Mandy Robertson Trichology

Another great result!
The addition of one treatment can make all the difference!
Photo is after 12 months of treatment of androgenetic alopecia.

20/87 weeks of the Evidence Based Hair Fellowship with Dr. Jeff Donovan complete!
I’m so grateful for all of the knowledge I have gained in this program so far and am looking forward to Block 2!

Want to switch up your hair care routine? Come for a visit and see what products are best for your hair and scalp!

Great results after a year of treatment on low dose oral prescription medications!
Oral medications aren’t for everyone, but this client’s results show that substantial improvement can be achieved with relatively low doses, limiting the chance of adverse side effects. As always, the potential use of any medications for hair loss should be discussed with a doctor who has experience treating hair loss.
Photo shows 12 months of progress treating androgenetic alopecia with low dose oral prescription medications.

I have some exciting news 👀!
My new clinic, located at the Fairmont Medical Building (906-750 West Broadway, Vancouver), will be open on July 21st.
Stay tuned for further details!

Another great result!
Are you curious if you can achieve a significant improvement in your hair density without oral medications? This is a great example of what can be achieved with scalp care and prescription topical treatments over a 6 month period.
Photo shows 6 months of treatment of androgenetic alopecia.

Oral minoxidil is FDA approved to treat high blood pressure. Doses for this purpose range from 10-40 mg, and common dose-dependent side effects include dizziness, fluid retention, tachycardia, nausea, and hypertrichosis (excessive hair growth on the scalp and body). Due to this serendipitous side effect, which occurs in approximately 80% of individuals, minoxidil was made into a topical preparation for hair growth in the 1980s.

Minoxidil can increase hair thickness and length due to its ability to shorten the resting phase and prolong the growth phase of the hair cycle. When minoxidil is applied to the scalp topically, the hair follicles have to convert it to its active form, minoxidil sulfate, in order for it to help with hair growth. This conversion is dependent on the individual having sufficient sulfotransferase enzymes in their hair follicles, so some individuals may be non-responders to topical minoxidil.

Over the last few decades, dermatologists have trialed the use of low dose oral minoxidil (LDOM) with the aim of improving hair density while limiting adverse side effects. Doses for this purpose range from 0.25 - 5 mg, with titration and max dosages differing for men and women. Its use for hair loss remains “off-label”.

Many people find oral administration more convenient than topical minoxidil, and since it is converted to its active form in the liver, a higher proportion of people will respond to treatment.
 
While chances of systemic side effects are much lower with topical use, low-dose oral minoxidil (LDOM) also has a good safety profile. In a multicenter study of 1404 patients, only 1.7% of patients discontinued the drug due to adverse effects. Potential adverse effects of LDOM include light-headedness, fluid retention, tachycardia, headache, pedal edema, and insomnia. All adverse side effects improved with dose adjustment or withdrawal of LDOM.

Have you heard about LDOM for hair loss? Leave your questions or comments!

Note: this post is intended as an informational resource only. As always, be sure to consult your health care provider for advice on prescription medications for hair loss.

Happy New Year Everyone 🎉!
This past year has been a busy one at the clinic and I’m very thankful that so many of you have trusted me to help you on your hair growth journey!
I’ve been meaning to share some progress photos of myself and my clients to show you the results that are possible for various hair loss and scalp health issues.
I’m starting with yours truly 👩🏼‍🦰 since I haven’t shared in a while. These results were achieved with 2 different topical treatments, low-level-laser-therapy with , scalp care with , and some lifestyle changes. 3 months ago I also included another treatment and I’m excited to continue to share my experience and progress.
Any guesses on the new treatment I’m trying? Share your thoughts below and stay tuned for my next post 👀!
Photo shows 12 months of progress treating androgenetic alopecia.

A fun and educational trip to Melbourne for the 2022 World Congress for Hair Research (including a stopover in Sydney to see some sights)!
It was amazing to attend this conference and learn about exciting new research and cutting edge treatments from world leaders in dermatology and trichology!
It was also amazing to meet up with some of my friends from the hair community and share some laughs.
I look forward to sharing some learnings in the coming weeks!

Shop SEEN Hair Care products. Use code MANDY10 at checkout for 10% off!

SEEN: Dermatologist Designed Luxury Hair Care - Won't Clog Pores Many hair products cause breakouts and skin irritation. Designed by a dermatologist, SEEN is skin-caring luxury hair care formulated without parabens, phthalates, sulfates, silicones, dyes, and mineral oils. SEEN products are clinically tested to be non-irritating and to not clog pores (non-comedoge...

Scalp is skin!
I’m so glad that recognized the need to bring skin science to hair care. is developed and tested like a skincare product. Their hair care line is clinically proven not to clog pores and be non-irritating, which turns out is great for both hair and skin!
A recently completed clinical trial assessed the effects of using SEEN Fragrance-Free Shampoo and Fragrance-Free Conditioner as a regimen in 29 patients with female pattern hair loss. Conducted by Dr. Maryanne Senna, the six-month randomized, controlled study found that the SEEN products reduced hair shedding by 44%. According to Dr. Senna, “hair care products can contribute to hair shedding by clogging the hair follicle, or by irritating and allergenic ingredients they contain, and all of this can impact scalp health. This study provided evidence that the use of non-comedogenic and non-irritating products can improve scalp health and hair growth.”
My clients and I have also been loving how the shampoo leaves our hair feeling and looking!
Click the link in my bio to shop my SEEN affiliate site and use the code MANDY10 for 10% off!

All of my initial trichology consultations begin with a review of the client’s completed intake questionnaire 📋.
In order to diagnose hair loss and scalp issues, it is necessary to gather lifestyle and medical information and hair loss/scalp health history. Relevant questions include:

- have you noticed your hair density changing? If so, when did you first notice this?
- how is your hair compared to 5 or 10 years ago?
- where is the hair loss occurring? Is it diffuse, patchy, or in certain areas of the scalp?
- do you experience itching, tingling, bruising or flaking?
- how is your overall physical and mental health?
- do you have any medical conditions or take any medications?
- have you had any recent blood tests?
- have you tried any treatments?

A review of this information and a visual/microscopic assessment are both needed to pinpoint the cause of the hair loss/scalp health issue and provide effective treatment recommendations ✅.

I thought this deserved a space on my squares 💕.
Come see me at my Vancouver office at 1089 West Broadway on Thursdays and Fridays. Link to book in my bio!

Trichologists can help with more than just hair loss and scalp issues 💁‍♀️.
There is so much misinformation floating around about hair care. Some current trends are mostly harmless (but probably also not very helpful), but some may be causing more problems than they’re solving!
If you’re curious about:
- how often you should be washing your hair
- which products are best for your hair and scalp
- if there are proactive steps that can be taken to promote healthy hair growth
- whether that TikTok hair growth trend is fact or fiction
Or, if you have any other questions related to general hair care, I would love to chat with you!
BRB trying to learn “how to TikTok” 🙈.

Office vibes 😍
📸

Does that photobiomodulation device blink?! When you turn on The Original LaserCap, you will notice the laser diodes blink rapidly, turning on and off many times per second. This is an important feature of LaserCap technology, called pulsed wave emission.
Studies have demonstrated that devices which use pulse wave emission can produce better outcomes vs. devices that use continuous wave emission.
Why is this? Well, there are a number of advantages associated with pulse wave emission:
* Pulse wave emission prevents excessive build up of heat, allowing for light output with greater power over longer periods of time. Consequently, power output and treatment strength can be much higher.
* Pulse wave emission may mitigate the filtering effect of melanin, leading to improved outcomes for those with darker skin types.
* Pulse wave emission may better “sync” energy delivery with the natural frequencies of biological processes, leading to enhanced biologic effect at the cellular level.
* Pulse wave emission makes patients look way cooler if they wear their LaserCap out to the nightclub 🤪. 
For more on the advantages of pulse wave emission go to: lasercap.com/prescription-strength-technology/ or reach out to me!

“Say the thing you must say. Go where you must go. Leave what you must leave. Do what you must do. Trust yourself.
When they say: You seem out of control.
You say: Thank you. That’s the plan. For the rest of my life.” - Glennon Doyle, Untamed.
Happy

Spironolactone is a medication that blocks the effects of androgens. It has been used as an off-label treatment for androgenetic alopecia in women for many years. Oral spironolactone is not recommended for men due to side effects such as gynecomastia (enlargement of breast tissue).
In a recent systemic review of 12 studies looking at the efficacy of oral spironolactone for the treatment of AGA in women, it was found that 49.3% of patients had an improvement in hair density. Doses of 100-200 mg/day for at least 12 months were needed to see a meaningful benefit.
Potential side effects such as menstrual irregularities, low libido, dizziness, breast tenderness and brain fog have prompted more studies on the use of topical spironolactone for the treatment of AGA. A recent study by Raouf and colleagues set out to study the effect of topical minoxidil 5% and topical spironolactone gel 1% in the management of AGA in both men and women. Of 60 participants, 20 received treatment with topical minoxidil alone, 20 received treatment with topical spironolactone alone and 20 received both minoxidil and spironolactone. 56% of the patients in the minoxidil or spironolactone alone groups had good or excellent results, compared to 90% in the combined minoxidil and spironolactone groups. Side effects included contact dermatitis, but the side effects seen with oral administration were not noted. While this study is small, it shows us that topical spironolactone deserves further research in the treatment of AGA.
One thing to note, however, is that spironolactone has quite an odor. It is also not easy to find a pharmacy that has experience compounding topical spironolactone.
If you’re interested in finding out more about topical spironolactone, feel free to send me a DM!

“I am real. What I feel and want and know. That’s all real. Yes, you are real.” - Glennon Doyle, Untamed
I frequently talk to women who say things like “maybe I’m just imagining it” or “maybe it’s not as bad as I think it is”. I find it hard to hear when women doubt themselves and their experiences. Unfortunately, it is all too common, since women are often questioned and challenged when they raise issues, leading to this distrust and doubt in themselves and what is happening to them.
I just wanted to write this post to remind you that you are real and that you can trust what you’re feeling and wanting and knowing. No one knows you better than you know yourself 💜.

Did you know that trichoscopy can be a very useful tool in differentiating between various types of hair and scalp conditions?
Yellow dots, black dots, variations in hair shaft diameter, perifollicular pigmentation or scaling, upright regrowing hairs, etc. can all give clues as to what is causing the condition.
If you’re unsure what may be causing your hair loss or scalp condition, come see me for your close up! 🔬

Excited to share some new photos that snapped the other day for my website 📷.
I wanted to capture what a typical trichology consultation entails at my home office, and she definitely delivered!
Check her out if you’re looking for business branding photos!

First off, WARNING ⛔️ do not swipe if you are squeamish about seeing balls of shed hair ⚠️.
Now that that’s out of the way, I wanted to update all of you on how my topical minoxidil treatment has been going now that I’ve hit the 6-week mark.
I mentioned earlier that I used 5% minoxidil for 6 years after being diagnosed with androgenetic alopecia about 14 years ago. I stopped 8 years ago when I found out I was pregnant with my first son. Babies and breastfeeding behind me now, I decided to give it a go again.
I expected to experience increased hair shedding in the first few months due to a phenomenon called immediate telogen release that happens in some individuals who start minoxidil. However, it was definitely not as bad as I remembered it being the first time (likely my current mental state helps)! If you took a look at the next pic, this is how my hair shedding increases from after week 2, 3, 4 and 5. Each of these were after washing my hair (which I wash every 3 days or so). At week 6 now, my hair shedding has started to slowly decrease again. It’s important to note that comparing hair shedding from person to person is usually not helpful since we all have varying amounts and lengths of hair. This is why I recommend comparing only to what is normal shedding for you individually.
I also haven’t noticed any other side effects such as lightheadedness or dizziness, or scalp irritation.
Unfortunately the 5% minoxidil serum that I was using was discontinued, so I’m now using a compounded product that I got from a local pharmacy. It also contains another prescription treatment that I’ve been wanting to try for a while, so I’ll update you on that soon!

I am 🖐. I mentioned recently that I decided to order the Advanced Trichology PM and PMb 5% minoxidil serums with retinoic and azelaic acid. I used minoxidil in the past for 6 years, but stopped when I got pregnant with my first son close to 8 years ago. While anticipating a potential “dread shed” when I start using minoxidil, I thought I’d explain what causes it and what one can expect.
When certain treatments for androgenetic alopecia (AGA) are started, there is a potential for diffuse hair shedding (the “dread shed”) in the first 2-8 weeks. The medical term for this is “immediate telogen release”.
Individuals with AGA already have a higher proportion of hairs in the telogen (resting) phase. When minoxidil is applied to the scalp, a signal is sent to all of the hairs waiting in line to be shed that they can shed now if they like. Hairs that usually stay in the telogen phase for 2-3 months are told to “get out the way” so that the anagen (growth) phase can begin again. This results in increased shedding that typically lasts 1-2 months. This shedding can be mild in some, and more pronounced in others.
While this can be stressful, it is expected and is thought to be a sign that the treatment is working. Of course, there are exceptions to this rule, and some may find that the increased shedding continues longer, or the hair does not improve by the 6-12 month mark. These scenarios should be run by your trichologist/doctor/dermatologist.
If you have used minoxidil, did you experience a dread shed?

Testing out my new phone camera 📸!