The Hair Genome Test

Hair Podcast Dr. Sam Lam:

This podcast is on the hair genome test that I’ve been doing now and I really do like it and also I don’t like it. There is a role for it and I try to use it in a way that would be helpful for my patients. So, what this test involves is a questionnaire as well as a buccal swab. So a buccal swab is basically a Q-tip placed inside your mouth and it swabs the inner part of your mouth. It’s sent out for analysis with a response in about three weeks, and it’s a very detailed analysis of everything that we need to know about your situation with sensitivity to different types of medical therapies. For example, it’ll tell you are you more sensitive to minoxidil than finasteride, what level of sensitivity, and what dosing would be appropriate.

It looks at 14 genetic parameters that could influence your hair loss and also it looks at vitamin deficiencies that you have. So it’s a very powerful test. The things that it looks at, for example, with minoxidil, it could tell you that it needs a 7% minoxidil rather than a 5%. It could tell you that you don’t have what’s called sulfur transferase, which is an enzyme that converts minoxidil into its active metabolite, known as minoxidil sulfate. 30-40% of people out there actually have a reduced amount of sulfur transferase in their scalp, and the way to treat that is with an oral dose. An oral dose can bypass that . Or with an increased topical dose, if someone wants a topical dose, there is an example looking at a glucocorticoid receptor. Sometimes a light steroid in there would be helpful and sometimes it doesn’t do anything. In standard concoctions it’s already all mixed together, so it already tells you and it gives you a standard dosing like everyone is treated in the same way.

So, I love it for those reasons and I love it in particular if, for example, it’s an older gentleman who wants to figure out, hey, they want to do something for medical therapy, but they don’t want to be on everything, then I could find out if they’re more sensitive to minoxidil or to finasteride and get them maybe on a single model therapy. That would be easy. It’s really great for women in particular because with women we often use finasteride. But does it do anything? What dose of finasteride? Of course, you have to be careful if someone’s of childbearing age that you don’t give them anything that’s called teratogenic or it could cause problems with childbirth. But if they’re on finasteride, oftentimes you just give them a dose and you wonder if it’s going to be effective. Is an oral dose going to be more effective than a topical? What is a topical dose? Is it going to be equivalent to the oral dose? Are they even sensitive to it? Do they need the glucocorticoid integration of steroids?

There is so much data out there that is helpful for me to guide a patient on the best therapy. What I mentioned at the very beginning of this podcast is there are things that I don’t like about it. For example, it may give a red line that says, “Not sensitive to finasteride.” The problem with that is I would say the vast majority of men out there are sensitive to finasteride. I would say 99% at some level. Now, is it the exact same across all patients? No. There are going to be men that respond better to finasteride than others. The problem when I’m dealing with a young gentleman where, for example, I don’t have the option to do a transplant for them because of ethical reasons where they could run out of hair and I need them on the strongest medication out there, my concern of interpreting that data is they’re going to see that and say, “I’m not really sensitive to finasteride. I’m not going to take it.” Or they’re going to say, “You know what? I’m not really sensitive to minoxidil. It’s game over.” And where I think the caution here is when you see that, I would say, “Well, we should dose it higher. We should work harder at it.” It’s sort of like if someone has love handles and they go, “You know what? I heard that for my genetics it’s really hard to lose love handles so I’m not going to even go to the gym.” And that’s a similar analogy though. No, if you have love handles and you’re genetically not sensitive to lose it, you need to work out harder to get that under control. Especially for younger men where I feel as if I don’t have the luxury of surgery, I need to throw more things at them medically and when there is different biases on that test where it shows that an area may not be as sensitive, then I’m concerned that the younger gentleman would just say, “Oh, scrap it. I’m just going to take this one barely.”

It’s important just to take a step back and understand with medical therapy, it’s not going to regrow a full head of hair. Surgery is meant to transplant areas where there is no hair there. This medicine has really helped to slow down laws to optimize it and also to regrow hairs that are miniaturized or thinning. So there’s a great value to this test. We do it in the office and get that test back to you. I always say this is very portable in the sense that when you get that information to you, we work with a compounding pharmacist to make the exact dosing that will help you. But after that, if you move to Seattle or somewhere else, you can basically take that information and have a compounding pharmacist with an appropriate physician work with you on getting that to you and you get to keep that report.

So this genome test to me is a really powerful way to look at things and to incorporate that regimen in a most effective way. I always encourage my patients to do it earlier than later because it’s great to know what you need dosing now than wait five years and then do the test. That being said, oftentimes with women that are experiencing hair loss, my go-to (which depends on the person) is really a natural regimen of hair loss. I’m going to do a podcast on that discussing that more in detail. But I think this genome test is very effective and the earlier you take the test, the more information you have early on and you can make those adjustments before it becomes too late for hair loss. It’s better to optimize everything on the early end of things, in my opinion.