasteride was evaluated in 3,200 men and it was very well tolerated, including patients on therapy for up to two years. Long-term suppression of DHT does not appear to be harmful. This is based on extensive research, dating back to 1974, of me Are there any contraindications for finasteride?Finasteride is not indicated for use in women or children. Finasteride is contraindicated in women who are or may potentially be pregnant. Finasteride is contraindicated in patients who are hypersensitive to any component of the product. Related information Does finasteride cause any interactions with other drugs?No drug interactions of clinical importance have been identified. Studies have been conducted with finasteride and antipyrine, digoxin, glyburide, propranolol, theophylline, and warfarin, and no interactions were found. In clinical trials, finasteride was used concomitantly with ACE inhibitors, acetaminophen, alpha blockers, benzodiazepines, beta blockers, calcium channel blockers, cardiac nitrates, diuretics, H2 antagonists, HMG-CoA Reductase inhibitors, prostaglandin synthesase inhibitors (NSAIDs), and quinolones, without evidence of clinically significant adverse interactions. I have heard that a combination of finasteride and minoxidil may be the best solution for male pattern hair loss. Is this true?There are no human data supporting the use of this combination. Scientific studies would be required to assess the safety and efficacy of such a combination. At this time, no combination studies are planned. |
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