The Provider Who's Also the Patient
In part two of the hair loss mini-series, Buchi Neita, PA-C, and co-host Lisa Weiss, PA-C, dig into non-scarring alopecias and open with something personal. Weiss shares that androgenetic alopecia (AGA) is 'very near and dear to my heart.' A Caucasian woman in her early 40s, she was diagnosed with AGA at age 24 after her mother noticed her ponytail was thinning. A physician she worked with as a medical assistant biopsied it and confirmed the diagnosis early.
Weiss doesn't sugarcoat the emotional weight — she recalls googling AGA, seeing worst-case-scenario images, and worrying she'd be a 'bald bride.' But she frames that experience as clinically useful. When she walks into a room and tells a patient, 'I understand you; I'm a hair loss patient myself,' she says it shifts the room's energy toward teamwork. She even pre-empts the inevitable Google search, warning patients that what they'll see online is the worst-case scenario, 'not what I'm going to do for you.'
Neita relates, sharing her own history with traction alopecia, a patch of alopecia areata in college, and postpartum telogen effluvium. Both hosts agree that this lived experience — and the fact that Weiss now has a full head of hair — builds an authentic connection that reassures anxious patients.
Androgenetic Alopecia: Exam Clues and Metabolic Overlap
AGA is the most common cause of hair loss in both men and women. Weiss notes clinicians recognize the male pattern easily, and the widened part in women, but warns that in women with lots of hair—or textured hair—the widened part and even bitemporal recession can be subtle or hidden under a swoop bang. Both hosts stress the dermatoscope: look for miniaturization and variation in hair shaft diameter, and watch for overlap with telogen effluvium (empty follicles alongside caliber variation).
Neita raises the hormonal and metabolic angle. She references a report of a male patient on no other AGA therapy who had significant regrowth after several months on a GLP (noting she wasn't sure whether it was tirzepatide or semaglutide), and points to insulin resistance, androgen excess, PCOS, and metabolic syndrome as things to keep on the radar. Weiss cautions the flip side: rapid weight loss from GLPs can trigger telogen effluvium, so patients may see shedding before any benefit.
AGA Treatment: Why the Hosts Reach for Oral Minoxidil
Weiss says she reviews every option on the market. She offers topical minoxidil as a safe, affordable OTC choice but is candid that it’s greasy—especially unpleasant for someone with thin, oily hair—and only works with consistent use. Neita adds that compliance is the real barrier, propylene glycol in OTC formulations can irritate, and compounded creams or oils (up to 7–8% minoxidil, sometimes with tretinoin added for efficacy) can improve tolerability.
Both hosts are enthusiastic about oral minoxidil. Weiss uses it for almost everything — praising a low-dose, clean safety profile that works well. She counsels women about increased vellus (peach fuzz) facial hair and an initial shed, and tells patients to watch for leg swelling. Neita adds that patients prone to male-pattern facial or body hair may get thicker, coarser hairs, not just peach fuzz. It requires consistency given its short half-life.
Other options discussed: finasteride and dutasteride (in women, only postmenopausal — not those of childbearing potential); spironolactone, often combined with oral minoxidil for the hormonal component, with counseling on hydration; and procedures like hair transplantation and PRP as combination therapy. Both hosts warn patients about post-finasteride syndrome and the online campaign around it, counseling every patient — male or female — on potential erectile dysfunction and decreased libido. On low-level (red) light therapy, both are open to it as an adjunct but steer patients toward inexpensive, effective oral options first, and recommend FDA-cleared devices used consistently if patients invest.
Alopecia Areata and Telogen Effluvium
For alopecia areata, Weiss's diagnostic clues include exclamation point hairs on dermatoscopy, nail pitting, and screening for other autoimmune disease (especially thyroid disease/Hashimoto's). She shares a practical trick: check lymph nodes to help differentiate tinea capitis — useful in pediatric patients at higher risk for tinea capitis. Neita's go-to is intralesional triamcinolone, with a topical numbing agent (like BLT) beforehand to ease injections. Weiss also offers topicals so patients feel empowered between visits, and uses low-dose systemic steroids in select cases — including a current patient who isn't a JAK candidate. Both love JAK inhibitors for more severe disease, stressing careful candidate screening (cardiovascular and cancer history, contraindicated meds) and reminding listeners to consider special sites — eyebrow and eyelash loss carry major emotional impact even below the 50% threshold.
On telogen effluvium, the hosts note two recent surges: COVID and now GLP-1-related rapid weight loss. Both warn against writing off all shedding as 'just COVID' or 'just the GLP' — a thorough history and exam matter, and TE often unmasks underlying AGA. On dermatoscopy, TE shows empty follicles and a positive pull test without the miniaturization seen in AGA. Weiss identifies chronic TE as genuine excessive shedding without miniaturization. Treatment centers on reassurance that the hair will return, plus nutraceuticals and minoxidil (topical first, oral if distressing), with counseling that minoxidil can transiently increase shedding. Both emphasize the lifestyle and psychosocial piece — sleep, nutrition, stress — as central to recovery and prevention.