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Join Dr. Zain Husain and special guest Dr. Fatima Z. Syed, a primary care physician and endocrinologist, as they discuss the intricate relationship between hormones and skin health in this episode of 'Skinside Out.' They cover how hormones such as estrogen, testosterone, and thyroid hormones influence various skin conditions like acne, hair loss, and perimenopause-related changes. The discussion includes practical insights on diagnosis, the importance of patient history, and treatment options including medications like spironolactone, Minoxidil, and hormone replacement therapies. They also touch on lifestyle changes, exercise, and stress management as key factors in maintaining hormonal balance and skin health. Stay tuned for an engaging and informative conversation that bridges the gap between medical and cosmetic dermatology.
00:00 Welcome to Skinside Out
00:38 Meet Dr. Fatima Z. Syed
01:32 Hormones and Their Impact on Skin
01:57 Understanding Hormonal Imbalances
03:04 Perimenopause and Post-Menopause Hormonal Changes
06:21 The Role of Thyroid in Skin Health
07:13 PCOS and Its Skin Manifestations
08:00 Acne and Hormonal Treatments
15:54 Hair Loss: Causes and Treatments
19:17 Low Dose Minoxidil: Benefits and Side Effects
20:09 Finasteride: Uses and Considerations
21:57 Spironolactone and Other Treatments for Hair Loss
24:03 Lifestyle and Diet for Healthy Hair and Skin
26:42 Stress and Its Impact on Hair and Skin
28:18 Hormone Replacement Therapy: Pros and Cons
30:35 Men's Hair Loss and Testosterone Replacement
32:45 Conclusion and Future Topics
Creators and Guests
What is Skinside Out?
Welcome to Skinside Out, where science meets beauty, the ultimate dermatology podcast! Dive deep into the fascinating world of skin health with expert insights, evidence-based discussions, and myth-busting truths. Each episode explores the medical, cosmetic, and surgical aspects of dermatology, while keeping you informed about trending skincare topics. Whether you’re a skincare enthusiast, medical professional, or just curious about how to achieve your best skin, Skinside Out is your go-to resource for staying informed and inspired.
08 Skinside Out
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[00:00:00] to Skin Side Out where Science Meets Beauty. I'm your host, Dr. Zane, and I'm here with special guest Dr. Fatima, ed. And today we're gonna talk about all about hormones.
Dr. Zain Husain, MD: So, Dr. Syed, I just want you to introduce yourself.
Fatma: Absolutely. Um, so it's nice to be here. Um, I am, um, a primary care doctor, a general internist, did do training in endocrinology, um, and, um, really like hormones found that I could do a lot of that in primary care. Yeah. So that's why I work as a general internist.
Mm-hmm . And, um, I am an academic [00:01:00] clinician in Durham, um, trained at Virginia Commonwealth. Jefferson and Philly were like the big transient city for a lot of people. Yeah. Um, I've been there too. Yep. and now we're in the lovely triangle, so, yep. Fantastic. Thanks for having me.
Dr. Zain Husain, MD: Yeah. And um, you're a mom of two kids and soon to get three.
Yes. Yes,
Fatma: exactly. Yeah, that's a big part of it. things also lots of hormones going on too. Lots of hormones. So excuse my anger if that comes out. Um, lots of hormones, lots of skin things happening, as you know, as my dermatologist, so. Absolutely.
Dr. Zain Husain, MD: All right, so let's get into it. So, um, as you may or may not know, um, hormones have a huge impact on the skin, and I think that this episode is great so that we can actually talk about the hormones at the basic level.
Mm-hmm . And how they apply to dermatology. Mm-hmm . Mm-hmm . So let's dive right in and kind of go into, um, you know, specific hormones and . What they do. Yeah. And how they can potentially impact the skin.
Fatma: Absolutely. Yeah. I think that's a great place to start. And there's a lot out there with patients [00:02:00] that I think patients read about, and then there's going to see your, your, your physician and ordering labs, and then sometimes there's like a disconnect of what matters and, and, and what doesn't.
So I often get patients talk to me about like, I think my hormones are off. I hear that
Dr. Zain Husain, MD: all the time.
Fatma: Yeah. And, and I think that that makes sense. That means that there's something going wrong and we're attributing it potentially to some endocrine or hormonal issues. Um, but it's important to sort of understand like what that means.
Um, and what can be corrected and what can't. So like when we think about hormone, it depends so much on symptomology and then that can drive like how we prescribe things or how we, how we decide what labs to check or not check. . Um, sometimes patients come in and they're like, I want my hormones checked.
And that's such a tough thing to do because it really, again, it's all about what I tell students too. It's all about your history. You can get so much mm-hmm . From the history of what's relevant and, and what's not. Um, if it's helpful, [00:03:00] we can maybe take, talk about like certain patient scenarios as well.
Sure. Yeah. So, you know, I think of a patient I see very often is, um, patients who are. Approaching perimenopause or post menopause, they're starting to get changes in their hair and their skin. Mm-hmm . Their cycles are starting to get irregular and they're like, I want my hormones checked. And oftentimes Right.
It may not change the clinical course, so they may get a little bit of pushback from their clinical providers saying like. I mean, we can check it, but we also, it, it may not be relevant to the course of what we can do. Um, and I, and I think there's merit to that, but at the same time, we also have to work collaboratively with our patients.
Mm-hmm . So in that patient, I'm interested in their estrogen levels. I'm in interested in the, the, so the reason I like endocrine is because there's just a bunch of . Little chains, that one turns on another, another turns on, another, another, turns off the other. It's kind of easy to think about. [00:04:00] So I'm interested in the hormones of the brain that are telling their, um, ovaries to make hormones or not.
I'm interested in their testosterone levels. I'm interested in, um, progesterone, their LH and FSH, the hormones of the brain. Mm-hmm . Also their thyroid. This comes really relevant in patients who might have irregular cycles and PCOS. So, um, and also in patients, um in our male patients, interested in their testosterone, their thyroid, all kinds of things.
So it's really important to really delve into the history and then you can kind of figure out like, where do I go from here?
Dr. Zain Husain, MD: Yeah. So you know the approach where people are just ordering a whole panel of labs. Yeah. Yeah. It's really hard to interpret. Sometimes it's
Fatma: really hard to interpret. Mm-hmm . And it's also like very accessible, which it's really cool that there's so much health access at our fingertips in a lot of ways.
But then . . People don't know how to interpret those things, and that's where you kind of get stuck. So I think it's really important to work with your physician, um, or whoever you're seeing, um, to be able to kind [00:05:00] of think about next steps.
Dr. Zain Husain, MD: Yeah, exactly. And then these hormones aren't just isolated, like they are affecting the whole body.
Exactly,
Joe: exactly. And there's
Dr. Zain Husain, MD: a complex interplay. Yeah. So it is a lot. And that's why I always respect it. Endocrinology, I always found it. Fascinating. Absolutely. What you guys do and how you can really improve someone's health. Yeah.
Fatma: And you can definitely like be able to put pieces together in a way.
Mm-hmm . As well. Like for example, I've got some patients who I might see for weight management or just in general, and they didn't know that they had PCOS. Because they were able to mask their insulin resistance. And I know we'll talk a little bit more about that as well. But they were able to mask it through their life because they exercised a ton or whatever.
They were able to lower it naturally. And then they're in their fifties and sixties and I'll really delve, like, tell me about your cycles when they were happening. Mm-hmm. And no one's really asked them those questions. Interesting. In like 10 or 20 years. 'cause it hasn't been relevant. Or did it take you a while to get pregnant?
That sort of thing. And then we find some of their skin findings, like PCOS [00:06:00] doesn't just end 'cause you go into menopause. Yeah. You may still have the manifestations afterwards. Um, and so again, I keep saying like it's just those conversations are so important. Yeah,
Dr. Zain Husain, MD: absolutely. Yeah. Um, so that's great. I mean, like we talked about estrogen, testosterone, um, there's some other hormones that we typically see.
Um, you mentioned thyroid disease as well. Yeah,
Fatma: absolutely. So, um, talking about the thyroid, sometimes, you know, patients may have hair thinning mm-hmm . Um, that they may find that their nails are more brittle. Um, and then they might have other symptoms like they're feeling more cold or . It's they're gaining weight and they don't know why, or they're feeling fatigued or off.
That points me towards hypothyroidism. Hyperthyroidism has the opposite symptoms, so feeling like your heart's palpitations. They might have some changes in their appearance of their eyes. That points me more towards hyperthyroidism. They may have more hair shedding as well. So, um, depending [00:07:00] on where the patient's symptoms are.
Um, we might sort of check those things and often, like if, if I'm getting meeting a patient for the first time and there's a lot of things going on, I'll probably check a lot of different things. Mm-hmm . Like, um, for PCOS, we call the, the, um, polycystic ovarian syndrome that is a disease of, um, of basically excluding other things.
Um, so there's this thing called the Rotterdam criteria. Which is basically irregular cycles plus either acne or unwanted hair. That alone can help me diagnose it. Mm-hmm . But the reason we do lab work is to make sure there's nothing else going on. So we check the testosterone, make sure there's not a tumor secreting testosterone that could explain symptoms.
D-H-E-A-S, um, cortisol levels, making sure that there's not a hormonal issues from in utero that are impacting things. Yeah. Um, so again, based on the scenario, we may check, we may check different things. Yeah.
Dr. Zain Husain, MD: So let's dive into some other, um, [00:08:00] you know, conditions. So acne and hormones. Yeah. Um, so I see that a lot in my practice.
Oh, yeah. . And, you know, we talked about PCOS, um, so . Tell me how you approach your patients.
Fatma: Yeah, absolutely. First, I think it's really important to know what you know and then know what you don't know. So if I need to phone a friend in dermatology, as you know, I will phone you, I got you, and send patients your way.
Um, or to other dermatologists as well. So if I've got a patient who's got PCOS, and I know that they have P-C-O-S-P-C-O-S is a disease of insulin resistance, and it'll be helpful to explain what that, what insulin resistance means. Um, so . Basically insulin is a hormone that's secreted by the pancreas. Its job is to get sugar to go from your bloodstream into your cells.
And sometimes that can be hard when we're carrying extra weight or we have natural disposition to be insulin resistant if we're South Asian, so all of us, um, or you've got family history of diabetes or whatever reason. Um, and so, um, [00:09:00] PCOS can have a whole consolation of symptoms. Irregular cycles like we talked about.
Mm-hmm . Unwanted hair, like we talked about acne. Um, but it can also be like hair that's thinning or shedding or mm-hmm . Um, um, you know, androgenic alopecia, things along those lines. Yeah. Um, and that's where I try to address the underlying hormone issue with diet, exercise, medications. Mm-hmm . Um, and if we're still having the skin manifestations or if we, we just wanna, you know, get in with someone, I'm like very quick to say, let's get a dermatologist involved.
Why, why delay getting the right care?
Joe: Absolutely.
Fatma: So, um, PCOS, again, so the, and the skin findings we might see is . The signs of insulin resistance. Mm-hmm . So like darkening, A acanthosis. Yep. Of the neck. Again, the unwanted hair or like the darkening of the skin and like patch, like melasma or that patchiness as well.
Yeah. Um, and again, if we can lower that insulin resistance, we see such improvement in symptoms. Yeah.
Dr. Zain Husain, MD: It's huge. I mean, I see so many [00:10:00] patients on a daily basis. Yeah. With all these manifestations of insulin resistance and they have no idea. Mm-hmm . Absolutely no idea. Exactly. Why is you a primary care physician?
Yeah. Um, when have you seen, have you seen an endocrinologist? And many people just don't know
Joe: exactly. And
Dr. Zain Husain, MD: they're actually literally coming in for like this hyperpigmentation on their neck that they can't throw in Ni your hands. Yeah. You know, like, oh, like I keep getting my, you know, unwanted hair waxed, you know, like I'm getting annoyed with it.
Yeah. I'm like. We need to do a deeper dive in seeing like, hey, what is the, what is the cause of this?
Joe: Absolutely.
Dr. Zain Husain, MD: And I think that's where we can do, um, you know, a lot for our patients. Absolutely. So many times they're going to me as the first step as a dermatologist and I'm like, hold on. I mean, I can help you with all these things, but we really need to partner with your primary care physician, endocrinologist, um, your OB GYN, and make sure that we get you the proper help that you need because mm-hmm
Like, you know, insulin resistance has a lot of serious consequences. Yeah.
Fatma: And we're so specialty focused in medicine. Mm-hmm . Right? That like everyone's in their own silo [00:11:00] and then patients can also access different specialties without having the anchor. And I think that anchor, that general internist family physician, that primary care is so important to like, put things together, um, just so that you can address some of those things as well.
Or seeing an endocrinologist if that's the right step as well. Yeah.
Dr. Zain Husain, MD: I wanna get your thoughts on Spironolactone. That's one of our favorites in dermatology. Yeah. Yeah.
Fatma: Yeah. Yeah. Um, so Spironalactone work works really well for hormonal acne. Mm-hmm . Um, I think that, um, you know, I'm an internist, so I'm obsessed with potassium.
Right? That's what we like . Half of what we talk about is I go hours about potassium pathways. Um, but obviously you just wanna make sure you're following so up with someone about lab work. Mm-hmm . It's a diuretic. Diuretics do have side effects. Yeah. And so you have to talk about like, the risks, benefits for people.
Yeah. Um, obviously you don't wanna take it if you're thinking about having a baby 'cause you don't wanna impact the hormones of the baby either. Um, so, um, I, I think it works really well. For the right cases, but again, we have to know the history, like Yeah. [00:12:00] Is your, is your acne particularly cyclical? Mm-hmm
Um, is, if so, if it's around your cycle, then spironolactone is a really great medicine. Yeah. But if it's not like, yeah, it might not be the right medicine for you. And why put you through? Through, um, yeah, a diuretic if you don't need to be on one. And
Dr. Zain Husain, MD: interestingly, there's been a huge push to topical. Yeah.
Um, spironolactone and other like androgen blockers. Absolutely. And that has been a new option for a lot of people. Yeah. And you can use it, male and females. That's awesome. Without getting those, you know, side effects, unwanted effects for the males especially. Can I
Fatma: ask you about topical estrogen? 'cause I actually wanna learn a little bit more about that myself.
Dr. Zain Husain, MD: Yeah. It's pretty remarkable. Like we see a lot of anti-aging properties. 'cause as, you know, estrogen, um, you know, there's estrogen receptors in our skin. Yeah. And those topicals can really help rejuvenate the skin. Yeah. Helps with. Collagen synthesis and other peptides that are formed in the skin. Mm-hmm
And it's, it's pretty remarkable. That's great. Um, and we've had a lot of patients ask about them. Yeah. And you know, you can get them compounded mm-hmm . Um, and you know, I think that [00:13:00] especially for our post-menopausal women Yeah. We're looking for rejuvenation. It's been a game changer. That's
Fatma: wonderful.
Yeah.
Dr. Zain Husain, MD: And
Fatma: it's okay for, 'cause the other thing I think about, again, with my internist hat is there's some people who cannot. Get, um, yeah, oral estrogens. Mm-hmm . Um, like, and those can be helpful in patients with PCOS, but let's say they have history of migraine with aura. Mm-hmm. We don't wanna increase their stroke risk.
Yeah. So that's an option for those. That's an patients, that's option. Yeah. Okay. Wonderful. Yeah. Like the safety profile of that. Yeah. Yeah. . Yeah.
Dr. Zain Husain, MD: So it's like not. Filtering through your whole body and everything. Exactly. Exactly's. So kind of localize it. So great. Yeah, yeah, yeah. It's an option.
Fatma: Yeah. I mean, we've been using it on the GYN side of things for a long time Oh yeah.
To help people like prevent getting urinary tract infections. Yeah. That sort of thing. So that's great.
Dr. Zain Husain, MD: Yeah. That's cool. Yeah. Um, so going back to PCOS. Mm-hmm . Um, so like in dermatology we see a lot of patients with acne, . We're also seeing, you know, that M Yes. Yes. Which is that unwanted hair. Yeah. And many of them are coming for us, Hey, for strategies to limit that.
Mm-hmm . So, you know what I do in my office, um, I use [00:14:00] a lot of laser hair removal. Yeah. It's safe, it's effective. Um, I dunno what your thoughts are. I mean, do you think that, um, you know, destructive methods for removing hair? Yeah. And wanted hair is a good thing or. Do you find that when patients are properly treated for their home imbalances, that tends to go away?
Fatma: I think it tends to improve. Mm-hmm . It may not go away entirely. Yeah. But if you can lower that insulin resistance again through, um, diet, exercise, medications, like metformin, maybe regular cycles with, um, birth control, it can definitely improve. Yeah. But I think laser and the old school methods of electrolysis in particular mm-hmm
They're, they're, you know, laser is less painful. Electrolysis is absolutely more painful. But it is something that can offer a permanent solution. 'cause think about like if you're . 20 and you have to get threaded or wax. Yeah. Like every week or shaving. Like that's a big thing on your mental health as well.
It is. If it's something that you, you know, that disturbs you. Mm-hmm . So I'm a big advocate of, you know Yeah. [00:15:00] Plug into these things early and why, why put yourself through more than you need to. Yeah.
Dr. Zain Husain, MD: And then, you know that topical medication, I dunno if you've heard of the Vica in the past yet.
Fatma: Yeah. It's supposed to slow hair growth.
I've never found that it worked. I agree. Like
Dr. Zain Husain, MD: it's just like. Nobody's really satisfied with it.
Fatma: Exactly. I remember actually when it came out Yeah. In the nineties, and I was a kid mm-hmm . As, you know, like in our population, unwanted hair and PCOS is like a big thing. Yeah. And I remember like the aunties being really excited about it and it was really expensive.
Yeah. And then it didn't help very much. So I,
Dr. Zain Husain, MD: I'll
Fatma: be, and it's, you've gotta mostly pay out of pocket for it, so. Yeah. And
Dr. Zain Husain, MD: actually it's been off the market. Yeah. Has it, and now it just has to be compounded, so. Okay.
Fatma: Okay. If it's not helping and I don't see the point basically. Yeah. Yeah. I would say
Dr. Zain Husain, MD: use that money and.
You know, get these hair. Yeah,
Fatma: absolutely. Absolutely. It works so much better.
Dr. Zain Husain, MD: Yeah. Um, all right, so one my least favorite topics, um, . Hair loss. Yes. So it's not that I don't like it. Yeah. It is just so frustrating. Yes. And [00:16:00] it does require a lot of detective work. Yeah. So, I mean, do you see hair loss in your practice?
Yeah. I'm usually the
Fatma: first person that people talk to about hair loss. Um, and it's, it's really tough. It's tough for everyone. It's tough for male patients. It's tougher female patients. Yeah. It's, it's something that people really struggle with. Yeah. And so I do do a hormonal workup on folks. I will say like it doesn't always help.
Right? Yeah. Um, and so I may be able to correct the hormonal imbalance, but there are so many other factors that go into hair, genetics, genetic genetics. Mm-hmm . Stress, all of those things. So I have like a lower threshold to refer early to dermatology of like, maybe you need a scalp biopsy, if that's something that you would recommend, like, yeah.
Maybe there are other things outside of the box that we can think of. Yeah. Because again, all of those things can really impact a patient's mental health.
Dr. Zain Husain, MD: 100%. Yeah. And
Fatma: so I am a big fan of, let's not dismiss it. Let's just say this bothers you enough. Let's own a friend on this. It,
Dr. Zain Husain, MD: it's important, I mean, it does play a huge [00:17:00] role on, um, a person's sense of self Absolutely.
Identity. Um, you know, for men and women.
Fatma: Yeah, absolutely. And
Dr. Zain Husain, MD: you know, if it's something that you're self-conscious about, I mean, we have . A lot of science and a lot of tools to help our patients with. Yeah. But it is complicated sometimes. Totally. And then we have to kind of really, you know, determine what the cause is.
If it is . Androgenetic alopecia then, you know, yes, we can help a little bit with, you know, balancing hormones, but a lot of it's genetically predetermined. Yeah, exactly. So we have to use certain tools for that. Yeah. Whereas if it's, you know, alopecia areata, that's more autoimmune. Yes, exactly. Um, if it's. An inflammatory scarring alopecia that requires a totally different type of treatment
Fatma: and there may be other health things going on.
Yeah. Right. In alopecia areata, like mm-hmm . Perhaps there's other autoimmune things going on that we need to maybe often thyroid disease. Yeah, exactly. Exactly. But we may need to loop in a rheumatologist, so we have to look at the medical side of things as well. I would say don't ignore it when it's happening.
Mm-hmm . Because it may be indicative of something else going on in your body.
Dr. Zain Husain, MD: Yeah. So [00:18:00] let's walk through like how we typically treat an alopecia patient in my office, so, mm-hmm . Many times, um, you know, patients already coming in with their labs. Yeah. Like, oh, I've already gone to my primary care physician.
Mm-hmm . Um, all the labs look normal. Yeah. So where are we at? So if I'm examining the patient, um, you know, it looks like clear clot, androgenetic, alopecia. Mm-hmm . Where, you know, in the males you typically either have hair loss in the vertex, um, by the crown of the scalp mm-hmm . Or in the frontal, temporal area in the front.
Mm-hmm . Or in a female patient predominantly in the front. Um, especially with a widening apart mm-hmm . The way that I kind of address them is by offering, you know, some of the FDA approved medications. Yeah. So for men, I, you know, talk about Minoxidil. Mm-hmm . So you know, that helps to stimulate hair growth.
Mm-hmm .
Joe: Mm-hmm .
Dr. Zain Husain, MD: But Minoxidil is actually a medication that I use internal medicine a lot. Yeah, right. Absolutely.
Joe: Yeah. So
Dr. Zain Husain, MD: it's originally a blood pressure medicine, but we're using it for its side effects.
Fatma: Atypical reasons. Yeah. Yeah. So sometimes I see blood pressure benefits for patients. Exactly. Yep.
Dr. Zain Husain, MD: [00:19:00] Yeah, so I mean that's, that's a great option.
You can do it topically over the counter. Mm-hmm . You can do oral, um, you know, prescription and it's been very helpful for a lot of my patients. Mm-hmm . Um, however, you know, like with any medication or side effects. Right. Yeah. So when minoxidil, I always tell my patients, okay, you know, it is a blood pressure medicine.
We use really low dose. Yeah. Like we do a two and a half milligram tablets. Sometimes cut them in half to that. Wow. So it's really low. So unlikely to cause to get
Fatma: the dizziness and lightness. Yeah.
Dr. Zain Husain, MD: But um, you know, if you're sensitive, you know, you always have those patients. Sure. So possible. So I always tell 'em about that.
Um, and you
Fatma: look to make sure like there are other blood pressure mes Exactly. That they need to reduce anything else. Exactly. Got it.
Dr. Zain Husain, MD: Um, but the other thing, you know, there are rare side effects, right? Mm-hmm . With any medicine. Mm-hmm . So with Minoxidil, I tell my patients they're taking it orally. You know, there's that whole
Think about pericardial effusions. Mm-hmm. Mm-hmm. Where you've gotten fluid around the heart. Mm-hmm . Or like swelling in the legs. Mm-hmm . Mm-hmm . So that can happen. Yeah. Um, just something I always remind my patients. Yeah. But manso is pretty safe medicine. It's, but not for a long time. It's
Fatma: good because [00:20:00] we're not using it for blood pressure control.
Yeah. That much in internal medicine. Mm-hmm . But we're seeing it more for, again, that cosmetic reason. So it's good for everyone to get a little refresher on the side effect profiles. Yeah. Yeah.
Dr. Zain Husain, MD: Um, and then of course Finasteride. Yes. Yeah. What are your thoughts on Finasteride?
Fatma: I think again, like not a medicine I use outside of prostate hypertrophy, that often, to be honest with you.
Yeah. But it's great that those benefits are there. Yeah. And so I think that, again, as long as we're familiar with the side effect profiles Yeah. Then whatever's working in evidence-based to help people, I think that's huge. Yeah.
Dr. Zain Husain, MD: So if an asteroid, um, if you guys don't know, it's a medicine that we often use to treat, um, enlarged prostate.
Mm-hmm . Um, but um, it's also been shown to help to retain your hair Yeah. By blocking the conversion of testosterone to dhy or testosterone. And that's what your hair follicles are sensitive to. Mm. Um, when you have androgenic alopecia, um, but you know, there is a rare side effect that sexual dysfunction in men.
Yeah. So we just always tell our patients about it. Yeah. I have never really seen it [00:21:00] in my patients. Okay. And I've prescribed it for like . 10 plus years. Is that
Fatma: a medicine? Can you tell me a little bit more if like a male patient is thinking about fertility and having kids Yeah. Is that anything that they need to be careful about?
So
Dr. Zain Husain, MD: sometimes, um, . Patients can have low libido with it. Mm-hmm . Um, and that's the one that I, that's the thing that I typically see with it. Mm-hmm . Mm-hmm . And some patients with low sperm counts. Got it. Okay. Um, you might wanna be careful about it, but many patients, um, you know, I've seen, um, have done well for decades and they, you know, successfully became fathers.
Yeah. Um, safe, healthy babies. Safe. Healthy.
Joe: Okay. Wonderful. So
Dr. Zain Husain, MD: I think that it's something that I counsel my patients on, but if experiencing those symptoms just. , you know, stopping it immediately, , and then, you know, there's topical versions of it too. Absolute. Which is nice. Absolutely. Yes. The nice thing about dermatology is we often have topical formulations of things.
Absolutely. Um, to target the, you know, actual skin. So that's, that's, and we like
Fatma: that more because and there's less sort of to, to look out for as well. Exactly. That. That's great. And then
Dr. Zain Husain, MD: we talked about spironolactone. We use that for [00:22:00] women. Yeah. Um, you know, for hair loss as well. So, and my post-menopausal women, we use like ide Okay.
Um, as well sometimes. So wonderful. Those are some things that we kind of offer our patients. That's great. Um, and then without tinkering with like, you know, medications mm-hmm . Red light therapy has been shown to be effective. Yeah. And regenerative medicine. So PRP Yes. , um, peptides. Yes. Um, you know, various different treatments are out there, exosomes.
Mm-hmm .
Fatma: So
Dr. Zain Husain, MD: it's really exciting to see what, um, we can do for our hair loss patients. Yeah. Yeah.
Fatma: And it's interesting 'cause I'll have patients reach out to me about peptides. Mm-hmm . And I'll, and I. I'm less familiar with that space. Yeah. As a, as a, as an internist and, and in the hormone space. Um, but I will say again, there are PE people who are doing more of these things.
Yeah. PRPI think can be very beneficial. Yeah.
Dr. Zain Husain, MD: We're doing a ton of it in our office. Yeah,
Fatma: absolutely. And you've got some new methods where it's less mm-hmm. Sort of invasive. Correct. Yeah. And then we
Dr. Zain Husain, MD: also have, um, this non-ablative fractional laser system mm-hmm . That has been shown to actually stimulate hair growth.
Mm-hmm . And also applying, [00:23:00] um, topical, um, peptides.
Fatma: That's amazing. That.
Dr. Zain Husain, MD: Really reduces the pain. It's almost painless. Yeah. Yeah. Which is nice. 'cause that's one of the things people are afraid of with PP. Yeah. Injections in your scalp. Absolutely. It does hurt. Yes. . But we try to make it as comfortable as possible for as comfortable as possible.
But it works. Like I see some beautiful results with it. Yeah. That's
Fatma: wonderful. That's wonderful. And again, like there's no need to gate keep some of these. Oh yeah. These things like if you've got a patient, I know if I have patients who are coming mm-hmm . And I've corrected some of the hormonal imbalances, but there's still those issues.
Yeah. Let's go see dermatology and see what we can do for you. Yeah, and the nice
Dr. Zain Husain, MD: thing is there's nothing foreign coming into your body. There are your own growth factors for the PRP. Um, and it can be used for various types of hair loss. Yeah. Not just the androgenetic alopecia. Yeah. So we're also treating like people with like thyroid, um, related hair loss.
Yeah. We're also treating, you know, inflammatory, um, you know, hair loss. Um, we're also treating, you know, patients who have telogen effluvium from postpartum. Yes. . Things to look forward to. Yeah.
Fatma: I'll be coming over your [00:24:00] way, . Yeah, you got it. . Wonderful.
Dr. Zain Husain, MD: All right, so I think that we talked a lot about the things that we touch on in dermatology Yes.
With hormones. So let's talk about what we can do. Um, counseling patients. Yeah. Like lifestyle and, you know. Yeah,
Fatma: absolutely. I think again, is being aware of your symptoms and going to the doctor at the right time is huge. Yeah. Um, and I think what you eat matters a lot too. A well balanced diet. An American diet is very carbohydrate heavy.
Yes. So. Focusing on high protein, low carbohydrate, helps keep a healthy weight maintenance as well. Mm-hmm . And all of those things help particularly if you need to lose weight. Yeah. Um, first to lower that insulin resistance. So I think a well-balanced diet. Um, I do get questions about anti-inflammatory diets.
Mm-hmm . One of the issues is there, there's not as much evidence. Yeah. Because some of it isn't as studied as much of various types of diet and impact on Yeah. Um, on, on skin and hair as well. Mm-hmm . But I think in general, a well-balanced diet, um, emphasizing protein and less emphasis on [00:25:00] carbohydrates, getting all your greens and veggies Yeah.
Is probably, you know, get all your colors in . That's probably huge. Yeah.
Dr. Zain Husain, MD: Absolutely. Yeah. Um, what are your thoughts on exercise?
Fatma: Exercise. Again, I think increasing blood flow is important. Right? Definitely. So just in general, exercise is really important. Yeah. If there's things like insulin resistance or hypothyroidism or other issues, I think particularly for insulin resistance, exercise is gonna be critical.
And then . For me, it's the exercise that sparks joy. So yes, like high intensity exercises and mm-hmm . You know, the 12 3 30 is what I often recommend, which is 12 resistance on the treadmill, three miles an hour, and you're just walking for 30 minutes is a way to get efficient calories burned as well. But like it's also You'll definitely get a sweat too.
Exactly. You'll get a sweat. You're giving yourself a stress test. It's kind of boring. Yeah. So do what, do what makes you happy is what I would recommend. Yeah. But, um, I think that can be critical as well for overall just looking, looking good. And feeling good from the inside out.
Dr. Zain Husain, MD: Absolutely.
Fatma: Yeah.
Dr. Zain Husain, MD: Um, [00:26:00] so what about when you know someone is noticing like
They're not feeling well. They're, yeah. You know, they're not, they're feeling off and you know, a lot of people are like, oh, it might be my hormones or whatnot. When should they seek the care of a primary care physician or endocrinologist? As
Fatma: soon as they feel that way? I would say always start with your primary care.
I had like a whole talk with someone about this earlier today. I would say start with your primary care doctor. Obviously if you have a dermatologist or you're able to see one, that's a place to start. 'cause we all collaborate together. Yeah. Like if. You see, we're all on the same team. Exactly.
We're all on the patient's team. So if you think that someone needs like more of a workup, you're gonna tell them to go back to their primary care, refer them to endocrine anyway.
Dr. Zain Husain, MD: Yeah. Um, what about stress? I. Talk to me about stress, .
Fatma: Yes.
Dr. Zain Husain, MD: We all have it. ,
Fatma: I'm sorry, I'm not familiar. Oh, stress. Um, I mean stress I think can really impact people.
Yeah. The telogen effluvium especially, you see and you hear about like what people's lives [00:27:00] are like and Yeah. So one of the things I find is that people are going through stressful periods or adjustment disorder. we're establishing that they've got some sort of an underlying anxiety and depression or an adjustment reaction.
Mm-hmm . So I might start them on an SSRI mm-hmm . And then the patient will tell me like, I'm losing my hair. And it's because of the SSRI and I think it's actually because of the stress. Stress. And they've got telogen of lium from that. Yeah. But it gets murky when we add all of the other medications. Yeah.
Um, in the, into the mix. So . That's definitely something that can contribute to hair loss and skin issues. Yeah.
Dr. Zain Husain, MD: But that's what I love about, you know, primary care. You're looking at the patient as a whole. Absolutely. The complex, interplay, mind, body, everything. Exactly.
Fatma: I say, I call it the bio-psychosocial model.
It's your body and your physiology. It's your mental health and the world around you. And some of those things can be very stressful at various times, especially these times . Yes, exactly. So everything kind of can get impacted for sure. Yeah. Yeah.
Dr. Zain Husain, MD: So it's important. I mean, people are always telling [00:28:00] me like, I'm so stressed and you know, it's leading to my acne, my hair loss.
Exactly.
Fatma: It probably is. Like, it probably is. And so we can do things to kind of correct what we can, but you know, you can't always correct the underlying stressors. Yeah. Okay.
Dr. Zain Husain, MD: So here's a controversial topic I know, um, in the medical field mm-hmm . Um, hormone replacement therapy. Yeah. Bioidentical hormones.
Yeah. What are your thoughts on it?
Fatma: So I'm thinking about hormone replacement therapy first, let's do first in our postmenopausal patients, sometimes it's the right step, but again, I need to know what all the symptoms are. Mm-hmm . Like for some people it's more autonomic, it's more localized, and so in which case, like topical estrogens, if it's more localized for.
Vaginal atrophy, that sort of thing. If it's more autonomic and mood things, then something like, um, Effexor is a better option. Mm-hmm . Um, I'm not opposed to it at all. Mm-hmm . I think there's safe ways about doing it, but sometimes I get patients who are, like, they've got hormone pellets that someone put inside of them.
Yeah. And then there's side effects [00:29:00] from that. Mm-hmm . And they're like, oh, why do I have ? Yeah, I have testosterone pellets in me. Why do I have, um, c cardiomegaly and excess and hair and raging acne and hair loss uhhuh. And so I think, I think it has to be done in the right hand. So it would encourage folks to talk to their gynecologists, primary care doctors and internists, endocrinologists who, whoever start there
Dr. Zain Husain, MD: for sure.
It is so complex. Yeah. And it's scary to see, um, you know, the type of . You know, practices that are offering it, that have Oh, absolutely No training, no specialty. I mean, this is complex stuff.
Joe: Factors. Yeah. Like, it's just, it's a big thing. It's,
Dr. Zain Husain, MD: it's scary.
Joe: Yeah, it is. Um,
Dr. Zain Husain, MD: wellness centers. Exactly. I'm like, what Yeah.
Is going on here. And then patients are getting like. Strange workups. They're going on weird, um, you know, elimination diets. Exactly. Yeah. And they're like getting sick. Yeah. Before my eyes. And it's scary. And
Fatma: I think that's probably, 'cause there's probably is like a gap in the wellness space in our profession, right?
Mm-hmm . Like we learn sick very well. [00:30:00] Yes. And so there may be a gap. For patients because of that. And I wanna understand that and empathize with it. Mm-hmm . But then also like, we went to school for a really long time. Yes. and went into a lot of debt to be doing what we're doing. Yeah. It's not for our bottom dollar.
Mm-hmm . We're here for our patients. Yeah. And so, um, to go on a rant a little bit like I do sometimes get frustrated by. Some of the other outside voices that are kind of undermining medical care, but
Dr. Zain Husain, MD: absolutely.
Fatma: What can you do ? Yeah.
Dr. Zain Husain, MD: Fight the good, fight, right? Fight the, keep fighting the good fight.
Fatma: Exactly. .
Dr. Zain Husain, MD: Awesome. Is there anything else that you wanted to discuss? Yeah, I, I think
Fatma: also we've talked about women a lot, so we should talk about men as well,
Dr. Zain Husain, MD: not to, not to ignore
Fatma: men, but you know. Um, hair loss is a big thing that men talk about. Huge. We talked about the topical options and the oral options.
Yeah. I think also testosterone replacement. It's important to sort of understand. Yeah. The ramifications of testosterone replacement. Yeah. And to please do it safely. Like I've had, everyone
Dr. Zain Husain, MD: wants to go on TI
Fatma: have [00:31:00] everyone. Everyone wants to go on tea. I have had young men go into heart failure because of just the wrong hormones are too much.
I've had patients, there's some other . Weird injectable out there. I don't even know what it is, but had kidney issues and all kinds of issues. So talk to your doctor, your doctor's, a safe space. Um, but there are reasons to give testosterone. Mm-hmm . That may, may or may not have to do with the skin. Right.
Erectile dysfunction. Yeah. Um, fatigue. Genuinely low testosterone. But, um, for men and hair loss, that's huge. Huge. We love our hair. Oh yes. And so again, like . And speaking to other like, primary care internist, endocrinologists, like, let's not discount that. Yeah. You know, if we don't know how to treat it ourselves, like phone a friend and dermatology to say to, to, to help with that.
Dr. Zain Husain, MD: Absolutely. I mean, like the hair thing with men, it's, it's really important to us guys. Exactly. Exactly. I mean, it, it really does play a role. Oh,
Joe: absolutely.
Dr. Zain Husain, MD: Full disclosure, my dad is complete. Completely. [00:32:00] Yeah. ,
Joe: my two
Dr. Zain Husain, MD: brothers, um, I'm the middle child, so they're thinning. Yeah. But I've kind of kept them at bay.
Fatma: Knock on wood for
Dr. Zain Husain, MD: that. , I am definitely scared losing my hair. Totally, totally. I mean, I get it. Like it's part of your identity and how you Absolutely. You see yourself in the world. Absolutely. Your confidence. Yeah. I mean that's actually one of the reasons why Dr. Amna like me in the first place. You're like, oh, I got, like, you got a head of hair.
Yeah,
Fatma: absolutely.
Dr. Zain Husain, MD: So it's important. So we do, um, and part oh, totally. You know, in dermatology, like we're looking . Not only at the medical side, but also the cosmetic side. Yeah. It's important.
Fatma: Absolutely. Absolutely. So being, 'cause it impacts mental health does right? It really impacts mental health. Yeah, it
Dr. Zain Husain, MD: really does.
And you know, restoring that confidence is one of those things that I love. Yeah. Doing as a dermatologist.
Fatma: Absolutely. No, I think that's huge. Yeah.
Dr. Zain Husain, MD: Great. I think we had an awesome discussion on the impact of hormones on her skin. I mean, I'm sure that there are even more interactions that we weren't able to discuss today.
Yeah. But, um, you know, hormones have a huge impact on . Every organ system of our body. [00:33:00] Absolutely. Including your skin.
Joe: Absolutely.
Dr. Zain Husain, MD: So I'm just so happy to be able to talk with an expert about it. Thank
Fatma: you. Yeah. Thanks for having me. Um,
Dr. Zain Husain, MD: yeah, and I mean, hopefully we shed some light on some of these impacts that hormones can have on your skin.
Yeah. 'cause many people aren't aware of that. Yeah,
Fatma: absolutely. Absolutely. Um, and you know,
Dr. Zain Husain, MD: there's things that we can actually do to help. Yeah, absolutely. And that's the key thing you. So I think that, um, you know, if we don't have any other, you know, questions or discussions. Yeah. Like, I think that I'm really excited for our next episode where we're going to be talking about GLP and diet and its impact on skin health.
Fatma: Absolutely. Sounds great. All right.
Dr. Zain Husain, MD: Awesome. Well. Guys, hopefully you enjoyed this episode. It's a little different than our other cosmetically focused episode, so kind of tying in both the medical and the cosmetic side. Um, if you have questions, feel free to message us. Um, please subscribe and like, and until next time, inside out
Joe: Thanks. [00:34:00]